Tag: CHIP

MHA Monday Report Jan. 22, 2024

Monday Report
MHA Monday Report

CMS Finalizes Prior Authorization Reform Rule for MA, Medicaid and CHIP Plans

The Centers for Medicare & Medicaid Services (CMS) released a final rule last week intended to expedite the prior authorization process for those covered by Medicare Advantage, Medicaid and Children’s Health Insurance Program (CHIP) plans. …

Register Now for MHA Human Resources Conference

Registration is now open for the 2024 MHA Human Resources Conference, scheduled for March 5, 2024 at the ACH Hotel Marriott University Area, Lansing. Attending the conference provides human resource professionals with an opportunity …

MDHHS Issues RFP to Expand Child Adolescent Health Center Programs

The Michigan Department of Health and Human Services (MDHHS) issued a Request for Proposal (RFP) to expand Child and Adolescent Health Center programs, focusing on school-based or school-linked health services. This initiative will support …

Now Accepting Nominations for the 2024 MHA Ludwig Community Benefit Award

The MHA is accepting nominations for the 2024 Ludwig Community Benefit Award, which recognizes healthcare organizations that improve the health and well-being of their communities through collaborative health, economic or social initiatives. Benefits provided include …

OAC Provides Recommendations and Hosts Panel Discussion

The Michigan Opioid Advisory Commission (OAC) provides recommendations to the legislature about initiatives that will bolster education, prevention, treatment and services of substance use disorders and mental health conditions. The Commission aims to equip local …

SAMHSA Rural EMS Training Grant Program Pre-Application Webinar

The Substance Abuse and Mental Health Services Administration (SAMHSA) is launching a grant program to recruit and train emergency medical service (EMS) providers to rural areas. This program intends to address substance use disorder and …

Outpatient Prospective Payment System Final Rule Includes Behavioral Health Additions

The Centers for Medicare & Medicaid Services (CMS) recently finalized several policies in the 2024 Medicare fee-for-service final rules for the outpatient prospective payment system and physician fee schedule final rule. These provisions, effective …

MHA Podcast Explores Workplace Violence Resources for Michigan Hospitals

The MHA released a new episode of the MiCare Champion Cast, which features interviews each month with experts in Michigan discussing key issues that impact healthcare and the health of communities. The January 2024 episode, …

The Keckley Report

Paul KeckleyEconomic Indigestion for U.S. Healthcare is Reality: Here’s What it Means in 2024

“By the end of this week, we’ll know a lot more about the economic trajectory for U.S. healthcare in 2024: it may cause indigestion. …

So, the conclusion that can be deduced from the four events this week is this: economic indigestion in U.S. healthcare will persist this year and beyond because there is no political will nor industry appetite to fix it.  Darwinism aka ‘survival of the fittest’ is its destiny unless….???”

Paul Keckley, Jan. 15, 2024

News to Know

  • MHA-member physician residents are encouraged to save the date for GME Capitol Day, scheduled from 8:30 a.m. to 3:30 p.m. Wednesday, May 1, at the MHA Capital Advocacy Center.
  • MHA-member communications professionals are encouraged to save the date for this year’s MHA Communications Retreat, scheduled from 8:30 a.m. to 4 p.m. Tuesday, May 7, at the Henry Center for Executive Development in Lansing.

CMS Finalizes Prior Authorization Reform Rule for MA, Medicaid and CHIP Plans

Member News

The Centers for Medicare & Medicaid Services (CMS) released a final rule last week intended to expedite the prior authorization process for those covered by Medicare Advantage, Medicaid and Children’s Health Insurance Program (CHIP) plans.

Under the new rule taking effect in 2026, Medicare Advantage, Medicaid and CHIP plans will have 72 hours to answer urgent requests and seven days for a standard request. Affected payers will also be required to provide a specific reason when denying requests, as well as publicly report certain prior authorization metrics.

Additionally, the rule will require affected payers to implement a Health Level 7 Fast Healthcare Interoperability Resources standard application programming interface (API) to support electronic prior authorization. Payers must expand patient access to APIs beginning in 2027 to include information about prior authorizations. They must also implement a provider access API that providers can use to retrieve their patients’ claims, encounters and clinical and prior authorization data.

These actions addressing prior authorization come amid conversations on this same issue on Capitol Hill. The House Ways and Means Committee advanced the bipartisan Improving Senior’s Timely Acccess to Care Act in 2023, which gained traction following a report from the U.S. Department of Health and Human Services highlighting abuse of the prior authorization program and a letter signed by 233 House and 61 Senate members urging action by the CMS. The bill would have required plans to adopt a “real time” process for answering routinely approved items and a 24-hour response for any urgent requests. The release of the final rule may pre-empt further legislative action.

Members with questions should contact Megan Blue at the MHA.