MHA Today | January 18, 2019

January 18, 2019
MHA Today: News for Healthcare Leaders

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January 18, 2019

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 Any question about whether Missouri Gov. Mike Parson would be timid, or act as a caretaker of the office, was dispelled this week. Wednesday, in his State of the State address, Parson articulated his vision for improved infrastructure and investments to build a stronger workforce — goals he’s touted since the first days of his administration. He followed Thursday with several executive orders reorganizing executive agencies to focus delivery of economic development support, and streamline education and workforce programs.

Parson promised bold action. These recommendations fit that mold.

In early January, MHA released a Reimagine Rural Health policy framework. Drawn largely from the issues discussed during the governor’s December rural health summit, the “Reimagine” document is designed to help policymakers identify the transformational policy and budgetary investments that could strengthen rural health care. Many of the targeted investments included in our framework appear in Parson’s budget and policy outline. In all, 25 of Parson’s budget recommendations fall within the MHA rural policy framework. These investments, if adopted, will improve health and health care throughout Missouri — not just rural areas.

Reimagine Rural Health 10 Issues The governor’s commitment to these investments is great news. His budget recommendations are targeted and conservative. However, it’s important not to view the 25 proposals as independent of one-another. Each recommendation is a building block. For example, this week the state released jobs data indicating that Missouri has a historically low unemployment rate. Health care jobs led in hiring. If Missouri doesn’t invest in the health care workforce of the future, many of the other priorities — behavioral health access, substance abuse care and telemedicine expansion — will be impossible.

Bold action is needed elsewhere. During his remarks Wednesday, Parson made a vague reference to the 2020 session, “We have already started intense planning for next session… because we must also… curb Medicaid costs, which accounts for over 10 billion dollars of the state budget.”

Value has to be the watchword with any Medicaid payment reform. Whether it’s value-based payments or investments in programs that focus on upstream health care costs, the key will be keeping the value generated by those scarce health care dollars in the state and in communities where they can do the most good. That kind of policy thinking sets up a challenge with the current system, which is more focused on entrusting Missouri tax dollars to insurance companies, only to see too many of those dollars sent out of state. The state’s increased reliance on Medicaid managed care organizations to manage Medicaid enrollees is driving up costs and reducing reimbursement for Missouri providers. The governor’s budget acknowledges a $140 million “actuarial” upward adjustment for Medicaid MCO’s — the largest in the state’s history. This, of course, means fewer dollars being delivered to community-based providers, only to be exacerbated by last July’s Medicaid MCO contract change when the state permitted these plans to pay out-of-network hospitals far less than cost for Medicaid services. The MCO contract amendment that allows payers to default to 90 percent of the Medicaid rate if a rate can’t be negotiated is a clear example of government putting its thumb on the scale. Ultimately, that’s how government allows Missouri tax dollars to leave the state.

Our constructive partnership with the state to support Medicaid and the safety net is decades old. It has been a win-win for Missourians. The dawn of an era where the government picks winners and losers would fray that partnership. Better health and better health care in Missouri will require bold action. Gov. Parson has a great lineup to improve health care this year.

Medicaid will play an important part in reimagining health in rural Missouri and statewide. As Parson and his team look over the shoulder of this General Assembly to the next to improve the state Medicaid model, we’ll continue to engage the administration with our own bold proposals to get value for each state dollar.

Parson wants to “Move Missouri Forward.” So do we.

Send me a note to let me know what you’re thinking.

