MHA Today | January 3, 2019

January 3, 2019
MHA Today: News for Healthcare Leaders

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January 3, 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
MHA Provides Input on Upcoming Medical Marijuana Rules
MHA Comments On Medicare Drug Pricing Proposal
MHD Announces Hospital Outpatient Pharmacy Rate Cuts
MHD Extends Behavioral Health Care Reimbursement To Additional Provider Types
MHD Updates Coding Requirements For ABA, Psychological Testing
CMS Finalizes New ACO Rule
CMS Updates IPFQR Program Resources
Phelps County Regional Medical Center Changes Name

Advocate
state and federal health policy developments


MHA Provides Input on Upcoming Medical Marijuana Rules

Staff Contact: Jane Drummond

Missouri voters authorized the use of medical marijuana beginning in 2018, with implications for hospitals, other health care providers and their patients. The Department of Health and Senior Services is charged with promulgating rules relating to the certification of patients eligible to use medical marijuana, along with other issues that will impact hospitals.

MHA submitted a memo to DHSS Director Randall Williams, M.D., with suggestions for minimizing the regulatory impact on hospitals. The department has expressed an interest in continued dialogue with stakeholders as it implements the constitutional amendment to avoid unnecessary or burdensome effects.

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Regulatory News
the latest actions of agencies monitoring health care


MHA Comments On Medicare Drug Pricing Proposal

Staff Contact: Daniel Landon or Andrew Wheeler

MHA submitted comments regarding the Centers for Medicare & Medicaid Services’ proposal to create a new pricing and supply chain system for drugs used in the Medicare Part B program. Prices would be based on what is paid in economically similar countries. CMS’ advance notice of proposed rulemaking sought to gather stakeholder comments as the agency refines its proposal.

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MHD Announces Hospital Outpatient Pharmacy Rate Cuts

Staff Contact: Brian Kinkade

The MO HealthNet Division hospital outpatient pharmacy reimbursement will be changed from a percent of billed charges for services delivered on or after Feb. 1. Hospitals that are “carved-in” as 340B providers for the Medicaid hospital program will be reimbursed at Wholesale Acquisition Cost minus 25 percent. Non-340B hospitals will be paid the same rates as retail pharmacies.

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

The advocacy efforts of MHA and its members this summer successfully blocked MHD’s original plan to set 340B reimbursement at WAC minus 49 percent. Of note is the decision rendered last week by the U.S. District Court for the District of Columbia that blocked the Centers for Medicare & Medicaid Services’ action to cut Medicare 340B reimbursement to Average Sales Price minus 22.5 percent. It is not clear if and how this decision, once finalized, will affect MHD’s very similar decision.

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MHD Extends Behavioral Health Care Reimbursement To Additional Provider Types

Staff Contact: Brian Kinkade

Licensed clinical social workers, licensed masters social workers, licensed professional counselors and provisionally licensed professional counselors may bill the MO HealthNet Division for medically necessary behavioral health services provided to eligible adults and children on and after Jan. 1, 2019. Also, licensed marital and family therapists, and provisionally licensed marital and family therapists may enroll as MHD providers and be paid by MHD for medically necessary behavioral health services provided to eligible adults and children on and after Jan. 1, 2019. Payments to provisionally licensed marriage and family counselors must be coordinated through and assigned to the enrolled provider under whom they are practicing.

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MHD Updates Coding Requirements For ABA, Psychological Testing

Staff Contact: Brian Kinkade

The MO HealthNet Division will require 2019 CPT and HCPCS coding definitions for reimbursement of applied behavioral analysis and psychological testing for services delivered on and after Jan. 1, 2019.

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CMS Finalizes New ACO Rule

Staff Contact: Andrew Wheeler

The Centers for Medicare & Medicaid Services recently finalized a rule that overhauls the Medicare Accountable Care Organization model. MHA published an issue brief about the new Pathways to Success ACO model.

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Quality and Population Health


CMS Updates IPFQR Program Resources

Staff Contact: Sherry Buschjost

The Centers for Medicare & Medicaid Services updated resources for hospitals participating in the Inpatient Psychiatric Facility Quality Reporting program. IPFQR manual version 4.1 includes changes to program requirements as outlined in the fiscal year 2019 Inpatient Psychiatric Facility IPF Prospective Payment System final rule. Updates are described in the associated release notes.

The IPFQR Program Paper Tools provide an optional, informal abstraction mechanism to assist IPFs in the collection of data for the IPFQR Program. Available on the Quality Reporting Center are updated paper tools for data submitted in the summer of 2019 and 2020.

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Noteworthy


Phelps County Regional Medical Center Changes Name

Staff Contact: Carol Boessen

Effective Jan. 1, 2019, Phelps County Regional Medical Center in Rolla, Mo., was renamed Phelps Health. The name change affects all departments, clinics and facilities at the main campus in Rolla and all outlying locations in the communities they serve. The goal of the name change is to clarify that all clinics and facilities throughout the six-county service area are tied together under one integrated health care organization.

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Consider This ...

People who stop smoking greatly reduce their risk for disease and early death. Although the health benefits are greater for people who stop at earlier ages, there are benefits at any age. You are never too old to quit.

Source: Centers for Disease Control and Prevention