MHA Today | January 2, 2019

January 2, 2019
MHA Today: News for Healthcare Leaders

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January 2, 2019

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


In This Issue
New Year Brings New Laws And Regulations
Final Rule CY 2019 Medicare OPPS Analysis Available
MHD Sets Fee Schedules For Certain Outpatient Surgical Procedures
CMS Extends Extraordinary Circumstance In Hospice Staffing
Missouri Continues Flu Query Surveillance, National ILI Activity Increases
Hospitals Gain Relief From 340B Cuts
CenterPointe Hospital Of Columbia Names CEO

What You Need To Know This Week

  • With the new year, several new laws and regulations take effect — see story below.
  • Watch for a new MHA initiative — Reimagine Rural Health — being rolled out tomorrow and continuing throughout the next couple of months.
  • More information about CMS DSH audits will be shared with the membership this week.

Advocate
state and federal health policy developments


New Year Brings New Laws And Regulations

Staff Contact: Daniel Landon

Several federal and state laws and regulations became effective Jan. 1. Federal regulations require electronic posting of hospital charges. They also reduce Medicare payments for 340B drugs used in off-campus hospital outpatient departments not operating or under construction on Nov. 2, 2015, and for Medicare outpatient evaluation and management services in off-campus hospital outpatient departments in place before that date. A state law creates new billing and insurer payment standards for out-of-network practitioners in network facilities when the patient needed emergency treatment. Another state law requires insurers to pay the resource cost of providing low-dose mammography, including a new modality for which insurance coverage is required. A third compels more rigorous review of legislation creating new or additional occupational or professional licensure standards. State Medicaid regulations impose new fee schedules for outpatient radiology and surgical procedures. Also, a voter-approved ballot measure increases the state minimum wage by 75 cents per hour on Jan. 1, 2019, with 85 cent per hour increases each subsequent year until it reaches $12 per hour in 2023.

More information about the newly effective state laws on out-of-network payment and mammography is available in a recording and slides from an MHA legislative education webinar.

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Final Rule CY 2019 Medicare OPPS Analysis Available

Staff Contact: Andrew Wheeler

MHA is providing a comprehensive analysis of the final Medicare outpatient prospective payment system for calendar year 2019. The analysis includes a summary of the final rule, a description of the methods underlying the analysis, assessments of the financial implications for your hospital and/or health system, and a 340B impact calculator. The financial implications include effects of the CY 2019 marketbasket updates, ambulatory payment classification factor updates, wage index adjustments, predetermined marketbasket reductions as outlined by the Affordable Care Act, the reduced payment rate for excepted off-campus provider-based departments and reduced payment for biosimilars purchased through the 340B program.

This analysis, which is available online for authorized users of HIDI Analytic Advantage®, includes a summary for the nation, Missouri and individual hospitals. Nationally, hospitals will experience an estimated 0.64 percent increase in payments. Missouri hospital payments are projected to increase by an estimated 0.29 percent. Even though the effects of the Medicare sequestration are not factored into the projected payment increases for 2019, the overall estimated sequestration cuts are footnoted.

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Regulatory News
the latest actions of agencies monitoring health care


MHD Sets Fee Schedules For Certain Outpatient Surgical Procedures

Staff Contact: Brian Kinkade

The MO HealthNet Division reimbursement for 50 spinal, lumbar, joint and bariatric outpatient surgical procedures will be paid on a fee schedule for dates of service on and after Jan. 1, 2019. All other outpatient surgical procedures will continue to be reimbursed as a percentage of billed charges. The advocacy efforts of MHA and its members blocked MHD’s plan to convert outpatient reimbursement to fee schedules without public notice and comment. Additional outpatient procedures cannot be converted to fee schedules without MHD first filing a rule that specifically lists the affected procedures, the basis of the fee schedule to be established and allowing public comment on the proposed change.

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CMS Extends Extraordinary Circumstance In Hospice Staffing

Staff Contact: Sarah Willson

The Centers for Medicare & Medicaid Services Center for Clinical Standards and Quality/Quality, Safety & Oversight Group issued an updated policy memorandum regarding extraordinary circumstances for hospice staffing requirements. Hospices, according to the updated memorandum, are exempt from notifying CMS of their utilization of contracted staffing services due to current workforce shortages. When contract services are utilized, the hospice agency maintains all professional, financial and administrative responsibility for the services.

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Quality and Population Health


Missouri Continues Flu Query Surveillance, National ILI Activity Increases

Staff Contact: Jackie Gatz

According to the Centers for Disease Control and Prevention, influenza activity in the U.S. is increasing, with New York City and nine states reporting high influenza-like illness activity during Week 51, which ended Dec. 22, 2018. Missouri is one of 11 states reporting low activity with a total of 338 laboratory-positive influenza cases (306 influenza A, 30 influenza B, and two untyped) reported for this same time period. A season-to-date total of 3,017 laboratory-positive influenza cases (70.9% influenza A, 28.1% influenza B and 1.0% untyped) have been reported in Missouri as of Dec. 22, 2018. A graphic from the DHSS weekly report visually demonstrates Missouri’s ILI activity compared to the previous three flu seasons.

Since late September, MHA has conducted weekly queries of Missouri hospitals in EMResource® to monitor flu-related hospital activity throughout the state. These queries are used to identify early indicators of potential impacts to hospital resources, bed availability and staffing levels due to increased flu activity. As ILI activity continues to rise nationally, hospital staff are strongly encouraged to respond to these weekly queries with accurate and timely information. The next scheduled query will be activated tomorrow, Thursday, Jan. 3, from 10 a.m. to 2 p.m. Additional details related to these queries, to include weekly data summaries, are available in the EMResource® library.

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Health Law Insight


Hospitals Gain Relief From 340B Cuts

Staff Contact: Jane Drummond

A federal judge ruled the Department of Health and Human Services exceeded its statutory rulemaking authority in enacting drastic cuts to the 340B program. The American Hospital Association and others challenged the department’s 2018 outpatient prospective payment system rule, which reduced Medicare reimbursement rates for certain outpatient drugs by more than 28 percent. The court concluded that while the secretary is permitted to “adjust” Medicare reimbursement rates, the magnitude of the 340B reductions, affecting a multitude of drugs, fundamentally altered the structure established by Congress for setting drug reimbursement rates.

The court granted a permanent injunction but expressed concerns about the appropriate remedy. Because adjustments to Medicare Part B rates must be budget neutral, vacating the 340B rates would disrupt the entire reimbursement scheme for 2018. The parties were asked to file supplemental briefs to assist the court in fashioning an appropriate remedy. MHA published an issue brief with additional details.

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CEO Announcements


CenterPointe Hospital Of Columbia Names CEO

Staff Contact: Carol Boessen

Mike Talmo has been named CEO of CenterPointe Hospital of Columbia, effective Dec. 10, 2018. Talmo has more than 35 years of experience in behavioral health care management roles and replaces Karla Quinn, vice president, clinical operations for CenterPointe Behavioral Health System, who served as interim CEO since the hospital opened in October 2018. A list of CEO changes is available online.

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Consider This ...

Between 1999 and 2016, 8,986 children and adolescents under the age of 20 died from opioid-related causes.

Source: The Hill