MHA Today | March 6, 2020

March 6, 2020
MHA Today: News for Healthcare Leaders

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March 6, 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 & CEOEarlier this week, the director-general of the World Health Organization warned governments that the continued international spread of the coronavirus disease 2019 is “not a drill.” According to Johns Hopkins, more than 100,000 individual cases have been confirmed globally, and 3,460 people have died. In the U.S., 14 have died, and several states have announced a state of emergency.

Congress has adopted a funding package, and President Trump signed the legislation authorizing more than $8 billion to support COVID-19 response. The funding includes $300 million for hospital and health systems' efforts to prepare for and respond to COVID-19.

Despite these efforts and warnings, the virus continues to advance.

As resources and guidance from state and federal partners become available, we are providing updates. It is becoming clear that hospital leadership will be essential to successfully protect and care for patients, hospital staff and Missouri’s communities.

As the situation in the U.S. and Missouri evolves, I encourage all hospital leaders to review these resources, which will help shape your understanding of the legal and operational environment. In addition, hospitals will be critical to helping educate the public — about what they should be doing and how to best interface with their local health care assets.

I had originally asked Daniel Landon, MHA’s Senior Vice President of Governmental Relations, to use this week’s column to provide an update on two Medicaid payment-related issues. Although I wanted to lead with thoughts on COVID-19, his update follows.

Herb Kuhn, MHA President & CEO

“Missouri hospitals are confronting two state Medicaid initiatives that threaten to significantly cut hospital payments. The first would revamp Medicaid outpatient payments. Currently, Missouri Medicaid uses a complex methodology based on hospital cost-to-charge ratios and regression analysis. For most hospitals and services, it would become a fee schedule paying 90% of Medicare payment rates.

Working with Milliman, Inc., to analyze Hospital Industry Data Institute and Medicaid data, MHA projects the proposal would lower Medicaid hospital outpatient payments by $120 million in the next fiscal year. In contrast, the MO HealthNet Division projects $60 million in budgetary savings from the change. A second MHD fiscal assessment estimates savings nearing $90 million, but this excludes consideration of Medicaid managed care payments. One thing is clear — legislators need to know the real effect on Missouri hospitals and their communities.

The notion of better aligning Medicaid and Medicaid outpatient payment standards and incentives has some merit. An MHA membership workgroup previously explored it in some detail, only to shelve the work in 2017 because of the state’s technology limitations. However, any payment reform benefits for hospitals are dwarfed by the adverse consequences of MHD’s decision to set a payment rate that cuts $120 million in hospital payments.

The outpatient payment reductions are not evenly distributed among the hospitals. They would be devastating for many hospitals. Some would see no effect or net gain. For everyone, extracting $120 million greatly would destabilize the Medicaid hospital financing system, which relies heavily on a provider tax pooling arrangement that encompasses most Missouri hospitals. The huge payment cuts jeopardize that system.

The second threat comes from state legislation to ban the Medicaid “out-of-state” payment, which goes to Missouri hospitals that treat Medicaid enrollees from other states. It allows hospitals to get comparable payment for out-of-state Medicaid patients and Missouri Medicaid enrollees. The state’s share of funding the out-of-state payment comes solely from the Federal Reimbursement Allowance ― the state provider tax paid by hospitals. The balance is federal funds. If enacted, the legislation would not yield any state General Revenue savings. Of the $220 million in out-of-state payments expected in the current fiscal year, 65% goes to four freestanding children’s hospitals, but many other hospitals also are affected. It is positive that one of the four legislative sponsors of legislation to ban the payment now appears to be open to changes that would end the immediate threat to the out-of-state payment.

MHA is urging senior hospital executives to meet with their state legislators in Jefferson City or the home district about these payment cuts. To address legislative budget timelines, these contacts should take place before the week-long legislative spring recess, which begins Thursday, March 19. Some legislators on key committees may need earlier attention. Success in blocking MHD’s proposed regulation to implement the outpatient initiative rests on convincing state legislators to block or limit MHD’s budget proposal.”

Daniel Landon
Vice President of Governmental Relations

In This Issue
Trump Signs Coronavirus Emergency Funding Package
CDC Provides Updated COVID-19 Testing Criteria
CMS Addresses Coronavirus Spread, MHA To Address At CoPs Conference
MHA Testifies In Favor Of Legislation Designed To Aid Schools’ Response To Traumatic Injuries
MLN Connects Provider eNews Available
CMS Invites Comments On Draft 2021 QRDA I Implementation Guide

COVID-19 Updates


For the latest updates and most current information on coronavirus disease 2019, visit MHA's website.

