MHA Today | June 9, 2021

Staff Contact: Brian Kinkade

The MO HealthNet Division issued guidance for revised 340B billing requirements, scheduled to take effect Thursday, July 1. For 340B providers carving-in for Medicaid, retail and specialty pharmacy claims must be submitted with Submission Clarification Code 20, which will be reimbursed at the 340B ceiling price or the providers’ actual acquisition cost if lower, plus the standard professional dispensing fee. Physician-administered drugs submitted as medical or outpatient claims must include a JG or TB modifier, and will be reimbursed at the 340B ceiling price plus 6%, not to exceed $600. No dispensing fee is paid on physician-administered drugs.

The changes imposed on 340B drug reimbursement disbursed through retail and specialty pharmacies are required by federal law. However, the same requirements do not necessarily extend to the reimbursement of physician-administered drugs, and MHA has registered its disagreement with MHD’s on this point.

MHD’s proposed rules on the changes to 340B reimbursement currently are open for public comment, which must be submitted by Wednesday, June 30. Comments can be emailed to Rules.Comment@dss.mo.gov or mailed to the following address.

Missouri Department of Social Services
Legal Services Division-Rulemaking
P.O. Box 1527
Jefferson City, MO 65102-1527

Emergency rules were filed earlier to effectuate the July 1 effective date of the change.

Staff Contact: Andrew Wheeler

UnitedHealthcare recently announced their intent to enhance its “capabilities to assess emergency department facility commercial claims to determine if the ED event was emergent or nonemergent.” UHC now has communicated to hospitals throughout the country the states that are compelled to abide by the policy. Missouri is not included on the list and currently is excluded from the program. MHA will continue to work with a national Multistate Managed Care Coalition on the issue and will provide an update if anything changes.

Staff Contact: Jamey Motter

Data for the April 2021 monthly utilization report have been posted on HIDI Analytic Advantage and are available to download for distribution or placement in a network folder. HIDI Analytic Advantage PLUS has been updated to include this data. The Excel worksheet may be downloaded and saved to a secure network location or PC. The data are encrypted on the site and also during the transmission from HIDI. Once the data have been transferred, it must be secured according to the hospital’s security procedures. May 2021 data are being collected now and are scheduled to be available Tuesday, July 6.

Staff Contact: Stephen Njenga

During Community Health Improvement Week, MHA is highlighting a variety of community health needs assessment resources available to member hospitals. To assist in completing the CHNA process, MHA offers a CHNA guidance document and implementation guide, which features useful tools and the most current regulatory requirements from the Internal Revenue Service. MHA also developed ready-to-use CHNA implementation plan templates on diabetes, heart disease and community resiliency. The templates highlight key strategies, action plans, internal and external partners, process and outcome measures, and a timeline. They are based on the most current best practice strategies to address those issues using a multifaceted approach. For more information, visit MHA’s CHNA web page.

Staff Contact: Sherry Buschjost

The Centers for Medicare & Medicaid Services released Inpatient Psychiatric Facility Quality Reporting manual version 7.0. Effective Jan. 1, 2022, the manual and associated release notes are available at the noted links.