MHA Today | October 11, 2018

MHA Today: News for Healthcare Leaders

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October 11, 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
President Trump Signs Bills Banning Pharmacy Gag Clauses
Marketplace Premiums Drop In 2019
CMS Releases Medicare Advantage And Medicare Part D Star Ratings For 2019
OIG Releases Medicare Advantage Appeal Outcomes And Audit Findings
Issue Brief: CMS Announces Participants In New Value-Based Bundled Payment Model
MLN Connects Provider eNews Available
Missouri Health Care Providers Support Hurricane Michael Response
CMS Announces Education Session
Ellett Memorial Hospital Names New CEO

Advocate
state and federal health policy developments


President Trump Signs Bills Banning Pharmacy Gag Clauses

Staff Contact: Andrew Wheeler

President Trump signed two bills that block insurers from enforcing gag clauses that prevent pharmacies from informing customers about how they can pay less for drugs. The Patient Right to Know Drug Prices Act and the Know the Lowest Price Act allow patients to determine if a prescription would cost less if they were to pay out of pocket in place of purchasing a drug using their health plans.

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Marketplace Premiums Drop In 2019

Staff Contact: Andrew Wheeler

The Centers for Medicare & Medicaid Services released information about the average monthly premium for the second lowest cost silver plans for 2019. The average SLCSP premium will drop 1.5 percent, with Tennessee having the largest reduction of 26.2 percent. The SLCSP monthly premium in Missouri will decrease from $432 in 2018 to $409 in 2019, a decrease of 5.3 percent.

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CMS Releases Medicare Advantage And Medicare Part D Star Ratings For 2019

Staff Contact: Andrew Wheeler

Medicare open enrollment begins next Monday, Oct. 15. To assist beneficiaries in selecting the best product, the Centers for Medicare & Medicaid Services released the 2019 Star Ratings for Medicare Advantage and Medicare Part D prescription drug plans. CMS Administrator Seema Verma stated, “Medicare Advantage enrollees will continue to have access to high-quality plans while plan choices are increasing and premiums are declining. We are committed to empowering Medicare beneficiaries to make informed choices in choosing high-quality plans that best fit their health needs.”

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OIG Releases Medicare Advantage Appeal Outcomes And Audit Findings

Staff Contact: Andrew Wheeler

The U.S. Department of Health & Human Services Office of Inspector General recently released a report about Medicare Advantage appeals outcomes and audit findings. The OIG conducted the study due to the potential incentive for Medicare Advantage Organizations to inappropriately deny authorization of coverage. The OIG found that MAOs overturned 75 percent of their own denials. In addition, independent reviewers at higher levels of appeals overturned additional denials in favor of beneficiaries and providers.

The OIG stated, “The high number of overturned denials raises concerns that some Medicare Advantage beneficiaries and providers were initially denied services and payments that should have been provided. This is especially concerning because beneficiaries and providers rarely used the appeal process.”

The OIG recommended that CMS enhance its oversight of MOA contracts, address persistent problems related to inappropriate denials and provide beneficiaries with clear, easily accessible information about serious violations. CMS concurred with all three recommendations.

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Regulatory News
the latest actions of agencies monitoring health care


Issue Brief: CMS Announces Participants In New Value-Based Bundled Payment Model

Staff Contact: Andrew Wheeler

Recently, the Centers for Medicare & Medicaid Services announced 1,299 entities signed agreements to participate in the Bundled Payments for Care Improvement - Advanced Model. MHA published an issue brief with additional model details. In Missouri, 165 entities signed agreements.

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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: destroy the old card
  • participants in new value-based bundled payment model
  • reprocessing claims for diagnostic services by certain physical therapists
  • CMS to strengthen oversight of Medicare’s Accreditation Organizations

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Quality and Population Health


Missouri Health Care Providers Support Hurricane Michael Response

Staff Contact: Jackie Gatz

Midwest-1, the federal Disaster Medical Assistance Team encompassing Missouri, was deployed yesterday to provide medical response in the aftermath of Hurricane Michael. Additionally, several EMS services rostered strike teams to support the anticipated and ongoing medical transport needs in the impacted areas. At this time, no additional resource requests have been made of Missouri. Providers are reminded of the danger and challenges in self-deployed resources.

MHA staff continues to monitor the national response, resource needs we may be able to support and the impact of resource deployments on Missouri health care operations.

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CMS Announces Education Session

Staff Contact: Sherry Buschjost

An outreach and education session for hospitals participating in the Hospital Inpatient Quality Reporting, and the Medicare and Medicaid Promoting Interoperability programs has been scheduled for 1 p.m. Wednesday, Oct. 24. The presentation is geared toward hospital staff with limited knowledge of the electronic clinical quality measure data submission process and those who would like a refresher demonstration specific to calendar year 2018 reporting. Discussion will include the steps to electronically report clinical quality measure data via the QualityNet secure portal. Registration is required.

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CEO Announcements


Ellett Memorial Hospital Names New CEO

Staff Contact: Carol Boessen

Julie Tootle has been named CEO of Ellett Memorial Hospital in Appleton City, Mo., effective Friday, Oct. 19. Tootle has 30 years of nursing experience and 25 years in leadership positions, including eight years as chief nursing officer and chief operating officer at Ellett Memorial Hospital, and five years as vice president of clinical services and quality management at Rural Community Hospitals of America in Kansas City. She succeeds Melissa Fletcher who is resigning to pursue other opportunities. A list of CEO changes is available online.

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Consider This ...

A small but increasing number of children in the U.S. are not getting some or all of their recommended vaccinations. The percentage of children under two years old who haven’t received any vaccinations has quadrupled since 2001.

Source: The Washington Post