Tag: Medicaid

MDHHS Releases FY 2024 Medicaid Program Rate Updates

Member News

The Michigan Department of Health and Human Services (MDHHS) recently released concurrent proposed and final policies to implement Medicaid rate increases included in the fiscal year (FY) 2024 budget. These increases, contingent upon approval by the Centers for Medicare & Medicaid Services (CMS), are effective for dates of service on and after Oct. 1, 2023.

The MDHHS will modify Medicaid reimbursement rates for specified services to provide:

  • A hospital Diagnosis Related Group rate increase for level I and II designated trauma facilities. The increase will apply to Medicaid fee-for-service and Medicaid Health Plan hospital payments. The level of rate increase is not specified. The MHA successfully advocated for these funds in the FY 2024 budget.
  • A 260% increase for transitional residential brain injury services (BIS) with these services reimbursed through a single bundled payment per day that covers both a daily rate for traditional residential care and case management services and a minimum of 15 hours of weekly therapy. BIS outpatient rates remain unchanged.
  • A 7.5% increase for professional services provided by physicians, physician assistants, advanced practice nurses, psychologists, clinical social workers, professional counselors and others. This increase would not apply for professional services that received a previous rate increase such as neonatal, obstetrical and other services listed. The increase would apply to Maternal Infant Health Program professional services.
  • A 10% increase for Anesthesia Professional Services represented by CPT codes 00100-01999.
  • A 10% increase for home health services billed with HCPCS codes G0151-G0496.
  • An increase to 100% of Medicare base rates for ground ambulance services for Locality 01 when reimbursement from the Medicaid ambulance provider assurance assessment is included.

Hospitals are encouraged to review the proposed policy and submit comments to MDHHS by Oct. 31 and should include “Medicaid Program Rate Updates FY 2024” in the subject line.

Members with questions should contact Vickie Kunz at the MHA.

News to Know – Sept. 25, 2023

Member News
  • To help Medicaid beneficiaries with the renewal process, a redetermination event is being hosted by the Salvation Army Great Lakes Harbor Light System in Grand Rapids, from 10 a.m. to 2 p.m., Sat, Sept. 30. During the event, beneficiaries will learn about when they need to renew their coverage, receive on-site help with completing renewal paperwork and get guidance on next steps.
  • Registration for the Root Cause Coalition National Summit on Social Determinants of Health is open. Population health, health equity and community-based organization leaders from across the nation will convene Dec. 3-5, 2023 to discuss, learn and share strategies to impact social determinants of health. Sponsorship opportunities are available at a variety of price points and are designed to position your organization as a change leader in health improvement and equity. Members with questions about The Root Cause Coalition may contact Erin Steward at the MHA.
  • The American Hospital Association (AHA) is accepting applications for the AHA’s Dick Davidson NOVA Award. The award celebrates the collaborative work of hospitals and community organizations that improve the health status of individuals and communities. This annual award will honor five organizations, who will be recognized at the 2024 AHA Leadership Summit in San Diego. Members are encouraged to apply by Nov. 13. Members with questions may email nova@aha.org.

Reproductive Health Act Introduced in State Legislature

Member News
capitol building

capitol buildingA package of 21 bills, referred to as the “Reproductive Health Act”, was introduced in the state House and Senate Sept. 7.  The legislation changes several Michigan laws on abortion.

These changes include a new act to create a right to an abortion in the state of Michigan, removing licensing restrictions on facilities that provide abortion services, eliminating the 24-hour waiting period for an abortion and repealing the requirement to provide state literature for those seeking an abortion. Additionally, the bills removes the ban on Medicaid reimbursement for abortion care, eliminate criminal punishments for miscarriages and stillbirths and allow certain commercial health companies to cover abortion related services.

The MHA has no position on House Bills 4949 – 4959 and Senate Bills 474 – 479.

Members with any questions may contact Elizabeth Kutter at the MHA.

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.

