WHEN: Introductory Capitol Workshops, each offering similar content, will be offered:

  • August 25-26 (Register by 8/12)
    • The August workshop will take place over two days with sessions running from 8 am – 12 pm. We will offer breaks in between.
  • November TBD

WHERE: This is a virtual workshop. We will send meeting details upon registration.

REGISTER

As a Missouri Foundation for Health (MFH) grantee or close community partner, your organization is eligible to register up to two staff for our Introductory Capitol Workshops.  

You work at the local level to address critical needs and can provide essential information to policymakers about the health challenges in their districts. To help you effectively and confidently engage with policymakers, MFH developed the Link Project, which includes workshops and experiential learning opportunities. The Introductory Capitol Workshops provide an overview of the state legislative process as well as guidance about ways you can engage elected officials.

To ensure we can provide training to as many partners as possible, this opportunity is open to no more than two participants from your organization.  We hope you or appropriate staff from your organization will attend.

Registration is currently open for the August 25-26 workshop only. We will send registration information for the November workshop in the fall.

Sessions fill quickly – register promptly below to ensure a slot!

QUESTIONS?
Contact Alex Rankin with questions or requests at
(314) 345-5571 or at arankin@mffh.org.

August 1, 2020

The current COVID-19 Public Health Emergency (PHE) does not waive any requirements related to Skilled Nursing Facility (SNF) Consolidated Billing (CB); however, CMS added CPT codes 99441, 99442, and 99443, to the list of telehealth codes coverable under the waiver during the COVID-19 PHE. These codes designate three different time increments of telephone evaluation and management service provided by a physician. These physician services can be billed separately under Part B when furnished to a SNF’s Part A resident.

Medicare Administrative Contractors (MACs) will reprocess claims for CPT codes 99441, 99442 and 99443 with dates of service on or after March 1, 2020, that were denied due to SNF CB edits. You do not have to do anything. If you already received payment from the SNF for these physician services, return that payment to the SNF once the MAC reprocesses your claim.

July 31, 2020

On July 31, the Centers for Medicare and Medicaid Services (CMS) finalized three Medicare payment rules that further advance efforts to strengthen the Medicare program by better aligning payments for Inpatient Psychiatric Facilities (IPFs), Skilled Nursing Facilities (SNFs), and hospices.

Inpatient Psychiatric Facilities: The final rule updates Medicare payment policies and rates for the IPF Prospective Payment System (PPS) for FY 2021. In this final rule, CMS is finalizing a 2.2 percent payment rate update and finalizing its proposal to adopt revised Office of Management and Budget (OMB) statistical area delineations resulting in wage index values being more representative of the actual costs of labor in a given area. CMS is finalizing updates to allow advanced practice providers, including physician assistants, nurse practitioners, psychologists, and clinical nurse specialists to operate within the scope of practice allowed by state law by documenting progress notes in the medical record of patients for whom they are responsible, receiving services in psychiatric hospitals.

Skilled Nursing Facilities: The final rule updates the Medicare payment rates and the quality programs for SNFs. These updates include routine technical rate-setting updates to the SNF PPS payment rates, as well as finalizes adoption of the most recent OMB statistical area delineations and applies a 5 percent cap on wage index decreases from FY 2020 to FY 2021. CMS is also finalizing changes to the ICD-10 code mappings that would be effective beginning in FY 2021 in response to stakeholder feedback. CMS projects aggregate payments to SNFs will increase by $750 million, or 2.2 percent, for FY 2021, compared to FY 2020.

Hospices: For FY 2021, hospice payment rates are updated by the market basket percentage increase of 2.4 percent ($540 million). Hospices that fail to meet quality reporting requirements receive a 2 percentage point reduction to the annual market basket percentage increase for the year. The hospice payment system includes a statutory aggregate cap. The aggregate cap limits the overall payments made to a hospice annually. The final hospice cap amount for the FY 2021 cap year is $30,683.93, which is equal to the FY 2020 cap amount ($29,964.78) updated by the final FY 2021 hospice payment update percentage of 2.4 percent.

