MHA Today | January 31, 2020

January 31, 2020
MHA Today: News for Healthcare Leaders

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January 31, 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 & CEOYesterday, MHA and a coalition of health care stakeholders released new research on how Missouri could emulate other conservative states’ approach to implement a Medicaid expansion under the Affordable Care Act. The analysis was conducted by Health Management Associates, a nonpartisan firm with deep expertise in state Medicaid policy.

The researchers found convincing evidence affirming that, with smart policy choices, Missouri could adopt a program without negative budget consequences. In fact, Missouri’s budget could benefit. According to Matt Powers, one of the authors of the research, “The Arkansas, Indiana and Ohio experiences demonstrated that expansion can be designed to free general revenue funds for other priorities — including K-12 education, transportation and law enforcement.”

Adding new enrollment to control state costs might seem counterintuitive. However, the researchers identify enrollee management strategies adopted by subject states that can offer significant budget savings for Missouri. They suggest that a well-designed and well-synchronized program in Missouri — a system that replaces state-only funded enrollees with the expansion’s 90% federal match, shifts enrollees that would be matched at a higher rate, and includes other policy and operational adjustments — could cover the full cost of expansion.

HMA Report The report identifies how to restructure to gain the savings. Researchers suggested significant opportunities for the state among individuals covered for behavioral health and substance abuse treatment, and individuals transitioning from incarceration. Currently, these individuals are state funded. In addition, some pregnant women, women eligible for the breast and cervical cancer program, the medically needy, and individuals with disabilities could be moved to the expansion enrollment category, generating state savings.

There are other advantages to the state. Researchers found that the new resources helped support reforms within the Medicaid program that support systemic transformation. As we know, transformation is a central goal of the Parson administration. Expansion could support these efforts.

As I was thinking about this research, I reflected on the state’s nickname. According to Missouri lore, the “Show-Me” state received its moniker from a speech by Congressman Willard Duncan Vandiver, who declared, “I come from a state that raises corn and cotton and cockleburs and Democrats, and frothy eloquence neither convinces nor satisfies me. I am from Missouri. You have got to show me.”

HMA chose Arkansas, Indiana and Ohio as research subjects deliberately. The results are clear.

Expansion — and the value it promises — won’t happen overnight. We have a lot of hard work to do. But, it’s difficult to argue that we can’t do it.

HMA did a good job of showing Missouri how.

Let me know what you’re thinking.

Herb Kuhn, MHA President & CEO

Herb B. Kuhn
MHA President and CEO

In This Issue
Trump Administration Releases Medicaid Block Grant Guidance
MHA Comments On Medicaid Fiscal Accountability Regulation
MLN Connects Provider eNews Available
MHA Provides 2019-nCoV Update, Plans Supply Chain Assessment
CMS Updates Hospital Compare January 2020 Data

state and federal health policy developments

Trump Administration Releases Medicaid Block Grant Guidance

Staff Contact: Brian Kinkade

On Wednesday, the Trump administration announced guidelines for states wishing to accept a portion of its federal Medicaid funding in the form of a capped grant. CMS calls the initiative Healthy Adult Opportunity. The CMS guidance explains how states can request a Section 1115 waiver to receive Medicaid funding for nondisabled adults under age 65 that are below 133% of the federal poverty level in the form of either a lump-sum block grant or a capped amount per enrolled participant. The capped federal funding is offered with the promise of increased flexibility for the states to incorporate features (like premiums, co-payments, work requirements, benefit limitations, etc.) that typically would not be allowed under the traditional Medicaid program. Participating states will be required to report 25 quality measures on rates of flu vaccination; screening for depression and follow-up care; prenatal and postpartum care; and effective treatment of high blood pressure, diabetes and mental illness. Medicaid funding for children, disabled persons, elders and pregnant women is excluded from the option.

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Regulatory News
the latest actions of agencies monitoring health care

MHA Comments On Medicaid Fiscal Accountability Regulation

Staff Contact: Kim Duggan or Daniel Landon

MHA submitted a comment letter responding to the Centers for Medicare & Medicaid Services’ proposed Medicaid Fiscal Accountability regulation. It addresses topics such as states’ ability to use provider taxes, local government revenue and other funds to qualify for federal Medicaid matching funds; Medicaid fee-for-service, Disproportionate Share Hospital and “supplemental” payments to providers; and Medicaid financing and reporting obligations. A draft of MHA’s comments was submitted earlier to the MHA membership. The deadline for submitting public comments regarding the proposed rule is 10:59 p.m. Saturday, Feb. 1.

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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.

  • Outpatient Prospective Payment System Pricer file: January 2020
  • Hospice Care: Safeguards for Medicare patients
  • CMS expands coverage of Next Generation Sequencing as a diagnostic tool for patients with breast and ovarian cancer

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Quality and Population Health

MHA Provides 2019-nCoV Update, Plans Supply Chain Assessment

Staff Contact: Jackie Gatz or Keri Barclay

Yesterday, MHA, in partnership with the Missouri Department of Health and Senior Services, hosted a joint information call on the 2019 novel coronavirus outbreak and outlined guidance for Missouri hospitals, health systems and other front-line providers. A recording is available on MHA’s website.

Today, the Centers for Disease Control and Prevention updated the definition of patients under investigation, which expanded screening questions and those individuals appropriate for further evaluation. Also today, the secretary of the U.S. Department of Health and Human Services declared a public health emergency.

Finally, given ongoing seasonal influenza activity and the evolving 2019-nCoV outbreak, MHA staff currently are working to develop a statewide supply chain integrity assessment that will be launched Monday to Missouri hospitals through EMResource to anticipate resource shortages related to CDC’s infection prevention guidance.

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CMS Updates Hospital Compare January 2020 Data

Staff Contact: Sherry Buschjost

The Centers for Medicare & Medicaid Services updated data for quality reporting programs, measures and measure groups on Hospital Compare and CMS also announced discontinued reporting on Hospital Compare for several measures. Additional details are available.

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Did You Miss An Issue Of MHA Today?

January 27, 2020
DHSS Issues Emergency Rule For Coronavirus, CDC Schedules Clinician Call
DHSS Issues Revised STEMI Regulation
Hospitals Making Progress Combating Opioid Overdoses
HRSA Announces Funding Opportunity For AMF Program

January 29, 2020
Legislative Committee Reviews Medicaid Enrollment Drop
State Legislators Advance PDMP Legislation
GAO Releases Report On 340B Program
MHA, DHSS To Host Joint Call On Coronavirus
TJC Offers Complimentary Certification Webinars
HIDI Releases Third Quarter 2019 VBP Payments Model
Nursing Workforce Report Shows Missouri’s R.N.s Are Nearing Retirement Age
HRSA Announces Funding For Opioid-Impacted Family Support

Consider This ...

The mortality rate has been higher in rural areas compared to urban areas since at least 1999, but the gap widened after 2009.

Source: Stateline