Final Medicaid Bulletin on Continuous Glucose Monitoring Systems

The Michigan Department of Health and Human Services issued a final Medicaid Policy Bulletin May 1 with revisions to the Continuous Glucose Monitoring Systems (CGMS) Policy.

In response to the proposed policy issued April 1, the MHA submitted a comment letter, offering seven recommended changes. Three of the seven changes the MHA suggested were adopted in the final policy:

  • Removal of a daily blood glucose testing requirement.
  • Removal of provider documentation requirements for the daily number of finger-stick tests prescribed.
  • Changing the requirement for diabetes self-management education from annual to bi-annual. This requirement became optional.

The additional suggestions not adopted include:

  • Removal of the provider documentation requirement for daily frequency of insulin administered.
  • Removal of the provider documentation requirement for beneficiary treatment plan and compliance.
  • Update the 90-day provider documentation requirement to align with the bi-annual monitoring requirement for CGMS.
  • Add Type II diabetes as a condition where prior authorization is not required.

This policy will go into effect June 1, 2023.

Members with questions may contact Kelsey Ostergren at the MHA.

Crain’s Healthcare Leadership Summit Features MHA and Hospital Leaders

The Oct. 20 Crain’s 2022 Healthcare Leadership Summit featured speakers from the MHA and member hospitals in a series of panels on policy issues, labor force solutions and technology integration.

MHA EVP Laura Appel spoke on a policy panel that covered what role government can play in affordability, equity & improving care.

Rising costs, uncertain governmental policies, workforce challenges, behavioral health and equity issues have put hospitals and health systems in a compromising position. The summit aimed to connect industry experts to collaborate on solutions and share best practices to tackle these issues.

Laura Appel, executive vice president of government relations and public policy at the MHA, spoke on a panel that covered solutions to the labor challenges and measures that reduce pressure on healthcare institutions throughout the state.

“There are no quick, easy fixes,” Appel noted. “Public health is a way for us to get people in a better place in the aggregate – we cannot solve diabetes, for example, with healthcare alone. We’ve got to do the policy work that it takes to push back and reduce rates [of illness], as opposed to just stopping the upward trends.”

Leaders from MHA-member hospitals and health systems were also featured in breakout sessions that covered workforce challenges and technological solutions to improve efficiency and safety. Panelists included:

  • Kimberly Keaton Williams, vice president of talent acquisition and development and chief diversity officer at McLaren Health Care.
  • Shana Lewis, vice president of talent acquisition and workforce development programs at Trinity Health.
  • Lisa Ouellette, interim chief human resources officer at Corewell Health.
  • Robert Riney, president & CEO of Henry Ford Health.

The event also featured keynote speaker Dr. Joneigh Khaldun, vice president and chief health equity officer at CVS Health, who spoke about attainable solutions for addressing inequities and improving health outcomes for underserved, vulnerable communities.

MDHHS Releases Proposed Policy to Resume Required Enrollment Activities

The Michigan Department of Health and Human Services (MDHHS) released a proposed policy to rescind remaining waived provider enrollment (PE) requirements implemented by MSA 20-28 and resume required enrollment activities that were waived during the federal COVID-19 Public Health Emergency (PHE).  The MDHHS proposes to reinstate the following processes beginning Dec. 1, 2022:

  • Community Health Automated Medicaid Processing System (CHAMPS) enrollment revalidations with MDHHS notifying providers beginning November 2022 of their rescheduled validation date, which will be assigned on a rolling basis starting with providers who have had the longest revalidation pause. Providers may view their rescheduled revalidation date in CHAMPS.
  • Site visits for prospective and current providers which will be performed following all state and federal public health guidelines, such as masking and social distancing.
  • Fingerprint-based criminal background checks associated with providers in the high-risk category.
  • Enrollment application fees for providers who had their fees waived under MSA 20-28. Providers may still request a hardship waiver per the Centers for Medicare and Medicaid Services (CMS) guidelines which will only be granted after the MDHHS receives approval from the CMS.

Members are encouraged to review the proposed policy and submit comments to the MDHHS by Oct. 28. Members with questions should contact Renée Smiddy at the MHA.

MDHHS Releases Proposed Policy for Attending Physician Claims

The Michigan Department of Health and Human Services (MDHHS) released a proposed policy to update existing policy for the attending provider field on institutional hospital inpatient and outpatient claims. This update is in response to concerns raised by the MHA and hospitals regarding the claim edits implemented Jan. 1, 2022, which resulted in claim denials. The MDHHS proposes to align claim editing policy and update the definition of attending provider to mirror current federal and state laws and regulations as follows:

  • The attending provider is the individual who has the primary responsibility for the treatment and care of the beneficiary.

The following providers can be reported in the attending provider field for hospital inpatient claims based on Michigan professional licensure and scope of practice statute:

  • Certified Nurse Midwives.
  • Dentists.
  • Oral/Maxillofacial Surgeons.
  • Physicians (MD/DO).
  • Podiatrists.

The allowed attending provider type varies in the outpatient setting depending upon the service provided. The provider with the primary responsibility for the treatment and care of the beneficiary in the outpatient setting, including nurse practitioners and physician assistants, should be reported as the Attending Provider.

Hospitals are encouraged to review the proposed policy and submit comments to the MDHHS by Oct. 28. Members with questions should contact Vickie Kunz at the MHA.