MHA Today | December 13, 2018

December 13, 2018
MHA Today: News for Healthcare Leaders

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December 13, 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
MHD Pharmacy Reimbursement Changes Begin To Take Effect
Congressional Committee Reviews Sexual Assault Forensic Examinations At Hospitals
MLN Connects Provider eNews Available

state and federal health policy developments

MHD Pharmacy Reimbursement Changes Begin To Take Effect

Staff Contact: Brian Kinkade

The MO HealthNet pharmaceutical reimbursement for all provider types except outpatient hospitals will be changed effective Sunday, Dec. 16, 2018. This will be determined by applying the following hierarchy methodology.

  • National Average Drug Acquisition Cost (NADAC); if there is no NADAC,
  • Missouri Maximum Allowed Cost (MAC); if there is no NADAC or MAC,
  • Wholesale Acquisition Cost (WAC); or
  • the usual and customary charge submitted by the provider if it is lower than the chosen price (NADAC, MAC or WAC)

Reimbursement for 340B providers who carve-in for Medicaid will be reimbursed at WAC minus 25 percent. MHA and several hospitals submitted comments on the change in 340B reimbursement, which originally was proposed to be WAC minus 49 percent. Pharmaceuticals reimbursed under the outpatient hospital program will continue to be reimbursed on a percent of charge basis until Friday, Feb. 1, 2019.

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Congressional Committee Reviews Sexual Assault Forensic Examinations At Hospitals

Staff Contact: Daniel Landon or Sarah Willson

The Oversight and Investigations Subcommittee of the U.S. House of Representatives’ Energy and Commerce Committee held a hearing on the availability of sexual assault forensic examination kits in hospitals and of practitioners with specific training in such forensic examinations. The subcommittee issued a press release summarizing some of the testimony, as well as responses from its survey of selected hospitals, health systems and state hospital associations.

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Regulatory News
the latest actions of agencies monitoring health care

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: Medicare Administrative Contractor’s look-up tool updated
  • Preview reports
    • Review Long-Term Care Hospital data by Wednesday, Jan. 2, 2019
    • Review Inpatient Rehabilitation Facility data by Wednesday, Jan. 2, 2019
    • Review Hospice by Wednesday, Jan. 9, 2019
  • Hospice Compare refresh
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Consider This ...

Prostate cancer is the No. 2 cause of cancer deaths in men, trailing only lung cancer. A three-decade study found that prostate-removal surgery added an average of nearly three years to lives of men with prostate cancer, compared with those who didn’t get surgery and were monitored.

Source: The Wall Street Journal