MHA Today | August 31, 2018

August 31, 2018
MHA Today: News for Healthcare Leaders

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August 31, 2018

MHA Today is provided as a service to members of the Missouri Hospital Association. Additional information is available online at MHAnet.

Editor's Note: Insights has the week off and will resume Friday, Sept. 7. MHA Today will not be published Monday, Sept. 3. Have a safe and happy Labor Day weekend!

In This Issue
MO HealthNet Files Rule To Cut 340B Pharmacy Reimbursement
MO HealthNet Posts Comments Received In Opposition To Proposed Outpatient Rate Cuts
CMS Provides Flexibility To Medicare Beneficiary Prescription Drug Coverage
Medicare ACOs Save CMS $314 Million
MLN Connects Provider eNews Available

Advocate
state and federal health policy developments


MO HealthNet Files Rule To Cut 340B Pharmacy Reimbursement

Staff Contact: Brian Kinkade

MO HealthNet has filed a proposed rule to cut pharmacy reimbursement for drugs dispensed to Missouri Medicaid participants by 340B hospitals to Wholesale Acquisition Cost minus 49 percent. The rule can be found on Page 2,566 of the Sept. 4 Missouri Register (or PDF Page 32.) The proposed rule also updates the reimbursement hierarchy for retail pharmacies that dispense drugs to Missouri Medicaid participants. MO HealthNet is converting pharmacy reimbursement from the percent of billed charges to the fee schedules established by this rule; these changes are slated to take effect in February 2019. The anticipated change in 340B reimbursement is strongly opposed by MHA and it was a topic of significant discussion at the meeting between hospitals and MO HealthNet last Friday. MO HealthNet Acting Director Jennifer Tidball committed to reviewing the WAC minus 49 percent reimbursement proposal in light of the arguments the hospitals offered for why the rate is unfairly austere. Comments on the proposed rule may be submitted by mail to the following address.

Department of Social Services Legal Services Division-Rulemaking
P.O. Box 1527
Jefferson City, MO 65102-1527
Comments may also be submitted by email to Rules.Comment@dss.mo.gov, and must be received by Oct. 4.

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MO HealthNet Posts Comments Received In Opposition To Proposed Outpatient Rate Cuts

Staff Contact: Brian Kinkade

Testimony offered at MO HealthNet’s Aug. 3 hearing by MHA and hospital representatives in opposition to the division’s proposed outpatient rate cuts has been summarized and posted on the department’s website. MHA filed comments in opposition to the regulation in June and continues to actively advocate for Missouri hospitals’ interests as MO HealthNet proceeds with its implementation of the change.

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CMS Provides Flexibility To Medicare Beneficiary Prescription Drug Coverage

Staff Contact: Andrew Wheeler

The Centers for Medicare & Medicaid Services issued a memo to Medicare Part D plans, offering new tools and flexibility to expand choices and lower drug prices for patients. Beginning in 2020, plans will have the opportunity to tailor their formularies so that different drugs can be included for different indications, known as “indication-based formulary design”.  U.S. Department of Health & Human Services Secretary Alex Azar stated, “this action delivers on President Trump’s drug pricing blueprint by offering Medicare plans new tools to negotiate lower drug prices and offer patients better choices. This is a significant step in modernizing the successful Medicare Part D program by giving plans the tools that serve patients well in the private sector.” 

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Medicare ACOs Save CMS $314 Million

Staff Contact: Andrew Wheeler

The Centers for Medicare & Medicaid Services released results of accountable care organizations in 2017. For the year, 472 Medicare ACOs generated a total of $1.1 billion in savings, which includes $780 million in bonuses to the ACOs and $313.7 million in gains to CMS. In Missouri, $36 million in savings was generated with $39 million paid out in bonuses to ACOs.

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Regulatory News
the latest actions of agencies monitoring health care


MLN Connects Provider eNews Available

Staff Contact: Andrew Wheeler

The Centers for Medicare & Medicaid Services issues updates to MLN Connects Provider eNews. 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.

  • ACOs taking risk in innovative payment model generate savings for patients and taxpayers
  • Home health agencies: 2016 utilization and payment data
  • MIPS targeted review request: deadline Oct. 1
  • Call for panel on 2018 MIPS IA performance category – nominations due Sept. 21

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Did You Miss An Issue Of MHA Today?


August 27, 2018
MO HealthNet Meets With Hospitals On Managed Care, Reimbursement Changes MHA Distributes Analysis For Proposed CY 2018 Medicare Outpatient PPS
CMS Releases Report About Next Generation ACO Model
HIDI HealthStats — How Effective Are Medicaid MCOs At Managing Care In Missouri?
MHA Releases 2019 Annual Quality Report
Ebola Outbreak Now At 105 Cases, And Bordering Countries Are On Alert
Clinician Shortages Driving Up Hospital Labor Budgets

August 28, 2018
Congressional Committee Leaders Support New 340B Regulations
MHD Provides Guidance To Rural Health Clinics Providing School-based Services
Whitepaper Explores Nurse Retention

August 29, 2018
Friday Is International Overdose Awareness Day
CMS Announces Deadline For QRDA Category I Files For the Hybrid HWR Measure
Millennial Nurses Bring Higher Expectations To The Work Environment

August 30, 2018
TJC Announces Pioneers In Quality Webinar
CMS Announces IQR Education Session



Consider This ...

Today is International Overdose Awareness Day. North America continues to experience the highest drug-related mortality rate in the world, accounting for one in four drug-related deaths globally.

Source: www.overdoseday.com