MHA Today | February 12, 2020

February 12, 2020

MHA Today: News for Healthcare Leaders

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February 12, 2020

MHA Today is provided as a service to members of the Missouri Hospital Association. Additional information is available online at MHAnet.

In This Issue
MHA Engages In Legislative Committee Debates
Legislative Committee Narrows Medicaid Coverage Proposal
Congressional Committees Add To Surprise Billing Debate
MHA Releases Issue Brief On President’s 2021 Budget
Anthem Completes Acquisition Of Missouri Care
Final Rule CY 2020 Medicare OPPS Available
TJC Releases Specifications Manual Version 2020B
Orman Announces Retirement From Samaritan Hospital


UPCOMING SEMINAR
CMS Hospital CoPs and State Licensure Regulation Update for Acute and Critical Access Hospitals
Seminar: Wednesday, March 18, and Thursday, March 19

Understanding Federal and State Hospital Regulations 101
Preconference: Tuesday, March 17

Tuesday, March 17, through Thursday, March 19
Camden on the Lake
Lake Ozark, Mo.
Register on or before Monday, March 2.


Advocate
state and federal health policy developments


MHA Engages In Legislative Committee Debates

Staff Contact: Rob Monsees or Bill Anderson

State legislative committees are busy reviewing bills. MHA recently expressed the following.

  • Support for Senate Bill 548, which would reauthorize the Federal Reimbursement Allowance. Staff reviewed the role of state provider taxes and hospital financing pressures.
  • Support for Senate Bill 714, which would create a separate system of licensure for advanced practice registered nurses who currently are licensed as registered nurses with an APRN certification.
  • Opposition for House Bill 2326, which would prohibit the use of covenants not to compete in employment contracts with physicians and other practitioners.
  • Opposition for Senate Bill 533, which would create a new system of hospital workplace violence regulation and reporting modeled on a California state law.

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Legislative Committee Narrows Medicaid Coverage Proposal

Staff Contact: Daniel Landon or Bill Anderson

A state Senate committee approved a revised version of Senate Bill 684. The bill would, upon federal approval, prevent retroactive Medicaid coverage of services delivered before the date of application for benefits. Currently, retroactive coverage could extend back to the start of the third month before the date of applying for Medicaid coverage, depending on eligibility. Before approving the bill by a 3-2 vote, the committee exempted children and pregnant women, as recommended in a letter from MHA.

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Congressional Committees Add To Surprise Billing Debate

Staff Contact: Daniel Landon or Andrew Wheeler

On Feb. 11, the U.S. House of Representatives Education and Labor Committee approved its Ban Surprise Billing Act. The next day, the House Ways and Means Committee considered its Consumer Protections Against Surprise Medical Bills Act of 2020. The primary point of disagreement between the proposals concerns the process for resolving payment disputes between insurers and health care providers. Of the congressional surprise billing proposals that have emerged in the past four months, the Ways and Means legislation most closely follows advocacy messages advanced by MHA and the American Hospital Association – reliance on arbitration/mediation rather than government-dictated benchmark prices to resolve billing disputes and not superseding states’ surprise billing laws. After failing to reach an accord in December on the politically popular issue, Congress is focused on enacting surprise billing legislation by mid-May.

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MHA Releases Issue Brief On President’s 2021 Budget

Staff Contact: Andrew Wheeler

President Trump released his fiscal year 2021 budget request to Congress on Monday. The net increase to the proposed Centers for Medicare & Medicaid Services budget increased by $47.6 billion to $1.23 trillion. The budget also projects that taxpayers would save $756 billion for Medicare and $920 billion for Medicaid throughout the next 10 years. MHA published an issue brief with additional details.

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Anthem Completes Acquisition Of Missouri Care

Staff Contact: Sarah Willson or Brian Kinkade

Anthem, through its affiliate ATH Holding Company, LLC assumed ownership of Missouri Care from WellCare, effective Jan. 23. Centene Corporation’s acquisition of WellCare necessitated WellCare’s divestiture of the plan. Missouri Care’s status as a MO HealthNet Division managed care plan is unaffected by the transaction; Missouri Care’s existing provider agreements were acquired by Anthem. However, because of the change in ownership, MHD participants enrolled with Missouri Care can change their plan if they wish by Tuesday, April 21.

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Regulatory News
the latest actions of agencies monitoring health care


Final Rule CY 2020 Medicare OPPS Available

Staff Contact: Andrew Wheeler

MHA released a comprehensive analysis of the final Medicare Outpatient Prospective Payment System for calendar year 2020. The analysis includes a summary of the final rule, a description of the methods underlying the analysis, and assessments of the financial implications for hospitals and/or health systems. The financial implications include effects of the CY 2020 marketbasket updates, ambulatory payment classification factor updates, wage index adjustments, predetermined marketbasket reductions as outlined by the Affordable Care Act, the reduced payment rate for excepted off-campus provider-based departments and potential impact of total hip arthroplasty procedures if performed in an outpatient setting. Even though the effects of the Medicare sequestration are not factored into the projected payment increases for 2020, the overall estimated sequestration cuts are footnoted.

This analysis, which is available online for authorized users of HIDI Analytic Advantage®, includes a summary for the nation, Missouri and individual hospitals. Nationally, hospitals will experience an estimated 1.28% increase in payments. Missouri hospital payments are projected to increase by an estimated 2.22%.

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Quality and Population Health


TJC Releases Specifications Manual Version 2020B

Staff Contact: Sherry Buschjost

Now available on The Joint Commission website is version 2020B of the Specifications Manual for Joint Commission National Quality Measures. Changes made to the manual are outlined in the release notes and include the following.

  • removal of retired perinatal care measures PC-03 and PC-04, references to ORYX vendors, patient-level data for chart-based measures, and data transmission throughout the manual
  • measure updates
  • multiple data element updates to Notes for Abstraction, Inclusions and Exclusions

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CEO Announcements


Orman Announces Retirement From Samaritan Hospital

Staff Contact: Carol Boessen

Bern Orman, CEO of Samaritan Hospital in Macon, Mo., announced his plans to retire effective Dec. 11. Orman has served as CEO for nearly 35 years. A search will be conducted for his replacement. A list of CEO changes is available online.

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Consider This ...

Physician telehealth/virtual care usage increased 100% in three years with 28% of physicians now using this approach to care. This is the largest growth among the digital health tool categories.

Source: HealthLeaders