Tag: Medicare

MHA Monday Report March 25, 2024

Monday Report
MHA Monday Report

Registration Open for Webinar on Virtual Care Models

Registration is open for the MHA webinar, Virtual Care Models that Improve Engagement and Support Staff, scheduled from noon to 1 p.m. May 2. Attendees will learn from experts and peers about how hospitals and …

Healthcare Leadership Award Nominations Due March 29

Nominations are being accepted for the annual MHA Healthcare Leadership Award, which honors those who have demonstrated outstanding healthcare leadership within individual facilities and in their communities. The deadline to nominate an exceptional healthcare trustee, …

Updates on Medicare Advantage Enrollment in Michigan

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. …

The Keckley Report

Paul KeckleyIt’s time to Repair the Affordable Care Act

This Saturday marks the 14th anniversary of the Affordable Care Act passage. It is arguably the most consequential healthcare legislation since passage of the Medicare and Medicaid Act in 1965. …

So, at best, the ACA moved needles in each of the three but its effectiveness is a mixed bag. Nonetheless, it has survived 7 Supreme Court challenges and more than 70 Repeal votes in Congress and is now a permanent fixture in healthcare’s regulatory framework. Hanging chads aside, it is here to stay.

The need for ACA 2.0 is apparent and urgent. The motivation to initiate the process is uncertain: tribalism in U.S. healthcare, where near-term advantage takes precedent over long-term solutions by many organizations, is the rule, not the exception.

What’s needed is a coalition committed first and foremost to the long-term future of the health system: it doesn’t exist today.”

Paul Keckley, March 18, 2024

News to Know

The American Hospital Association (AHA) is accepting applications for the AHA’s 2025 Foster G. McGaw Prize.

MHA in the News

The MHA received media coverage since March 15 on efforts to reform the state’s auto no-fault insurance system as well as the future for healthcare teams. The Detroit News published an article March 17 describing …

Congressional Spending Package Solidifies Medicare SUD Coverage

Member News

The President signed March 9 a six-bill Congressional funding package to avoid a federal government shutdown that evening. The funding package included several healthcare provisions, including a measure expanding access to substance use disorder (SUD) services.

Specifically, the legislation permanently requires state Medicaid plans to cover medication-assisted treated for opioid use disorder. This includes counseling services, behavioral therapy and methadone. The bills also add the option for states to cover care in Certified Community Behavioral Health Clinics, as well as Institutions of Mental Disease, regardless of the size of the facility, for up to 30 days per 12-month period. The MHA will follow-up with the Michigan Department of Health and Human Services  to ensure the Michigan Medicaid program is prepared to comply.

Finally, the package calls for states to monitor the prescribing of antipsychotic medications to adults in institutional care setting, home health and community-based settings and requires the U.S. Department of Health and Human Services to issue guidance on integrating behavioral health services with other medical services under Medicaid and the Children’s Health Insurance Program.

The following healthcare measures were also included in the funding package:

  • Eliminated Medicaid Disproportionate Share Hospital cuts for fiscal year (FY) 2024 and delays FY 2025 cuts until Jan. 1, 2025.
  • Provides partial relief for Medicare physician reimbursement rates by increasing the Medicare conversation factor adjustment from 1.25% to 2.93%. This results in a final cut of 1.66%, compared to a previously expected 3.4% cut.
  • Extends incentive payments for alternative payment models though calendar year 2026.
  • Extends the Work Geographic Index Floor (GPCI) under the Medicare program by extending a 1.0 floor on the GPCI through Dec. 31, 2024.
  • Extends the Medicare-dependent hospital and enhanced low-volume hospital programs for three months through Dec. 31, 2024 opposed to Sept. 30, 2024.

Members with questions should contact Megan Blue at the MHA.