Trump Signs Coronavirus Emergency Funding Package

Staff Contact: Daniel Landon or Jackie Gatz

Today, President Trump signed the $8.3 billion emergency spending package to combat the COVID-19 outbreak. This measure provides financial support for response efforts, development of possible vaccines and treatment.

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CDC Provides Updated COVID-19 Testing Criteria

Staff Contact: Jackie Gatz or Keri Barclay

The Centers for Disease Control and Prevention updated COVID-19 testing criteria to allow clinicians to use their judgment to determine if a patient has signs and symptoms compatible with COVID-19 and whether the patient should be tested. Providers who need to test for COVID-19 should contact their local public health department or the 24-hour Emergency Response Center at 800-392-0272 for testing kits. Private companies will be able to begin testing as early as today with capacity expanding in the coming days. Today, the Missouri State Lab released a training video on testing and packaging of COVID-19 samples.

The MHA member call at 3 p.m. Wednesday, March 11, will focus on laboratory testing guidance and capabilities.

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CMS Addresses Coronavirus Spread, MHA To Address At CoPs Conference

Staff Contact: Sarah Willson or Jackie Gatz

The Centers for Medicare & Medicaid Services issued a news release outlining steps being taken by the agency to address the spread of COVID-19. CMS placed health care providers on notice to ensure sound infection control principles are being employed consistently throughout facilities. CMS announced its plans to ensure compliance by alerting all state agencies and accrediting organizations to focus all survey attention on infection control and other serious health threats and issues. The agency communicated their expectations and provided supporting information through the following three memos.

MHA’s upcoming conference, “CMS Hospital CoPs and State Licensure Regulation Updates for Acute and Critical Access Hospitals,” has been updated to include the new CMS information into conference presentations. Plan to attend this year’s event, taking place Wednesday, March 18, and Thursday, March 19, for the latest regulatory updates from CMS.

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state and federal health policy developments

MHA Testifies In Favor Of Legislation Designed To Aid Schools’ Response To Traumatic Injuries

Staff Contact: Bill Anderson or Jackie Gatz

A state House committee held a hearing on legislation that would ensure that bleeding control kits are present in every classroom, and that schools have protocols and training on the use of blood control kits following a traumatic injury. House Bill 1991 is sponsored by Representative Brenda Shields. MHA, along with the Missouri School Boards’ Association, testified in favor of the legislation. MHA is working with MSBA to promote Stop the Bleed, a nationwide initiative to deploy and train on the use of bleeding control kits following a traumatic injury.

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Regulatory News
the latest actions of agencies monitoring health care

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 Promoting Interoperability Program
    • Critical access hospitals reconsideration forms due Friday, March 6
    • Submit proposals for new measures by Wednesday, July 1
  • 2018 geographic variation public use files
  • Average sales price files: April 2020
  • Program for Evaluating Payment Patterns Electronic Reports for short-term acute care hospitals

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Quality and Population Health

CMS Invites Comments On Draft 2021 QRDA I Implementation Guide

Staff Contact: Sherry Buschjost

The Centers for Medicare & Medicaid Services invites comments on the draft 2021 CMS Quality Reporting Document Architecture Category I Implementation Guide for Hospital Quality Reporting. Additional information, including how to submit comments, is available. The deadline to submit comments is Wednesday, April 1.

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Did You Miss An Issue Of MHA Today?

March 2, 2020
America’s Essential Hospitals Sponsors Briefing On The Perils Of MFAR
DHSS Adds COVID-19 To Reportable Diseases
Missouri’s Severe Weather Preparedness Week Begins Today
MoDOT Offers Free Training For First Responders

March 4, 2020
DHSS Revises Medical Marijuana Rule To Provide For Physician Investigations
Amicus Brief Filed In Transparency Lawsuit
U.S. Supreme Court To Hear Affordable Care Act Appeal
CDC Expands PUI Criteria For COVID-19
TJC Accepting Submissions For Pioneers In Quality Proven Practices Program
TJC Announces Upcoming Webinars

Consider This ...

March is National Nutrition Month. Between 2012 and 2016, more than 4,800 schools obtained and offered salad bars to more than 2.4 million children and school staff to increase healthy fruit and vegetable options.

Source: Centers for Disease Control and Prevention