July 31, 2020

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COVID-19 Updates

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

Insights

Public policy ultimately is about values. Sometimes, there is a sweet spot where the values that drive policy also create significant opportunity for value — both economic value and an opportunity to improve the quality of life in our state. Tuesday’s vote on Medicaid expansion provides one of those special moments.

Several years ago, I penned a column that compared the process of selling Medicaid expansion to the Missouri General Assembly as a pitch on the television series “Shark Tank.” The question — would a savvy investor take up Medicaid expansion in Missouri when presented with the facts? The answer then — a resounding yes! Six years later the evidence from states that have adopted expansion affirms that it’s still a winning proposition.

The facts are clear. No single state that has expanded Medicaid has rolled it back. Studies have shown that it created an economic advantage for states that have adopted expansion. This includes some very conservative states — including Indiana during the governorship of Vice President Mike Pence, who was among the first to expand Medicaid. Studies show Missouri can benefit similarly when armed with a well-synchronized implementation plan. Our state can create significant economic value while improving lives.

What does a “yes” vote on Amendment 2 mean? As our campaign has demonstrated, expansion would bring precious tax dollars back to the state of Missouri, grow our economy, support access to rural health services and make it easier for veterans to access care. That’s what happens when we provide Medicaid coverage for an additional 230,000 Missourians.

Critics assert that Missouri can’t afford Medicaid expansion. They claim — depending on the source — that it could cost the state between $200 million to $2 billion annually. But when you push back on these arguments, there really is nothing behind them. Everyone is entitled to their own opinion, but not their own set of facts.

So why are critics ignoring all the research and empirical evidence? Because recognizing it invalidates their only talking point.

Six years ago, there was a clear opportunity for significant ROI. Today, in the middle of a pandemic, the case is stronger yet.

A June report from the Center on Budget and Policy Priorities supports the proposition that the uninsured may, out of concern that they can’t afford it, forgo testing or treatment for COVID-19. And since many of the uninsured that would benefit from expansion are “essential or front-line workers,” their potential exposure and possible need to access care is salient.

These workers — those employed in transportation, waste management, grocery and other retail, food production, and health care — are more likely to be required to show up for work. Stay-at- home orders largely exempt or bypass these individuals.

If that wasn’t convincing enough, think about the long-term impact of the pandemic — even after a vaccine is available. I was on an American Hospital Association-sponsored call last week, where Dr. Anthony Fauci was a guest. When asked about the progress toward a vaccine, Dr. Fauci made two important observations. First, we don’t know whether a vaccine will provide complete immunity — he hoped for at least 75%. And even if we achieve that lofty goal of 75% immunity (50% is the threshold for a vaccine to be released for broad authorized use), an effective vaccine might very well act like the flu vaccine — it helps minimize the most severe symptoms, rather than prevent you from becoming sick. Second, he was concerned about a vaccine’s durability. Unlike the measles vaccine, which provides lifetime protection, a COVID-19 vaccine may only provide immunity for “several seasons” before requiring a booster.

The bottom line is that we are going to have to learn to live with this disease for the rest of our lives. We need every tool available to do that. Expanding Medicaid coverage to 230,000 could provide a huge lift for the state in both combatting COVID-19 and sustaining our economic comeback.

Campaigns usually are built in two parts — education and Get Out The Vote. We’ve made a strong case and now we’re in the process of turning out voters.

Between now and Tuesday, we’ll be encouraging absentee voters to turn in their ballots and in-person voters to show up on Election Day. You can help with GOTV. Reach out to friends and family members, and urge their support of Amendment 2. Ask them to do the same with their networks.

Leann Chilton from BJC Healthcare coined what I think is a great outreach motto — “Text 10 and Call 10.” That is, text 10 friends and call 10 friends. Every vote matters!

Thank you for all your work so far. Let’s keep pushing until the finish line. Our communities are looking for our leadership.

Let me know what you’re thinking.

Herb B. Kuhn
MHA President and CEO

In This Issue


CMS Releases Medicare FY 2021 Final Rules For SNF, IPF And Hospice

CMS Announces Average Basic Medicare Part D Premiums

CMS Publishes RFI For Electronic Prescribing Of Controlled Substances In Medicare Part D

CMS Releases Medicare FY 2021 Final Rules For SNF, IPF And Hospice

MLN Connects Provider eNews Available

CMS Seeks Feedback On QualityNet Submission Process

AHRQ Promotes Rural Postpartum Mental Health Challenge
Appeals Court Reinstates 340B Cuts

DMH To Host Zero Suicide Academy

Regulatory News
the latest actions of agencies monitoring health care

CMS Releases Medicare FY 2021 Final Rules For SNF, IPF And Hospice

Staff Contact: Andrew Wheeler

The Centers for Medicare & Medicaid Services released fiscal year 2021 final payment and policy updates for the Medicare hospice, skilled nursing facility and inpatient psychiatric facility prospective payment systems. CMS is projecting payments to SNFs will increase by 2.2%, or $750 million; payments to IPFs will increase by 2.3%, or $95 million; and payments to hospice providers will increase by 2.4%, or $540 million. MHA will publish issue briefs and additional details soon.

