The MHA recently updated its analysis of Medicare enrollment data to reflect Medicare enrollment as a percentage of each county’s total population and the split for Medicare between traditional fee-for-service (FFS) and Medicare Advantage (MA). Statewide, 22% of the total population is enrolled in Medicare.
Total Medicare enrollment is approximately 2.21 million with 61% of beneficiaries enrolled in a Medicare Advantage (MA) plan. MA enrollment as a percentage of total Medicare enrollment varies by county, ranging from 45% to 76%. January enrollment is spread across 52 MA plans with up to 30 plans covering beneficiaries in some Michigan counties.
Members with enrollment questions should contact the Health Finance team at the MHA.
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. …
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 …
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 …
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 …
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 …
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 …
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 …
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, …
“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….???”
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.
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.
The Michigan Business Network (MBN) hosted the 2024 Economic Forecast Breakfast Jan.11, which featured the inaugural release of the latest Michigan Future Business Index survey data, 2023 reviews and a look ahead on regional economic, …
Hospitals are urged to apply for additional graduate medical education (GME) full-time equivalent resident cap slots for fiscal year 2025 by March 31. Section 126 of the Consolidated Appropriations Act, 2021, made available …
In partnership with the Michigan Department of Health and Human Services, the MHA conducted a survey during Spring 2023 to gather insights on Assisted Outpatient Treatment (AOT) utilization within hospitals and health systems. AOT offers …
The MHA recently updated its analysis of Medicare enrollment data to reflect Medicare enrollment as a percentage of each county’s total population and the split for Medicare between traditional fee-for-service and Medicare Advantage. Statewide, …
“Healthcare is big business. That’s why JP Morgan Chase is hosting its 42nd Healthcare Conference in San Francisco starting today– the same week Congress reconvenes in DC with the business of healthcare on its agenda as well. The predispositions of the two toward the health industry could not be more different. …
The big question facing JPM attendees this week and in Congress over the next few months is the same: is the U.S. healthcare system status quo sustainable given the needs in other areas at home and abroad? Investors and organizations at JPM think the answer is no and are making bets with their money on “better, faster, cheaper” at home and abroad. Congress agrees, but the political risks associated with transformative changes at home are too many and too complex for their majority. …”
The MHA received media coverage since Jan. 4 related to hospital cybersecurity, proposed legislation mandating hospital nurse staffing ratios and maternal health. Below is a collection of headlines from around the state, which include interviews …
The MHA recently updated its analysis of Medicare enrollment data to reflect Medicare enrollment as a percentage of each county’s total population and the split for Medicare between traditional fee-for-service and Medicare Advantage (MA). Statewide, nearly 22% of the total population is enrolled in Medicare.
Total Medicare enrollment is approximately 2.21 million, with 60% of beneficiaries enrolled in a MA plan. MA enrollment as a percentage of total Medicare enrollment varies by county, ranging from 43% to 75%. November enrollment spread across 49 MA plans with up to 32 plans covering beneficiaries in some Michigan counties.
The MHA recently submitted comments to the Centers for Medicare & Medicaid Services (CMS) on the 2025 MA proposed rule. The MHA continues to urge the CMS to hold MA plans accountable for complying with provisions of the 2024 MA final rule and recommend the CMS impose intermediate sanctions, civil monetary penalties or terminate contracts of noncompliant plans.
Members with enrollment questions should contact the Health Finance team at the MHA.
The Centers for Medicare and Medicaid Services (CMS) recently released a final rule for Medicare Advantage plans (MA) and the Medicare Prescription Drug Benefit Program for calendar year (CY) 2024.
The rule increases oversight of MA plans and seeks better alignment with Medicare fee-for-service (FFS), including clarifying that MA plans cannot use clinical criteria guidelines that are more restrictive than Medicare FFS to ensure that MA beneficiaries receive access to the same medically necessary care which is increasingly important as enrollment in MA continues to grow.
