MHA Today | May 15, 2020

May 15, 2020


MHA Today: News for Healthcare Leaders

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May 15, 2020

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

COVID-19 Updates


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


Herb Kuhn, MHA President & CEOThe Missouri General Assembly’s regular session ends today. Despite its long interruptions and the awkward environment created by social distancing and new technologies, the session yielded good outcomes for hospitals. After crafting a $35 billion state budget last week, lawmakers remain engaged until the final moments. Legislative work must stop at 6 p.m.

If the COVID-19 emergency had a positive aspect, it was to underscore the importance of hospitals among many legislators and statewide officials. Aware of the daunting financial challenges confronting hospitals, many legislators recognized the need to insulate them from the harsh budget cuts occurring elsewhere.

A prime example includes action taken by members of the Missouri House earlier this week to block a proposal to end the Medicaid “out-of-state” payments that currently furnish $220 million to Missouri hospitals. The same proposal was debated by the Senate and ultimately withdrawn after several senators from both parties spoke against it. In addition, legislators blocked the MO HealthNet Division’s budget proposal to impose a fee schedule to pay for Medicaid outpatient services. The plan would have trimmed payments to Missouri hospitals by an estimated $100 million.

In addition to avoiding these cuts, the final budget includes a late change promoted by MHA to authorize an additional $190 million in Medicaid Disproportionate Share Hospital payments in the coming state fiscal year. At the same time, key lawmakers recognized the particular challenges facing small rural hospitals during the COVID-19 emergency, and added $35 million in federal stimulus money to support at least 10 grants to support rural facilities.

Several hospital priorities have advanced to the governor’s desk. One newly-enacted law raises the threshold for health care providers to be held liable for punitive damages. This change was a top advocacy priority for MHA. The legislation also bars lawsuits based on the Missouri Merchandising Act for cases involving medical malpractice. Also, the General Assembly approved legislation to improve the process by which insurers credential practitioners in their networks, including getting retroactive payments to the date of application.

Legislation to authorize a statewide prescription drug monitoring program has faltered in the closing hours. Negotiations salvaged a PDMP proposal soundly defeated by the House of Representatives earlier this week, but the Senate is filibustering the measure. Missouri will continue to be the only state without a statewide PDMP, but we do have a voluntary county-based system that encompasses 85% of Missourians and 94% of Missouri’s health care providers.

In the final weeks, numerous bad ideas from the first part of the session resurfaced as amendments. Moreover, with the good and the bad, many bills were cobbled together in the final weeks to create huge and shifting “omnibus bills” of loosely related topics. Managing this process is always a challenge.

It would not be surprising if, in the coming months, a special session was held to address emerging COVID-19-related challenges facing the state’s economy and revenues. However, lawmakers appear to have done significant work in a very complicated environment during the final weeks of session. Hospitals — and the communities they serve — will benefit from their efforts.

A full accounting of the legislative session will be available next week.

As always, send me a note to let me know what you're thinking.

Herb Kuhn, MHA President & CEO

Herb B. Kuhn
MHA President and CEO

In This Issue
CMS Releases Medicare IPPS And LTCH Proposed Rules
MHA Distributes Analysis For Proposed Updates To 2021 SNF PPS
MLN Connects Provider eNews Available
HRSA Announces Rural Residency Planning And Development Program

Regulatory News
the latest actions of agencies monitoring health care

CMS Releases Medicare IPPS And LTCH Proposed Rules

Staff Contact: Andrew Wheeler or Daniel Landon

The Centers for Medicare & Medicaid Services recently released proposed rules and a fact sheet for the Medicare Inpatient Prospective Payment System and the Long-Term Care Hospital PPS. MHA published an issue brief with additional details.

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MHA Distributes Analysis For Proposed Updates To 2021 SNF PPS

Staff Contact: Andrew Wheeler

MHA released a summary and comprehensive analysis of the proposed updates to the Medicare Skilled Nursing Facility Prospective Payment System for federal fiscal year 2021. The analysis compares estimates for FFYs 2020 and 2021, which include updates to the market basket, productivity reductions mandated by the Affordable Care Act, wage index and SNF Value-Based Purchasing program. Projected payment rates for FFY 2021 are based on the new patient-driven payment model rates. The analysis does not include effects caused by high-cost outliers, payments for managed care patients, or any modification in fee-for-service payments as a result of hospital participation in new payment models being tested under Medicare demonstration or pilot programs. The analysis also does not include the effects of the 2% Medicare sequestration. Comments about the proposed rule must be submitted by Tuesday, June 9. The analysis is posted online for authorized users of HIDI Analytic Advantage®. Current subscribers with questions about downloading files should contact HIDI.

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MLN Connects Provider eNews Available

Staff Contact: Andrew Wheeler

The Centers for Medicare & Medicaid Services issued updates to MLN Connects Provider eNews. 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 clarifies recognition of interstate license compacts
  • Quarterly update to the Medicare physician fee schedule database – April 2020 update revised

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Workforce News

HRSA Announces Rural Residency Planning And Development Program

Staff Contact: Jill Williams

The Health Resources and Services Administration announced the opportunity to apply for funding under the Rural Residency Planning and Development Program. The purpose of this grant program is to support the development of new rural residency programs in family medicine, internal medicine, public health and general preventive medicine, psychiatry, general surgery, and obstetrics and gynecology, to address the physician workforce shortages and challenges faced by rural communities. Rural residency programs are accredited medical residency training programs that primarily train residents in rural training sites for greater than 50% of their total time in residency and focus on producing physicians who will practice in rural communities.

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Did You Miss An Issue Of MHA Today?

May 11, 2020
House Committee Advances Constitutional Change For Medicaid
State House Rejects PDMP Legislation
CMS Releases Medicare IPPS And LTCH Proposed Rules
March MUR Available On HIDI Analytic Advantage
CMS Releases Updated eCQM Specifications And eCQM Materials For 2021 Reporting
District Court Hears Arguments In AHA Challenge To Transparency Rule

May 13, 2020
General Assembly Limits Health Care Provider Liability
State Legislators Approve Licensure Legislation
General Assembly Approves Legislation Relating To Victims Of Sexual Offenses
Missouri Medicaid Caseload Growth Accelerates
MHA Distributes Final Wage Index, Occupational Mix Data For Review
HRSA Releases Rural Communities Opioid Response Program – $200K Planning Grants
NIHCM Highlights Increase In Mortality Rates Involving Stimulants
Parkland Health Center Names New President

Consider This ...

It's National Hospital Week. In 2019, there were more than 14 million inpatient and outpatient visits to Missouri hospitals.

Source: Hospital Industry Data Institute