 

 

MHA Monday Report March 11, 2024

Monday Report
MHA Monday Report

capitol buildingMichigan Legislature Advances Healthcare and Economic Measures

The Michigan Legislature reviewed, discussed and moved forward legislation the week of March 4 that positively impacts patients, hospitals and health systems. Notably, the legislature took final action a bill related to the Renaissance Zone …

Congressional Spending Package Solidifies Medicare SUD Coverage

The President signed March 8 a six-bill Congressional funding package to avoid a federal government shutdown that evening. The funding package included several healthcare provisions, including a measure expanding access to substance use disorder (SUD) …

Michigan HR Professionals Gathers at the MHA HR Conference

More than 90 healthcare human resources (HR) professionals from across the state gathered at the MHA Human Resources Conference March 5 in Lansing. Attendees participated in hands-on facilitated discussions that developed innovative ideas focused on …

Change Healthcare Outage Continues to Impact Members

The MHA has been in close contact with the American Hospital Association, the Michigan Healthcare Security Operations Center and other partners regarding the Change Healthcare cyberattack that has impacted hospitals nationwide over the …

MHA Behavioral Health Learning Series: Second Webinar

The MHA is hosting a five-part webinar series to provide hospital staff with a deeper understanding of Michigan’s behavioral health system and the hospital’s role in connecting patients with care. These webinars are part of …

MIHI Hosts Webinar Series on BEAD State Challenge Process

The Michigan High-Speed Internet Office (MIHI) will be hosting three educational webinars to answer questions about the Broadband Equity Access and Deployment (BEAD) State Challenge Process, which is currently pending approval from the National Telecommunications …

MHA Podcast Uplifts Importance of Submitting Adverse Event Data to Improve Patient, Staff Safety

The MHA released a new episode of the MiCare Champion Cast during Patient Safety Awareness Week to uplift why hospitals should prioritize submitting adverse event data, in addition to what can be done to improve the culture around reporting. …

The Keckley Report

Paul KeckleyHealthcare Spending 2000-2022: Key Trends, Five Important Questions

“Last week, Congress avoided a partial federal shutdown by passing a stop-gap spending bill and now faces March 8 and March 22 deadlines for authorizations including key healthcare programs. …

The reality is this: no one knows for sure what the U.S. health economy will be in 2025 much less 2035 and beyond. There are too many moving parts, too much invested capital seeking near-term profits, too many compensation packages tied to near-term profits, too many unknowns like the impact of artificial intelligence and court decisions about consolidation and too much political risk for state and federal politicians to change anything. …”

Paul Keckley, March 4, 2024

News to Know

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.

MHA CEO Brian PetersMHA in the News

Chief Healthcare Executive published an article March 5 about the impact of the Change Healthcare cyberattack on hospitals and health systems across the country. The publication spoke with several state hospital associations representing Michigan, Florida, …

CMS Finalizes Physician Fee Schedule for 2024

Member News

The Centers for Medicare & Medicaid Services (CMS) released the calendar year 2024 Medicare Physician Fee Schedule final rule Nov. 2, aimed at promoting healthcare equity and expanding access to essential services for Medicare beneficiaries. These policies include several crucial areas, such as behavioral health strategies, caregiver support, oral and dental health services linked to cancer treatments, enhancements to the Medicare Diabetes Prevention Program and assessments of social determinants of health.

Building on the agency’s commitment to health equity, CMS is finalizing coding and payment mechanisms for caregiver training services to ensure that healthcare practitioners are compensated for helping Medicare beneficiaries adhere to treatment plans. These are the first Physician Fee Schedule services to include payment for community health workers to address unmet social needs and enable person-centered planning.

The rule also finalizes payments for risk assessments for social determinants of health to ensure seamless integration into healthcare visits.

Lastly, the CMS Behavioral Health Strategy enhances emotional and mental well-being through behavioral health care. This rule creates a mechanism for marriage and family therapists and mental health counselors, including addiction, alcohol or drug counselors, to enroll in Medicare and bill for services beginning January 1, 2024. It also increases payment for crisis care, substance use disorder treatment, psychotherapy and Health Behavior Assessments and Intervention services.