As recently reported, 59% of Michigan’s total Medicare beneficiaries are enrolled in an MA plan, with enrollment by county ranging from 42% to 75%. The final rule:
Prohibits MA plans from limiting or denying coverage for a Medicare-covered service based on their own internal or proprietary criteria if such restrictions do not exist under Medicare FFS.
Explicitly states that MA plans must adhere to the Two-Midnight Rule, the Inpatient Only List and case-by-case expectation criteria that apply for Medicare FFS.
Prohibits MA plans from denying coverage or redirecting post-acute care to a lower level unless the patient explicitly does not meet the Medicare coverage criteria required for the recommended level of care.
Explicitly states that MA plans must provide both coverage and payment for care provider to stabilize an emergency medical condition determined using the prudent layperson standard regardless of the final diagnosis.
Requires health plan physician or other professionals to have expertise in the field of medicine related to the service being requested in the prior authorization (PA).
Requires PAs to be valid for an entire course of approved treatment and provide a minimum 90-day transition period if an enrollee undergoing treatment switches to a new MA plan.
Establishes additional processes to oversee MA plan utilization management programs including an annual review of policies to ensure compliance with Medicare rules and consistency with current clinical guidelines.
Strengthens behavioral health network adequacy requirements in several ways:
MA plans are currently required to provide access to an adequate network of “appropriate providers”, including primary care physicians, specialists, hospitalists and others. Plans are also required to demonstrate that the network includes an adequate number of psychiatrists and inpatient psychiatric facilities. This rule adds providers that specialize in behavioral health services to this list, including clinical psychologists and licensed clinical social workers.
Codifies standards for appointment wait times for primary care and behavioral health services.
Clarifies that emergency behavioral health services are not subject to PA.
Requires MA plans to notify enrollees when the enrollee’s behavioral health or primary care provider is dropped from the network mid-year.
Amends general access to services standards to explicitly include behavioral health services.
Requires MA plans to establish care coordination programs to increase parity between behavioral and physical health services.
Restricts MA plan marketing practices to protect beneficiaries from misleading advertisements and pressure tactics designed to increase enrollment.
Expands requirements for MA plans to provide culturally and linguistically appropriate services.
Establishes a new Health Equity Index to be incorporated into the MA plan Star Ratings beginning in 2027 to improve performance for patients with certain social risk factors.
Implements statutory provisions of the Inflation Reduction Act and the Consolidated Appropriations Act of 2021 related to the prescription drug affordability and coverage for eligible low-income individuals.
The CMS indicates that it intends to release a second rule to address remaining proposals from the December 2022 proposed rule that were not addressed in this rule, with the second rule to have a later effective date, expected to be no earlier than Jan. 1, 2025.
Members with questions should contact Vickie Kunz at the MHA.
The MHA Board of Trustees began its Feb. 8 meeting with a federal advocacy briefing from federal lobbyist Carlos Jackson with Cornerstone Government Affairs. Jackson highlighted the policy and funding threats and opportunities healthcare providers …
Gov. Whitmer released her executive budget recommendation Feb. 8 for fiscal year 2024. The proposed budget fully protects traditional hospital line items for Medicaid and the Healthy Michigan program, continues targeted rate increases from recent budget cycles and includes …
The MHA and rural hospital leaders visited Capitol Hill in Washington D.C. Feb. 7-9 to advocate for specific rural healthcare policies as part of the National Rural Health Association’s Rural Health Policy Institute event. …
Registration is now open for the MHA Keystone Center Safe Patient Handling Conference. The all-day event will take place April 13 at the Ann Arbor Marriott Ypsilanti at Eagle Crest. In partnership with the MHA Keystone Center, EarlyMobility.com …
Medicare Advantage (MA) enrollment in Michigan totaled approximately 1.25 million in January, an increase of 33,000 beneficiaries since October. The January enrollment is spread across 48 MA plans that are currently operating in the state, …
“Wave One of the Value Based Care environment was marginally effective: CMS’ alternative payment models showed promise but savings to Medicare fell short of expectations per MedPAC. Medicare Advantage enrollment grew but plan sponsors were overpaid by Medicare. Hospital avoidable readmissions and complications efforts have been successful but the pandemic economy decapitated hospital resources necessary to compete in the value-based environment. Wave One is a mixed bag. …
The Wave Two Value Agenda in U.S. healthcare will impact every player and be messy. The backdrop of the 2024 Campaign cycle and post-pandemic economy mean impetus will shift from resource-constrained Medicare to the private sector as both offer significant but distinct opportunities for lower spending. And the revolution of generative AI assures shortcomings of the system—diagnostic error, administrative waste, fraud—will be widely exposed. …”
Prospective payment system hospitals are reminded that any requests for corrections to the January public use file data being used by the Centers for Medicare and Medicaid Services to develop the fiscal year 2024 Medicare wage index must be received, along with supporting documentation, by the Medicare Administrative Contractor by Feb. 15, 2023.
