Tag: Jason Jorkasky

MDHHS Announces Medicaid Health Plan Rebid Requirements

Member News

The Michigan Department of Health and Human Services (MDHHS) announced new information Aug. 22 related to the rebidding of contracts for health plans that provide services to 2.2 million Michiganders receiving coverage through Medicaid and Michigan’s Healthy Michigan Plan. The announcement included network requirements and minimum qualifications for bidders in its upcoming request for proposals for the Comprehensive Health Care Program contract for Michigan’s Medicaid health plans.

The MHA has been and will continue to monitor all relevant aspects to the Medicaid health plan bidding/proposal process and continue to advocate when appropriate to ensure Michigan residents get the coverage and networks they need and deserve to receive high-quality, timely services.

Members with questions may contact Jason Jorkasky at the MHA.

CMS Releases Medicare Physician Fee Schedule CY 2024 Proposed Rule

Member News

The Centers for Medicare & Medicaid Services (CMS) released its calendar year (CY) 2024 proposed rule for the physician fee schedule. The rule proposes a decrease to the conversion factor by 3.34%, to $32.75 in CY 2024, as compared to $33.89 in CY 2023. This reflects the expiration of the 2.5% statutory payment increase for CY 2023; a 1.25% statutory payment increase for 2024; a 0.00% conversion factor update under the Medicare Access and CHIP Reauthorization Act; and a -2.17% budget-neutrality adjustment. Other provisions in the proposed rule include:

  • Delaying implementation of a split (or shared) visit based on the amount of time spent by the billing practitioner. Under this policy, if a non-physician practitioner performed at least half of an evaluation and management visit and billed for it, Medicare would only pay 85% of the physician fee schedule rate.
  • Creating a new benefit category for marriage and family therapists and mental health counselors under Part B. In addition, the CMS would establish new payment codes for mobile psychotherapy for crisis services.
  • Creating five new, optional Merit-based Incentive Payment System (MIPS) Value Pathways for reporting beginning in 2024. The CMS also proposes to increase both the performance threshold score that MIPS participants must achieve to earn positive payment adjustments, and the quality data completeness threshold.
  • Extending the Advanced Alternative Payment Model (APM) Incentive Payments into CY 2025 to those qualifying clinicians. This one-year extension of Advanced APM bonus payments at a reduced rate of 3.5% was required by the Consolidated Appropriations Act of 2023.
  • Extending several telehealth waivers, such as reimbursement at the non-facility rate for certain telehealth services in the patients’ home.

The CMS will accept comments on the proposed rule through Sept. 11. Members with questions may contact Jason Jorkasky at the MHA.

MHA Monday Report March 27, 2023

Monday Report
MHA Monday Report

capitol buildingMHA-supported Bills See Action Before Break

The Michigan House of Representatives acted on a pair of MHA-supported bills during the week of March 20. In the House Health Policy Committee, members voted to report legislation to strengthen Michigan’s Healthy Michigan statute. …

Speakers of the Protect Our Care press conference.MHA Celebrates ACA Anniversary with Congresswoman Slotkin

MHA Executive Vice President Laura Appel joined U.S. Rep. Elissa Slotkin and other healthcare advocates March 23 as part of a virtual press conference organized by Protect Our Care to celebrate the 13th anniversary of …

MHA, Industry Leaders Gather at Trinity Health to Discuss Food Insecurity

As individuals and families across the state and country continue to face food insecurity, Michigan’s hospitals, health systems and community leaders are engaged in creating collaborative solutions. MHA CEO Brian Peters joined fellow food security …

Expanding Advocacy Roots with the Next Generation

The MHA collaborated with Wayne State University for the first-ever student-led advocacy day March 22. Science Policy Network-Detroit is a student organization at Wayne State that aims to advocate for science-related issues in …

March 30 Webinar Outlines Considerations for the End of the Public Health Emergency

The Department of Health and Human Services COVID-19 public health emergency expires May 11, 2023, which may significantly decrease the flexibility providers have become accustomed to. The MHA will host The End of the …

Medicaid Eligibility Redetermination Webinar Recording Available

The Michigan Medicaid program has grown to nearly 3.2 million Michiganders, an increase of more than 700,000 when compared to pre-pandemic levels, due to federal statutory limitations on states’ abilities to remove people from the …

MHA Webinar Explores PACE Program Partnerships

With the closure of nursing homes and long-term care facilities, hospitals and health systems need options to care for seniors. Dually eligible frail seniors are one of the most complex cohorts with multiple co-morbidities, frequent …

Applications Open for Excellence in Governance Fellowship, Prepares Trustees to Lead

The MHA Excellence in Governance Fellowship is now available to healthcare board members looking for innovative, effective ways to lead their organizations as hospitals and health systems navigate financial strain and labor challenges. Applications are …

The Keckley Report

Paul KeckleyAffordable Care Act 2.0: New Trends and Issues, New Urgency

“Thursday marks the 13th anniversary of the signing of the Affordable Care Act– perhaps the most consequential healthcare legislation since LBJ’s passage of the Medicare Act in 1965. Except in healthcare circles, it will probably go unnoticed. …

