MHA Today | July 14, 2017

July 14, 2017



MHA Today: News for Healthcare Leaders

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

Insights

Herb Kuhn, MHA President & CEO
Missouri’s regular session of the General Assembly closed more than two months ago. It seems like ancient history with the constant media attention focused on federal health care policy. However, the end of the session isn’t the end. In fact, for most bills, it’s a beginning.

Since the session’s close, all eyes have been on Gov. Eric Greitens. This was his first legislative session, and as we all know from Schoolhouse Rock, you generally need an executive signature to make a law. Several hospital-related measures that made it to Greitens' desk have recently been signed.

Two weeks ago, Greitens signed House Bill 452. The law addresses the employee liability questions created by the Jefferson v. Missouri Baptist court ruling. The new law narrows hospitals’ liability for those who are not hospital employees, helps liability insurers clarify their exposure to risk, and should reduce claims against hospitals and hospital insurance premiums. This was one of several bills adopted this session related to the state’s litigation climate. Others include changes in standards for expert witnesses, time-limited offers of settlement agreements and medical expenses that plaintiffs may claim as damages in civil litigation.

On Tuesday, Greitens signed Senate Bill 50. The law included several health-related topics of interest to hospitals. With the new law, state hospital licensure regulations cannot contradict or duplicate the Centers for Medicare & Medicaid Services’ Medicare Conditions of Participation. In addition, the law clarifies standards for state designation of stroke, STEMI and trauma centers. These are both examples of reform activities that will simplify the rules and streamline hospital operations.

The General Assembly enacted, and the governor signed, a state budget that includes funds for Medicaid and disproportionate share hospital payments to hospitals in keeping with current payment standards and expected billings for state fiscal year 2018. The budget bills also include $50 million in additional funding to address Medicaid hospital costs that were higher than expected for the last fiscal year.

No list of successes would be complete without a list of bad things that were avoided because of hospital advocacy. Here are a few things that didn’t happen.

Legislation to prohibit most noncompete clauses in contracts between employers and their employees was thwarted, as was a bill to limit the ability of hospitals and medical staffs to make employment and privileging decisions based on medical specialty certification.

“Right to shop” legislation, which would have used expanded price transparency to fuel a complicated system of patient price negotiations and incentives was defeated.

A full summary of legislation that was adopted and defeated was published immediately after the session. However, with the governor’s signature, some of these bills now are becoming laws. With all of the noise at the federal level, I thought it was worth reflecting on the state legislation that will be helping hospitals reduce costs and red tape.

The General Assembly helped make it easier for hospitals to deliver on their missions in 2017. And, Gov. Greitens deserves credit for helping get their legislation across the finish line.

Thank you to all of the members of the hospital community who helped deliver these successes.

Let me know what you think.

Herb Kuhn, MHA President & CEO



Herb B. Kuhn
MHA President and CEO

In This Issue
CMS Updates 2018 Marketplace Insurer County Map
Department Of Social Services Solicits Regulatory Reform Comments
MO HealthNet Implements FY 18 Budget Medicaid Rate Cuts
CMS Releases Proposed CY 2018 OPPS And ASC Payment And Policy Updates
CMS Releases Proposed CY 2018 PFS Payment, Policy Updates
HIDI Releases First Quarter Update To Discharge Data-Based Quality Indicators
CMS Announces IQR, EHR Incentive Programs Education Session
FLEX Program Releases Educational Resources For Participating CAHs
CDC Resource Offers Antimicrobial Stewardship Framework For Small Hospitals, CAHs


Advocate
state and federal health policy developments



CMS Updates 2018 Marketplace Insurer County Map

Staff Contact: Andrew Wheeler

The Centers for Medicare & Medicaid Services has released a third iteration of the projected 2018 marketplace insurer county map. The map illustrates by county the number of insurers projected to offer plans in the marketplace. CMS is projecting that 40 counties in the U.S. will have no plans offering coverage. This is the first iteration in which CMS projects that all counties in Missouri will have at least one plan offering products in 2018.