For More Information:

New National Organization of State Offices of Rural Health (NOSORH) issue brief examines the definitions of population health and health equity for rural stakeholders, and offers examples of successful rural strategies.

In recent years, the terms “population health” and “health equity” have often been used interchangeably by some rural stakeholders. This issue brief aims to examine the differences between the two terms, and offers successful examples of rural population health and health equity activities by State Offices of Rural Health (SORH) and their partners. The brief also offers suggestions on how rural health stakeholders can get started in population health and health equity efforts at the state and local levels.

With support from the Federal Office of Rural Health Policy, NOSORH developed this issue brief for SORH and other rural health stakeholders as a means of ensuring unified definitions and approaches to population health and health equity by rural stakeholders.

July 30, 2020

On July 29, CMS announced the average basic premium for Medicare Part D prescription drug plans, which cover prescription drugs that beneficiaries pick up at a pharmacy. Under the leadership of President Trump, for the first time seniors that use insulin will be able to choose a prescription drug plan in their area that offers a broad set of insulins for no more than $35 per month per prescription.

The average basic Part D premium will be $30.50 in 2021. The 2021 and 2020 average basic premiums are the second lowest and lowest, respectively, average basic premiums in Part D since 2013. This trend of lower Part D premiums, which have decreased by 12 percent since 2017, means that beneficiaries have saved nearly $1.9 billion in premium costs over that time. Further, Part D continues to be an extremely popular program, with enrollment increasing by 16.7 percent since 2017.

“At every turn, the Trump Administration has prioritized policies that introduce choice and competition in Part D,” said CMS Administrator Seema Verma. “The result is lower prices for life-saving drugs like insulin, which will be available to Medicare beneficiaries at this fall’s Open Enrollment for no more than $35 a month. In short, Part D premiums continue to stay at their lowest levels in years even as beneficiaries enjoy a more robust set of options from which to choose a plan that meets their needs.”

In addition to the $1.9 billion in premium savings for beneficiaries since 2017, the Trump Administration has produced substantial Part D program savings for taxpayers. With about 200 additional standalone prescription drug plans and 1,500 additional Medicare Advantage plans with prescription drug coverage joining the program between 2017 and 2020, and that trend expected to continue in 2021, increased market competition has led to lower costs and lower Medicare premium subsidies, which has saved taxpayers approximately $8.5 billion over the past four years.

Earlier this year, CMS launched the Part D Senior Savings Model, which will allow Medicare beneficiaries to choose a plan that provides access to a broad set of insulins at a maximum $35 copay for a month’s supply. Starting January 1, 2021, beneficiaries who select these plans will save, on average, $446 per year, or 66 percent, on their out-of-pocket costs for insulin. Beneficiaries will be able to choose from more than 1,600 participating standalone Medicare Part D prescription drug plans and Medicare Advantage plans with prescription drug coverage, all across the country this open enrollment period, which runs from October 15 through December 7. And because the majority of participating Medicare Advantage plans with prescription drug coverage do not charge a Part D premium, beneficiaries who enroll in those plans will save on insulin and not pay any extra premiums.

In January 2020, CMS, through the Part D Payment Modernization Model, offered an innovative new opportunity for Part D plan sponsors to lower costs for beneficiaries, while improving care quality. Under this model, Part D sponsors can better manage prescription drug costs through all phases of the Part D benefit, including the catastrophic phase. Through the use of better tools and program flexibilities, sponsors are better able to negotiate on high cost drugs and design plans that increase access and lower out-of-pocket costs for beneficiaries. For CY 2021, there will be nine plan options in Utah, New Mexico, Idaho and Pennsylvania that participate in this model.

