It’s been a week of surprises. And, as I am fond of saying to staff, the only people who like surprises are children. Unfortunately, the final weeks of the legislative session are fertile soil for such occurrences.
Thursday, citing the General Assembly’s lack of an appropriation for Medicaid expansion, Gov. Parson rescinded the state plan amendment that the administration had sent to the Centers for Medicare & Medicaid Services to authorize the program. Today, despite the constitutional deadline for the legislative session, a bill reauthorizing the Federal Reimbursement Allowance and other provider taxes failed to pass. Throughout 30 years of partnership between hospitals and the state to fund Medicaid, this has never occurred before.
Although both surprises were disappointing, neither represent an endgame. It was likely that funding for Medicaid expansion would end up in litigation, and this week’s announcement increases that likelihood. The FRA and other provider taxes generate approximately $1.6 billion for the state and help secure about $3 billion in federal matching funds. The state doesn’t have the general revenue to replace these funds, and it is certain that a special session will be convened to reauthorize the program before its expiration date of Thursday, Sept. 30.
There were other surprises on the positive side of the ledger. After years as the only state in the nation without a statewide prescription drug monitoring program, one was adopted by lawmakers and sent to the governor. This system would replace the St. Louis County program that was serving about 80% of the state but creating a patchwork policy.
Although a MO HealthNet outpatient fee schedule will proceed, lawmakers added $50 million in the budget to soften the transition.
The last days and hours of the legislative session often are chaotic. This year was no different. The Missouri Senate adjourned early — just after 2 p.m. with four hours left on the legislative clock — stranding legislation and raising the ire of the House. Among the casualties was an effort to improve the Time Critical Diagnosis program.
Before the final hours, lawmakers adopted legislation restricting the powers of local public health authorities. This action was in response to COVID-19 mitigation efforts taken by local health authorities to manage the pandemic in their communities. Some saw this as prudent public health action. Other members of the general assembly characterized it as government overreach.
It’s been a very wild ride since January. However, there’s room for optimism. Every session sees bad and good ideas proliferate. While fewer of the good will make it to the governor’s desk this year, fewer of the bad advanced there as well.
Early next week, MHA will produce a summary of the legislative session.
MHA Submits Comments On Medicaid 340B State Plan Amendment
Parson Withdraws Medicaid Expansion Application
MMAC Allows DocuSign For Many MO HealthNet Provider Enrollment Actions
MLN Connects Provider eNews Available
HHS Issues New X-Waiver Changes
APS Staffing-Qualivis Offer Locum Tenens Lunch & Learn Webinar For APS Members
MHA submitted comments on the Medicaid state plan amendment that the MO HealthNet Division proposed to limit 340B reimbursement to actual acquisition cost of drugs dispensed or administered. Although federal law requires actual acquisition cost reimbursement for 340B drugs under certain circumstances, MHA asserts that the change is not required for physician administered drugs and questions the wisdom of unnecessarily reducing 340B pharmacy reimbursement by an estimated $18 million in light of COVID-19-related challenges hospitals have faced. MHA also objects to the proposed implementation date of Thursday, July 1, that MHD set for the change, observing that the accelerated timeframe leaves insufficient time for hospitals to comply with the burdensome administrative processes the proposed state plan will impose. 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.
Gov. Parson announced that his administration withdrew the Medicaid expansion state plan amendment submitted previously to the Centers for Medicare & Medicaid Services. State officials wrote that the state lacked authority to implement expansion since the General Assembly had not appropriated funding to implement it. The Medicaid state plan amendment notifies CMS and requests federal approval of Missouri’s implementation of Medicaid expansion. The constitutional amendment adopted by the voters required the Missouri Department of Social Services to submit the expansion state plan amendment to federal officials by March 1, which it did.
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 Shared Savings Program application: Notices of Intent to Apply opens Tuesday, June 1
Cognitive impairment: Medicare provides opportunities to detect and diagnose
Outpatient rehabilitation therapy services: comply with Medicare billing requirements
FY 2021 Skilled Nursing Facility PC Pricer updates
The U.S. Department of Health and Human Services recently issued new practice guidelines for the administration of buprenorphine for treating opioid use disorders. While these new guidelines allow eligible medical providers to prescribe buprenorphine without completing X-Waiver training, providers only can treat as many as 30 OUD patients without completing the X-Waiver training. Once training is completed, providers can treat 100 patients with OUD. For more information on the changes, visit the SAMSHA website. For more information on the waiver process, visit Providers Clinical Support System’s website.
APS Staffing is partnering with Qualivis to offer a lunch & learn webinar, “Leveraging Locum Tenens During COVID-19 and Beyond,” to APS members. The webinar will be offered at noon on Thursday, May 20, and Wednesday, July 16. For more information, contact Dennis George at 913-327-8730.
