Medicaid Will Allow Authorization of Return Transfers for NICU Patients

The Michigan Department of Health and Human Services (MDHHS) recently released a final policy effective Aug. 1, allowing authorization for return transfers of stabilized infants from a neonatal intensive care unit (NICU) to the community hospital from which the patient was originally transferred or to another community hospital when the original facility is at capacity or not located near the patient’s home. The policy will allow NICU patients to receive care closer to home, reducing the need for family members to travel long distances and supporting NICU bed availability. The MDHHS will reimburse hospital and ambulance providers based on existing reimbursement policy when prior authorization is granted.

A Prior Authorization Certification Evaluation Review (PACER) is required for elective transfers between hospitals. NICU return transfer requests for continuing care at a community hospital will be authorized if a neonatologist provides a written order to transfer to the originating hospital. Newborns delivered in an emergency department and subsequently admitted to another hospital are not considered transferred and do not require a PACER.

Medicaid fee-for-service (FFS) payment methodology will provide a daily rate to the transferring hospital based on the Diagnosis Related Group (DRG) rate, not to exceed the full DRG payment, plus an outlier payment if appropriate. The receiving hospital will be paid the full DRG payment, plus an outlier if appropriate, upon discharge. Medicaid health plans (MHPs) reimburse hospitals based on contractual terms between the MHP and hospitals. MHPs that reimburse hospitals based on the Medicaid FFS payment methodology are subject to alignment with MDHHS payment policies. Out-of-network and noncontracted hospital providers are reimbursed by the MHPs based on Medicaid FFS payment methodology and rates in effect on the date of service. Members with questions should contact Vickie Kunz at the MHA.

 

MHA Monday Report April 11, 2022

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The Michigan Department of Health and Human Services reported there were an average of 752 new confirmed and suspected COVID-19 cases per day from April 2 through April 6. As of April 6, 453 adults and 17 children were hospitalized with confirmed and suspected cases; 96 adults were in intensive care units, 39 of them …


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Medicaid Proposed Policy to Allow Back Transfers for NICU Infants

The Michigan Department of Health and Human Services recently released a proposed policy, effective July 1, 2022, allowing authorization for return transfers of stabilized infants from a neonatal intensive care unit back to the community hospital from which the patient was …


Proposed Rule to Update Inpatient Rehabilitation Facilities Payment for FY 2023

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Explore Resources During Workplace Violence Awareness Month

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“Last Monday, Medicare Trustees released the 56th edition of their National Health Expenditures (NHE) Forecast for 2021-2030 which is widely used by policymakers and operators to gauge what’s ahead for U.S. healthcare. Regrettably, it’s flawed.”

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The Circle of Life Awards recognize innovative palliative or end-of-life care providers that measure and evaluate the impact of their work on patients, family and/or the community. Part 1 applications for the 2023 awards will be accepted through May 31.

Medicaid Proposed Policy to Allow Back Transfers for NICU Infants

The Michigan Department of Health and Human Services (MDHHS) recently released a proposed policy, effective July 1, 2022, allowing authorization for return transfers of stabilized infants from a neonatal intensive care unit (NICU) back to the community hospital from which the patient was originally transferred. This policy will allow NICU patients to receive care closer to home, reducing the need for family members to travel long distances and supporting NICU bed availability. The MDHHS will reimburse hospital and ambulance providers based on existing reimbursement policy when prior authorization is granted.

A Prior Authorization Certification Evaluation Review (PACER) is required for elective transfers between hospitals. NICU return transfer requests for continuing care at a community hospital will be authorized if a neonatologist provides a written order to transfer to the originating hospital. Newborns delivered in an emergency department and subsequently admitted to another hospital are not considered a transfer and do not require a PACER.

Medicaid health plans (MHPs) reimburse hospitals based on contractual terms between the MHP and hospitals. MHPs that reimburse hospitals based on the Medicaid fee-for-service (FFS) payment methodology are subject to alignment with MDHHS payment policies. Out-of-network and noncontracted hospital providers are reimbursed by the MHPs based on Medicaid FFS payment methodology and rates in effect on the date of service. Comments are due to the MDHHS May 10. Members with questions should contact Vickie Kunz at the MHA.

MHA Monday Report June 15, 2020

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Combating the Novel Coronavirus (COVID-19): Week of June 8

The MHA continues to keep members apprised of developments during the COVID-19 pandemic through regular email updates and the MHA Coronavirus webpage. Important updates on how the pandemic is affecting Michigan hospitals are outlined …


Telehealth Bills Move to Governor’s Desk​

The Michigan Senate voted unanimously June 4 to support a package of bills that would expand opportunities for providers to receive Medicaid payment for telehealth services. House Bills 5412 through 5416 were previously passed in the House of Representatives and …


Joint Commission Offers June 18 Webinar to Prepare Hospitals for Resumed Surveys

The Joint Commission is planning to restart its on-site survey process, which will have minor changes as it employs physical distancing practices to ensure the safety of all parties. …


Final Medicaid Policies Affect Outpatient, Neonatal Intensive Care Services

The Medical Services Administration recently released two final policies that impact hospital Medicaid payments. One relates to the rural access pool and the other updates payment to hospitals with approved neonatal intensive care units. …


Webinars Explore Resilience and Transparency During COVID-19 Pandemic

The MHA webinar series Leadership and Resiliency: Navigating Through and Beyond COVID-19, explores several mission-critical leadership qualities leaders need to help traverse this difficult time. The series studies six topics over the next several weeks; each session will be held from …


National Safety Month Focuses on Building Safety Culture

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Infection Prevention Boot Camp Series Enhances Quality and Safety

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The Keckley Report

Charity Care: Do For-profit Hospitals Do Their Fair Share?​

“A new study in Economic Inquiry compared changes in levels of charity care provided by for-profit and not-for-profit hospitals in the context of consolidation and competition. …

“Nonetheless, the study’s likely to prompt attention from policymakers about charity care in the context of hospital competition and consolidation.”

Paul Keckley, June 8, 2020

Final Medicaid Policies Affect Outpatient, Neonatal Intensive Care Services

The Medical Services Administration (MSA) recently released two final policies that impact hospital Medicaid payments. One relates to the rural access pool and the other updates payment to hospitals with approved neonatal intensive care units (NICUs).

MSA Policy 20-39 restores the rural access pool for fiscal year (FY) 2020 and provides a Medicaid outpatient rate increase for critical access hospitals (CAHs) effective Jan. 1, 2020, while removing CAHs from rural access pool eligibility for FY 2021.

The MSA received approval of the state plan amendment (SPA) submitted to the Centers for Medicare & Medicaid Services to increase Medicaid outpatient rates by 42.5% for services provided at CAHs effective Jan. 1, 2020. The SPA approval gives the MSA flexibility to implement the 7% outpatient rate increase for all hospitals effective April 1, 2020, as included in the FY 2020 Medicaid budget.

The MSA recently released the outpatient rate changes for CAHs and all other hospitals and is making system changes to implement the increases, which apply to both Medicaid fee-for-service and managed care organization claims. Affected claims will be reprocessed and paid at the higher rate following completion of the system changes.

MSA Policy 20-45 updates payment policy for hospitals that have approved NICUs effective for discharges on and after July 1, 2020. The final policy aligns with updated guidance from the National Uniform Billing Committee, which recognizes revenue codes 0173 and 0174 as NICU services that are eligible for payment at the alternate all-patient refined diagnosis-related group (APR-DRG) weight. This is a change from the current policy that recognizes only revenue code 0174 as NICU services.

Members with questions on these final policies should contact Vickie Kunz at the MHA.