News to Know – Week of Jan. 10

Hospital staff are encouraged to participate in a national webinar hosted by DataGen to review the Medicare fee-for-service outpatient prospective payment system final rule and impact analysis for calendar year 2022. The webinar is scheduled from 3 to 4 p.m. Jan. 19 and is available free of charge; however, registration is required. The MHA plans to distribute hospital-specific impact analyses before the webinar takes place. Members with questions should contact Vickie Kunz at the MHA.

Advocacy Continues to Defend Healthcare from Harmful Federal Policies

President Joe Biden Dec. 10 signed legislation to postpone several proposed cuts in Medicare rates recently approved by Congress. The MHA and the American Hospital Association had urged lawmakers to delay the cuts that would have taken effect Jan. 1 due to the pandemic-related financial pressures healthcare providers continue to experience. Provisions in the legislation include:

  • Eliminating the 2% Medicare sequester cuts from Jan. 1 to April 1, 2022. The legislation would also reduce the cut to 1% from April 1 to June 30, 2022. Absent future legislation, the 2% cuts will take effect July 1, 2022. The package is being funded by increasing the sequester percentage in 2030.
  • Halting the 4% statutory Pay-As-You-Go (PAYGO) sequester for 2022 and adding them to the “2023 scorecard.” This will require additional advocacy with the Congress in late 2022 to eliminate these cuts again.
  • Mitigating the 3.75% payment cut to the Medicare physician fee schedule (PFS) payments finalized for calendar year 2022 by implementing a one-year 3% increase to the PFS conversion factor.
  • Delaying the Clinical Laboratory Fee Schedules cuts for one year, from Jan. 1, 2022, to Jan. 1, 2023. The requirements that certain hospital laboratories report their private payer clinical laboratory test codes, payments and volume data are also delayed.
  • Delaying implementation of the Radiation Oncology Model finalized in the 2022 Medicare outpatient prospective payment system final rule from Jan. 1, 2022, to Jan. 1, 2023.

Despite the limits on visiting Capitol Hill due to the COVID-19 pandemic, the MHA is continuing its work with the Michigan delegation using virtual connections to protect hospitals and other providers from detrimental payment cuts and other healthcare policies. Members with questions regarding payment implications should contact Vickie Kunz at the MHA, while questions regarding advocacy efforts should be addressed to Laura Appel at the MHA.

MHA Monday Report Nov. 22, 2021

MHA Covid-19 updateCombating the Novel Coronavirus (COVID-19): Week of Nov. 15

Michigan is once again among the states with the highest numbers of COVID-19 cases in the nation, with the New York Times reporting that Michigan and Minnesota lead the country in cases per capita. On Nov. 19, there were 3,424 adults hospitalized with confirmed cases of COVID-19, in addition to …


Out-of-state Licensure Provider Exemption to Expire Jan. 11

The Michigan Department of Licensing and Regulatory Affairs has provided a 30-day notice that the out-of-state licensure provider exemption will no longer be in effect as of Jan. 11, 2022. The MHA worked with the state to develop this provision effective March 16, 2020, and to keep it in effect since …


Medicare Premiums and Deductibles Announced for 2022

The Centers for Medicare & Medicaid Services recently announced that the Medicare Part A deductible for inpatient hospital services will increase by $72 in calendar year  2022 to $1,556. The Part A daily coinsurance amounts …


Webinar Offered to Apprise Providers on Transgender Issues in Healthcare

Transgender and gender nonconforming individuals deal with many common fears that can be debilitating. Healthcare providers need to understand the obstacles that this population faces to improve medical care for their patients. The MHA Health Foundation Transgender Healthcare Dignity Model …


Prepare Now for March Application Period of State Loan Repayment Program

Applications for the 2022 Michigan State Loan Repayment Program will be accepted from March 7-11 through the File Transfer Application System. Providers should create an account in the system as soon as possible, but should not upload their MSLRP application documents before March 7. …


Trustee Insights Edition Highlights Workforce Trends

The latest edition of Trustee Insights, the monthly digital package from the American Hospital Association, is now available. This month’s issue includes a report on the latest forces and trends affecting healthcare human resources, including education, training and the evolving practice …


covidHeadline Roundup: Week of Nov. 15  for COVID-19 in Michigan

The MHA has been actively fielding and responding to media requests related to the growth in COVID-19 cases and hospitalizations, hospital capacity and healthcare workforce sustainability. …


The Keckley Report

Paul Keckley

The KFF Employer Health Benefits Survey: An Accurate but Incomplete Picture

“Last Wednesday, Kaiser Family Foundation released its 2021 Employer Health Benefits Survey—the 23rd in the series. …

“The KFF researchers note that changes in employer benefits participation are ‘unchanged’ but noticeable trends suggest changes ahead.”

