MHA Today | December 14, 2018

December 14, 2018
MHA Today: News for Healthcare Leaders

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December 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 On Monday, nine insurer, employer and consumer groups called for federal legislation on “surprise” patient bills from out-of-network providers. Within hours, the American Hospital Association and Federation of American Hospitals shot back with a statement calling for policymakers to eliminate gaps in coverage that can expose patients to out-of-network charges, especially for emergency care.

Patients are fed up with surprise medical bills. It’s less clear who they blame for the problem. Moreover, providers and payers seem to agree on the destination. There’s much less consensus on how to get there.

However, Missouri has been blazing a trail to surprise billing solutions. During the 2018 state legislative session, MHA and physician groups were engaged in a full-court press to pass legislation to block the insurer Anthem’s emerging practice of unilaterally denying coverage of emergency department services deemed by Anthem to be unnecessary. The legislators themselves brought the topic of surprise billing into the mix, based on complaints and horror stories from their constituents. This led to intensive and extensive negotiations between providers, insurers and legislators.

Ultimately, the final negotiated product created new law addressing both topics. Restrictions on surprise billing set parameters and a process for determining payment of out-of-network practitioners in an in-network facility. New protections were created for ED coverage decisions.

The surprise billing debate likely is not over, however. As noted, there are calls from insurers, employers and consumers for federal legislation. Earlier this year, a bipartisan group of U.S. senators, including Missouri’s Claire McCaskill, circulated a draft of legislation called the Protecting Patients from Surprise Medical Bills Act. It is expected to be introduced in early 2019 and will be one of a number of congressional bills on surprise billing.

In the Missouri General Assembly, legislators may seek to expand the scope of the surprise billing restrictions. Most of the out-of-network billing and payment standards of the 2018 law are limited to cases in which the patient required emergency treatment. There already is one bill filed for 2019 to tweak the new law. There may well be others, some with more ambitious aims.

Missouri’s law provides consumers a lot more protection now than in the past. However, with payers and providers in very different places nationally — and patients caught in the middle — the issue likely is to continue to draw attention from Congress. MHA will be in the debate, along with AHA, seeking to protect your interests. This will include working to ensure that our hard-won workable state laws aren’t superseded by a cumbersome or onerous federal law.

Let me know what you’re thinking.

Herb Kuhn, MHA President & CEO

Herb B. Kuhn
MHA President and CEO

In This Issue
Congress Enacts Maternal Mortality Legislation
MHD Denies Medicare Crossover Claims When Third Party Payer Is Identified
CMS Extends Deadline For Voluntary Reporting Of HWR Measure Data Under IQR Program
CMS Releases CY 2018 eCQM Data Receiving System Edits Document
Two Rivers Behavioral Health System Announces Closure

state and federal health policy developments

Congress Enacts Maternal Mortality Legislation

Staff Contact: Daniel Landon or Alison Williams

With U.S. Senate approval of the Preventing Maternal Deaths Act of 2017, Congress completes its enactment of the bill. The legislation authorizes grants to states to promote assessments of maternal mortality.

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Regulatory News
the latest actions of agencies monitoring health care

MHD Denies Medicare Crossover Claims When Third Party Payer Is Identified

Staff Contact: Brian Kinkade

Beginning today, the MO HealthNet Division will deny Medicare crossover claims when a third-party payer is identified. Because Medicaid is the payer of last resort, providers must bill other entities who may have liability for a Medicaid participant’s health care expenses before billing Medicaid. The new edit will prevent MHD from paying a crossover claim unless and until the identified third-party payer has been billed. MHD will pay any remaining allowable cost after Medicare and third-party payer(s) claims have been settled.

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Quality and Population Health

CMS Extends Deadline For Voluntary Reporting Of HWR Measure Data Under IQR Program

Staff Contact: Sherry Buschjost

The deadline for the voluntary reporting of hybrid hospitalwide readmission measure data under the Hospital Inpatient Quality Reporting Program was extended from Friday, Dec. 14, to Friday, Jan. 4, 2019. This extension is being granted to provide hospitals and their vendors with additional time to voluntarily submit data for the hybrid HWR measure. Additional details are available.

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CMS Releases CY 2018 eCQM Data Receiving System Edits Document

Staff Contact: Sherry Buschjost

Now available on the Quality Reporting Center is the CY 2018 eCQM Data Receiving System Edits Document. This resource assists data submitters as they troubleshoot errors that may be generated during the submission of Quality Reporting Document Architecture Category I test and production files to the Hospital Quality Reporting system through the QualityNet Secure Portal. Errors are identified with a conformance statement or system-requirement specification. Conformance statement errors must be addressed to successfully submit QRDA Category I files to fulfill electronic clinical quality measure reporting requirements for the Hospital Inpatient Quality Reporting and Promoting Interoperability Programs.

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Two Rivers Behavioral Health System Announces Closure

Staff Contact: Carol Boessen

Two Rivers Behavioral Health System in Kansas City, Mo., announced it will be closing, effective Saturday, Feb. 9, 2019. The hospital opened in 1986 and is owned by Universal Health Services, Inc.

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Did You Miss An Issue Of MHA Today?

December 10, 2018
TJC Issues Additional Suicide Measures
Trajectories — Trauma Informed Care: Improving Health and Resiliency
CMS Releases IPF Specific Reports For Claims-Based Measures
CMS Publishes Addendum To QRDA Category I Implementation Guide

December 11, 2018
Uninsured Rate Increases For The First Time Since The ACA
Third Quarter CY 2018 Update To Discharge Data-Based Quality Indicators Available
TJC Posts An Additional Update To Specifications Manual Addendum 2018B1
HRSA Releases Behavioral Health Workforce Projections

December 12, 2018
U.S House Passes Maternal Mortality Legislation
U.S. House Authorizes Medicaid Coordinated Care Option For Medically Complex Kids
CMS Releases Marketplace Week 6 Enrollment Data
CMS Begins Reporting Additional Oversight Initiatives
CMS Releases Sample QRDA I File For HWR Measure
Steinkruger Announces Retirement From Community Hospital - Fairfax

December 13, 2018
MHD Pharmacy Reimbursement Changes Begin To Take Effect
Congressional Committee Reviews Sexual Assault Forensic Examinations At Hospitals
MLN Connects Provider eNews Available

Consider This ...

Fentanyl now is the most commonly used drug involved in drug overdoses. The rate of drug overdoses involving the synthetic opioid skyrocketed by about 113 percent each year from 2013 through 2016.

Source: CNN