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Department Of Social Services Solicits Regulatory Reform Comments

Staff Contact: Brian Kinkade

The state Department of Social Services is soliciting public comments about the agency’s administrative regulations. The review is part of a broader gubernatorial initiative to assess whether state regulations are ineffective, unnecessary or unduly burdensome. Comments and suggestions can be submitted by email or mail before Friday, Sept. 15, to the following address.

Rules Comment
P.O. Box 1527
Jefferson City, MO  65102-1527


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MO HealthNet Implements FY 18 Budget Medicaid Rate Cuts

Staff Contact: Brian Kinkade

MO HealthNet has issued bulletins on rate reductions for home and community-based services and school-based, hearing aid, therapy and personal care/private duty nurse services. These cuts are elements of the budget-balancing plan Gov. Greitens put in place when he approved the fiscal year 2018 state budget. These rate cuts are effective for dates of service on or after July 1.

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Regulatory News
the latest actions of agencies monitoring health care



CMS Releases Proposed CY 2018 OPPS And ASC Payment And Policy Updates

Staff Contact: Andrew Wheeler

The Centers for Medicare & Medicaid Services released calendar year 2018 proposed payment and policy updates to the outpatient PPS and ambulatory surgical center payment systems. CMS is continuing to solicit feedback with additional requests for information about ways to improve transparency, flexibility, program simplification and innovation. CMS Administrator Seema Verma stated “CMS is committed to transforming the Medicare program and updating our policies to provide high-quality and affordable patient-centered care. These changes require innovative strategies, and we look forward to receiving stakeholder comments and incorporating new ideas in our final rule this fall”. Comments about the proposed rule must be received no later than 4 p.m. Monday, Sept. 11. The major changes within the proposed rule include the following.

OPPS

  • OPPS payments are estimated to increase by 2 percent.
  • 340B drug and biological payments proposed to be changed from average sales price plus 6 percent to ASP minus 22.5 percent. Drugs not purchased under 340B would continue to be paid at ASP plus 6 percent.
  • Non-enforcement of direct supervision for outpatient therapeutic services for critical access hospitals and small rural hospitals extended for CYs 2018 and 2019.
  • Various revisions to the hospital outpatient quality reporting program.

ASC

  • Payment update proposed to be 1.9 percent.
  • Solicitation for comment about ASC payment reform.
  • Various ASC quality reporting program changes.

MHA will release an issue brief with additional details early next week.

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CMS Releases Proposed CY 2018 PFS Payment, Policy Updates

Staff Contact: Andrew Wheeler

The Centers for Medicare & Medicaid Services released calendar year 2018 proposed payment and policy updates to the physician fee schedule and Medicare diabetes prevention program. Like the CY 2018 proposed outpatient PPS rule, CMS is continuing to solicit feedback with additional requests for information about ways to improve transparency, flexibility, program simplification and innovation. Comments about the proposed rule must be received no later than 4 p.m. Monday, Sept. 11. Major changes in the proposed rule include the following.

  • PFS rates will increased by .31 percent. This includes the .5 percent update as mandated by the Medicare Access and Children’s Health Insurance Program Reauthorization Act of 2015, and reduced by .19 percent as mandated by the Achieving a Better Life Experience Act of 2014.
  • Nonexcepted off-campus provider-based hospital department payments would be reduced from 50 percent to 25 percent of the outpatient PPS rate.
  • Addition of certain telehealth services.
  • Increased payment rates for office-based behavioral health services to better recognize overhead expenses.
  • Solicitation for comments about revising evaluation and management visit codes.
  • Solicitation for comments to determine if emergency department visits are undervalued.
  • Payment for regular and complex chronic care management for services provided in rural health clinics or federally qualified health centers.
  • Various changes to the physician quality reporting system.
  • Proposed implementation of the Medicare Diabetes Prevention Program expanded model.