Members with questions may contact Lauren LaPine at the MHA.

OPPS 2024 Final Rule Released

Member News

The Centers for Medicare and Medicaid Services (CMS) recently released a final rule to update the Medicare fee-for-service (FFS) outpatient prospective payment system (OPPS) effective Jan. 1, 2024.

The rule:

  • Provides a net 2.1% to the outpatient conversion factor for hospitals that report quality measure data. This will increase the factor from the current $85.58 to $87.38, after the 3.3% market basket is reduced for the required productivity cut, budget neutrality and other adjustments.
  • Continues paying average sales price plus 6% for drugs and biologicals acquired under the 340B drug discount program.
  • Consolidates the use of modifiers, “JG” and “TB”, for 340B drugs effective Jan. 1, 2024, with hospitals having the option to continue reporting the “JG” modifier or transition to solely using the “TB” modifier during 2024.
  • Implements several provisions of the Consolidated Appropriations Act that will expand access to behavioral health services including:
    • Adopting an additional, untimed code for virtual group psychotherapy and making technical refinements to how these codes are recorded that would allow billing for multiple units on the same day.
    • Delaying the requirement for an in-person visit within six months prior to the first virtual mental health service and within 12 months after virtual remote mental health service until Jan. 1, 2025.
    • Establishing an intensive outpatient program (IOP) benefit beginning Jan. 1, 2024, with regulatory changes to ensure consistency in requirements among rural health clinics, federally qualified health centers and hospitals. The requirements govern:
      • The scope of benefits and definition of IOP services paid on a per-diem basis.
      • Minimum number of hours of IOP services per week (nine) and frequency (at least every other month) for IOP coverage eligibility.
      • Payment rates, established as two ambulatory payment classifications for each provider type and number of services per day.
  • Expands the practitioners who may supervise cardiac rehabilitation, intensive cardiac rehabilitation and pulmonary rehabilitation services to include nurse practitioners, physician assistants and clinical nurse specialists. The CMS also allows for the direct supervision of these services to include virtual presence through audio-video, real-time communications technology (excluding audio-only) through Dec. 31, 2024, and extends this policy to these non-physician practitioners, who are eligible to supervise these services in CY 2024.
  • Adds 10 services to the inpatient only list.
  • Updates the outpatient quality reporting program.
  • Adds 26 dental surgical procedures and 11 additional procedures to the ambulatory surgical center covered procedure list for CY 2024.
  • Adopts four quality measures for required reporting beginning in CY 2024 for rural emergency hospitals:
    • Abdomen CT – Use of Contrast Material.
    • Median Time from ED Arrival to ED Department for Discharged ED Patients.
    • Facility Seven-Day Risk-Standardized Hospital Visit Rate after Outpatient Colonoscopy.
    • Risk-Standardized Hospitals Visits Within Seven Day After Hospital Outpatient Surgery.
  • Requires hospitals to utilize a standard template for hospital transparency files, including additional required data elements and establishes additional CMS enforcement mechanisms for reporting requirements. While hospitals need to utilize the new format by July 1, 2024, several of the new data elements will not be required until Jan. 1, 2025.

The MHA will provide hospitals with an updated estimated impact analysis within the next several weeks.

Members with questions should contact Vickie Kunz at the MHA.

2024 Medicare Home Health Final Rule Released

Member News

The Centers for Medicare and Medicaid Services (CMS) recently released a final rule to update the home health (HH) prospective payment system (PPS) for calendar year (CY) 2024. The rule includes updates to the Medicare fee-for-service (FFS) HH PPS payment rates based on changes by the CMS and those previously adopted by Congress.

