Reimbursement for Age-Friendly Quality Data Included in FY 2025 Hospital IPPS Final Rule

Included in the Centers for Medicare & Medicaid Services’ (CMS) Medicare fee-for-service hospital inpatient prospective payment system (IPPS) fiscal year (FY) 2025 final rule is a reimbursement model for hospitals submitting age-friendly quality data.

Hospitals will be asked to report on several measures to assess whether they are improving care for older patients in emergency departments, operating rooms and other settings.

Hospitals will need to report that they are:

  • Attesting annually to having procedures that enable patients’ healthcare goals, such as determining whether living wills and healthcare proxies are included in care plans.
  • Reviewing medication regimens and eliminating unnecessary prescriptions.
  • Implementing frailty screenings and interventions, such as for mobility or cognition.
  • Assessing social vulnerabilities, such as isolation or elder abuse.
  • Designating age-specialized leadership within hospitals.

The CMS will add the age-friendly structural measures to the FY 2025 inpatient quality reporting program reporting, which will impact Medicare payments in FY 2027.

The MHA Keystone Center has supported numerous age-friendly initiatives in recent years, including Age-Friendly Health Systems Action Communities, which implements the 4Ms framework (What Matters, Medication, Mentation and Mobility) – aligning with the proposed measures outlined by CMS.

Members seeking assistance implementing age-friendly policies and procedures should contact the MHA Keystone Center.

Members with questions about the IPPS final rule should contact Vickie Kunz at the MHA.

MDHHS Releases Medicaid Doula Services Proposed Policy

The Michigan Department of Health and Human Services (MDHHS) recently released a proposed policy updating Medicaid coverage for doula services, effective Oct. 1, 2024. Key updates include increasing the number of covered doula visits to 12 per pregnancy, raising reimbursement rates to $1,500 for labor and delivery support and $100 per prenatal and postpartum visit. Additionally, beneficiaries may qualify for up to six extra visits if more support is needed, based on criteria such as promoting health literacy, emotional support, addressing social determinants of health and more.

These changes aim to improve maternal and infant outcomes, support birth equity and reduce disparities. Doulas provide essential emotional, physical and educational support during pregnancy, leading to better birth outcomes.

Members are encouraged to review and provide feedback on the proposed changes to Kimberly Lorick at LorickK1@michigan.gov. Comments must be submitted by Oct. 31, 2024.

Members with questions may contact Lauren LaPine at the MHA.

MHA Provides Comment on Proposed Medicaid Reimbursement for Group Prenatal Care

The MHA submitted a comment letter to the Michigan Department of Health and Human Services regarding the proposed Medicaid coverage of group prenatal care, set to begin in October 2024. The MHA expressed support for the policy, highlighting its potential to significantly improve maternal and infant health outcomes in Michigan. However, in its comment letter, while supporting the policy, the MHA requested clarification on the reimbursement rate and suggested a higher rate for sessions with larger attendance due to the increased resources required.

Members with questions may contact Lauren LaPine at the MHA.

MDHHS Release Medicaid Reimbursement Proposed Policy

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.