MHA Today | July 5, 2017

July 5, 2017
MHA Today: News for Healthcare Leaders

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In This Issue
Greitens Approves Tort Reform, Workers’ Comp Bills
Centene Plans To Fill Missouri’s Marketplace Deserts
CMS Updates Data Used To Determine Medicare DSH Adjustments
Trajectories — Opioid Use Disorder
CMS Releases OQR Specifications Manual

Advocate
state and federal health policy developments


Greitens Approves Tort Reform, Workers’ Comp Bills

Staff Contact: Daniel Landon

Gov. Eric Greitens has approved several bills enacted in the 2017 session of the Missouri General Assembly. Senate Bill 31 modifies state courts’ evidentiary standards used to define the medical expenses that plaintiffs may claim as damages in civil litigation. House Bill 339 creates new standards for time-limited offers of settlement agreements of personal injury, bodily injury or wrongful death litigation. Senate Bill 66 revises various workers’ compensation payment and procedural standards, including a change to the standard of proof for workers’ compensation discrimination lawsuits. 

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Centene Plans To Fill Missouri’s Marketplace Deserts

Staff Contact: Andrew Wheeler

The Centers for Medicare & Medicaid Services previously released a county-level snapshot of the number of insurers projected to offer products on the health insurance marketplace. CMS projected that 25 counties in Missouri would be without a marketplace plan in 2018. Centene has announced it will offer plans in the marketplace, which would include the 25 counties that would otherwise be left without coverage.

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Regulatory News
the latest actions of agencies monitoring health care


CMS Updates Data Used To Determine Medicare DSH Adjustments

Staff Contact: Andrew Wheeler

The Centers for Medicare & Medicaid Services released a change request informing Medicare Administrative Contractors about the updated data used for determining Medicare disproportionate share adjustments for inpatient PPS hospitals and the low-income patient adjustment for inpatient rehabilitation facilities. The data will be used for settlement purposes for IPPS and IRF cost-reporting periods beginning fiscal year 2015. The request also provides guidance for accepting amended fiscal year 2015 worksheet S-10 data. For these revisions to be considered, amended cost reports, including revised worksheet S-10 data, must be received by MACs by Saturday, Sept. 30.

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Quality and Population Health


Trajectories — Opioid Use Disorder

Staff Contact: Leslie Porth AHCA Per Capita Fed Net Medicaid Expenditures by Expansion Status

The July 2017 edition of Trajectories highlights the issue of opioid use and abuse. While prevention through safe prescribing practices is essential, many patients already live with an opioid addiction. Collaboration between the provider and patient is critical to success. Physicians, nurses, case managers and social workers all play an important role in assisting patients to manage their medical condition and formulate a tapering plan or minimize their use of opioids. A successful plan includes the following.

  • Understanding how to manage the challenges of living with a chronic condition.
  • Learning how to inform and activate patients to take responsibility for self-management using the skills of empathy and “motivational interviewing.”
  • Using realistic goal-setting instead of a “silver-bullet” approach.
  • Shared decision-making.
  • Identifying responsibility.
  • Identifying and using self-management strategies.

Another resource for providers is to use ongoing screening tools to re-assess the need for continued opioid therapy and risk for addiction. These tools, used at provider-defined intervals during opioid treatment, promote close monitoring of use and help identify when intervention is necessary. Read more to learn about additional tools.

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CMS Releases OQR Specifications Manual

Staff Contact: Sherry Buschjost

Version 11.0 of the Hospital Outpatient Quality Reporting Specifications Manual, effective for outpatient encounters from Jan. 1 through Dec. 31, 2018, is available on QualityNet. A complete list of the changes is available in the release notes. Major changes include the following.

  • added outcome measures OP-35: Admissions and Emergency Department Visits for Patients Receiving Outpatient Chemotherapy and OP-36: Hospital Visits after Hospital Outpatient Surgery
  • redefined OP-18b as the performance measure of nonpsychiatric/mental health and transferred patients
  • provided clarification of OP-13 by adding cardiac computed tomography angiography to the imaging modalities included in the measure’s denominator
  • provided example changes to OP-29 to better align denominator exclusions with similar measures in other programs
  • added a denominator exclusion to OP-33
  • provided clarification of certain data elements
  • removed patient HIC# from the data elements


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Consider This ...

In the U.S., 14.9 million adults reported having had coronary heart disease, angina or a heart attack in 2015.

Source: Centers for Disease Control and Prevention