MHA Monday Report July 31, 2023

MHA Monday Report

Hospitals for Patient Access Advocacy Day Scheduled

MHA chief nursing officers and other Michigan hospital leaders are encouraged to register for Hospitals for Patient Access Advocacy Day from 8 a.m. to 4 p.m. Sept. 13 at the MHA Capitol Advocacy Center in …


CMS Releases Medicare Physician Fee Schedule CY 2024 Proposed Rule

The Centers for Medicare & Medicaid Services (CMS) released its calendar year (CY) 2024 proposed rule for the physician fee schedule. The rule proposes a decrease to the conversion factor by 3.34%, to $32.75 in …


Toolkit Created to Strengthen Caregiver Support Programs

The MHA Keystone Center recently released the Michigan Caregiver Navigation Toolkit to guide hospitals and health systems implementing and maintaining caregiver navigation programs. These initiatives are designed to support caregivers in their role by providing …


CMS Releases Occupational Mix Data

The Centers for Medicare & Medicaid Services (CMS) released July 12 the fiscal year 2025 Hospital Wage Index Development Timetable, a public use file (PUF). The PUF contains data reported by prospective payment system hospitals on …


AI and Workforce Development Webinar Series Offers CME Credit

The MHA and other state hospital associations are hosting a webinar series in partnership with the Huron Consulting Group Aug. 10 through Nov. 9 from 1 – 2 p.m. EST. CME and continuing education credit …


Corewell Health’s Freese Decker Named AHA Chair-elect Designate

The American Hospital Association (AHA) Board of Trustees elected Tina Freese Decker, president & chief executive officer, Corewell Health as its Chair-elect Designate July 16. Freese Decker will be Chair-elect in 2024 and become the …


The Keckley Report

Paul KeckleyThe Four Issues that will Impact Healthcare Services Providers and Insurers Most in the Last Half of 2023 and First Half of 2024

“As first half 2023 financial results are reported and many prepare for a busy last half, strategic planning for healthcare services providers and insurers point to 4 issues requiring attention in every boardroom and C suite …

These issues frame the near-term context for strategic planning in every sector of U.S. healthcare. They do not define the long-term destination of the system nor roles key sectors and organizations will play. That’s unknown. …”

Paul Keckley, July 24, 2023

MHA Monday Report July 24, 2023

MHA Monday Report

capitol buildingGovernor Signs MHA Supported Legislation and Announces Round of GoingPro Awards

Gov. Whitmer signed several MHA-supported bills during the week of July 17 related to the Healthy Michigan Plan, organ donation and vaccine distribution. Those bills include: House Bills 4495–4496 (Public Acts  98-99 of …


CMS Releases Medicare FFS OPPS Proposed Rule

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


MHA Webinar Focuses on Crisis Events

Crisis events are unpredictable and often present unique challenges in healthcare. The MHA is convening healthcare and community leaders virtually from 8:30 to 10 a.m. Aug. 25 to exchange ideas and resources for crisis events …


Latest AHA Trustee Insights Focuses on Quality Oversight

The July edition of Trustee Insights, the monthly digital package from the American Hospital Association (AHA), focuses on the board’s role in improving quality. Elizabeth Mort, MD, MPH, former senior vice president of quality and safety …


The Keckley Report

Paul KeckleyThe Health System needs a Heart Transplant

“It’s a time when workforce activism is peaking, and hourly workers in hospitals, long-term care facilities and in home care are targets of organizing efforts by unions. …

In an industry as big and prominent as healthcare, hourly workers including nurses, techs, business office and patient support services are vital to its performance. Those in skilled professions that require licenses are buffered by shortages: that’s the case with nurses, physical therapists and others. But not as much for non-skilled positions where cost-cutting has heightened labor-management tensions. And this comes as most hospitals have recovered to pre-pandemic financial health and CEO compensation in not-for-profit systems has become a lightening rod for industry critics like Arnold Ventures, West Health and Lown Institute among others. …

Hourly workers are the beating heart of the healthcare industry: they don’t have star power, they don’t have a voice, and they don’t feel they’re seen or heard. As the system transitions to AI-powered workforce solutions in bigger organizations, the heartbeat is irregular. It needs attention.”