Paul Keckley, Nov. 15, 2021


News to Know

  • The MHA Monday Report will not be published Nov. 29, but timely news will continue to be posted in the MHA Newsroom prior to publication of the Dec. 6 edition of Monday Report.
  • The MHA will offer a webinar on Unemployment Compensation and Vaccine Mandates at 10 a.m. EST Dec. 9.
  • The MHA will host a free webinar from noon to 12:45 p.m. EST Dec. 9 to review new requirements from The Joint Commission on workplace violence that take effect in January.

Medicare Premiums and Deductibles Announced for 2022

The Centers for Medicare & Medicaid Services (CMS) recently announced that the Medicare Part A deductible for inpatient hospital services will increase by $72 in calendar year (CY) 2022 to $1,556. The Part A daily coinsurance amounts will be:

  • $389 for days 61-90 of hospitalization in a benefit period, up from the current $371.
  • $778 for lifetime reserve days up from the current $742.
  • $194.50 for days 21-100 of extended care services in a skilled nursing facility in a benefit period, up from the current $185.50.

The monthly Part A premium, paid by beneficiaries who have fewer than 40 quarters of Medicare-covered employment and certain people with disabilities, will increase by $28 in CY 2022 to $499.

The CMS announced that the annual deductible for Medicare Part B will increase by $30 in 2022 to $233, while the standard monthly premium for Medicare Part B will increase by $21.60 to $170.10. Members with questions should contact Vickie Kunz at the MHA.

MHA Monday Report Nov. 15, 2021

 

Comments Due Jan. 4 on Federal Vaccine Mandates; MHA Summary Available

The Centers for Medicare & Medicaid Services and the federal Occupational Safety and Health Administration recently released the anticipated detailed rules mandating vaccines for employees of healthcare facilities and businesses with 100 or more workers. …


Medicare Home Health Prospective Payment System Updated for 2022

The Centers for Medicare & Medicaid Services recently released a final rule to update the Medicare fee-for-service prospective payment system for home health agencies effective Jan. 1, 2022. …


Michigan Harvest GatheringsMichigan Harvest Gathering 2021 Campaign Concludes

For several weeks, Michigan hospitals and health systems helped generate donations to the Food Bank Council of Michigan through the Michigan Harvest Gathering. The campaign ended Nov. 12, and the MHA will issue a final report in late November outlining …


Healthcare Organizations Gather Virtually for Michigan Health Equity Summit

Nearly 137 safety and quality professionals participated in the virtual Michigan Health Equity Summit Nov. 3 hosted by the Michigan Public Health Institute, the Michigan State University Institute for Health Policy and the MHA Keystone …


Webinar Will Discuss Unemployment Compensation and Vaccine Mandates

As deadlines take effect for COVID-19 vaccine mandates at healthcare organizations, unemployment compensation claims will arise from employees who elect to resign or who are discharged for noncompliance with the mandate. …


covidHeadline Roundup: Week of Nov. 8 for COVID-19 in Michigan

The MHA has been actively fielding and responding to media requests related to the growth in COVID-19 cases and hospitalizations, hospital capacity and healthcare workforce sustainability. Below is a collection of headlines from around the …


Paul Keckley

The Keckley Report

Financial Sponsors Pose Unique Challenge to Healthcare Providers

“Outside pressures for affordability, equitable access and price transparency are finding their way into regulations like surprise medical billing and constraints on consolidation. But the specter of proposed increases to both the corporate tax rate … capital gains … and related carried interest rules … are prompting investors to rethink future capital deployment.”

Paul Keckley, Nov. 8, 2021


News to Know

The Root Cause Coalition, of which the MHA is a founding member, is accepting applications for its inaugural Health Justice Award through 11:59 p.m. PST Jan. 31.

Medicare Home Health Prospective Payment System Updated for 2022

The Centers for Medicare & Medicaid Services (CMS) recently released a final rule to update the Medicare fee-for-service prospective payment system for home health (HH) agencies effective Jan. 1, 2022. Key aspects of the final rule include:

  • A one-year delay, until Jan. 1, 2023, of the proposed national expansion of the HH value-based purchasing model to replace the pilot that began in nine states (Arizona, Florida, Iowa, Maryland, Massachusetts, Nebraska, North Carolina, Tennessee and Washington) in 2016.
  • A 6.9% increase to the national, standardized 30-day period payment rate HH band from $1,901.12 to $2,031.61 for HH agencies that submit the required quality data.
  • Recalibration of the Patient-driven Groupings Model (PDGM) case-mix weights for the 432 payment groups, using 2020 data.
  • Modification of the HH quality reporting program measures to:
    • Remove an OASIS-based measure: the Drug Education on All Medications Provided to Patient/Caregiver During All Episodes of Care measure.
    • Replace two claims-based measures — the Acute Care Hospitalization During the First 60 Days of Home Health (NQF #0171) measure and the Emergency Department Use without Hospitalization During the First 60 days of Home Health (NQF #0173) measure — with one claims-based measure — the Home Health Within Stay Potentially Preventable Hospitalization measure.
  • Continuation of the 4.36% behavioral adjustment that was implemented in 2020 when the new PDGM case-mix classification system was implemented.
  • Finalization of the proposal to make permanent the blanket waiver related to virtual supervision of home health aides that was granted temporarily for the duration of the COVID-19 pandemic.
  • Implementation of a provision of the Consolidated Appropriations Act that would allow occupational therapists to perform the initial and comprehensive patient assessment.
  • Continuation of the 4.36% payment cut to the standardized 30-day payment rate implemented in 2020 when the new PDGM was adopted.