Highlights of the final rule which takes effect Jan. 1, 2024, include:

  • A negative 2.89% behavioral offset to achieve budget neutrality due to the transition to the Patient-driven Groupings Model (PDGM). This is half of the estimated permanent adjustment of 5.78%.
  • A 30-day standard payment rate of $2,038.13, for home health agencies that submit the required quality data. This is a 1.4% increase from the current rate after the 3% market basket update is reduced for the negative behavioral adjustment and budget neutrality.
  • Recalibration of the PDGM case-mix weights, low utilization payment adjustment thresholds, functional levels and comorbidity adjustment subgroups.
  • Updates to the expanded HH value-based purchasing program previously expanded to all 50 states. All HH agencies certified before Jan. 1, 2022, will have a reduction or an increase to their Medicare payments by up to 5% based on their performance on specified quality measures beginning in CY 2025.
  • The adoption of two new measures to the HH quality reporting program with the CMS finalizing the removal of two measures and public reporting of four measures.
  • Payment rates for the administration of home intravenous immune globulin items and Services.
  • Creation of the hospice informal dispute resolution and special focus programs.
  • Changes to durable medical equipment, prosthetics, orthotics and supplies outlined by the Consolidated Appropriations Act of 2023.
  • A decrease in the labor-related share of the HH 30-day period standard rate from 76.1% in 2023 to 74.9%.

 

The MHA will provide an updated impact analysis of the final rule in the near future.

Members with questions should contact Vickie Kunz at the MHA.

News to Know – Nov. 6, 2023

Member News
  • The MHA will host a virtual member from 2 to 3 p.m. on Nov. 9 to outline the MHA 2023 – 2024 strategic action plan approved by the MHA Board of Trustees.The forum will review the priorities and tactics to accomplish goals and how the membership can support these initiatives along with presentations from MHA CEO Brian Peters and other MHA leaders. There is no cost to attend, but members are asked to register by Nov. 7. Access information for the virtual session will be sent Nov. 8. Questions about the member forum can be directed to  at the MHA.
  • The Centers for Medicare and Medicaid Services recently released an updated 2024 Medicare & You Handbook which provides information for patients regarding traditional Medicare, Medicare prescription drug plans, Medicare Advantage and more. Members with questions may contact Vickie Kunz at the MHA.

Healthcare Legislative Activity Includes Hearings on Auto No-Fault

Member News, Issues in Healthcare, Top Issues - Healthcare
capitol building

capitol buildingHealthcare legislative activity in the Michigan Legislature included hearings on auto no-fault and several other bills during the week of Oct. 2. The Senate Finance, Insurance and Consumer Protection Committee held their first hearing on Senate Bills (SBs) 530 and 531. Introduced by Sen. Mary Cavanagh (D-Redford Twp.) and Sen. Sarah Anthony (D-Lansing), the legislation would adjust the hospital fee schedule, clarify the definition of Medicare and provide rate certainty for post-acute care providers. The MHA is supportive of this legislation and will be testifying in an upcoming committee hearing on the importance of hospital access for individuals involved in an auto accident.

The House Health Policy Committee voted out two MHA supported bills, House Bill (HB) 4101 and SB 384. Sponsored by Rep. Curt VanderWall (R-Ludington), HB 4101 would increase the time a speech language pathologist’s temporary license can be active while they complete required training. SB 384, sponsored by Sen. Kevin Hertel (D-St. Clair Shores), would prohibit insurers from discriminating against living organ donors. Further, the committee took testimony on two separate packages of bills. HBs 4131, 4213, 4579 and 4580 would increase telehealth access while HBs 4504, 4505, 4169 and 4170 would add Michigan to the interstate physical therapy and occupational therapy licensure compacts. The MHA is supportive of both the increases to telehealth access and licensure compact legislation.

The Senate Civil Rights, Judiciary, and Public Safety Committee took up SB 410, sponsored by Sen. Jeff Irwin (D-Ann Arbor), which would rescind prescription drug product immunity from liability, therefore allowing pharmaceutical drug product liability claims in the state. Current immunity has resulted in several complaints against manufacturers being dismissed. This legislation would allow complaints to move forward on their merits. The MHA is supportive of this legislation.