Paul Keckley, July 17, 2023


MHA in the NewsBrian Peters

The MHA received media coverage the week of July 17 regarding the healthcare workforce, federal legislation to address drug shortages and bills signed by Gov. Whitmer eliminating burdensome provisions in the Healthy Michigan Plan and …

CMS Releases Medicare FFS OPPS Proposed Rule

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

  • Increase the outpatient conversion factor by a net 2.2% from the current $85.585 to $87.488, after the proposed 2.8% market basket is reduced for budget neutrality and other adjustments.
  • Pay average sales price plus 6% for drugs and biologicals acquired under the 340B drug discount program and require use of a single modifier, “TB”, for 340B drugs, effective Jan. 1, 2025. Hospitals would have the option to continue reporting the “JG” modifier or transition to solely using the “TB” modifier during 2024.
  • Implement several provisions of the Consolidated Appropriations Act that will expand access to behavioral health services including:
    • Adopting an additional, untimed code for remote 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 remote mental heath service and within 12 months after each 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 proposed 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 (9) 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.
  • Expand 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 proposed to allow 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 to extend this policy to these nonphysician practitioners, who are eligible to supervise these services in calendar year (CY) 2024.
  • Update the outpatient quality reporting program.
  • Seek comments regarding whether gastric restrictive procedures (CPT codes 43775, 43644, 43645 and 44204) are appropriate for removal from the inpatient only list. Specifically, the CMS requests information on whether these services can be performed safely on the Medicare population in the outpatient setting. The CMS also proposes to add nine services for which codes were newly created.
  • Add 26 dental surgical procedures to the ambulatory surgical center covered procedure list for CY 2024.
  • Adopt 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 7-Day Risk-Standardized Hospital Visit Rate after Outpatient Colonoscopy.
    • Risk-Standardized Hospitals Visits Within 7 Day After Hospital Outpatient Surgery.
  • Require hospitals to utilize a standard template to display their standard charge information.

The MHA will provide hospitals with an estimated impact analysis within the next several weeks and encourages hospitals to review the rule and submit comments to the CMS by Sept. 11.

Members with questions should contact Vickie Kunz at the MHA.

Federal Court Rules on 340B Underpayment Remedy

A recent United States District Court for the District of Columbia ruling allows the Department of Health and Human Services (HHS) to propose a remedy for hospital 340B drug underpayments for calendar years 2018 to 2021. This is the latest 340B decision following the late September ruling where the District Court ruled to vacate the 340B payment cuts for the remainder of 2022 and ordered the Centers for Medicare and Medicaid Services (CMS) to halt the cuts immediately. Hospitals are required to submit adjustments for each 2022 claim paid at the lower rate. However, that prior ruling failed to address claims from 2018 through 2021, with the CMS indicating these years would be addressed in future rulemaking prior to release of the 2024 outpatient prospective payment system (OPPS) final rule. The 2023 OPPS final rule restored 340B payments to the average sales price (ASP) plus 6%, up from ASP minus 22.5%.

The HHS has indicated a proposed remedy is expected to be released by April. The MHA, along with the American Hospital Association and others, continues to advocate for a remedy that quickly restores payments to hospitals for 2018 through 2021, with interest, and which does not penalize any hospitals.

Members with questions should contact Katie Jaskolski at the MHA.

MHA Monday Report Nov. 7, 2022

MHA Monday Report

MHA Board of Trustees Advances Strategic Action Plan, Affirms Policy Panel Legislative Recommendations

The MHA Board of Trustees began their Nov. 2 meeting with a review of key communication strategies to assist hospitals and health systems to “tell their stories” about the unprecedented financial and workforce challenges they currently face and how they are adapting to meet the critical healthcare and economic development needs of their communities …


Logo for MI Vote Matters, Tuesday Nov. 8Healthcare Community Urged to Vote in Nov. 8 General Election

The MHA encourages its staff, members and other stakeholders in the healthcare community to vote in the state’s general election Nov. 8.- Polls will be open from 7 a.m. to 8 p.m. …


Parents Urged to Take Preventive Measures as Pediatric Beds Fill Up

Michigan children’s hospitals and pediatric healthcare leaders are raising awareness about a pediatric hospital bed shortage and urging the public to help prevent respiratory illnesses, which are rapidly spreading in the form of respiratory syncytial virus (RSV) and influenza …


