MHA Today | December 27, 2016

December 27, 2016

MHA Today: News for Healthcare Leaders

twitter linkedin MHA Today is provided as a service to members of the Missouri Hospital Association. Additional information is available online at MHAnet.

In This Issue
GAO Assesses Medicaid Personal Care Oversight
MO HealthNet Publishes Medicaid Fee-For-Service Report
CMS Seeks Comments On Expanding PACE Model
MHA Publishes Issue Brief On Episode Payment Model Rule
CMS Issues Preliminary Guidance On Off-Site Outpatient Payment Changes


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Advocate
state and federal health policy developments


GAO Assesses Medicaid Personal Care Oversight

Staff Contact: Daniel Landon

The U.S. Government Accountability Office has issued a report and summary on federal and state oversight of Medicaid personal care services. It finds inconsistencies among states and federal programs in regulatory oversight to protect against fraud and ensure beneficiary safety.

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MO HealthNet Publishes Medicaid Fee-For-Service Report

Staff Contact: Steve Renne

MO HealthNet has published its 2016 report on access to providers by Medicaid participants. Part of the report compares Medicaid reimbursement rates for several program components to Medicare (Page 24). Hospital reimbursement was excluded from the rate study since the Medicaid reimbursement methodologies used by MO HealthNet and Medicare are different enough that no comparison is possible (Page 17).

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Regulatory News
the latest actions of agencies monitoring health care


CMS Seeks Comments On Expanding PACE Model

Staff Contact: Daniel Landon

The Centers for Medicare & Medicaid Services is soliciting public comments on its proposed model to expand the Program of All-Inclusive Care for the Elderly Program. PACE provides a set of medical and social support services designed to prevent institutionalization of people ages 55 or older whose conditions warrant the care intensity of a nursing home. As authorized by federal legislation enacted in 2015, the CMS proposal considers expanding the program to a broader range of clients. Comments are due Feb. 10, 2017.

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MHA Publishes Issue Brief On Episode Payment Model Rule

Staff Contacts: Andrew Wheeler or Daniel Landon

MHA has published an issue brief on the Centers for Medicare & Medicaid Services’ final rule to expand Medicare’s episode payment models. The final rule was issued last week and applies to cases involving surgical hip and femur fracture, acute myocardial infarction, coronary artery bypass graft and cardiac rehabilitation. If the rule is implemented, all of Missouri’s eight metropolitan areas would be involved in at least one Medicare EPM. However, the rule may be blocked or revised. It has substantial opposition from members of Congress, including Rep. Tom Price, M.D., who will be nominated as the next Secretary of the U.S. Department of Health & Human Services.

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CMS Issues Preliminary Guidance On Off-Site Outpatient Payment Changes

Staff Contact: Daniel Landon

The Centers for Medicare & Medicaid Services has issued preliminary guidance to implement a federal law clarifying the application of “site-neutral” payment standards for off-site hospital outpatient settings. The federal law was included in the 21st Century Cures Act enacted earlier this month.

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Consider This ...

Between 1999 and 2014, drug overdose deaths in the U.S. nearly tripled. From 2014 to 2015, death rates increased by 15.6 percent, and 72.2 percent of deaths were from synthetic opioids, mostly fentanyl and heroin.

Source: The New York Times