Lastly, the Senate Health Policy Committee took up SB 27, sponsored by Sen. Sarah Anthony (D-Lansing), which would ensure that behavioral health parity is meaningfully applied in Michigan. The MHA is supportive of this legislation as well as HB 4707, sponsored by Rep. Felicia Brabec (D-Ann Arbor). Both bills look to expand and protect access to behavioral health services through insurance coverage parity.

Members with questions about state legislative action may contact Adam Carlson at the MHA.

Auto No-Fault Legislation Highlights Healthcare Activity in Michigan Legislature

Member News
capitol building

capitol buildingSenate Bills (SBs) 530 and 531 were introduced Sept. 26 by Sen. Mary Cavanagh (D-Redford Twp.) and Sen. Sarah Anthony (D-Lansing) that would adjust the hospital fee schedule, clarify the definition of Medicare and provide rate certainty for post-acute care providers. Specifically, the legislation would eliminate the various rate tiers for reimbursement and coalesce hospitals around the national median reimbursement rate of 250% of Medicare. Additionally, the legislation clarifies the definition of Medicare based upon actual reimbursement experience at hospitals. The MHA issued a media statement in support of the legislation, which also creates fee schedules for post-acute care providers and adjusts the provisions related to attendant care. The legislation is referred to the Senate Insurance Committee and the MHA will keep members updated on its progress.

The legislature continued its breakneck pace this week with numerous healthcare bills seeing both committee action.

The Senate Finance, Insurance and Consumer Protection Committee voted out SBs 483, 484 and 485 sponsored by Sen. Darrin Camilleri (D-Trenton), Sen. Veronica Klinefelt (D-Eastpointe) and Sen. Kristen McDonald Rivet (D-Bay City). The legislation, creating the Prescription Drug Affordability Board, was reported along party lines with Senator Mark Huizenga (R-Walker) passing based on a potential conflict of interest. The MHA continues to work with the sponsors, stakeholder, and leadership on this legislation to ensure it accurately reflects the important role hospitals serve as purchasers and administrators of prescription drugs. The MHA is opposed to the package as it is currently written.

The Senate Health Policy Committee took up SB 133, sponsored by Sen. Sean McCann (D-Kalamazoo), which creates the Overdose Fatality Review Act. The act would allow for the establishment of overdose fatality review teams to identify potential causes of drug overdoses, as well as recommend solutions to address drug overdoses. The MHA successfully recommended changes to reflect more appropriate information sharing practices and timelines and supports this legislation. In addition, the committee reported out House Bills (HBs) 4619, 4620, 4621, 4622 and 4623, codifying aspects of the Affordable Care Act in state law. The MHA supports this work.

The House Insurance and Financial Services Committee took up several of the Affordable Care Act codification bills including SBs 356, 357 and 358 sponsored by Sen. Kevin Hertel (D-St. Clair Shores), Sen. Mary Cavanagh (D-Redford Twp.) and Sen. Veronica Klinefelt (D-Eastpointe). Both SBs 356 and 357 failed to garner enough votes in committee to be voted out of committee. SB 358 was reported to the House Floor. The MHA supports this legislation and looks forward to seeing the remaining bills reported favorably to the House floor next week.

Finally, the House Health Policy Committee took testimony on two pieces of MHA supported legislation. HB 4101, sponsored by Rep. Curt VanderWall (R-Ludington), would allow for the issuance and extended renewal period of a temporary license for individuals completing their required supervised clinical hours as a speech language pathologist (SLP). Extending the timeline for supervised clinical hour completion will deter new graduates from leaving the state to complete their supervised hours and will assist in the retention of SLPs in Michigan.

SB 384, sponsored by Sen. Kevin Hertel (D-St. Clair Shores), prohibits a disability insurer, long term care insurer or life insurer from discriminating against an individual based on their status as a living organ donor. Individuals who choose to be a living organ donor must meet stringent requirements and many of those who do donate continue to live similarly healthy lives post donation. However, the possibility of discrimination could deter individuals from choosing to be a living donor and therefore limiting access to organs for those most in need. Prohibiting discrimination based on living donor status could increase organ availability, ultimately supporting opportunities for individuals in need of an organ transplant.