CMS Releases Final Rule to Update OPPS

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, 2023 …


Provider Enrollment Requirements Reinstated Effective Dec. 1, 2022

The Michigan Department of Health and Human Services (MDHHS) issued MMP 22-38 COVID-19 Response: Termination of Bulletin MSA 20-28, which reinstates provider enrollment requirements …


CMS Releases Final to Update Medicare PPS Effective 2023

The Centers for Medicare and Medicaid Services (CMS) recently released a final rule to update the Medicare fee-for-service home health (HH) prospective payment system (PPS) effective Jan. 1, 2023 …


MHA Supports Increased Access to Affordable Post-Secondary Education

The MHA, along with stakeholders across diverse fields, supported record state investment in Michigan’s future workforce. On October 11th, the Governor signed Public Act 212 of 2022 establishing the Michigan Achievement Scholarship, and applications starting with students in the high school class of 2023 will now be eligible for increased state financial aid …


CE Credits Available for Unionization and Legal Guidelines Webinar

The webinar Dispelling Misinformation About Unionization and Legal Guidelines 8:30 – 10 a.m. ET Nov. 11 has been approved by HR Certification Institute® (HRCI®) for 1.5 hours …


MHA Rounds Report - Brian Peters, MHA CEOMHA CEO Report — Your Vote Matters

At the MHA, we often say that politics is not a spectator sport. It requires continual engagement and relationship building so that when you are in a crisis and need assistance, you have trusted friends you can turn to …


The Keckley ReportPaul Keckley

The Three Blind Spots in Hospital Strategic Plans

“For 40 years, I have facilitated Board Retreats for hospitals, health systems, insurance plans and medical groups. At no time has the level of uncertainty about the future for hospitals been as intense nor the importance of a forward-looking strategic vision and planning been as necessary as now. The issues are complicated: lag indicators about demand, clinical innovations, reimbursement, costs et al are a foreboding backdrop for these discussions. And three issues have surfaced as blind spots in the environmental assessments and deliberations preceding the plan …”

Paul Keckley, Oct 31, 2022


Michigan Harvest GatheringsNews to Know

Many Michigan hospitals are underway with their Michigan Harvest Gathering campaign which runs through Nov. 18. Online donations by hospital employees and community members to the Michigan Harvest Gathering program can be made through the Food Bank Council of Michigan’s website …


MHA in the News

The MHA received media coverage on the surge of RSV cases across Michigan’s pediatric hospitals during the week of Oct. 31. The coverage included several comments provided to news outlets and the distribution of a press release Nov. 4 to statewide media …

CMS Releases Final Rule to Update OPPS

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, 2023.

The rule restores 340B drug payments to the default rate, generally average sales price (ASP) plus 6%, up from the previous ASP minus 22.5%, in response to the recent federal Supreme Court (SC) ruling.  The CMS notes that the agency is still evaluating how to apply the SC’s decision in the American Hospital Association (AHA) v Becerra case which ordered the CMS to restore payments. The CMS will address this in future rulemaking prior to the 2024 OPPS proposed rule.  

The MHA, along with the AHA and others, continue to urge the Court to order the CMS to promptly repay hospitals harmed by the unlawful cuts implemented in 2018 and ensure that no hospitals are not penalized.  Other provisions of the final rule include:

  • Increasing the conversion factor by a net 1.7% after budget neutrality adjustments from $84.18 to $85.59 for hospitals that comply with the CMS outpatient quality reporting (OQR) program requirements.
  • Establishing the new rural emergency hospital provider type to allow critical access hospitals and rural hospitals with less than 50 beds to continue providing essential outpatient services while eliminating inpatient services.
  • Exempting rural sole community hospitals from the site neutral clinic visit cuts and instead paying the full OPPS rate for visits provided at grandfathered off-campus hospital outpatient departments.
  • Increasing the cost outlier threshold by 40% from $6,175 to $8,625, to maintain outlier payments at the targeted 1% of total OPPS payments, resulting in fewer cases qualifying for an outlier payment.
  • Removing 11 services from the inpatient only list and adding 8 services that were newly created by the American Medical Association Common Procedural Terminology Editorial Panel.
  • Implementing a permanent 5% cap on wage index decreases.
  • Adding four procedures to the Ambulatory Surgical Center covered procedures list.
  • Requiring prior authorization for an additional service category,­ facet joint interventions, beginning dates of service on or after July 1, 2023.
  • Continuing payment for virtual behavioral health services with an in-person service required within six months prior to the initiation of the virtual service and then annually thereafter, with exceptions made based on beneficiary circumstances. The CMS clarified that the requirement for an in-person visit within six months prior to the initial services is not required for patients who began receiving services during the public health emergency (PHE) or during the 151-day period following the end of the PHE.
  • Maintaining the current policy of providing separate payment for non-opioid pain management drugs and biologicals that function as supplies in the ASC setting.
  • Implementing a payment adjustment for costs incurred for domestically manufactured National Institute for Occupational Safety and Health (NIOSH)-approved surgical N95 respirators with payments provided biweekly as interim lump-sum payments and reconciled at cost report settlement for cost reporting periods beginning on or after Jan. 1, 2023.
  • Creating a new G-code for dental rehabilitation services that require monitored anesthesia and the use of an operating room and assigning it to APC 5871 (Dental Procedures), effectively increasing the payment from roughly $200 to approximately $2,000.
  • Changes to the hospital OQR program including:
  • Making the Cataracts: Improvement in Patient’s Visual Function within 90 Days Following Cataract Surgery (OP-31) measure voluntary rather than mandatory beginning with the 2025 reporting period and 2027 payment determination.
  • Aligning the patient encounter quarters for chart-abstracted measures to the calendar year for annual payment update determinations.
  • Adding a targeting criterion for measure data validation.

The MHA will provide hospitals with an updated impact analysis and additional details of the rule in the coming weeks.

Members with questions should contact Vickie Kunz at the MHA.

MHA Drafts Comments on 340B Provisions and REH Payment Policies

The MHA has drafted comments in response to the Centers for Medicare and Medicaid Services (CMS) proposed rule to update the Medicare fee-for-service (FFS) outpatient prospective payment system (OPPS) for calendar year 2023. The MHA submitted comments regarding the 340B provisions in mid-August urging the CMS to:

  • Restore payment rates for 340B drugs to average sales price (ASP) plus 6%.
  • Hold all hospitals harmless for 2018-2022 claims.
  • Find new funds to restore 340B payments to ASP plus 6% with no reduction to the outpatient conversion factor.

The MHA also prepared comments in response to the proposed payment policies for rural emergency hospitals (REHs), a new hospital designation established by the Consolidated Appropriations Act, for critical access hospitals and rural prospective payment system hospitals with fewer than 50 beds.

The MHA recently posted hospital-specific estimated impact reports of the OPPS proposed rule on the hospital association reporting portal (HARP) for members to access and encourages hospitals to review the impact of the proposed rule on their operations and submit comments to the CMS by 5 p.m. Sept. 13. The CMS is expected to release a final rule to update the OPPS, including finalization of REH payment policies around Nov. 1 for the Jan. 1, 2023 effective date.

The MHA will provide an updated impact analysis following release of the final rule. Members with questions should contact Vickie Kunz at the MHA.

CMS Seeks Comment on Rural Emergency Hospital Proposed Rule

The Centers for Medicare and Medicaid Services (CMS) recently released a proposed rule to obtain comment on potential Conditions of Participation (CoPs) for critical access hospitals (CAHs) and certain rural hospitals seeking to convert from their current status to be designated as a Rural Emergency Hospital (REH). REHs are a new provider type authorized by the Consolidated Appropriations Act passed Dec. 27, 2020, to address concern regarding the closure of rural hospitals across the country. This new designation provides an opportunity for CAHs and rural hospitals with 50 or fewer beds to continue providing essential services in their communities effective Jan. 1, 2023. REHs would be required to:

  • Discontinue providing acute care inpatient services.
  • Provide 24-hour emergency services, observation care and can choose to offer additional outpatient services.
  • Have an annual per patient average stay of 24 hours or less.
  • Have a transfer agreement with a Level I or II trauma center but not precluded from having agreements with Level III or IV trauma centers.

