MHA Today | February 24, 2017

February 24, 2017

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.


Herb Kuhn, MHA President & CEO

If in the late 1970s you invested in Betamax or LaserDisc for your movie collection, you probably understand the danger in being an early adopter. When a market is shaking out, choosing a format is risky. In technology, early adopters often are referred to as being on the “bleeding edge.”

There are times when early adopters win — think VHS, compact disc and digital. However, it often makes sense to wait until the market signal is clearer so you don’t have to reinvest if you made the wrong choice.

Last week, I wrote about the U.S. House of Representatives’ policy brief for repeal and replacement of the Affordable Care Act, with emphasis on the reimbursement cuts to hospitals. This week, I want to focus on another issue included in both the U.S. House plan and legislation being discussed in Missouri’s General Assembly — Medicaid global waivers, block grants and per-capita caps.

Missouri Sen. David Sater has filed legislation to allow the state to enter into a global waiver for its Medicaid program. Having a discussion about how this might work for Missouri makes sense. Seeking authorization to enter into one of these agreements would make Missouri an early adopter.

Today, the MHA Board of Trustees met to discuss a set of principles related to block grants and per-capita allocations. In thematic terms, the board focused on how to maintain federal funding, provide for fair treatment of expansion and nonexpansion states, establish a reasonable transition, preserve state flexibility in managing their program and adequate care for patients, and have a robust toolkit to allow for program innovation.

There are very real concerns about how such a fundamental change in the state-federal Medicaid relationship could affect policy, providers and patients in Missouri. Anyone who works in health care knows that the need for safety-net services will remain. And, before embarking on an era of enhanced state flexibility, the board believes that all stakeholders should understand the implications of enhanced state responsibility.

One of the fundamental issues is how a base rate might be set. Missouri didn’t expand Medicaid and could, depending on the trajectory of congressional negotiations and administration priorities, be based lower than states that have expanded Medicaid through the ACA. This is a very real concern with significant long-term implications. Missouri is one of 19 states that have not implemented an expansion through the ACA, and could be harmed in perpetuity.

Although the U.S. House Republicans have released a policy brief, there seems to be a deepening chasm within the Republican Party about the future of the ACA. Republican governors in expansion states have a stake in the outcome. But so do Republican U.S. Senators from nonexpansion states — there are 32, which is the majority of the majority — who will have an outsized voice on the direction of policy. And, as it turns out, Obamacare’s popularity is increasing in the midst of the repeal and replace discussion. This could have significant implications for the upcoming debate.

In Missouri, we share Sen. Sater’s values when it comes to improving the value of Medicaid. However, there’s been little evidence that the state is ready for the significant financial risk of a global waiver, block grant or per-capita allotment. The stability of the state’s safety net — for seniors, the vulnerable and kids — hangs in the balance.

There are opportunities for innovation. We’ve been leading the discussion about how to create a framework to take advantage of new models of care. However, a global waiver — in advance of stronger signals from Washington — could put Missouri on the bleeding edge of Medicaid policy.

Missouri can’t afford to invest in a Betamax Medicaid program in a digital world. The MHA Board’s principles reflect an approach built on stronger, clearer signals.

Let me know what you think.

Herb Kuhn, MHA President & CEO

Herb B. Kuhn
MHA President and CEO

In This Issue
Early House ACA Replacement Draft Leaks
MHA Publishes 2017 Legislative Guide
CMS Develops Market Saturation And Utilization Data Tool
MHA Releases Observation Notification Guide
DHSS Hosts Death Certificate Completion Webinar
CDC Hosts Zika Response Webinar

state and federal health policy developments

Early House ACA Replacement Draft Leaks

Staff Contact: Andrew Wheeler

Today, a leaked draft of the House Republican’s repeal bill, which dismantles pieces of the Affordable Care Act, was released by POLITICO. The draft bill, which has no number and apparently has not been filed, would eliminate the individual mandate, certain subsidies and all of the law’s taxes. It also would roll back Medicaid spending and eliminate the ACA’s Medicaid expansion by the year 2020. The replacement bill would include tax credits based on age instead of income, and be paid for by limiting tax breaks on generous health plans offered by an employer. Speaker Paul Ryan has indicated that work will begin on ACA repeal and replace after the congressional recess.

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MHA Publishes 2017 Legislative Guide

Staff Contact: Daniel Landon

MHA has published its legislative guide for the 2017 session of the Missouri General Assembly. It summarizes key legislative issues affecting hospitals that are pending or expected to be debated. Topics include: reforming managed care, Medicaid budget and savings, medical liability, streamlining government, workforce, behavioral health services, FRA diversion, and other legislative threats and opportunities.