MHA Endorsed Business Partner Demand Workforce/Qodex will host a free 30-minute webinar on Mission Impossible: Let’s Talk About How to Heal Your Staffing Crisis at noon ET Feb. 22 to discuss healthcare trends in staffing including creative approaches to deliberately using your nursing workforce.
The MHA received media coverage the week of Feb. 6 regarding a variety of topics, including the fiscal year 2024 executive budget recommendation, the role food insecurity has as a social determinant of health, the new state House Behavioral …
Medicare Advantage (MA) enrollment in Michigan totaled approximately 1.22 million in October, an increase of 17,000 beneficiaries since July. The October enrollment is spread across 48 MA plans that are currently operating in the state, with approximately 56.5 percent of Michigan’s 2.15 million Medicare beneficiaries covered by an MA plan. With up to 48 plans covering beneficiaries in some Michigan counties, a significant burden has been created for hospitals, which may be intensified if MA plans conduct their own audits for medical necessity and other utilization issues.
To assist hospitals in identifying which MA plans are currently operating in their region, the MHA has updated the list of plans in each Michigan county, based on July enrollment.
Members with questions should contact Katie Jaskolski at the MHA.
Medicare Advantage (MA) enrollment in Michigan totaled approximately 1.2 million in July, an increase of 15,000 beneficiaries since April. The July MA enrollment is spread across 47 MA plans that are currently operating in the state, with approximately 56% of Michigan’s 2.1 million Medicare beneficiaries covered by an MA plan.
Hospitals are encouraged to carefully review payments from each MA plan to ensure that the plan has paid the correct rates. With up to 30 plans covering beneficiaries in some Michigan counties, a significant burden has been created for hospitals, which may be intensified if MA plans conduct their own audits for medical necessity and other utilization issues.
To assist hospitals in identifying which MA plans are currently operating in their region, the MHA has updated the list of plans in each Michigan county based on July enrollment. In addition to the 47 plans currently licensed in the state, Michigan hospitals often treat patients covered by MA plans licensed in other states, further complicating the payment process. Members with questions should contact Katie Jaskolski at the MHA.
Medicare Advantage (MA) enrollment in Michigan totaled approximately 1.18 million in April, an increase of 23,000 beneficiaries since January. The April MA enrollment is spread across 46 MA plans that are currently operating in the state, with approximately 56 percent of Michigan’s 2.1 million Medicare beneficiaries covered by an MA plan.
Hospitals are encouraged to carefully review payments from each MA plan to ensure that the plan has paid the correct rates. With up to 31 plans covering beneficiaries in some Michigan counties, a significant burden has been created for hospitals, which may be intensified if MA plans conduct their own audits for medical necessity and other utilization issues.
To assist hospitals in identifying which MA plans are currently operating in their region, the MHA has updated the list of plans in each Michigan county, based on April enrollment. In addition to the 46 plans currently licensed in the state, Michigan hospitals often treat patients covered by MA plans licensed in other states, further complicating the payment process. Members with questions should contact Katie Jaskolski at the MHA.
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