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HIDI Tech Connect



HIDI Releases First Quarter Update To Discharge Data-Based Quality Indicators

Staff Contact: Josette Bax

The Readmissions, Hospital-Acquired Conditions and AHRQ Quality Indicators datasets have been refreshed in HIDI Analytic Advantage® PLUS to include measure calculations based on discharge data from the first quarter of calendar year 2017. These quality data updates can be found in various reports in the following Analytic Advantage PLUS locations.

  • Quality > Benchmarking
  • Quality > Readmissions
  • Quality > Strategic Quality Initiatives

Users with technical questions about the measures should contact Josette Bax. For questions about accessing the website or running reports, please contact HIDI.

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Quality and Population Health



CMS Announces IQR, EHR Incentive Programs Education Session

Staff Contact: Sherry Buschjost

An outreach and education session for hospitals participating in the hospital inpatient quality reporting and Medicare electronic health reporting incentive programs is scheduled at 1 p.m. Tuesday, July 25. The presentation will provide an overview of the steps for successful submission of Quality Reporting Document Architecture Category I files. Registration is required.

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FLEX Program Releases Educational Resources For Participating CAHs

Staff Contact: Stephen Njenga

The Medicare Rural Hospital Flexibility Program released a new orientation and overview of educational resources for all critical access hospitals that participate in the program. The resources provide individuals with a basic knowledge of the different aspects of the grant: quality reporting and improvement; financial and operational excellence; and population health management. These short presentations, available through the CareLearning platform, are designed for hospital teams new to the FLEX grant or new to health care.

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CDC Resource Offers Antimicrobial Stewardship Framework For Small Hospitals, CAHs

Staff Contact: Jessica Stultz

The Centers for Disease Control and Prevention released a new resource for small and critical access hospitals developed with guidance from these providers and designed to address antimicrobial stewardship challenges within these organizations. The "Implementation of Antimicrobial Stewardship Core Elements at Small and Critical Access Hospitals" resource uses the CDC's Core Elements of Hospital Antibiotic Stewardship Programs as a framework for initiating or expanding antibiotic stewardship activities.

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Did You Miss An Issue Of MHA Today?


July 13, 2017
Senate Releases Updated Version Of The BCRA
MO HealthNet Solicits Comments On Medicaid Fee-For-Service Access Plan
CMS Extends Date To File Or Amend FY 2014 S-10 Data
MMAC Issues Update On Women’s Health Services Attestation
MHA Releases CAH FFY 2018 VBP Reports
MLN Connects Provider eNews Available
CMS Announces Hospital VBP Program Education Session
CMS Updates IQR Known Issues Documents

July 12, 2017
State Agency Solicits Regulatory Reform Comments
Governor Signs Bill On Emergency Services
Trajectories — Opioid Use Disorder
Deadline Approaches For Readmission Immersion Project
CMS Issues Additional Guidance Regarding IPFQR PY 2018 Reporting
Pemiscot Memorial Health Systems Names New CEO

July 11, 2017
Governor Approves Health Bill
Missouri Chamber Cautions Senators About Better Care Reconciliation Act
U.S. Senate Shortens August Recess
MHA Distributes Financial Indicators Analysis
CMS Offers MIPS Webinar For Providers In Small, Rural And Underserved Areas
Whitepaper Explores Executive Turnover Issues

July 10, 2017
Fewer Marketplace Insurance Issuers Apply For 2018 Coverage
CMS Delays CoPs For Home Health Agencies
CMS Releases Hospital Quality Reporting Center Summer 2017 Newsletter
May MUR Available On HIDI Analytic Advantage®
HIDI Releases First Quarter 2017 VBP Payments Model
Randall Nyp Retires As CEO For Prime Healthcare Kansas City Market



Consider This ...

Nearly 5 million people are treated for skin cancer each year in the U.S.

Source: Centers for Disease Control and Prevention