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Regulatory News
the latest actions of agencies monitoring health care

CMS Develops Market Saturation And Utilization Data Tool

Staff Contact: Andrew Wheeler

The Centers for Medicare & Medicaid Services has made available a market saturation and utilization data tool that includes interactive maps of utilization data for selected health service areas. CMS uses the tool to monitor and prevent fraud, waste and abuse. The most recent dates available to study are July 1, 2015, to June 30, 2016. A detailed dataset also is available and can be downloaded as a .csv file.

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MHA Releases Observation Notification Guide

Staff Contacts: Sarah Willson or Jim Mikes

In 2015, the U.S. Congress enacted new laws requiring hospitals to provide patients who received observation care with written notice of their status. The notice was to outline coverage implications for potential out-of-pocket expenses and encourage patients to contact their payer for specific information related to their individual plans. On Dec. 9, 2016, the Centers for Medicare & Medicaid Services released the final Medicare Outpatient Observation Notice and accompanying form instructions. Hospitals must begin using the MOON no later than Wednesday, March 8. MHA has developed educational materials to help explain observation care, specifically how it relates to Medicare billing and three-day stay requirements for skilled nursing care. MHA authorizes the revision of these materials to meet organizational and/or patient population needs.

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DHSS Hosts Death Certificate Completion Webinar

Staff Contact: Sarah Willson

Research from the Missouri Department of Health and Senior Services, published Jan. 13 in the U.S. Department of Health & Human Services’ and Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report, questioned the accuracy of certain hospital’s cause of death listed on Missouri death certificates. Hospitals are one of many organizations and individuals that process death certificates, including coroners and medical examiners. MHA responded to the research by creating talking points and requesting that DHSS expand training to ensure that all parties can be trained to the CDC’s death certificate standards. Hospitals, physicians and medical records departments are encouraged to attend a free webinar scheduled at noon, Monday, March 27. Register online.

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Quality and Population Health

CDC Hosts Zika Response Webinar

Staff Contact: Jackie Gatz

On behalf of the Centers for Disease Control and Prevention’s Zika virus response, the State Coordination Task Force is hosting a Zika jurisdiction and partner sustainment strategy planning webinar at 2 p.m. Wednesday, March 1. The webinar will highlight lessons learned, provide updates to Zika guidance and review functional task force recommendations for jurisdictional and CDC actions for 2017. The 90-minute webinar will be followed by function-specific, two-way discussion sessions scheduled later in March. The following questions will be addressed during the webinar.

  • Is your jurisdiction ready for potential Zika virus outbreaks in 2017?
  • How can your jurisdiction better prepare for Zika in 2017?
  • What elements of comprehensive Zika planning does your jurisdiction need to review, reconsider or sustain?
  • How can your jurisdiction customize a set of activities appropriate for your unique characteristics of risk, resources and community input?

Invited participants include state health officials; state, local and territorial preparedness directors; and other staff with Zika-related expertise within their jurisdictions. A Q&A session will be provided. Any questions to be addressed during the webinar should be emailed in advance. Questions emailed after the webinar also will be addressed. Dial 888/790-1964 and enter passcode 6643270 to participate.

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Did You Miss An Issue Of MHA Today?

February 23, 2017
Governor Wants Settlement Funds To Reverse Budget Cuts
State Senate Approves PDMP Legislation
Senate Committee Approves Mandated Flu Shots
MLN Connects Provider eNews Available
AHA Releases New Workforce Report
St. Joseph Medical Center Names New Administrator

February 22, 2017
DHSS Develops Chronic Disease Toolkit
CMS Announces IQR Outreach And Education Webinar
CMS Updates EHR Known Issues Documents
CMS Announces Data Center System Maintenance
Mercy And St. Anthony’s Medical Center Enter Affiliation Agreement

February 21, 2017
CMS Announces VBP Outreach And Education Session

February 20, 2017
MHA Encourages Hospital Community To Weigh In On ACA Cuts
CMS Helps Small Practices Succeed In Quality Payment Program
BDO Offers MACRA And Quality Payment Program Conference
CMS Releases Hospital Quality Reporting Winter 2017 Newsletter

Consider This ...

Each year, between 600 and 900 people in the U.S. learn that they have aplastic anemia — a rare disease in which the bone marrow stops producing enough blood cells.

Source: The Aplastic Anemia and MDS International Foundation