Tag: final policy

MDHHS Releases Outpatient Hospital 340B Billing Final Policy

Uncategorized

The Michigan Department of Health and Human Services (MDHHS) recently released a final policy to modify hospital outpatient billing requirements for drugs purchased through the 340B drug pricing program. Existing policy requires 340B hospitals to bill 340B drugs at acquisition cost. Effective for dates of service on or after Jan. 1, 2024, hospitals may bill up to usual and customary charges for 340B acquired physician-administered drugs or products when provided in the hospital outpatient setting. This policy also revises the hospital outpatient 340B acquisition cost reporting and discontinues the 340B final settlement adjustment process. The MDHHS expects this change will have no reimbursement impact.

In addition, the policy revises 340B hospital cost reporting requirements. Annually, starting by December 2024, hospitals will be required to report 340B cost data for all Medicaid outpatient fee-for-service claims paid during the prior fiscal year.

Questions regarding this process should forwarded to the MDHHS Drug Rebate Specialist.

Members with questions should contact Vickie Kunz at the MHA.

 

Psychiatric Residential Treatment Facility Final Policy in Effect

Member News

The Michigan Department of Health & Human Services (MDHHS) recent policy for Psychiatric Residential Treatment Facilities (PRTF) went into effect Dec. 1, 2023.

Initially released for comment in May 2023, the MHA provided feedback on the proposed rule to ensure that a final policy adequately captured clinical workflow, while balancing access, service availability, insurance coverage and evidence-based clinical care.

The proposed rule was adopted as written and outlines essential elements of a PRTF program, including:

  • Certification and Certificate of Need.
  • Provider certification criteria.
  • Patient eligibility requirements.
  • Service authorization.
  • Responsibilities of prepaid inpatient health plans, PRTF and referring providers.
  • Provider requirements, including reimbursement and staff education.
  • Coverage of out-of-state services.

Members with questions about the PRTF model may contact Lauren LaPine at the MHA.

MDHHS Releases REHs Medicaid Reimbursement Final Policy

Member News

The Michigan Department of Health and Human Services (MDHHS) recently released a final policy to establish Medicaid reimbursement for rural emergency hospitals (REHs) effective Jan. 1, 2023. The MDHHS reimburses REHs based on the existing outpatient prospective payment system (OPPS) methodology. Critical access hospitals (CAHs) that convert will continue to be paid using the enhanced OPPS reduction factor, while non-CAHs will continue to be paid using their existing OPPS reduction factor. REHs must update their enrollment and subspecialty with the MDHHS through the Community Health Automated Medicaid Processing System (CHAMPS) provider enrollment system within 35 days of any change. Hospitals that convert to REHs must end date their inpatient specialty.

Members with questions regarding the policy should contact Vickie Kunz while members that need assistance evaluating potential conversion should contact Lauren LaPine at the MHA.

MDHHS Releases Final Policy to Increase Rates for Certain Dental Procedures

Member News

The Michigan Department of Health and Human Services (MDHHS) recently released a final policy to increase the minimum Medicaid payment rates to $2,300 for covered dental services provided under general anesthesia at outpatient hospitals and $1,495 for services provided in an ambulatory surgical center (ASC).

The policy took effect Oct. 1, 2022 and was approved by the Centers for Medicare and Medicaid Services in early November. The policy modified the reimbursement methodology for dental services provided in these settings from the outpatient prospective payment system to a Medicaid fee schedule. Outpatient hospital and ASC fee schedules are available on the MDHHS website under the Billing and Reimbursement and Provider Specific Information tabs.

Members with questions should contact Vickie Kunz at the MHA.