Tag: proposed policy

MDHHS Release Medicaid Reimbursement Proposed Policy

Member News

The Michigan Department of Health and Human Services (MDHHS) recently released a proposed policy to establish additional Medicaid reimbursement for certain medically necessary drugs and therapeutics when provided in the inpatient hospital setting. The policy, pending approval by the Centers for Medicare & Medicaid Services, proposes to establish separate payment for drugs and therapeutics that are carved out of the diagnosis related group (DRG) in addition to providing the inpatient DRG payment. Payment would be made under Medicaid fee-for-service (FFS) for beneficiaries covered under both FFS and managed care plans with no beneficiary copayment.

The MDHHS publishes and maintains a list of applicable drugs and therapeutics. The payment rates for drug and therapeutic reimbursement are outlined in the Michigan Medicaid State Plan with these drugs and therapeutics covered as either professional claims or pharmacy claims as specified in the policy.

The provider must request prior authorization (PA) if the drug or therapeutic is purchased directly through a pharmacy, distributor or wholesaler. PA requests may be submitted either via Direct Data Entry through the Community Health Automated Medicaid Processing System or via fax.

Hospitals are encouraged to review the proposed policy and submit comments to MDHHS by March 5, 2024. Members with questions should contact Vickie Kunz at the MHA.

MDHHS Releases FY 2024 Medicaid Program Rate Updates

Member News

The Michigan Department of Health and Human Services (MDHHS) recently released concurrent proposed and final policies to implement Medicaid rate increases included in the fiscal year (FY) 2024 budget. These increases, contingent upon approval by the Centers for Medicare & Medicaid Services (CMS), are effective for dates of service on and after Oct. 1, 2023.

The MDHHS will modify Medicaid reimbursement rates for specified services to provide:

  • A hospital Diagnosis Related Group rate increase for level I and II designated trauma facilities. The increase will apply to Medicaid fee-for-service and Medicaid Health Plan hospital payments. The level of rate increase is not specified. The MHA successfully advocated for these funds in the FY 2024 budget.
  • A 260% increase for transitional residential brain injury services (BIS) with these services reimbursed through a single bundled payment per day that covers both a daily rate for traditional residential care and case management services and a minimum of 15 hours of weekly therapy. BIS outpatient rates remain unchanged.
  • A 7.5% increase for professional services provided by physicians, physician assistants, advanced practice nurses, psychologists, clinical social workers, professional counselors and others. This increase would not apply for professional services that received a previous rate increase such as neonatal, obstetrical and other services listed. The increase would apply to Maternal Infant Health Program professional services.
  • A 10% increase for Anesthesia Professional Services represented by CPT codes 00100-01999.
  • A 10% increase for home health services billed with HCPCS codes G0151-G0496.
  • An increase to 100% of Medicare base rates for ground ambulance services for Locality 01 when reimbursement from the Medicaid ambulance provider assurance assessment is included.

Hospitals are encouraged to review the proposed policy and submit comments to MDHHS by Oct. 31 and should include “Medicaid Program Rate Updates FY 2024” in the subject line.

Members with questions should contact Vickie Kunz at the MHA.