The CMS recently included payment policies related to the new REH in the 2023 Medicare outpatient prospective payment system (OPPS) proposed rule. Medicare outpatient services provided by a REH will be paid 105% of the Medicare OPPS rate with the REH also receiving a monthly facility payment. The CMS proposes a monthly payment of $268,294 for each REH in 2023, with this amount increased annually based on the hospital market basket change.

The CMS proposes that REHs may provide outpatient services that are not paid under the OPPS such as laboratory services paid under the Clinical Lab Fee Schedule (CLFS), which would be paid at the CLFS rate. REHs can also provide distinct part skilled nursing facility (SNF) services which would be paid based on the SNF prospective payment system. Services paid outside of the OPPS such as lab and SNF would not receive the additional 5% payment. The CMS also seeks input on quality measures recommended by the National Advisory Committee on Rural Health and Human Services, and additional suggested measures for the REH quality reporting program. The CMS is seeking additional comments on behavioral and mental health, rural virtual care and maternal health services.

Comments on the proposed CoP rule are due Aug. 29, while comments regarding payment provisions included in the OPPS proposed rule are due Sept. 13. The CMS is expected to release a final OPPS rule around Nov. 1. Members with questions should contact Lauren LaPine at the MHA.

Medicare Outpatient Payment Final Rule Makes Changes for 2022

The Centers for Medicare & Medicaid Services (CMS) recently released a final rule to update the Medicare fee-for-service outpatient prospective payment system (OPPS) effective Jan. 1, 2022. Provisions of the rule will:

  • Increase the civil monetary penalty (CMP) for hospitals that fail to comply with the price transparency requirements that took effect Jan. 1, 2021. The CMS is setting a minimum CMP of $300/day that will apply to smaller hospitals with a bed count of 30 or fewer and a penalty of $10/bed/day for hospitals with a bed count greater than 30, up to a maximum daily penalty of $5,500.
  • Increase the standard outpatient conversion factor by 1.7%, from $82.80 to $84.18, for hospitals that comply with the outpatient quality reporting program (QRP) requirements.
  • Implement a cost outlier threshold of $6,175, a 16.5% increase from the current threshold of $5,300.
  • Halt the elimination of the inpatient only list and add back to the list the services removed in 2021 except for CPT codes 22630 (Lumbar spine fusion), 23472 (Reconstruct shoulder joint), 27702 (Reconstruct ankle joint) and their corresponding anesthesia codes.
  • Reinstate the ambulatory surgical center (ASC) covered procedures list (CPL) criteria that were in effect in 2020 and prior years and adopt a process, beginning in March 2022, to allow an external party to nominate a surgical procedure to be added to the ASC CPL.
  • Continue the current policy of paying a reduced amount of average sales price minus 22.5% for drugs and biologicals purchased under the 340B drug discount program. The CMS will continue to exempt rural sole community hospitals, prospective payment-exempt cancer hospitals and children’s hospitals from the reduced payment policy implemented for most hospitals in 2018.
  • Make non-opioid pain management drugs and biologicals that function as a surgical supply in the ASC setting eligible for separate payment when such product is approved by the Food and Drug Administration, indicated for pain management or as an analgesic, and has a per-day cost above the OPPS drug packaging threshold.
  • Modify the hospital outpatient QRP by adopting three new measures, including the COVID-19 Vaccination Coverage Among Health Care Personnel measure in the OPPS and ASC settings, and removing two measures:
  • OP-02: Fibrinolytic Therapy Received Within 30 Minutes of Emergency Department Arrival measure.
  • OP-03: Median Time to Transfer to Another Facility for Acute Coronary Intervention measure.
  • Require mandatory reporting of the outpatient and ASC consumer assessment of healthcare providers and systems patient experience survey beginning in 2024.
  • Make several modifications to the Radiation Oncology Model and officially launch the model Jan. 1, 2022.

The CMS received input on the new Rural Emergency Hospital designation and continues to review comments; the agency will respond to the comments in future rulemaking. The CMS also received input on making reporting of health disparities based on social risk factors and race and ethnicity more comprehensive and actionable by including additional demographic data points.

The MHA will provide hospitals with an estimated impact analysis of the final rule soon. Members with questions should contact Vickie Kunz at the MHA.