MHA Today | January 24, 2020

January 24, 2020
MHA Today: News for Healthcare Leaders

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January 24, 2020

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 & CEOThroughout the past several weeks, I’ve shared thoughts about the Medicaid program. This week, I want to talk about how the MO HealthNet Division envisions Medicaid transformation.

Last fall, I attended the Missouri Health Connection annual meeting where MO HealthNet Director Todd Richardson outlined his vision for Medicaid transformation. Throughout this presentation and in previous conversations, including one with the MHA board, Richardson used the term “transformation,” rather than “reform.” That may seem like a distinction without a difference. However, the administration’s vision includes much more than tinkering around the edges.

“Together we will build a best in class Medicaid program that addresses the needs of Missouri’s most vulnerable in a way that is financially sustainable.”

Richardson has defined what he believes to be the primary challenges. He argues that the current system is unsustainable, that health outcomes are not acceptable, that the payment models are outdated and not aligned with the state’s goals, and that there are very few incentives to increase quality and almost no incentives to control costs.

Many of these criticisms are fair with respect to certain aspects of the program. However, as stakeholders in the system, we know that Medicaid isn’t monolithic — it is a combination of programs designed to serve discrete enrollment categories. At the same time, Richardson indicates that successes exist, although he believes systemwide problems exist, as well.

Richardson demonstrates the problem by pointing to the significant variation in reimbursement within the outpatient payment system. It’s clear that addressing outpatient care costs will be an early initiative for MHD. He previously described it as a precursor of transformation.

A transition to a value-based system could reduce variation. However, as I discussed last week, not all value-based programs that exist in Medicare or among commercial insurers can transfer directly to Medicaid. Success in the movement to a value-driven system will require understanding the patient and provider, community-based externalities, and how incentives can drive improvement within each covered population category.

Richardson’s guiding principles for transformation include transparency and stakeholder engagement. Among the goals are decision-making using objective facts to drive transformation timelines, goals and program development. Also included in the principles are considerations of value-improvement and systemwide efficiency. Among these areas, Richardson recognizes that all stakeholders must be engaged — MHD, providers and program enrollees.

Richardson also outlined his vision for success in Medicaid transformation. He wants to create a system that ensures access to services, improves patient experience and outcomes, includes strong provider partnerships that help modernize the program, and establishes Missouri as a leader in value-based transformation.

None of these goals necessarily put hospitals and MHD at cross purposes. However, at this point, the path to these changes largely are aspirational.

MHA and members of the hospital community continue to actively engage Medicaid transformation leaders in the administration to ensure that the benefits of a value-focused program accrue to all stakeholders — the state, hospitals and other providers, and Medicaid enrollees.

Let me know what you’re thinking

Herb Kuhn, MHA President & CEO

Herb B. Kuhn
MHA President and CEO

In This Issue
Medicare To Cover Acupuncture For Lower Back Pain
Centene Completes Acquisition Of WellCare
MLN Connects Provider eNews Available
HRSA Announces Notice of Funding For Nurse Anesthetist Traineeships
KHA Names Next President And CEO

Regulatory News
the latest actions of agencies monitoring health care

Medicare To Cover Acupuncture For Lower Back Pain

Staff Contact: Daniel Landon or Andrew Wheeler

The Centers for Medicare & Medicaid Services issued a National Coverage Determination allowing Medicare coverage of acupuncture as a treatment for chronic low back pain. A CMS media statement says that “over-reliance on opioids for people with chronic pain is one of the factors that led to the [opioid] crisis, so it is vital that we offer a range of treatment options for our beneficiaries.” Coverage is limited to 20 sessions per year with up to 12 sessions in 90 days, and 8 additional sessions if the treatment improves the pain.

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Centene Completes Acquisition Of WellCare

Staff Contact: Daniel Landon or Andrew Wheeler

Centene announced the completion of regulatory approvals for and closing of its $17.3 billion acquisition of WellCare. In Missouri, Centene must divest the WellCare Medicaid managed care plan, which has been sold to Anthem. Merger documents indicate Centene’s Medicare Advantage plan in Missouri also must be divested.

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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.

  • Medicare Diabetes Prevention Program: valid claims
  • CMS updates open payments data
  • Open payments search tool: new features
  • CMS Quality Conference – Feb. 25-27

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Workforce News

HRSA Announces Notice of Funding For Nurse Anesthetist Traineeships

Staff Contact: Jill Williams

The Health Resources and Services Administration is accepting applications for the fiscal year 2020 Nurse Anesthetist Traineeships program. The application cycle closes on Friday, March 6.

This funding opportunity will allow eligible institutions to cover the costs of nurse anesthesia programs for individuals. The NAT program will increase the number of certified registered nurse anesthetists to provide care to underserved populations.

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CEO Announcements

Chad Austin

KHA Names Next President And CEO

Staff Contact: Carol Boessen

Chad Austin has been selected by the Kansas Hospital Association Board of Directors as the next president and CEO of KHA. Austin has been with KHA since 1999 and most recently served as senior vice president of government relations. He will serve as executive vice president until Tuesday, Sept. 1, when he will succeed Tom Bell who is retiring.

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Did You Miss An Issue Of MHA Today?

January 20, 2020
HIDI HealthStats Investigates Coding Social Determinants Of Health
FDA Approves Ebola Vaccine
CMS Announces Education Sessions
AHA Releases Health Care Workforce Report

January 22, 2020
State Legislators Consider Opioid-Related Bills
Committee Approves Medicaid Global Waiver Bill
Missouri Medicaid Provider Reverification Effort Creates Confusion
MHA Distributes Medicare Home Health PPS Analysis
CDC Reports First U.S. Case Of Coronavirus From China
PFAC Releases Final In Vlog Series
Supreme Court Declines To Expedite Affordable Care Act Appeal

Consider This ...

Quitting smoking lowers risk of 12 different types of cancer and can increase life expectancy up to 10 years.

Source: Centers for Disease Control and Prevention