MHA Today | June 29, 2018

June 29, 2018
MHA Today: News for Healthcare Leaders

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June 29, 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 & CEOOn Tuesday, Missouri hospitals offered a full-throated critique of the Missouri Department of Social Services’ Medicaid managed care contract amendment. Despite the strong case made by hospitals — including more than 60 written comments, more than a dozen individuals providing in-person testimony, nearly 100 hospitals writing the governor and countless contacts with state legislators — state government has decided not to delay, modify or withdraw the proposal.

Beginning Sunday, July 1, hospitals and other providers not contracted with an enrollee’s managed care vendor will be paid 90 percent of the fee-for-service payment rate for treating Medicaid managed care enrollees. Medicaid managed care covers children and low-income parents statewide.

While all hospitals have contracted with at least one of the three managed care plans and only 12 have not contracted with all three, the policy affects all hospitals that treat those populations. The state’s action gives all the negotiating leverage to the plans. Accordingly, the plans are beginning to terminate current contracts and demand new contracts with lower rates. Refusal results in the 90 percent FFS rate. This is where the 10 percent rate cut — which is pernicious, unfair and bad policy — becomes absolute malpractice by DSS.

According to the two MCO representatives who participated in the hearings — the only voices of support for the DSS proposal — Missouri hospitals are paid far in excess of what their counterparts in other states are receiving. Further, the MCOs argue that contracting changes are needed to bring that excess state spending into line. Not only are their arguments inconsistent with the underlying principle of the rate cut, they don’t stand up to even minimal scrutiny.

The idea that hospitals are enriching themselves on Medicaid is farcical to anyone with an even basic understanding of reimbursement rates, hospital finance or the provider tax system.

It is abundantly clear that this policy is indefensible in light of the facts. And, MHA will continue to investigate every available option to alter DSS’ rush to embrace Medicaid managed care, which has proceeded with minimal attention to the plans’ accountability and value.

We’ll be expanding our work to monitor and report on contract changes, restrictions and barriers to access, resulting financial challenges from the policy and network adequacy. MHA will continue to collaborate with other providers affected by Medicaid managed care policy and provide regular updates on these and other issues to the state, lawmakers and ultimately the Centers for Medicare & Medicaid Services if we identify potential violations of federal standards.

Now, for the good news.

Sen. Roy Blunt has included language in just-adopted appropriation legislation requiring a report from the Department of Health & Human Services and Department of Labor on “how they can collaborate to provide protections and support safe environments for health care workers, patients, families and visitors.” Violence in hospitals is among the highest of priorities for hospital leaders. This type of interdepartmental initiative could resolve some of the regulatory inconsistencies that have bedeviled hospitals by identifying and reconciling the often-conflicting rules and agendas of the agencies.

I sent out a note yesterday alerting hospitals about the addition. Almost immediately, a hospital CEO replied by email saying, “It is an important message for our employees to know our senator wants to protect them.” I agree. This is an important first step.

If you see Sen. Blunt over the Independence Day holiday, thank him for his work on this issue.

As always, I want to know what you’re thinking. Send me an email with your thoughts.

Herb Kuhn, MHA President & CEO

Herb B. Kuhn
MHA President and CEO

In This Issue
MO HealthNet Retroactively Increases Selected Pediatric Critical Care Rates
CMS Advances The Medicare Advantage Quality Payment Arrangement Incentive Demonstration
MLN Connects Provider eNews Available
St. Louis County Releases New Action Plan Addressing Opioids

state and federal health policy developments

MO HealthNet Retroactively Increases Selected Pediatric Critical Care Rates

Staff Contact: Brian Kinkade

The MO HealthNet Division announced that it has increased rates for selected neonatal and pediatric critical care procedure codes retroactively to July 1, 2017. Providers do not need to resubmit claims to receive the higher reimbursement; MHD will reprocess paid claims that qualify for the increased reimbursement.

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Regulatory News
the latest actions of agencies monitoring health care

CMS Advances The Medicare Advantage Quality Payment Arrangement Incentive Demonstration

Staff Contact: Andrew Wheeler

The Centers for Medicare & Medicaid Services announced that it is advancing the Medicare Advantage Qualifying Payment Arrangement Incentive Demonstration. If approved and adopted, MAQI would waive Merit-Based Incentive Payment System requirements for clinicians who participate sufficiently in certain Medicare Advantage plans that involve taking on risk. CMS Administrator Seema Verma stated, “The MAQI Demonstration aligns with the agency’s goal of moving to a value-based health care system and aims to put Medicare Advantage on a more equal playing field with Fee-for-Service Medicare.” CMS is seeking public comments on the information collection burdens associated with the demonstration.

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MLN Connects Provider eNews Available

Staff Contact: Andrew Wheeler

Updates to MLN Connects Provider eNews were issued by the Centers for Medicare & Medicaid Services. eNews includes information about national provider calls, meetings, events, announcements and other MLN educational product updates. The latest issue provides updates and summaries of the following.

  • New Medicare card: Use Medicare Beneficiary Identifier like Health Insurance Claim Number
  • 2016 CMS program statistics
  • Qualified Medicare Beneficiary information on Remittance Advices and Medicare Summary Notices
  • Comprehensive Error Rate Testing: Arthroscopic rotator cuff repair
  • Administrative simplification compliance resources
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Quality and Population Health

St. Louis County Releases New Action Plan Addressing Opioids

Staff Contact: Leslie Porth

Yesterday, St. Louis County Executive Steve Stenger signed an executive order declaring opioid addiction and overdose a public health emergency in St. Louis County. An action plan focused on prevention, treatment and recovery — and developed in partnership with 25 organizations, including MHA — also was released.

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Did You Miss An Issue Of MHA Today?

June 25, 2018
MO HealthNet Schedules Second Hearing On Impending Managed Care Contract Amendment

June 26, 2018
MO HealthNet Holds Hearing On Medicaid Managed Care Contracting Change
TJC Releases R3 Report On New Newborn Identification Requirements
Missouri Foundation For Health Launches The Net Benefit
Pagers May Be Disclosing PHI

June 27, 2018
CMS Announces Medicaid Program Integrity Initiatives
MHA Comments On Proposed Medicaid Outpatient Hospital Reimbursement Rule
CDC Extends NHSN Consent Deadline
CMS Releases CART Resources
Selle Announces Resignation From Pike County Memorial Hospital

June 28, 2018
Senate Appropriations Legislation Includes Workplace Safety Regulatory Initiative
U.S. House Committee Advances Emergency Preparedness, Workforce And Palliative Care Bills
U.S. Senate Committee Reviews Medicaid Fraud Concerns
CMS Releases IPFQR Submission Checklists
CMS Releases OQR Manual Version 12.0

Consider This ...

Only two in 100,000 women live to age 110; for men, the chances are two in 1,000,000. According to a new study, at age 105, the odds of surviving to your 106th birthday are in the ballpark of 50 percent. It's another 50-50 coin flip to 107, then again to 108, 109 and 110.

Source: The Washington Post