Governor Signs New Budget Including Investments in Hospitals

Member News
capitol building

capitol buildingGov. Whitmer signed the fiscal year 2024 state budget Aug. 1, which includes $92 million in new investments directly to hospitals. It specifically provides $59 million to support increased Medicaid reimbursement rates at Level I and II trauma centers and $33 million to support an increase in Medicaid inpatient psychiatric reimbursement rates. The signed budget will go into effect Oct. 1.

In addition to the ongoing and targeted new investments, the agreement provides necessary resources to assist hospitals and health systems in advancing the health of individuals and communities throughout Michigan. It maintains funding for the Healthy Michigan Plan, Medicaid, graduate medical education, disproportionate share hospitals and the rural access and obstetrical stabilization pools.

The MHA is also pleased with new investments in workforce by lowering the age for Michigan Reconnect from 25 years to 21 years of age and investing $2.5 million to support recruitment and retention programs for behavioral health professionals. The budget also increases ongoing funding for the Michigan Achievement Scholarship, which provides significantly reduced tuition for many students at public universities.

Consistent with the strategic action plan of the MHA, the budget places a new emphasis on health equity and reducing disparities for maternal health care with specific, targeted new investments. Funding is included for the Michigan Alliance for Innovation on Maternal Health and $49.5 million for community health programs, healthy community zones, IT improvements and mobile health units to address racial disparities in health. Additionally, the budget further expands the Medicaid program by eliminating the five-year waiting period for pregnant and new mothers who are legally residing in Michigan.

Members with questions on the state budget may contact Adam Carlson.

News to Know – July 10, 2023

Member News
  • The MHA submitted a comment letter in response to the Michigan Department of Health and Human Services (MDHHS) Medicaid Policy Bulletin (MMP) 23-39 on Psychiatric Residential Treatment Facilities (PRTF) issued May 30, 2023. The purpose of MMP 23-39 is to establish an MDHHS Medicaid Provider Manual chapter specific to PRTF service providers. The MHA utilized the MHA Behavioral Health Integration Council to inform the development of the comment letter on behalf of MHA member hospitals and health systems. MMP 23-39 was issued with a concurrent final policy effective date of July 1, 2023. Members with questions may contact Lauren LaPine at the MHA.
  • Michigan Medicaid Provider Outreach and Provider Support invite new or currently enrolled doula providers to attend the upcoming Doula 101 webinar scheduled Aug.  2 from 1 – 2 p.m. or Aug. 9 from 10 – 11 a.m. ET. This webinar will introduce providers to the Medicaid basics, offer an overview of the CHAMPS provider enrollment process, how to check a patient’s eligibility, submitting Medicaid fee for service claims, common claim denials and additional resources. Members with questions regarding registering may contact Provider Outreach at MDHHS.
  • MDHHS issued Medicaid Policy Bulletin (MMP) 23-45, Change in Non-Routine Therapy Prior Authorization (PA) Requirements for Medicaid Beneficiaries Residing in a Nursing Facility, June 30 with an effective date of Aug. 1, 2023. The purpose of the policy is to update PA and prescription signature requirements for non-routine therapy services provided to Medicaid beneficiaries residing in a skilled nursing facility. The change is expected to remove significant hurdles to beneficiaries obtaining services that may allow them to regain or retain crucial functionality while residing in a skilled nursing facility. Members with questions may contact Lauren LaPine at the MHA.
  • The MHA and the Huron Consulting Group are hosting the webinar How AI @ Work Will Advance Human Intelligence Aug. 10 from 1 – 2 p.m. The webinar will outline ways to rethink data systems and readiness, clinician training and engagement and ethical frameworks. Gurpreet Dhaliwal, MD, will address each of these and what comes next when AI makes healthcare better, stronger and faster. Members are encouraged to register for the webinar. Registration for these MHA-member events is limited to 25 attendees per session, for a flat rate of $500. Members with questions regarding the webinar series should contact Erica Leyko at the MHA.

