MHA Today | January 26, 2018

January 26, 2018
MHA Today: News for Healthcare Leaders

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January 26, 2018

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
Throughout the week, MHA hosted a series of calls to inform members about the governor’s budget recommendation, which was released Monday. Although the governor’s recommendations hold weight with members of the General Assembly, changes are likely before the May deadline. Or, as politicians like to say, the executive branch proposes and the legislative branch disposes.

The budget contains some very good news for the effort to combat the opioid crisis. The recommendation allocates $6.5 million in funding for several efforts, including $4.7 million for peer recovery coaches in emergency departments, and faith and community recovery-support services. Additionally, $750,000 would be directed to promote medication safety, $730,000 would be allocated for Narcan training and use, and $374,000 would fund the governor’s prescription drug monitoring effort through pharmacy benefit managers. These are important investments, and their inclusion in the budget sends a strong signal that Missouri is committed to combating the opioid crisis.

Although Gov. Greitens called the growth in Medicaid costs an “explosion,” much of the growth in this year’s spending is connected with recent policy decisions. Several requests for new funds derive from the transition to statewide managed care. In addition, the change in the asset limit for Medicaid eligibility — a limit that had not increased in approximately four decades — led to increased spending.

The most troubling part of the Medicaid portion of the proposal was an undefined $40 million cut to the program. Details were not provided for how the cuts would be made, and the state’s budget director said the administration’s plan was to “define that as we go along.” Last year, a similar unspecified spending reduction — a $30 million cut paid for through “efficiencies” — was part of Gov. Greitens’ budget withholdings. It was not clear whether this year’s total included the unrealized amount from last year or whether the two were to be aggregated as a $70 million total reduction throughout two years. Last year’s cut resulted in the recently announced laboratory payment rate reduction. Obviously, provider payment reductions aren’t efficiencies — they are cuts. We plan to be very engaged on this issue.

A significant part of the state’s budget problem is attributable to slow growth, tax cuts at the state level and federal tax reform that will reverberate through the state’s federally-linked income tax system. Health care spending is increasing. However, the Federal Reimbursement Allowance program continues to shield the state from significant general revenue commitment to hospital payments for Medicaid. It’s important to note that the FRA, which is demonstrating its significant value, requires legislative renewal this year.

Overall, from a health care perspective, the budget news is good. However, Gov. Greitens’ significant cuts to the state’s higher education system were poorly received by members of the General Assembly. Lawmakers looking to add funds back to the higher education budget will be seeking revenue elsewhere. Our mission is to wall off the FRA, and hospital funding, from raids.

The real work on the budget is just beginning. We’ll continue to share developments.

Let me know what you’re thinking.

Herb Kuhn, MHA President & CEO

Herb B. Kuhn
MHA President and CEO

In This Issue
MMAC Identifies Billing Error
Influenza Activity In Missouri Continues
Missouri FY 2017 Organ And Tissue Donor Annual Report Available

Regulatory News
the latest actions of agencies monitoring health care

MMAC Identifies Billing Error

Staff Contacts: Kim Duggan or Brian Kinkade

The Missouri Medicaid Audit and Compliance Unit of the Department of Social Services has determined, from a review of requested medical records, that a number of Missouri’s 340B outpatient hospital facilities are billing medications by combining all medication charges and utilizing revenue code 0250 without a valid J-Code or HCPCS code. 13 CSR 70-20.340 (1) states the following.

Claims from 340B health care facilities for outpatient hospital covered are exempt from the National Drug Code requirement in this rule so long as those claims utilize a valid J-Code (not a dump code) and comply with all other applicable state and federal laws. This rule is effective Feb. 29, 2016.

MMAC plans to send letters to the identified facilities asking them to self-audit and adjust the claims. If the claims are not adjusted within 30 days, MMAC will initiate the process to recoup overpayments due to the billing errors.

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Quality and Population Health

Influenza Activity In Missouri Continues

Staff Contacts: Jackie Gatz or Carissa Van Hunnik

Federal health officials identified this year’s flu season as more intense than any since the 2009 swine flu pandemic, and the number of people being diagnosed with the flu continues to rise. More worrying, the hospitalization rate — a predictor of the death rate — has just jumped, and now is on track to equal or surpass that of the 2014-2015 flu season.

Regional and state coordination systems are actively monitoring influenza-like illness activity and potential impacts to health care facilities. MHA continues to conduct EMResource queries, and data compiled from the most recently conducted query indicate hospitals continue to experience high patient volumes, and many have implemented surge strategies. However, the number of patients with confirmed cases of the flu that are admitted as inpatients has dropped since the beginning of the week. Staffing shortages also have improved slightly. Information from future queries will assess current or potential impacts to our health care system. Information from the queries is shared with key regional and state partners for continued collaboration and event monitoring.

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Missouri FY 2017 Organ And Tissue Donor Annual Report Available

Staff Contact: Dave Dillon

The Governor’s Organ Donation Advisory Committee released its annual report. The report summarizes organ and tissue donation activities, provides updates on the status of the state’s registry, and shares donor statistics and stories.

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Did You Miss An Issue Of MHA Today?

January 22, 2018
MACs Continue Operations During Shutdown
DHHS Proposes Rule On Protecting Conscience Rights In Health Care
HIDI HealthStats — The Economic Cost Of The Opioid Epidemic In Missouri
SHEA Provides Contact Precautions Recommendations
Eady Leaving Mercy Rehabilitation Hospital Springfield

January 23, 2018
Governor Releases Budget Proposal
Congress Reauthorizes CHIP, Postpones Shutdown
State Senate Committee Advances FRA Legislation
New Report Highlights The Public Health Consequences Of E-Cigarettes
CMS Corrects Third Quarter 2017 Other VTE Sub-Population Discrepancy
CMS Posts HQR News Blast

January 24, 2018
Issue Brief: Congress Enacts Resolution To Fund Government Through Feb. 8
Senate Confirms Azar As HHS Secretary
Lawsuit Challenges Kentucky Medicaid Work Requirement
2018 CPC Plus Participants Announced
FDA Extends Shelf Life Of Certain IV Solutions In Short Supply
CMS Updates OQR Specifications Manual

January 25, 2018
MLN Connects Provider eNews Available
CMS Announces Outreach And Education Webinar

Consider This ...

During the second week of January, more people sought care for flu-like illnesses than at any comparable period in nearly a decade, and in Missouri last week, more than 8,200 flu cases were reported.

Sources: The Washington Post |