MHA Today | July 12, 2019

MHA Today: News for Healthcare Leaders

linkedin twitter facebook
July 12, 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 Games like billiards, poker or Monopoly are designed around a set of rules that govern play. In practice, virtually every game with rules also may include a set of parallel “house rules” that bend, add or subtract from traditional understanding of the rules of play.

As the state’s rules related to medical marijuana roll out, it’s becoming clear that hospitals will be required to make choices. Those choices and associated challenges are multifaceted.

For example, hospitals — as providers of clinical services — must develop policies to govern how clinicians within their facilities interface with the new constitutional right. It doesn’t end there. Hospitals must define policies for whether physicians will certify patients, whether patients may possess medical marijuana within a hospital, and how — if allowed — it will be administered. While nowhere near an exhaustive list, these fundamental questions point to the complexity of adopting a policy.

At the same time, hospitals are employers. There’s strong evidence that the state’s practitioner licensing boards will take a zero-tolerance policy for clinicians who are under the influence. However, being under the influence of medical marijuana while at work may not be significantly different from being under the influence of any other legal or illegal substance with judgement or performance-impairing properties. Alcohol is legal. That doesn’t mean hospital staff can be intoxicated on the job, and the law prohibits individuals from working while impaired.

As the state rolls out additional regulations, the rules of the game are becoming clearer. However, no set of regulations will address every operational challenge hospitals will face. For example, a practitioner cannot prescribe medical marijuana, they only can certify that an individual meets one of the established criteria as eligible to purchase and possess. However, the form to certify apparently includes a checkbox that would allow a clinician to recommend that a qualifying patient be allowed to purchase or possess more than the legal limit. The result looks like a prescription, rather than validating a qualifying condition. The state may be setting the option, but hospitals and other providers will need to determine whether house rules will allow physicians to make this type of judgement.

Currently, four-fifths of the states have either legalized recreational use, decriminalized possession or allowed medical marijuana. Missouri is not a trailblazer on this issue, and can benefit from the experiences of other states. Nonetheless, not being in the vanguard doesn’t reduce the number of hard questions about implementation. It just clarifies some potential answers.
Medical Marijuana Guidance
Earlier this week, MHA published draft templates for changing medical staff bylaws. These resources — and the other tools that MHA has available —support your organization’s medical marijuana policy development work.

We’re committed to helping hospitals build internal policies and controls that comply with the regulations — the official rules. At the same time, we’re sensitive to hospitals’ need to craft rules that make sense locally and operationally. That is where house rules will come into play.

Once the official and house rules are established, there will be additional work. Hospital employees, patients and members of the community will need to understand the rules and expectations. Hospitals will be required to educate staff and the public, and enforce the rules they establish.

As anyone who has played a game knows, announcing house rules after the fact is a recipe for disaster.

Let me know what you think.

Herb Kuhn, MHA President & CEO

Herb B. Kuhn
MHA President and CEO

In This Issue
Governor Approves New State Laws
Congressional Subcommittee Advances Surprise Billing, DSH Cut Legislation
MHA Releases Issue Brief On Mandatory Payment Models
CMS Releases Proposed CY 2020 Home Health Updates
CMS Changes Course On Monitoring Of Medicaid Network Adequacy
MLN Connects Provider eNews Available

MHA Seeks Member Feedback

MHA Today now is only published on Mondays, Wednesdays and Fridays. As we work to redesign the publication, MHA seeks feedback to better meet the needs of our membership.

state and federal health policy developments

Governor Approves New State Laws

Staff Contact: Daniel Landon

Governor Parson has until Sunday, July 14, to approve or veto enactments of the 2019 state legislative session. In the past several days, he approved a number of bills in which MHA and its members were engaged. They address such topics as reauthorization of the hospital provider tax, legal standards to improve the liability climate, workforce development, do-not-resuscitate policies for pediatric patients and the state’s process for issuing emergency rules. Senate Bill 514, an omnibus package with a number of beneficial hospital-related changes, was approved.

