February 28, 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
State Launches Opioid Prescriber-Accountability Initiative
State Senate Approves Hospital Regulatory Relief Legislation
MMAC Rescinds Audit Letter
HIDI Releases Third Quarter 2017 VBP Payments Model
Missouri Board Of Nursing Hosts First Military Connect Meeting
the latest actions of agencies monitoring health care
Staff Contacts: Daniel Landon or Brian Kinkade
The Missouri Departments of Social Services, Health and Senior Services, and Mental Health announced that “Opioid Prescription Intervention” reports and accompanying letters will be mailed to as many as 8,000 prescribing health care providers who wrote Medicaid prescriptions for opioids in the previous quarter that do not meet certain quality standards. This notice is similar to those that have been mailed regularly for the past several years.
Beginning Thursday, March 1, providers will need to respond to the Missouri Medicaid Audit and Compliance Unit within 30 days with the clinical data justifying the prescription history or a plan for modification to comply with the MO HealthNet standard. Providers who do not respond will be sent a second letter requesting a response within 20 business days. Further failure to respond will incite referral to the Bureau of Narcotics and Dangerous Drugs, the State Board of Registration for the Healing Arts, and the practitioner’s employer.
In addition, on Tuesday, March 6, MO HealthNet will begin to introduce edits to the pharmacy payment system that will deny claims for prescriptions that fail to comply with certain quality criteria. Additional details of this initiative will be distributed in the coming days.
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state and federal health policy developments
Staff Contacts: Daniel Landon or Rob Monsees
The Missouri Senate gave first-round approval to Senate Bill 951. The bill redefines a hospital premises to include property that is “catty-corner” across an intersection from the main hospital property. It also allows state hospital licensure regulations to automatically update to be in synch with the Centers for Medicare & Medicaid Services’ standards. Current state law prevents state regulations from automatically updating to stay current with external standards, such as CMS’ Conditions of Participation. Updates now require new state regulations, a process taking six to nine months to complete.
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Staff Contacts: Kim Duggan or Brian Kinkade
On Wednesday, Feb. 7, the Missouri Medicaid Audit and Compliance Unit of the Department of Social Services sent letters to 43 340B hospitals asking them to self-audit and adjust their outpatient pharmacy claims in instances where they had combined all medication charges and billed them with revenue code 0250 without a valid J-code or HCPCS code. After receiving numerous questions from MHA staff, MMAC has decided not to proceed with the audit at this time. Affected hospitals should be notified by letter soon.
Although the audit has been cancelled, 340B hospitals are required to file claims with a valid J-code or HCPCS code, not a dump code. We anticipate that although MMAC has backed away from an audit of these claims at this time, they may conduct one in the near future. As a result, hospitals should review their compliance with this regulation.
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HIDI Tech Connect
Staff Contact: Shane VanOverschelde
The Value-Based Purchasing Payments Model is a companion utility to the VBP Analysis that was produced for hospitals on Thursday, Feb. 8. The VBP Payments Model is an interactive tool that provides hospitals with the ability to manipulate their hospital-specific quality scores to evaluate the associated change to estimated VBP payments. The VBP Payments Model is provided to subscribers of the 2018 Premier Reporting Package. The modeling utility is located on HIDI Analytic Advantage® in the “Finance and Policy/Premier Reports” or “Quality/Premier Reports” folders, with the following file name: MOxxxx_VBP FFY2019 Payments Model_2017_Q3_(2018.02.28).xlsx. Hospitals interested in subscribing to the HIDI Premier Report Package should review the package information. Current subscribers with questions about downloading files should contact HIDI.
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Staff Contact: Jill Williams
The Missouri State Board of Nursing hosted its very first Military Connect meeting on Friday, Feb. 23, to continue to further identify pathways for military personnel to obtain credit and licensure for their education, training and service. Fifteen educators from all levels of nursing education programs and SMSgt Sherod Thompson from the United States Air Force attended the meeting. He said, “The U.S. Air Force nursing leaders should and will be more greatly engaged in assessing the LPN needs and utilization within our military medical facilities.”
Lori Scheidt, Director of the Board said, “We were pleased to host this meeting to brainstorm how to position Missouri as a leader in improving the lives of military families by providing a pathway to higher education and nurse licensure.”
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Missouri has one of the highest rates of maternal smoking in the country. In 2016, 7.2 percent of women who gave birth in the U.S. reported smoking during pregnancy. But in Missouri, that figure is much higher, reaching 15.3 percent.
Source: The Kansas City Star