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CMS Announces Average Basic Medicare Part D Premiums

Staff Contact: Andrew Wheeler

The Centers for Medicare & Medicaid Services released the 2021 Medicare Part D premiums for beneficiaries to gain access to prescription drugs. The 2021 Part D base beneficiary premium is $33.06, and the de minimis amount is $2. CMS stated that the 2021 average basic premiums are the second lowest since 2013. CMS Administrator Seema Verma stated, “At every turn, the Trump administration has prioritized policies that introduce choice and competition in Part D. The result is lower prices for life-saving drugs like insulin, which will be available to Medicare beneficiaries at this fall’s Open Enrollment for no more than $35 a month. In short, Part D premiums continue to stay at their lowest levels in years even as beneficiaries enjoy a more robust set of options from which to choose a plan that meets their needs.”

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CMS Publishes RFI For Electronic Prescribing Of Controlled Substances In Medicare Part D

Staff Contact: Andrew Wheeler

The Centers for Medicare & Medicaid Services  released a Request for Information for the Electronic Prescribing of Controlled Substances in Medicare Part D. The RFI seeks input from stakeholders around implementation of Section 2003 of the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act), which generally requires that prescriptions for controlled substances covered under a Medicare Part D prescription drug plan or Medicare Advantage Prescription Drug Plan be transmitted by a health care practitioner electronically. The RFI seeks input from stakeholders about whether CMS should include exceptions to the EPCS and under what circumstances, and whether CMS should impose penalties for noncompliance with this mandate in its rulemaking, and what those penalties should be. Comments will be due 60 days after the publication of the rule in the Federal Register.

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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.

• Short-term acute care hospitals: submit occupational mix surveys by Sept. 3
• Hospice quality reporting program: HART v1.6.0
• PEPPERs for SNFs, hospices, IRFs, IPFs, CAHs and LTCHs
• CMS updates data on COVID-19 impacts on Medicare beneficiaries

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Quality and Population Health

CMS Seeks Feedback On QualityNet Submission Process

Staff Contact: Sherry Buschjost

The Centers for Medicare & Medicaid Services is seeking feedback from hospitals that use QualityNet to submit data for the following quality reporting programs.

• Inpatient Quality Reporting
• Outpatient Quality Reporting
• Inpatient Psychiatric Facility Quality Reporting
• Ambulatory Surgical Center Quality Reporting
• PPS-Exempt Cancer Hospital Quality Reporting

Interested hospitals will be asked to participate in a 30-60 minute call to discuss the submission process and potentially test updates. Registration is required.

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AHRQ Promotes Rural Postpartum Mental Health Challenge

Staff Contact: Alison Williams

The Agency for Healthcare Research and Quality is hosting a webinar at 1 p.m. CST Wednesday, Aug. 5, to provide an overview and panel discussion about its competition to improve postpartum mental health care for rural American families. The challenge seeks to elicit success stories and proposals to address postpartum mental health diagnoses and treatment in rural communities. Success story winners will receive $15,000 each, and winners in the program proposal category can win up to $50,000 to support implementation. Submissions are due Tuesday, Sept. 15.

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Health Law Insight

Appeals Court Reinstates 340B Cuts

Staff Contact: Jane Drummond or Andrew Wheeler

The Court of Appeals for the District of Columbia Circuit overturned a favorable decision previously obtained by the American Hospital Association and other industry groups to roll back drastic cuts to the 340B program. The 2018 rule proposed to cut outpatient drug payments by approximately 28.5%, which the lower court deemed outside the U.S. Department of Health and Human Service’s authority to impose. The appellate court upheld the rule, finding the agency reasonably interpreted the Medicare statute. The court relied heavily on the Chevron doctrine, which grants executive agencies wide discretion in interpreting laws they administer.

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Noteworthy

DMH To Host Zero Suicide Academy

Staff Contact: Sarah Willson

The Missouri Department of Mental Health, in partnership with the Coalition for Community Behavioral Healthcare, is hosting their fourth Zero Suicide Academy Wednesday, Aug. 26, through Thursday, Aug. 27. A Zero Suicide Academy is a two-day training for organizations that wish to dramatically reduce suicides among patients in their care. Using the Zero Suicide framework, participants learn how to incorporate best practices into their organizations to improve care and safety for their patients. All health care organizations including hospitals are encouraged to apply. This will be a virtual event and there is no cost for the course. Applications are due by Monday, Aug. 3.

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Did You Miss An Issue Of MHA Today?

July 27, 2020
HHS Extends Public Health Emergency
Trump Issues Executive Orders On Prescription Drugs
July 2020 Hospital Compare Data Updates Now Available

July 29, 2020
HHS Issues Report On Surprise Billing
HHS Issues Report On Medicare Telemedicine During COVID-19 Pandemic
CMS Delays Occupational Mix Deadline
BKD To Host CMS Price Transparency Webinar
Board Of Pharmacy To Host Legislative Webinar
AJPH Paper Examines Rural And Urban Public Health Delivery Systems
DMH To Host Zero Suicide Academy
Rusk Rehabilitation Hospital Names New CEO
Ste. Genevieve County Memorial Hospital Names New CEO

Consider This …

Medicaid expansion would provide coverage for an estimated 230,000 low-income Missourians. However, undocumented immigrants do not qualify for Medicaid benefits. Neither are they eligible to purchase health care through the Affordable Care Act marketplace or enroll in Medicare or CHIP, a federal health care program for children.

Source: The Kansas City Star