Back To Top

Congressional Subcommittee Advances Surprise Billing, DSH Cut Legislation

Staff Contact: Daniel Landon or Andrew Wheeler

The Health Subcommittee of the U.S. House of Representatives Energy and Commerce Committee revised and approved a number of bills on July 11. A high-profile proposal addressed “surprise billing” – revising billing and payment standards for treatment by those outside the provider network of the patient’s insurance coverage. The subcommittee did not incorporate the use of negotiation and arbitration to replace a government-specified payment rate in resolving payment disputes between insurers and providers, as recommended by MHA and others. The surprise billing proposal soon will be reviewed by the full committee.

The subcommittee also amended a bill to delay the pending reductions in states’ Medicaid Disproportionate Share Hospital funding allotments. The reductions would be delayed for two years. Without congressional action by Oct. 1, Missouri hospitals face Medicaid DSH cuts of $146 million in federal fiscal year 2020 and more than $300 million in FFY 2021. The amendment also calls for a report to Congress on equity in states’ Medicaid DSH allotments.

Back To Top


Regulatory News
the latest actions of agencies monitoring health care

MHA Releases Issue Brief On Mandatory Payment Models

Staff Contact: Andrew Wheeler

Earlier this week, the Centers for Medicare & Medicaid Services announced several innovation models, which included the end-stage renal disease treatment choices model and the radiation oncology model. MHA published an issue brief with additional details.

Back To Top

CMS Releases Proposed CY 2020 Home Health Updates

Staff Contact: Andrew Wheeler

The Centers for Medicare & Medicaid Services released the proposed calendar year 2020 Home Health Prospective Payment System payment and policy updates. CMS projects the payment update to increase payments to home health agencies by an aggregated 1.3 percent, or $250 million. Major changes include rate changes for home infusion therapy temporary transitional payments, new home infusion therapy benefits, eliminating the need to submit a request for anticipated payment for every period/episode and greater transparency under the Home Health Quality Reporting Program. Comments about the proposed rule are due by 4 p.m. Monday, Sept. 9. MHA will publish an issue brief with additional details next week.

Back To Top

CMS Changes Course On Monitoring Of Medicaid Network Adequacy

Staff Contact: Brian Kinkade

The Centers for Medicare & Medicaid Services announced plans to rescind regulations that direct how states must document that their Medicaid fee-for-service rates are sufficient to ensure adequate access for noninstitutional health care services and to develop a new “streamlined and comprehensive” approach using existing data. States have argued the current regulation is costly to administer and is of limited benefit because, in most states, so few Medicaid participants are in traditional fee-for-service care. Although CMS suggests interest in the approach that includes managed care, CMS historically has been deferential to state standards regulating managed care programs.

No timeline for establishing the replacement procedure is given. Irrespective of the regulatory status monitoring processes, the CMS guidance reminds states that federal law requires Medicaid programs to pay rates that “are sufficient to enlist enough providers to assure that beneficiary access to covered care and services is at least consistent with that of the general population.”

Back To Top

MLN Connects Provider eNews Available

Staff Contact: Andrew Wheeler

Updates to MLN Connects Provider eNews were issued by the Centers for Medicare & Medicaid Services. eNews includes information about national provider calls, meetings, events, announcements and other MLN educational product updates. The latest issue provides updates and summaries of the following.

  • CMS expands coverage of ambulatory blood pressure monitoring
  • Open Payments Program year 2018 data
  • Department of Health and Human Services to transform care delivery for patients with chronic kidney disease
  • New Medicare card: Transition period ends in less than six months
  • Medicare preventive services – revised
  • Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Competitive Bidding Program: Round 2021 webcast series

Back To Top


Did You Miss An Issue Of MHA Today?

July 8, 2019
Missouri Revenues Fall Short Of Projections
CMS Updates Inpatient Abstraction And Reporting Tools
MSPB HSRs For FY 2020 VBP Program Now Available
CMS Announces IPFQR Education Session

July 10, 2019
MHA Comments On Surprise Billing Legislation
MHD Lifts Behavioral Health Limits
Trump Issues Kidney Health Executive Order And Kidney Care Innovation Models
MHA Releases Draft Medical Staff Bylaw Provisions Addressing Medical Marijuana
Missouri DHSS Hosts ESSENCE Training Sessions
Pulsipher Announces Retirement From Mercy Hospital Joplin

Consider This ...

Americans 65 or older have the lowest rates of opioid overdose deaths. Even so, the number of deaths among seniors increased by 279 percent from 1999 to 2017.

Source: Kaiser Health News