MHA Today | September 14, 2018

September 14, 2018
MHA Today: News for Healthcare Leaders

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September 14, 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 & CEO This week, the Missouri General Assembly convened for its annual veto session and for a concurrent special session called by Gov. Parson. Looking at the week through the narrow lens of hospital interests, it might be easy to assume that the only item of importance was whether the veto of funding for the Time Critical Diagnosis program was overridden. A broad view, on the other hand, provides an entirely different picture — a “trifecta” of important issues for hospitals and the communities they serve.

Wednesday, members of the Missouri House of Representatives voted to override the veto of $154,000 in funding for three staff in the Missouri Department of Health and Senior Services to administer the Time Critical Diagnosis Program. The program addresses the designation of stroke, STEMI and trauma centers, as well as the transport of patients with those conditions. Hours later, the Missouri Senate adjourned without taking action on the TCD veto, so the veto will stand. However, the Parson administration indicated that it will continue to fund the TCD staffers using its budget flexibility. Key Senators reiterated that intent. While many in the House of Representatives argue that the executive branch does not have that flexibility, they have no interest in harming the TCD program. The issue may be resolved in the 2019 legislative session when legislators consider whether and how to address budget shortfalls.

The veto and special sessions provided an opportunity for the House of Representatives’ Health and Mental Health Policy Committee to hold a hearing on Medicaid managed care contracting, reimbursement and provider relations. During the hearing, MHA and members of the hospital community discussed the MO HealthNet Division’s recent changes to contracting standards, allegations of “excessive” Medicaid payment rates for hospitals and the challenges posed by Medicaid managed care plans’ utilization review standards, among other topics. Holding the Medicaid managed care plans accountable is a top priority. The hearing helped the committee understand how the implementation of statewide Medicaid managed care for children and low-income parents is affecting hospitals and constituents in their districts, as well as the health care system statewide.

The third issue was a hearing held on Tuesday. The Joint Committee on Administrative Rules met at MHA’s request to review a MHD outpatient hospital services reimbursement rule. MHA staff, testifying in opposition to the rule, expanded on the arguments contained in MHA’s previously filed brief, contending in part that the rule violates statutory fiscal note requirements, and is arbitrary and capricious in reducing reimbursements beyond cuts approved by lawmakers in the state fiscal year 2019 appropriations bill.

Several JCAR members questioned the department’s representatives at length about the decision to impose payment reductions beyond those set by the legislature. Others questioned whether the department had adequately considered the impact on the Federal Reimbursement Allowance and contracted managed care rates. Committee member Rep. Gina Mitten introduced a motion to disapprove the rule; however, the absence of two members prevented the committee from voting. The committee adjourned with no formal action but may reconvene to vote at any time before its authority to disapprove the rule expires on Thursday, Sept. 27.

All three of these developments were positive. However, taking that wider view of the week’s activities, I think the special session agenda, which was called to fix problems that led to vetoes, has been very positive — for hospitals, but more importantly, the patients they serve.

Gov. Parson vetoed a bill related to curriculum for science, technology, engineering and math — known as STEM — because the bill appeared to favor one potential vendor. STEM education is essential to the hospital workforce, providing the basic skills needed for health care careers. MHA’s recent reports on the hospital workforce and primary care physician workforce underscore the significant career opportunities in health care.

The special session also included expansion of treatment courts. Numerous Missouri jurisdictions do not have access to these specialized courts that can assist individuals with substance abuse issues toward recovery and keep them out of the corrections system. It’s abundantly clear that Missouri’s opioid crisis only will be resolved through new approaches. As providers, we’re working to reduce the stigma of opioid use disorder and embracing medication-assisted treatment. Innovations in the courts and corrections will help as well. Incarcerated and with a record, individuals with OUD or other substance abuse-related problems will have a much more difficult time reentering the mainstream.

Considering the limited agenda for this veto and special session, Missouri will benefit significantly from lawmakers’ week of work. Our focus — that of MHA and hospitals across the state who participated in this week’s legislative activities — was squarely on the patients we serve. Whether it be a TCD program that ensures that patients will get to the right hospital as fast as possible for their life-saving care, or fair payment systems that ensure access in both rural and urban areas, the patient was the center of all of our advocacy this week.

