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

CMS Releases Occupational Mix Data

The Centers for Medicare & Medicaid Services (CMS) released July 12 the FY 2025 Hospital Wage Index Development Timetable, a public use file (PUF). The PUF contains data reported by prospective payment system hospitals on the 2022 occupational mix (OM) survey submitted to the Medicare Administrative Contractor (MAC) by June 30. The 2022 OM data will be used to adjust the Medicare wage index for fiscal years 2025, 2026 and 2027.

The MHA provided updated hospital wage data worksheets that include the 2022 OM data based on the July 12 PUF. Hospitals are encouraged to review both the wage and OM data and submit all requests for changes, along with supporting documentation, to the MAC by Sept. 1, 2023.

The MHA recently became aware of an issue with the latest PUF that has resulted in 0 being reflected for nursing aide dollars and hours for a significant number of Michigan hospitals. The MHA is currently working with the CMS and American Hospital Association on a resolution. The MHA has also urged the CMS to release a corrected PUF as soon as possible. 

The MHA hosted an educational webinar in late June to assist hospitals with the annual data review process with materials available upon request. Members with questions regarding the OM or wage data should contact Vickie Kunz at the MHA.

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.

CMS Releases Proposed Rule to Update Home Health PPS

The Centers for Medicare and Medicaid Services (CMS) recently released a proposed rule to update the home health (HH) prospective payment system (PPS) for calendar year (CY) 2024. The proposed rule includes updates to the Medicare fee-for-service (FFS) HH PPS payment rates based on changes by the CMS and those previously adopted by Congress.

The proposed updates include:

  • A negative 5.653% behavioral offset to achieve budget neutrality due to the transition to the Patient-Driven Groupings Model (PDGM).
  • A 30-day standard payment rate of $1,974.38, which is a 1.81% decrease from the current rate after the 3% marketbasket update is reduced for the negative behavioral adjustment and budget neutrality.
  • Recalibration of the PDGM case-mix weights, low utilization payment adjustment thresholds, functional levels and comorbidity adjustment subgroups.
  • Updates to the expanded HH value-based purchasing program previously expanded to all 50 states. All HH agencies certified before Jan. 1, 2022, will have a reduction or an increase to their Medicare payments by up to 5% based on their performance on specified quality measures beginning in CY 2025.
  • The addition of two new measures to the HH quality reporting program.
  • Payment rates for the administration of Home Intravenous Immune Globulin items and services.
  • Creation of the Hospice Informal Dispute Resolution and special focus programs.
  • Changes to durable medical equipment, prosthetics, orthotics and supplies outlined by the Consolidated Appropriations Act of 2023.
  • A decrease in the labor-related share of the HH 30-day period standard rate from 76.1% in 2023 to 74.9%.
  • A request for information on the use of home health aides.

Comments on the proposed rule are due to the CMS Aug. 29 and can be submitted electronically by using the website’s search feature to search for file code “1780-P.” The MHA will provide an estimated impact analysis of the proposed rule within the next few weeks.

Members with questions should contact Vickie Kunz at the MHA.

Webinar Reviews Medicare FFS Quality-based Programs

The MHA and Data Gen hosted June 14 the second webinar focused on the Medicare fee-for-service (FFS) quality-based programs to review the Medicare readmissions reduction program (RRP) and hospital-acquired conditions (HAC) reduction programs. The Medicare FFS RRP was implemented in fiscal year (FY) 2013 and penalizes hospitals for exceeding expected readmission rates on the following six select medical conditions/procedures:

  • Acute Myocardial Infarction.
  • Heart Failure.
  • Pneumonia.
  • Chronic Obstructive Pulmonary Disease.
  • Total Hip Arthroplasty/Total Knee Arthroplasty.
  • Coronary Artery Bypass Graft.

The program excludes certain planned readmissions, with payment penalties applied to Medicare FFS inpatient payment for all discharges, ranging from 0 to 3%.

The HAC program, implemented in FY 2014, evaluates hospital performance on AHRQ claims based measures and Centers for Disease Control and Prevention chart abstracted measures, penalizing 25% of hospitals nationally. There is no upside opportunity for these two programs, with remaining whole the most favorable outcome. All program penalties benefit the CMS.

A recording and materials from the webinar are available.

Members with questions regarding these programs or webinars should contact Vickie Kunz at the MHA.

MDHHS Informs Hospitals on Medicare Crossover Files Issue

The Michigan Department of Health and Human Services (MDHHS) recently notified hospitals about an issue with the Medicare crossover files from the Centers for Medicare & Medicaid Services (CMS) that impacts CMS files from May 4 to May 23, 2023. Since the MDHHS was not able to load Medicare crossover files received from the CMS during that timeframe, hospitals may need to submit crossover claims.  Hospitals are encouraged to review their Medicare Explanation of Benefit (EOB) to determine which claims are impacted and submit them directly to Michigan Medicaid, as necessary. The MDHHS indicated this appears to be a one-time issue and will continue to track and provide future updates, if necessary.