Herb Kuhn, MHA President & CEO

Herb B. Kuhn
MHA President and CEO

In This Issue
CMS Releases Notice Of Benefit And Payment Parameters For Marketplace Plans
MedPAC Presents Recommendations To Congress
Myers And Stauffer LC Address CMS’ Recent Guidance For DSH Audits
CMMI Begins Part D Payment Modernization Model In 2020

Regulatory News
the latest actions of agencies monitoring health care

CMS Releases Notice Of Benefit And Payment Parameters For Marketplace Plans

Staff Contact: Andrew Wheeler

The Centers for Medicare & Medicaid Services released the proposed annual Notice of Benefit and Payment Parameters for the 2020 benefit year, setting payment parameters related to the risk adjustment and risk adjustment data validation programs, cost-sharing parameters, and user fees for federally facilitated and state-based exchanges. The rule also invites a public discussion on the practice of “silver-loading.” Silver-loading is when health insurers load premium increases into the silver level exchange plans to make up for the loss of cost-sharing reduction payments. MHA published an issue brief with additional details.

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MedPAC Presents Recommendations To Congress

Staff Contact: Andrew Wheeler

The Medicare Payment Advisory Commission approved recommendations to Congress, granting hospitals a full payment update for the next fiscal year. Hospitals would receive a 2.8 percent update to base rates in 2020, divided into a 2 percent marketbasket increase and another 0.8 percent from a new hospital value incentive program. Recommendations also were made to eliminate “incident to” billing. MedPAC has posted slides for the following.

  • Medicare prescription drug program (part D): status report
  • Opioids and alternatives in hospital settings: payments, incentives and Medicare data
  • Assessing payment adequacy and updating payments for hospital inpatient and outpatient services, and redesigning Medicare’s hospital quality incentive programs
  • Assessing payment adequacy and updating payments: physicians and other health professional services; and Medicare payment policies for advanced practice registered nurses and physician assistants
  • Assessing payment adequacy and updating payments: ambulatory surgical center services
  • Assessing payment adequacy and updating payments: long-term care hospital services
  • Assessing payment adequacy and updating payments: outpatient dialysis services

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Myers And Stauffer LC Address CMS’ Recent Guidance For DSH Audits

Staff Contact: Kim Duggan

Upon receiving additional guidance from the Centers for Medicare & Medicaid Services, Myers and Stauffer LC clarified yesterday by memo that hospitals should continue to gather Medicare and private insurance payments at the patient detail level and submit it with their completed state fiscal year 2016 DSH audits since there still is pending litigation. However, they also indicated that these payments will not be included in SFY 2016 DSH audits or the SFY 2020 interim DSH payment UCC calculations.

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CMMI Begins Part D Payment Modernization Model In 2020

Staff Contact: Andrew Wheeler

The Centers for Medicare & Medicaid Services’ Center for Medicare and Medicaid Innovation will begin a Part D Payment Modernization model in 2020 to test the effect of a revised Part D program and incentive alignment on overall Part D prescription drug spending. CMMI intends that the model will reduce Medicare expenditures while preserving quality of care.

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Did You Miss An Issue Of MHA Today?

January 14, 2019
MHA Comments On Proposed Federal Medicaid Managed Care Regulation
Human Trafficking Poster Available On DPS Website
HIDI HealthStats – Predicting Opioid Risk in Hospital Patients
Flu Season Continues With Low Severity Resulting In Fewer Hospitalizations

January 15, 2019
MHA Distributes Analysis For Final Updates To CY 2019 Medicare Home Health PPS
CMS Hosts Open Door Forum On Lab Private Payer Rates Data Collection
CMS Announces OQR Education Session
Opioid Overdoses Overtake Motor Vehicle Accidents In Missouri Deaths
SSM Health Mid-Missouri Names New President

January 16, 2019
Parson Delivers First State Of The State Address
CMS Surveyor Training Available To Providers
CMS Completes New Medicare Card Distribution Ahead Of Schedule
CMS Announces IPFQR Education Session

January 17, 2019
MA Enrollment Increases Are Lower Than Expected
Analysis Of S-10 Data And Medicare DSH Implications
MLN Connects Provider eNews Available
CDC COCA Hosts Call To Provide Update On Current Influenza Season
CMS And TJC Release Guidance For Reporting Results Data

Consider This ...

Missouri ranks 24th for youth suicide rates, with guns in about 44 percent of households.