MHA Today | September 1, 2017

September 1, 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
Congress has a full plate when it returns after Labor Day. Several important health care items are on the agenda with a hard deadline of Sunday, Oct. 1. A long-term solution to the Affordable Care Act’s Medicaid disproportionate share hospital cuts is among the most important.

Reductions in state Medicaid DSH allotments were included in the ACA with the expectation that hospitals would have more insured patients and, as a result, need less federal help to offset the costs of the uninsured. In states like Missouri, that hasn’t been the case. The absence of Medicaid expansion has left hundreds of thousands of otherwise eligible Missourians within the ranks of the uninsured. Uncompensated care has not dropped at the pace experienced in expansion states. And, without a smart DSH policy, the harm to Missouri and the other 18 nonexpansion states through Medicaid DSH allocation cuts would be pronounced.

Earlier Congresses have kicked the can down the road. Originally slated to take effect Jan. 1, 2014, DSH cuts were delayed in 2013, 2014 and 2015. However, the total amount of Medicaid DSH cuts has increased with each delay, so the financial Sword of Damocles remains above us, with an even sharper blade. While Missouri’s Medicaid DSH cuts in this first fiscal year are expected to be negligible because of CMS’ DSH audits, subsequent years get increasingly harsh.

Earlier this week, MHA sent a letter to Centers for Medicare & Medicaid Services’ Administrator Seema Verma presenting options for the proposed DSH rule released in late July. The proposed rule specifies how the reductions in state Medicaid DSH allotments will occur. CMS has indicated that a final rule will be released before Oct. 1. However, there are many unknown issues with very real financial consequences. If the Medicaid DSH allotment reductions take effect Oct. 1, Missouri’s share appears to be $2.2 billion through fiscal year 2025. However, we can’t know for sure. Some of the data needed to assess the effect of the proposed regulation will not be available until well after the final regulation is issued.

In our letter to Verma, we recommended delaying the proposed state DSH allotments — something we believe CMS has the authority to do. This would allow time to evaluate the options that we recommended, or other options that may bring additional equity to the program.

The best result, which could be achieved through a variety of approaches, would be to link states’ DSH needs with long-term policy goals. Until there’s a level playing field for ACA coverage, the disparities between expansion and nonexpansion states will require a reshuffling of federal DSH allotments.

Absent a total reset of the ACA, this problem will remain. Kicking the can down the road doesn’t make sense. It’s time to pick up the can, recycle the policy, and get the resource back to where it can do the most good.

Tell me what you’re thinking.

P.S. Visit MHA’s website to learn how you can help victims of Hurricane Harvey. MHA will update the website with resources and guidance for hospitals as they become available.

Herb Kuhn, MHA President & CEO

Herb B. Kuhn
MHA President and CEO

In This Issue
Anthem Exits Insurance Marketplace In 16 Counties And City Of St. Louis
Senate Finance Committee Schedules Hearing On CHIP Reauthorization

Hurricane Harvey Response

state and federal health policy developments

Anthem Exits Insurance Marketplace In 16 Counties And City Of St. Louis

Staff Contacts: Daniel Landon or Andrew Wheeler

Anthem has announced that it will stop participating in the federal health insurance marketplace in 16 Missouri counties and the City of St. Louis in 2018. The counties are: Barry, Boone, Christian, Franklin, Greene, Jasper, Jefferson, Lawrence, Lincoln, Newton, Saint Charles, Saint Francois, Saint Louis, Sainte Genevieve, Warren and Washington. Anthem’s exit will not create any counties with no insurer, according to the company, but will increase the number of Missouri counties with one insurer offering. Anthem currently offers plans in 85 Missouri counties.

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Senate Finance Committee Schedules Hearing On CHIP Reauthorization

Staff Contact: Brian Kinkade

The Senate Finance Committee will conduct a hearing on the reauthorization of the Children’s Health Insurance Program on Thursday, Sept. 7. The current law authorizing CHIP expires Saturday, Sept. 30, and Congress must renew it for the program to continue. CHIP extends health care coverage for children with family incomes above the federal Medicaid standards. Missouri’s CHIP funds provided health care coverage to almost 88,000 kids during federal fiscal year 2016. Bipartisan support for CHIP portends its renewal, although the number of years Congress will extend the program and states’ matching requirements remains uncertain.

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Did You Miss An Issue Of MHA Today?

August 31, 2017
MO HealthNet Alerts Providers About Online Claims Submission Problem
MO HealthNet Posts Telehealth Rate Cut
Board Of Pharmacy Publishes Class J Proposed Pharmacy Rules
MLN Connects Provider eNews Available
AAMC Assesses Medical School Cost And Student Debt

August 30, 2017
MHA Shares Hurricane Harvey Response Resources
OIG Issues Medicare Shared Savings Program ACO Report
CDC Reports Uninsured Rate At Lowest Point Since Tracking
CMS Accepts Comments On Star Ratings Methodology
CMS Announces IQR And EHR Education Session
HealthCurve Analytics And Apervita Host Webinar

August 29, 2017
Texas Hospital Association Establishes Employee Assistance Fund
HHS Seeks Comments On Further Delay Of 340B Drug Pricing Rule
ASPR TRACIE Hosts HCC Tools And Templates Webinar
HRET Provides Physician And Leader Adaptive Workshop

August 28, 2017
HIDI HealthStats — Population Health
Report Highlights National Nursing Workforce Challenges

Consider This ...

A 2016 survey of prime-age men 25 to 54 who were not in the labor force — defined as not employed or looking for work — found that 47 percent had taken a pain medication on the previous day, and among those, nearly two-thirds had taken a prescription pain medication.

Source: MHA and Kansas Hospital Association Opioid Policy Brief