February 26, 2018
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 Opposes Legislation To Expand Concealed Weapons In Hospitals
Anthem Rescinds Modifier 25 Policy
MO HealthNet Tightens “Refill Too Soon” Criteria
state and federal health policy developments
Staff Contacts: Daniel Landon or Rob Monsees
Today, a Missouri House of Representatives committee held a hearing on House Bill 1936, which would expand the settings and circumstances where concealed weapons are authorized. One change in the bill would allow those with concealed weapons permits to bring their weapons into areas of a hospital accessible to the public. Private hospitals could restrict access by adopting policies and posting signs; governmental hospitals could not. MHA expressed opposition to the measure.
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Staff Contact: Andrew Wheeler
Anthem Blue Cross and Blue Shield previously notified physicians in Missouri that it will begin reducing payments of evaluation and management services billed with modifier 25, effective Thursday, March 1. Modifier 25 is used when the patient’s condition requires a significant, separately identifiable E/M service above and beyond the usual pre- and post-procedure work on the same day as a procedure or other service. Due to significant pushback, Anthem has decided to rescind the modifier 25 policy.
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the latest actions of agencies monitoring health care
Staff Contact: Brian Kinkade
MO HealthNet’s refill too soon criteria for pharmaceuticals was increased from 75 percent utilization to 85 percent utilization for scripts filled on and after Wednesday, Feb. 21. Claims for refills before meeting the 85 percent standard will be denied. Exceptions to the RTS limit will be considered when an increase in dosage has been prescribed or for prescriptions that have been lost, damaged or stolen. RTS exceptions for lost, damaged or stolen prescriptions will be allowed only one time in a given 12-month period, and requests for RTS exceptions for stolen prescriptions must be accompanied by a police report. Long-term care facilities may not request exceptions. Pharmacies may not request RTS exceptions due to errors made at the time the original prescription was dispensed or for mailed prescriptions being lost.
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Health insurance claims for type 2 diabetes — formerly known as adult-onset diabetes — among people younger than 23 years old more than doubled between 2011 and 2015. Claims for prediabetes among children and youth rose 110 percent, while high blood pressure claims rose 67 percent.