MHA Today | May 11, 2017

May 11, 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.

In This Issue
MHA Releases Q&A On Missouri’s Former High-Risk Pool
MLN Connects Provider eNews Available
CMS Selects Targeted Hospitals For IQR Program Validation


MHA Releases Q&A On Missouri’s Former High-Risk Pool

Staff Contact: Mary Becker

From 1991 to 2013, the state of Missouri operated a high-risk insurance pool for individuals without other coverage options to purchase insurance. Mary Becker, MHA Senior Vice President of Strategic Partnerships and Communications, served on the board of directors of the Missouri Health Insurance Pool from 2004 until all operations ceased in December 2016 and as its chair since 2014. The following questions are addressed in an FAQ document that highlights the operational aspects of Missouri’s former high-risk pool and the results.

  • What was the purpose of the Missouri Health Insurance Pool?
  • How was MHIP governed?
  • Who operated the pool?
  • How was the pool funded?
  • What were the requirements for enrollment?
  • What was the enrollment in MHIP?
  • How were premiums determined?
  • What coverage was provided by the pool?
  • What was the average deductible for participants?

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Regulatory News
the latest actions of agencies monitoring health care

MLN Connects Provider eNews Available

Staff Contact: Andrew Wheeler

The Centers for Medicare & Medicaid Services issues updates to MLN Connects Provider eNews. eNews includes information about national provider calls, meetings, events, announcements and other MLN educational product updates. The latest issue provides updates and summaries of the following.

  • look-up tool to help determine merit-based incentive payment system participation status
  • new program for evaluating payment patterns electronic reports available for hospices, skilled nursing facilities, inpatient rehabilitation facilities, inpatient psychiatric facilities, critical access hospitals and long-term care hospitals
  • SNF billing reference booklet revised
  • dual-eligible beneficiaries under Medicare and Medicaid booklet revised

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Quality and Population Health

CMS Selects Targeted Hospitals For IQR Program Validation

Staff Contact: Sherry Buschjost

The Centers for Medicare & Medicaid Services has selected the targeted sample of hospitals for validation of chart-abstracted and health care-associated infection measures for the fiscal year 2019 annual payment update determination. The quarters included in FY 2019 inpatient validation are third quarter 2016, fourth quarter 2016, first quarter 2017 and second quarter 2017. CMS targeted hospitals based on their:

  • failure to meet validation requirements in FY 2018;
  • lower bound confidence interval less than or equal to 75 percent in FY 2018;
  • failure to report at least half of the HAI events detected during FY 2018 to the National Healthcare Safety Network;
  • rapidly changing data patterns;
  • abnormal or conflicting data patterns;
  • submission of data to NHSN after the IQR submission deadline; and/or
  • not having been validated in the previous three years.

An updated list of the selected hospitals is available on QualityNet. Validation resources also are available.

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Consider This ...

According to a 2015 American Hospital Association survey, there are 5,564 AHA-registered hospitals in the U.S. The total expenses for those hospitals was more than $936 billion.

Source: American Hospital Association