The outpatient rule should be resolved in the next few weeks. But, the TCD and Medicaid managed care issues are ripe. September offered a preview of the work we’ll undertake during the 2019 session of the Missouri General Assembly. Nonetheless, it was a very good week, all-in-all.

Have a great weekend. And, let me know what you’re thinking.

Herb Kuhn, MHA President & CEO

Herb B. Kuhn
MHA President and CEO

In This Issue
Missouri Board Of Nursing Clarifies APRN Mileage Regulation
Missouri Providers Support Hurricane Florence Response Efforts

Regulatory News
the latest actions of agencies monitoring health care

Missouri Board Of Nursing Clarifies APRN Mileage Regulation

Staff Contact: Sarah Willson

Amidst some concern voiced by Missouri nurses, the State Board of Nursing provided a clarification statement regarding new regulations that change the mileage restriction for collaborative practice agreements from 50 miles to 75 miles for advanced practice registered nurses. On May 15, the rule was filed as an emergency and a regular proposed rule at the same time. The emergency rule became effective April 26 and expires Feb. 5, 2019.

The Order of Rulemaking already has been filed, which will make the effective date of the permanent rule Tuesday, Oct. 30 well before the emergency rule expires. If there are questions or concerns, please contact the Missouri State Board of Nursing at 573/751-0681 or The board’s website contains an information page dedicated to changes with APRN collaborative practice agreements.

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Missouri Providers Support Hurricane Florence Response Efforts

Staff Contact: Jackie Gatz

This morning, Hurricane Florence made landfall on the southeastern coast of North Carolina as a Category 1 hurricane. Despite the downgraded status based on the storm’s wind speed, its slow moving pace and heavy rainfall creates increased risk for widespread, life-threatening flooding. As of Friday afternoon, there are reports of 600,000 power outages with more anticipated through the weekend. Hospitals and health care providers in the impacted area implemented appropriate preventive measures in advance of the storm, and report working closely with their local and state partners on weather forecasts, infrastructure status and regulatory requirements related to disaster operations.

Missouri health care providers are supporting the response through nationally-coordinated efforts.

  • With the activation of the national ambulance contract by the Federal Emergency Management Agency, Missouri has rostered 20 EMS units that are enroute or onsite to stage in Bowling Green, Va.
  • Missouri Task Force-1 was deployed earlier in the week to Brunswick County, N.C., an identified area of immediate impact. The team is conducting search and swift water rescue.
  • Midwest – 1, Missouri’s Disaster Medical Assistance Team, which is partially comprised of Missouri hospital staff, is on call for October and has not been activated at this time.

MHA staff remain engaged in response coordination to monitor the status of our fellow hospital and health care providers in the impacted areas. As September is National Preparedness Month, Hurricane Florence highlights the importance of hospital preparedness and community partnerships.

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Did You Miss An Issue Of MHA Today?

September 10, 2018
CMS Releases Updated Guidance For Swing-bed Providers
IQR Specifications Manual Addendum Available

September 11, 2018
JCAR Examines Outpatient Hospital Services Reimbursement Rule
Hospitals File Lawsuit Over 340B Drug Pricing And Overcharging

September 12, 2018
General Assembly Considers Veto Of Time Critical Diagnosis Funding State Legislative Committee Reviews Medicaid Managed Care
Navigator Programs Receive $10 Million To Support Marketplace Enrollment
MHA Distributes Analysis Of Final Updates To 2019 Medicare SNF PPS
CMS Modifies Individual Mandate Hardship Exception Process
Trajectories — Integrating Evidence-Based OUD Treatment: A Medication First Model
CMS Identifies Error In FY 2019 Readmissions Reduction Program HSR User Guide
IPFQR Education Session Registration Open
OQR Specifications Manual Available
Lee’s Summit Medical Center Names New CEO

September 13, 2018
U.S. House Passes Four Medicare Bills
MLN Connects Provider eNews Available
Today Is World Sepsis Day
CMS Now Accepting CY 2018 eCQM Data
CMS Announces Education Session
CenterPointe Hospital Names New CEO

Consider This ...

Living in poverty or rural areas increases the odds of suffering from chronic pain, and one-fifth of adults in the U.S. live with the condition. In 2016, 50 million adults had chronic pain, defined as pain on most days or every day in the past six months.