MHA Today | March 29, 2024

Staff Contact: Andrew Wheeler

MHA prepared a report illustrating the average Medicare spending per beneficiary by hospital, with comparisons to average spending for Missouri and the nation. The information includes details about Medicare Part A and Part B spending for as much as three days before admission, during the admission and as much as 30 days post-discharge. The report is based on information released on the CMS Hospital Compare website for reporting periods 2020 through 2022. Policy and analytic studies, prepared for distribution by HIDI, are available for download to authorized users of HIDI Advantage^®.

Staff Contact: Brian Kinkade

CMS extended the Special Enrollment Period for individuals who have lost Medicaid coverage during the Medicaid “unwinding.” These individuals will have until Saturday, Nov. 30 to apply for coverage through the federal marketplace at the Healthcare.gov website. The Cover Missouri Coalition is available to help individuals apply for new or reverify existing Medicaid coverage or enroll in a marketplace plan.

Staff Contact: Andrew Wheeler

The U.S. Departments of HHS, Labor, and the Treasury released a final rule regarding short-term, limited-duration insurance and independent, noncoordinated excepted benefits coverage. The final rule will affect STLDI sold or issued on or after Sunday, Sept. 1.

According to the agencies, “the Biden-Harris Administration is taking yet another action to lower health care costs and protect consumers from being scammed into purchasing lower quality insurance, or “junk insurance.” The rule would amend the existing federal definition of STLDI to limit the length of the initial contract term to no more than three months and revise the maximum coverage period to no more than four months.

Staff Contact: Andrew Wheeler

CMS released the FFY 2025 Medicare Hospice, Inpatient Psychiatric Facility and Skilled Nursing Facility PPS proposed rules.

Facilities paid under the Medicare hospice payment program are estimated to receive an increase of $705 million or 2.6% as compared to 2024.

The proposed SNF PPS payment update is estimated to increase Medicare payment rates by $196.5 million or 4.1%. This new rate includes a market-basket update of 2.8%, plus 1.7% market-basket forecast error adjustment, less 0.4% mandated productivity adjustment.

The proposed Inpatient Psychiatric Facility PPS payments are estimated to increase by $70 million or 2.6%. MHA soon will publish issue briefs.

Staff Contact: Andrew Wheeler

CMS released the FFY 2025 Medicare Inpatient Rehabilitation Facility PPS proposed rule. CMS proposed to increase the market basket by 3.2%. After reducing the market basket by the mandated productivity factor and accounting for increases to outlier thresholds, the resulting overall gain is estimated to be 2.5%. The rule includes proposed updates for the wage index, updates to the IRF quality reporting program, and requests for information about the future measure concepts for the IRF QRP and creating an IRF QRP Star Rating System.

MHA published an issue brief with additional information.

Staff Contact: Sarah Willson

CMS published guidance on EMTALA related to procedures around the release of the Quality Improvement Organization’s 60-day report. This report is requested when CMS refers an EMTALA case to the HHS Office of the Inspector General and for OIG’s investigation of the case. Specifically, the guidance states the 60-day report may not be released to the affected physician and/or hospital until after the OIG investigation is completed and the OIG closes the case.

Staff Contact: Brian Kinkade

CMS announced that rules streamlining certain Medicaid enrollment standards will be published Tuesday, April 2. DSS officials said a full analysis of the rule’s impact on Missouri Medicaid enrollment practices will be released soon. Among the changes that can be expected are the elimination of lockout for nonpayment CHIP premiums, increased time for Medicaid applicants to respond to documentation data requests and more flexible rules for accounting for spenddown expenses.

Staff Contact: Hannah Prince

The Drug Abuse Warning Network released an updated report focused on emergency department visits for alcohol-related concerns. The report shows the staggering number of ED visits nationwide — 8,566,725 — and outlines the reasons behind these visits, which range from intoxication to injury to chronic liver disease. The data continue to show the importance of accessible and equitable care for patients with alcohol and other substance-related disorders.

Staff Contact: Becky Boyce

Andrea McKay was named the next president of Cox Barton County Hospital in Lamar, effective March 22. McKay also serves as the president of Cox Monett Hospital. She replaces Christopher Wyatt, who served as the president since February 2019.