Complicating matters, the political environment today is more complicated than in 2010 when the ACA became law. The economic environment is more challenging: the pandemic, inflation and economic downturn have taken their toll. Intramural tensions in key sectors have spiked as each fights for control and autonomy i.e. primary care vs. specialty medicine, investor-owned vs. not-for-profit hospitals, retail medicine & virtual vs. office-based services, carve-outs, direct contracting et al . Consolidation has widened capabilities and resources distancing big organizations from others. Today’s media attention to healthcare is more sophisticated. Employers are more frustrated. And the public’s confidence in the health system is at an all-time low. …“

Paul Keckley, March 19, 2023

News to Know

  • Registration is now open for the MHA Keystone Center Safe Patient Handling Conference.
  • The MHA is issuing a request for proposal for a $50 million competitive grant program for Michigan healthcare entities to expand access to pediatric inpatient behavioral health services.
  • The MHA Health Foundation will host a four-part webinar series MHA Board Governance Education that outlines the trends affecting current and future strategic plans, techniques for effectively communicating with stakeholders on key issues and ways to build trust, drive engagement and develop relationships.
  • The MHA will host an in-person Human Resources Member Forumat the MHA Headquarters in Okemos from 8:30 a.m. to noon April 26, with a virtual option available as well.
  • The Root Cause Coalition is accepting requests for proposals to present at the 8th Annual National Summit on the Social Determinants of Health Dec. 3-5 in Kansas City.

Medicaid Eligibility Redetermination Webinar Recording Available

Member News

The Michigan Medicaid program has grown to nearly 3.2 million Michiganders, an increase of more than 700,000 when compared to pre-pandemic levels, due to federal statutory limitations on states’ abilities to remove people from the program during the public health emergency. The Michigan Department of Health and Human Services (MDHHS) recently released a final policy bulletin informing providers that Medicaid eligibility redeterminations will resume in June 2023 for the first time since early 2020, with some enrollees who no longer meet program eligibility criteria losing coverage as early as July.

The MHA, in partnership with the Michigan Primary Care Association, Michigan Association of Health Plans, Michigan State Medical Society and Michigan Osteopathic Association, hosted a member webinar March 20 to cover the Medicaid eligibility redetermination process, timelines and provider roles. A recording of this webinar is available.

Hospitals are encouraged to discuss the importance of updating Medicaid patient contact information in the state’s MI Bridges system and how to maintain Medicaid coverage or find new coverage on the federal marketplace.

Members with questions are encouraged to contact Jason Jorkasky at the MHA.

Resources, Webinars Available for Navigating Medicaid Eligibility Changes

Member News

The Michigan Department of Health and Human Services (MDHHS) recently released a final policy bulletin informing providers that Medicaid eligibility redeterminations will resume in June 2023 for the first time since early 2020, with some enrollees who no longer meet program eligibility criteria losing coverage as early as July.

The Medicaid program has grown to nearly 3.2 million Michiganders, an increase of more than 700,000 when compared to pre-pandemic levels. The MDHHS will complete eligibility redeterminations for all Medicaid enrollees over a 12-month period. Hospitals are encouraged to discuss the importance of updating Medicaid patient contact information in the state’s MI Bridges system and how to maintain Medicaid coverage or find new coverage on the federal marketplace. Hospitals are invited to join the MHA, the Michigan Primary Care Association, the Michigan Association of Health Plans and other stakeholders for a members-only webinar March 20. This will cover the redetermination processes, timelines and provider roles.

The MDHHS also announced that it has started unwinding many of the changes that were made to the Michigan Medicaid program in order to ease rules and provide flexibilities to providers as a result of the COVID-19 public health emergency (PHE). Michigan will continue to unwind the pandemic-related program changes before the authority for these policies expires on May 11, 2023. The MHA will host an additional webinar on March 30 to cover details of the PHE ending and what hospitals need to know.

The MDHHS developed a website with information important to providers that will be updated as new information becomes available. The Centers for Medicare & Medicaid Services also recently released a fact sheet related to the PHE expiration’s impact on:

  • COVID-19 vaccines, testing, and treatments.
  • Telehealth services.
  • Healthcare access and continuing flexibilities for healthcare professionals.
  • Inpatient hospital care at home.

Members with questions are encouraged to contact Jason Jorkasky at the MHA.

CMS Issues Proposal to Modify the Prior Authorization Process

Member News

The Centers for Medicare and Medicaid Services (CMS) recently issued a proposed rule to modify the prior authorization process for certain payers. The proposal would require payers to:

  • Include a specific reason when denying a request.
  • Publicly report certain prior authorization metrics.
  • Make decisions within 72-hours for urgent requests.
  • Make decisions within seven days for standard, non-urgent requests, which is twice as fast as existing Medicare Advantage response timelines.
  • Enable improved data exchange.

The proposal generally applies to Medicare Advantage, Medicaid and Medicaid managed care and Children’s Health Insurance Program (CHIP) and CHIP managed care plans, as well as qualified health plans on the federally facilitated exchanges. Members are encouraged to review the proposal and submit comments to the CMS by the March 13, 2023 deadline.

Members with questions should contact Jason Jorkasky at the MHA.