Last week, the U.S. Congress and President Barack Obama passed and signed H.R. 1586 into law, which, among other things, will provide for a critical six-month (through June 2011), extension of the enhanced Federal Medical Assistance Percentage (FMAP) for states. Although the additional two quarters of funding will result in higher FMAP rates than the standard amounts, the FMAP enhancement is reduced from the original 6.2 percent to 3.2 percent for the first quarter of calendar year (CY) 2011 and to 1.2 percent for the second quarter of CY 2011. States with high unemployment that qualify would continue to receive additional percentage points in funding for the six-month extension.

The MHA will advocate for Michigan's estimated $379 million benefit to be directly applied to the fiscal year (FY) 2011 community health budget. Without the extension, Michigan would have faced a sudden drop of $500 million in FMAP support for the state Medicaid budget in FY 2011. With nearly one in every six, or 1.8 million, Michigan residents relying on Medicaid for their healthcare coverage, and 1.15 million uninsured individuals unable to pay for their care, this funding is critical to preserving the ability of community hospitals to continue serving as the state's healthcare safety net. The federal assistance will lower the amount of additional funding that will be necessary to avoid provider cuts in FY 2011. For more information, contact Laura Appel at the MHA.

Back to Top

The Medical Services Administration (MSA) recently distributed correspondence to hospitals requesting additional information to supplement the Medicaid cost report. The supplemental data collected will be used to calculate each hospital's share of the Medicaid quality assurance assessment tax for fiscal year (FY) 2011. The supplemental form is available on the Michigan Department of Community Health file transfer site and was due to the MSA by July 23. Hospitals that have not already done so are encouraged to submit the supplemental cost report form to the MSA as soon as possible. Doing so will ensure that hospitals are appropriately taxed for FY 2011. Members with questions should contact Cindy Drumm at the MSA or Jason Jorkasky at the MHA.

Back to Top

In difficult times, leadership is a point of emphasis - especially in the healthcare sector. Yet due to the complicated nature of hospital operations, executives realize that there are limits to what an administrator can accomplish in the areas of physician-led quality improvement, joint ventures and other issues. Doctors have a special relationship with other clinicians, and a physician leader with a foot in both worlds - clinical and administrative - can get a lot done. However, challenges exist when bringing physicians into a new role. One solution is to identify what facets of the work environment frustrate physicians, and work together to eliminate these problems. The MHA Health Foundation webinar Investing in Physician Leadership Development: Factors that Frustrate and Facilitate Effectiveness, scheduled from noon to 1:30 p.m. Aug. 24, will present the survey results collected by Integrated Healthcare Strategies and the Governance Institute that identify the factors that frustrate and fulfill physicians, and discuss specific steps that can be taken to enhance the effectiveness of physician leaders. The webinar connection fee is $195 per participating MHA-member organization. For more information or to register, contact Leigh Anne Jewison at the MHA.

Back to Top

As part of the 2011 Medicare outpatient prospective payment system proposed rule, the Centers for Medicare & Medicaid Services (CMS) included regulations to implement provisions of the Patient Protection and Affordable Care Act of 2010. These provisions change the way Medicare reimburses hospitals for Medicare graduate medical education (GME) and indirect medical education (IME) under the inpatient prospective payment system. Major provisions of the proposed rule include the counting of resident time for Medicare IME and GME purposes and the redistribution of unused residency slots. A detailed summary of the proposed rule is available online.

Because the proposed rule affects reimbursement, hospitals are encouraged to review the summary. The CMS will accept comments until Aug. 31. Members with questions should contact Vickie Seal at the MHA.

Back to Top

Although Medicaid fee-for-service claims prior to the Community Health Automated Medicaid Processing System (CHAMPS) conversion Sept. 18, 2009 have been converted to the new system, some claims remain unpaid. At last week's Medical Services Administration (MSA) hospital work group meeting, the MSA indicated that hospitals should contact Karen Scott regarding any Medicaid accounts with dates of service prior to Jan. 1, 2009, as the MSA will give these claims priority processing over the next two weeks. If, after the two-week processing period, hospitals still have additional outstanding aging accounts, they may then contact provider support with a listing of 25 to 50 transaction control numbers (TCNs) for aging accounts. These will be considered for priority processing. Hospitals submitting TCNs are reminded that, per the Health Insurance Portability and Accountability Act Privacy Rule, their communications to provider support do not include any protected health information.

The MSA is also in the process of completing Medicaid interim payment (MIP) reconciliations for hospitals with fiscal years ending March 31, and will provide a 30-day notice to hospitals regarding any MIP settlement amounts. If hospitals have unpaid claims due to the CHAMPS conversion, they should provide this information to the MSA for consideration in their MIP reconciliation.

In addition, the MSA is in the process of ensuring that Medicaid eligibility records are updated for files exceeding one year and will notify the MHA and others when this process is complete. This information is vital to hospitals to validate Medicaid eligibility for Medicare disproportionate share hospital payment calculations completed by the Medicare fiscal intermediary. Members with questions should contact Vickie Seal at the MHA.

Back to Top

The U.S. Department of Health & Human Services and the Office of the National Coordinator for Health Information Technology recently released a final rule on the meaningful use of electronic health records (EHRs). The rule mandates that, over the next 10 years, a funding pool be distributed as Medicare incentive payments for healthcare providers who use EHRs. The rule also details the steps that hospitals and physicians must take to qualify for their share of the roughly $27 billion pool. The MHA Health Foundation webinar, The Final Meaningful Use Rules: Moving From Paper to Portal, will examine the rule's requirements and the Centers for Medicare & Medicaid Services regulations to ensure hospitals receive appropriate incentives. It will also put EHR and technology into the larger contexts of systemic change and healthcare reform.

The webinar will take place from 11 a.m. - 12:30 p.m. Sept. 16 and has a connection fee of $195 per MHA-member organization. For more information or to register, contact Leigh Anne Jewison at the MHA.

Back to Top

In early August, the Michigan Department of Human Services (MDHS) hosted a meeting with representatives from hospitals, the MHA and the Michigan Department of Community Health (MDCH) to resolve issues with the Bridges eligibility system. In August 2009, this new eligibility system for all of Michigan social service programs, including cash assistance, food stamps and Medicaid, was expanded statewide. Record Medicaid enrollment levels, coupled with limited MDHS and MDCH staff resources and the learning curve associated with a new system, led to significant delays in obtaining Medicaid coverage for patients. Additionally, it resulted in increases in the number of pending Medicaid applications and accounts receivable balances for Michigan healthcare providers.

A key issue that hospitals continue to face relates to the delayed enrollment of newborns into Medicaid health maintenance organizations (HMOs) when the mother is enrolled in an HMO at the time of birth. An automated newborn interface, being implemented by the MDCH and MDHS with the state vital statistics file, should correct this problem in the near future. Other issues that the MDCH staff is working to resolve include a delay in obtaining Medicaid coverage for disability cases and misdirected beneficiary mail.

As a result of monthly system fixes, outstanding help desk tickets for correcting Medicaid coverage issues have been reduced considerably. To address remaining problems, the MDCH and MDHS have implemented bi-weekly calls, additional training and educational modules to assist staff with further education on Bridges functionality. In addition, the Bridges help desk is now monitoring trends relative to Bridges issues, and system fixes will be developed based on those findings. Members with questions should contact Vickie Seal at the MHA.

Back to Top

• The Collecting and Handling Electronic Evidence educational session, part two of a three-part webinar series, will be held from 11 a.m. to 12:30 p.m. Tuesday. Participants will examine steps to collecting and handling electronic evidence, including best practices. For more information, contact Leigh Anne Jewison at the MHA.