Legislative Fiscal Year 2024 State Budget Renews Commitment to Healthcare

News Releases, Member News, Issues in Healthcare, Top Issues - Healthcare
Brian Peters

The following statement can be attributed to Brian Peters, CEO of the Michigan Health & Hospital Association.

Brian PetersThe fiscal year 2024 state budget approved by the Michigan Legislature renews a longstanding commitment lawmakers have made to the health and wellness of Michigan’s hospitals, health systems and communities.

We are extremely pleased to see the inclusion of new funding to support trauma centers and inpatient psychiatric services that will provide a net benefit of $92 million. Trauma centers at hospitals provide lifesaving treatment to people with the most severe injuries, ready at a moment’s notice for mass casualty events and catastrophic accidents with a vital network of EMS services. This added funding makes Michigan a national leader in recognizing the importance of access to trauma services and makes sure trauma centers can continue to be equipped with the resources needed to staff these services 24/7, year-round.

Michigan is also in the middle of a behavioral health crisis where the demand of patients needing inpatient care continues to increase. We commend the Legislature for recognizing this need and increasing rates to inpatient psychiatric facilities based on patient acuity to help hospitals afford the staffing, security and facilities necessary to accept patients with more severe illness.

In addition, the budget continues to support long-standing programs crucial to access to healthcare services throughout Michigan. These include funding for rural and critical access hospitals, obstetrical services, graduate medical education, the Healthy Michigan Plan and Michigan’s Medicaid population.

We look forward to a signed budget that provides hospitals with the needed support to continue to provide high-quality care to every patient.

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.

MHA Enrollment Data Analysis Expansion

Member News

The MHA recently expanded its analysis of enrollment data to reflect Medicare and Medicaid enrollment as a percentage of each county’s total population and the split for Medicare and Medicaid between fee-for-service and managed care organizations. Statewide, nearly 22% of the total population is enrolled in Medicare and 32% enrolled in Medicaid.

Total Medicaid enrollment, including the Healthy Michigan Plan, is 3.2 million as of April 2023, with 71% of beneficiaries enrolled in one of nine managed care plans. The MHA will update this data monthly as we monitor the impact of the Medicaid redetermination process that requires eligibility be redetermined for all enrollees over the next 12 months. The Michigan Department of Health and Human Services began the process April 1, with some enrollees expected to lose coverage July 1.

Total Medicare enrollment is 2.17 million with 59% of beneficiaries enrolled in a Medicaid Advantage (MA) plan. April enrollment is spread across 48 MA plans with up to 28 plans covering beneficiaries in several Michigan counties. The MHA will also update this data monthly as Michigan’s population continues to age and MA enrollment continues to grow.

Members are encouraged to review the MHA’s COVID-19 PHE webpage for information about the end of the PHE and additional resources.

Members with enrollment questions should contact Health Finance at the MHA.

Final Medicaid Bulletin on Continuous Glucose Monitoring Systems

Member News

The Michigan Department of Health and Human Services issued a final Medicaid Policy Bulletin May 1 with revisions to the Continuous Glucose Monitoring Systems (CGMS) Policy.

In response to the proposed policy issued April 1, the MHA submitted a comment letter, offering seven recommended changes. Three of the seven changes the MHA suggested were adopted in the final policy:

  • Removal of a daily blood glucose testing requirement.
  • Removal of provider documentation requirements for the daily number of finger-stick tests prescribed.
  • Changing the requirement for diabetes self-management education from annual to bi-annual. This requirement became optional.

The additional suggestions not adopted include:

  • Removal of the provider documentation requirement for daily frequency of insulin administered.
  • Removal of the provider documentation requirement for beneficiary treatment plan and compliance.
  • Update the 90-day provider documentation requirement to align with the bi-annual monitoring requirement for CGMS.
  • Add Type II diabetes as a condition where prior authorization is not required.

This policy will go into effect June 1, 2023.

Members with questions may contact Kelsey Ostergren at the MHA.