Members with questions about state legislative action may contact Adam Carlson at the MHA.

MHA Monday Report June 19, 2023

Monday Report
MHA Monday Report

MHA Members Testify in House Judiciary Committee

Several MHA members testified June 13 to the House Judiciary Committee in support of legislation that would increase the fines for assaulting a healthcare professional or volunteer. House Bills 4520 and 4521 were introduced …

MI Hospital Careers Campaign LogoMHA Launches MI Hospital Careers Healthcare Career Campaign

Michigan hospital and education leaders joined forces June 8 to highlight the current state of Michigan’s healthcare workforce shortage and launch a campaign to expand interest in health careers in Michigan. The goal of the …

Webinar Reviews Medicare FFS Quality-based Programs

The MHA and Data Gen hosted June 14 the second webinar focused on the Medicare fee-for-service (FFS) quality-based programs to review the Medicare readmissions reduction program and hospital-acquired conditions reduction programs. The Medicare …

MDHHS Informs Hospitals on Medicare Crossover Files Issue

The Michigan Department of Health and Human Services (MDHHS) recently notified hospitals about an issue with the Medicare crossover files from the Centers for Medicare & Medicaid Services (CMS) that impacts CMS files from May …

New Pediatric Specialty Loan Repayment Program

The Department of Health and Human Services launched a $15 million loan repayment program to recruit and retain clinicians who provide healthcare to children and adolescents. The Pediatric Specialty Loan Repayment Program aims to …

MDHHS Releases REH Medicaid Reimbursement Final Policy

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 …

Preceptor Training Available Through HRSA Grant

Michigan nurses have an opportunity to participate in preceptor training as part of a Health Resources and Services Administration (HRSA) Nurse Education, Practice, Quality and Retention Clinical Faculty and Preceptor Academy grant awarded to Southern …

2023 Ludwig Nominee: Trinity Health Coalition Working to Prevent Youth Suicide

Since 1990, the MHA has honored member healthcare organizations working to enrich the overall welfare of their local communities through the Ludwig Community Benefit Award. This year, the MHA is excited to showcase all award nominees, …

The Keckley Report

Paul KeckleySenate Finance Hearing on Hospital Consolidation: Political Theatre or Something More?

“Congress’ concern about consolidation in healthcare is broad-based. Pharmacy benefits managers and health insurers face similar scrutiny. Drug price control referenda have passed in several states and a federal cap was included in the Inflation Reduction Act. The reality is this: the entire U.S. health system is on trial in the court of public opinion for ‘careless disregard for affordability’. And hospitals are seen as part of the problem justifying consolidation as a defense mechanism. …

Sadly, this hearing is the latest evidence that the good will built by hospital heroics in the pandemic is now forgotten. It’s clear hospital consolidation is an issue that faces strong and increased headwinds with evidence mounting—accurate or not– showing more harm than good. …“

Paul Keckley, June 12, 2023

 

News to Know

  • MHA offices will be closed and no formal meetings will be scheduled June 19 in honor of Juneteenth.
  • MHA Endorsed Business Partner Medical Solutions’ Chief Nursing Officer, Patti Artley recently spoke with Becker’s Hospital Review to offer expert insight into the complex challenges facing nurses today and the proven strategies healthcare leaders must adopt to initiate lasting change.
  • Medicare prospective payment system hospitals are reminded that the completed 2022 occupational mix survey is due to the Medicare Administrative Contractor on June 30, 2023.

Sam WatsonMHA in the News

The MHA received media coverage the week of June 12 regarding prescription drug costs, COVID-19 and behavioral health. MHA representatives appearing in published stories include CEO Brian Peters, Senior Vice President Sam Watson and Senior …