MHA Today | January 31, 2019

 

MHA Today: News for Healthcare Leaders

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January 31, 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
MHD Publishes Final Pharmacy Reimbursement Rule
Trump Administration Mulls Changes To Stark/Anti-Kickback Regulations
CVS Caremark Delays 340B Payment Cuts
VA Alters Standards For Coverage Of Treatment By Community Providers
Telehealth Conference Reviews Challenges And Opportunities
MHA Staff Attend CMS Quality Conference

Advocate
state and federal health policy developments


MHD Publishes Final Pharmacy Reimbursement Rule

Staff Contact: Brian Kinkade

The MO HealthNet Division published its final rule that will change the reimbursement hierarchy for retail pharmacies to the lesser of the National Average Drug Acquisition Cost, the Missouri maximum allowable cost, Wholesale Acquisition Cost minus 3.1 percent or the pharmacy’s usual and customary charge for non-340B pharmacies, and WAC minus 25 percent for 340B pharmacies effective Dec. 18, 2018. Hospital outpatient pharmacy costs will continue to be reimbursed on a percent of charge basis until April 1, 2019, when reimbursement will be changed to the aforementioned hierarchy.


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Regulatory News
the latest actions of agencies monitoring health care


Trump Administration Mulls Changes To Stark/Anti-Kickback Regulations

Staff Contact: Daniel Landon or Jane Drummond

Deputy U.S. Secretary of Health and Human Services Eric Hargan said his department expects to propose changes to stark/anti-kickback regulatory standards “soon.” The department previously solicited public comments on the topics to inform its rulemaking and received 3,500 pages of comments, which include MHA’s comment letter. Some argue current anti-fraud laws and regulations impede health care providers’ ability to coordinate care and use new payment models. In its proposed regulations, the department may define new “safe harbors” from enforcement actions.


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CVS Caremark Delays 340B Payment Cuts

Staff Contact: Andrew Wheeler

CVS Caremark is delaying the implementation of a payment reduction in commercial prescription payment rates for 340B-covered entity-owned pharmacies. CVS is delaying the policy from Friday, Feb. 1, to Monday, April 1. CVS Caremark will be conducting additional outreach to affected pharmacies.


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VA Alters Standards For Coverage Of Treatment By Community Providers

Staff Contact: Daniel Landon

The U.S. Department of Veterans Affairs announced new standards for VA coverage of treatment by community providers. They are expected to become effective in June 2019. The revisions create new standards of access to care for VA patients, defined using drive times and wait times. They are one of several options for qualifying for VA coverage of community providers’ services.


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Noteworthy


Telehealth Conference Reviews Challenges And Opportunities

Staff Contact: Jim Mikes
Telehealth Talks: Tina Gillespie
MO HealthNet Director Todd Richardson and Missouri Senator Caleb Rowden participated in a panel discussion regarding telehealth opportunities and challenges at today’s 5th Annual Missouri Telehealth Summit. Richardson and Rowden both voiced their support of telehealth solutions to address health care access for all Missourians. The panelists answered questions about the expansion of broadband, potential coordination between MHD and the Department of Corrections to use telehealth services, and interest in better understanding ideas that challenge the status quo. They indicated the opportunities for providing high-quality care at an affordable cost. Richardson also expressed the need for MHD to evaluate current provider rates to ensure future access. Hospital leaders discussed the opportunities expanded broadband could provide for both urban and rural hospitals.

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Quality and Population Health


MHA Staff Attend CMS Quality Conference

Staff Contact: Leslie Porth

CMS Quality Conference According to speakers at the Centers for Medicare & Medicaid Services 2019 Quality Conference, listening to the patient is a simple act that serves as a critical solution to improve quality of care. CMS Administrator Seema Verma opened the conference setting three goals: focus on the patient, measure the results and innovate. Dr. Paul Rosen, Medical Director at CMS’ Transforming Clinical Practice Initiative, shared that most successful practices started with a simple question: Why? He encouraged quality leaders to answer with “the drive to provide exceptional care to our patients.” Mike Levitt, consultant and former Health and Human Services Secretary, said in the conference closing, “It is time to make a commitment to quality. Not just a wait and see commitment but a deep, philosophical commitment… Why, because the current clash of human compassion with global economic dispassion will not lead us to better lives.”

The conference provides a forum for Missouri quality improvement leaders to learn directly from national physician and research leaders, and use this knowledge to inform rural health, patient engagement, opioid and health equity strategies in Missouri. In addition, the new tools and policies will guide meaningful data collection and measurement to advance value-based care.

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Consider This ...

This time last January, Missouri had about 12,000 lab-positive flu cases, but this year, Missouri has about 1,000 cases at the same point in the timeline — as flu season enters its peak in early February.

Source: Springfield News-Leader