Members with questions should contact Vickie Kunz at the MHA.

MDHHS Releases REHs Medicaid Reimbursement Final Policy

The Michigan Department of Health and Human Services (MDHHS) recently released a final policy to establish Medicaid reimbursement for rural emergency hospitals (REHs) effective Jan. 1, 2023. The MDHHS reimburses REHs based on the existing outpatient prospective payment system (OPPS) methodology. Critical access hospitals (CAHs) that convert will continue to be paid using the enhanced OPPS reduction factor, while non-CAHs will continue to be paid using their existing OPPS reduction factor. REHs must update their enrollment and subspecialty with the MDHHS through the Community Health Automated Medicaid Processing System (CHAMPS) provider enrollment system within 35 days of any change. Hospitals that convert to REHs must end date their inpatient specialty.

Members with questions regarding the policy should contact Vickie Kunz while members that need assistance evaluating potential conversion should contact Lauren LaPine at the MHA.

CMS Releases Final Rule for MA Plans and Medicare Prescription Drug Benefit Program

The Centers for Medicare and Medicaid Services (CMS) recently released a final rule for Medicare Advantage plans (MA) and the Medicare Prescription Drug Benefit Program for calendar year (CY) 2024.

The rule increases oversight of MA plans and seeks better alignment with Medicare fee-for-service (FFS), including clarifying that MA plans cannot use clinical criteria guidelines that are more restrictive than Medicare FFS to ensure that MA beneficiaries receive access to the same medically necessary care which is increasingly important as enrollment in MA continues to grow.

As recently reported, 59% of Michigan’s total Medicare beneficiaries are enrolled in an MA plan, with enrollment by county ranging from 42% to 75%. The final rule:

  • Prohibits MA plans from limiting or denying coverage for a Medicare-covered service based on their own internal or proprietary criteria if such restrictions do not exist under Medicare FFS.
  • Explicitly states that MA plans must adhere to the Two-Midnight Rule, the Inpatient Only List and case-by-case expectation criteria that apply for Medicare FFS.
  • Prohibits MA plans from denying coverage or redirecting post-acute care to a lower level unless the patient explicitly does not meet the Medicare coverage criteria required for the recommended level of care.
  • Explicitly states that MA plans must provide both coverage and payment for care provider to stabilize an emergency medical condition determined using the prudent layperson standard regardless of the final diagnosis.
  • Requires health plan physician or other professionals to have expertise in the field of medicine related to the service being requested in the prior authorization (PA).
  • Requires PAs to be valid for an entire course of approved treatment and provide a minimum 90-day transition period if an enrollee undergoing treatment switches to a new MA plan.
  • Establishes additional processes to oversee MA plan utilization management programs including an annual review of policies to ensure compliance with Medicare rules and consistency with current clinical guidelines.
  • Strengthens behavioral health network adequacy requirements in several ways:
    • MA plans are currently required to provide access to an adequate network of “appropriate providers”, including primary care physicians, specialists, hospitalists and others. Plans are also required to demonstrate that the network includes an adequate number of psychiatrists and inpatient psychiatric facilities. This rule adds providers that specialize in behavioral health services to this list, including clinical psychologists and licensed clinical social workers.
    • Codifies standards for appointment wait times for primary care and behavioral health services.
    • Clarifies that emergency behavioral health services are not subject to PA.
    • Requires MA plans to notify enrollees when the enrollee’s behavioral health or primary care provider is dropped from the network mid-year.
    • Amends general access to services standards to explicitly include behavioral health services.
    • Requires MA plans to establish care coordination programs to increase parity between behavioral and physical health services.
  • Restricts MA plan marketing practices to protect beneficiaries from misleading advertisements and pressure tactics designed to increase enrollment.
  • Expands requirements for MA plans to provide culturally and linguistically appropriate services.
  • Establishes a new Health Equity Index to be incorporated into the MA plan Star Ratings beginning in 2027 to improve performance for patients with certain social risk factors.
  • Implements statutory provisions of the Inflation Reduction Act and the Consolidated Appropriations Act of 2021 related to the prescription drug affordability and coverage for eligible low-income individuals.

The CMS indicates that it intends to release a second rule to address remaining proposals from the December 2022 proposed rule that were not addressed in this rule, with the second rule to have a later effective date, expected to be no earlier than Jan. 1, 2025.

Members with questions should contact Vickie Kunz at the MHA.

MHA Comments on LTCH PPS Proposed Rule

The MHA recently submitted comments to the Centers for Medicare and Medicaid Services (CMS) regarding the proposed rule to update the Medicare fee-for-service (FFS) long term care hospital (LTCH) prospective payment system (PPS) for fiscal year 2024. These comments were due to the CMS June 9.

The CMS is expected to release a final rule to update the LTCH PPS in early August (2023) ahead of the Oct. 1 effective date. The MHA will provide members with an updated Medicare FFS impact analysis following the final rule’s release.

Members with questions should contact Vickie Kunz at the MHA.