The CMS continues to review input received on the agency’s plans to define digital quality measures for the HH quality reporting program and the potential use of fast healthcare interoperability resources in support of digital quality measurement. The MHA will provide members with an updated estimated impact analysis soon. Members with questions should contact Vickie Kunz at the MHA.

Physician Fee Schedule Final Rule Affects Telehealth, Vaccines, More

The Centers for Medicare & Medicaid Services recently released the Medicare Physician Fee Schedule final rule for calendar year 2022, which includes updates to Medicare payments under the schedule and other Medicare Part B issues effective Jan. 1. Provisions of the rule will:

  • Reduce the conversion factor by $1.31, from $34.89 to $33.58, to accommodate budget neutrality with changes in relative value units and the expiration of the 3.75% payment increase provided in the 2021 Consolidated Appropriations Act.
  • Extend eligible telehealth services that were added to the Medicare telehealth services list during the COVID-19 public health emergency (PHE) through Dec. 31, 2023. This will allow for more time for stakeholders to gather data and submit support for requesting that services be permanently added to the Medicare telehealth services list.
  • Implement an in-person visit requirement at least every 12 months to qualify for telehealth service payment.
  • Include audio-only communications technology when used for telehealth services for the diagnosis, evaluation or treatment of mental health disorders furnished to established patients in their homes under certain circumstances.
  • Delay the start date for compliance actions related to electronic prescribing of controlled substances to Jan. 1, 2023, and delay the compliance start date for Part D prescriptions written for beneficiaries in long-term care facilities to Jan. 1, 2025.
  • Delay the penalty phase of the appropriate use criteria program to Jan. 1, 2023, or the Jan. 1 that follows the declared end of the COVID-19 PHE, whichever comes later.
  • Pay $30 per dose for the administration of the influenza, pneumococcal and hepatitis B virus vaccines, and maintain the current payment rate of $40 per dose for the administration of the COVID-19 vaccines. In addition, make the additional payment of $35.50 for COVID-19 vaccine administration in the home through the end of the calendar year in which the ongoing PHE ends.
  • Define and clarify policies for split (or shared) evaluation and management visits, which can be billed by the physician or practitioner who provides the substantive portion of the visit.
  • Allow physician assistants (PAs) to bill Medicare directly for their professional services, reassign payment for their professional services, and incorporate with other PAs and bill Medicare for PA services.
  • Delay the increase in the quality performance standard Accountable Core Organizations must meet to be eligible to share in savings until program year 2024.

Members with questions should contact Renée Smiddy at the MHA.

Medicare Advantage Enrollment Continues to Rise

Medicare Advantage (MA) enrollment in Michigan totaled approximately 1.12 million in October, an increase of 13,000 beneficiaries since July. The October MA enrollment is spread across 45 MA plans that are currently operating in the state, with approximately 49 percent of Michigan’s 2.3 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 28 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 October enrollment.  In addition to the 45 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 Kellen Teel at the MHA.

MHA Comments on Outpatient, Physician Fee Schedule Proposed Rules

The MHA submitted comments on two proposed rules for Medicare payment systems in calendar year 2022 that the Centers for Medicare & Medicaid Services recently released.

The MHA’s comments on the combined rule for the hospital outpatient and ambulatory surgical center payment systems largely focused on price transparency changes, continuing payment cuts to the 340B drug discount program, reduced payment rates for clinic visits provided at grandfathered off-campus hospital outpatient departments, and restoration of the inpatient only list.

The association’s comments on the Medicare Physician Fee Schedule (MPFS) rule focused on a few key issues, including the MPFS conversion factor, appropriate use criteria, telehealth services, electronic prescribing of controlled substances for Part D drugs and closing the health equity gap.

Members with questions regarding the outpatient and ambulatory surgical center rule should contact Vickie Kunz and questions about the MPFS rule should be directed to Renée Smiddy.

News to Know – Week of August 23

The MHA invites members to join a free webinar from DataGen to review key provisions included in the final rule to update the Medicare fee-for-service inpatient prospective payment system for fiscal year 2022, which begins Oct. 1, 2021. The Centers for Medicare & Medicaid Services released the final rule Aug. 2. Registration is required for the webinar.