MHA Today | May 10, 2021

Staff Contact: Brian Kinkade

MHA submitted comments on the Medicaid state plan amendment that the MO HealthNet Division proposed to implement a Medicare-based simplified outpatient fee schedule. MHA commented on the shortcomings of the proposed methodology in reimbursing children’s services, the significant disparities in MHD’s fiscal note estimates, and MHD’s aggressive proposed implementation date of July 1. Federal law requires MHD to include an analysis of the public comments made on the proposed plan amendment at the time it is submitted to the Centers for Medicare & Medicaid Services for review and approval.

Staff Contact: Brian Kinkade or Daniel Landon

The MO HealthNet Division filed a proposed rule allowing hospitals to perform presumptive eligibility determinations for adults ages 19 to 64. At higher income levels, this population would be eligible for coverage under Medicaid expansion. Currently, presumptive eligibility determinations for Medicaid are limited to children, pregnant women and certain parents/caretaker relatives of very low-income Medicaid-eligible children.

Staff Contact: Sarah Willson

The Missouri Board of Pharmacy proposed several rule changes, which have been published in the Missouri Register, including an emergency rule change on sterile compounding. The board is amending 20 CSR 2220-2.200 Sterile Compounding subsection (5)(C). This amendment removes the requirement that Risk Level 3 preparations must remain Risk Level 3 for the life of the preparation. The emergency rule is effective with a set expiration of February 2022. A proposed rule also is included in the most recent publication. Another rule, 20 CSR 200-22.010 Licensing Procedures for Pharmacy Benefits Managers, also was published. Comments must be received by Thursday, June 17, and a public hearing on the proposed rule is scheduled for 9:30 a.m. the same day. Finally, the Board’s final rule, 20 CSR 2220-7.025 Intern Pharmacist Licensure, was amended and finally published becoming effective June 17.

Staff Contact: Sarah Willson

The Centers for Medicare & Medicaid Services released new guidance for hospitals and critical access hospitals on interoperability standards stemming from the Interoperability and Patient Access final rule (CMS-9115-F), published May 1, 2020. Hospitals, psychiatric hospitals and CAHs are required to send electronic patient event notifications of a patient’s admission, discharge and/or transfer to another health care facility or to another community provider or practitioner. The Conditions of Participation are updated in the guidance. The rule went into effect May 1, 2021.

Staff Contact: Mary Becker

Last week, MHA celebrated the honorable work of Missouri’s nurses throughout National Nurses Week. This week, we shift our focus to the great work of Missouri’s hospitals and the individuals who work in them by celebrating National Hospital Week. All week, we’ll be posting on Facebook and Twitter, and we’ve created Facebook Frames that you can add to your profile pictures and stories — one for those who work in Missouri hospitals, and the other for those who support Missouri hospitals. We encourage you to follow along, engage with us and tag us in your posts.

Staff Contact: Sherry Buschjost

The Centers for Medicare & Medicaid Services posted the electronic clinical quality measure specifications for the 2022 reporting period for eligible hospitals and critical access hospitals, and the 2022 performance period for eligible professionals and eligible clinicians. The updated eCQMs are to be used to electronically report 2022 clinical quality measure data for CMS quality reporting programs. CMS updated eCQMs for potential inclusion in the following programs.

• Hospital Inpatient Quality Reporting Program
• Medicare Promoting Interoperability Programs for Eligible Hospitals and CAHs
• Quality Payment Program: The Merit-based Incentive Payment System and Advanced Alternative Payment Models
• Advanced APM: Primary Care First

Additional details are available

Staff Contact: Sherry Buschjost

Outpatient imaging efficiency measures facility-specific reports for calendar year 2021 payment determination are available for facilities participating in the Hospital Outpatient Quality Reporting Program. The OIE measures include the following.

• Magnetic Resonance Imaging Lumbar Spine for Low Back Pain (OP-8)
• Abdomen Computed Tomography) – Use of Contrast Material (OP-10)
• Cardiac Imaging for Pre-Operative Risk Assessment for Non-Cardiac, Low-Risk, Surgery (OP-13)

Additional details are available.