MHA Today | February 26, 2018

February 26, 2018
MHA Today: News for Healthcare Leaders

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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

What You Need To Know This Week

  • This week, an announcement from multiple state agencies will be made related to physician prescribing practices of opioids in the Medicaid program.
  • Watch for the call for nominations for MHA’s 2018 Visionary Leadership Award.

Advocate
state and federal health policy developments


MHA Opposes Legislation To Expand Concealed Weapons In Hospitals

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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Anthem Rescinds Modifier 25 Policy

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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Regulatory News
the latest actions of agencies monitoring health care


MO HealthNet Tightens “Refill Too Soon” Criteria

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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Consider This ...

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.

Source: NPR