In Medicare Part D, beneficiaries choose the prescription drug plan that best meets their needs, and plans have to improve quality and lower costs to attract beneficiaries. This competitive dynamic sets up clear incentives that drive towards value. CMS has taken steps to modernize the Part D program by providing beneficiaries the opportunity to choose among plans with greater negotiating tools that have been developed in the private market and by providing patients with more transparency on drug prices. Improvements to the Medicare Part D program that CMS has made to date include:

  • Beginning in 2021, providing more information on out-of-pocket costs for prescription drugs to beneficiaries by requiring Part D plans to provide a real time benefit tool to clinicians with information that they can discuss with patients on out-of-pocket drug costs at the time a prescription is written
  • Implementing Part D legislation signed by President Trump to prohibit “gag clauses,” which keep pharmacists from telling patients about lower-cost ways to obtain prescription drugs
  • Beginning in 2021, requiring the Explanation of Benefits document that Part D beneficiaries receive each month to include information on drug price increases and lower-cost therapeutic alternatives
  • Providing beneficiaries with more drug choices and empowering beneficiaries to select a plan that meets their needs by allowing plans to cover different prescription drugs for different indications, an approach used in the private sector
  • Reducing the maximum amount that low-income beneficiaries pay for certain innovative medicines known as “biosimilars,” which will lower the out-of-pocket cost of these innovative medicines for these beneficiaries
  • Empowering Medicare Advantage to negotiate lower costs for physician-administered prescription drugs for seniors for the first time, as well allowing Part D plans to substitute certain generic drugs on plan formularies more quickly during the year, so beneficiaries immediately have access to the generic, which typically has lower cost sharing than the brand
  • Increasing competition among plans by removing the requirement that certain Part D plans have to “meaningfully differ” from each other, making more plan options available for beneficiaries

For More Information:

  • Part D Senior Savings Model webpage
  • Ratebooks & Supporting Data webpage: View the 2021 Part D base beneficiary premium, the Part D national average monthly bid amount, the Part D regional low-income premium subsidy amounts, the de minimis amount, the Medicare Advantage employer group waiver plan regional payment rates, and the Medicare Advantage regional PPO benchmarks

July 30, 2020

On July 30, CMS and the Centers for Disease Control and Prevention (CDC) are announcing that payment is available to physicians and health care providers to counsel patients, at the time of Coronavirus Disease 2019 (COVID-19) testing, about the importance of self-isolation after they are tested and prior to the onset of symptoms.

The transmission of COVID-19 occurs from both symptomatic, pre-symptomatic, and asymptomatic individuals emphasizing the importance of education on self-isolation as the spread of the virus can be reduced significantly by having patients isolated earlier, while waiting for test results or symptom onset. The CDC models show that when individuals who are tested for the virus are separated from others and placed in quarantine, there can be up to an 86 percent reduction in the transmission of the virus compared to a 40 percent decrease in viral transmission if the person isolates after symptoms arise.

Provider counseling to patients, at the time of their COVID-19 testing, will include the discussion of immediate need for isolation, even before results are available, the importance to inform their immediate household that they too should be tested for COVID-19, and the review of signs and symptoms and services available to them to aid in isolating at home. In addition, they will be counseled that if they test positive, to wear a mask at all times, and they will be contacted by public health authorities and asked to provide information for contact tracing and to tell their immediate household and recent contacts in case it is appropriate for these individuals to be tested for the virus and to self-isolate as well.

CMS will use existing evaluation and management payment codes to reimburse providers who are eligible to bill CMS for counseling services no matter where a test is administered, including doctor’s offices, urgent care clinics, hospitals, and community drive-thru or pharmacy testing sites.

For More Information:

Part I: How to Keep Your Funding

Description: This session is designed to provide rural hospital and clinic leaders with information needed to retain COVID funding and prepare for a single audit. BKD will recommend best practices for procedures, documentation and example methodologies for tracking various funding sources, revenues and expenses related to COVID.  

BKD Speaker(s): Travis Skinner, Ally Jackson, and Ryan O’Grady

Part II: Current Funding Guidance and Cost Report Implications

Description: Staying up-to-date on funding opportunities and associated guidance has been a challenge for all hospital leaders. BKD’s subject matter experts will share the most current information on funding sources and explore the potential downstream impact on the hospital’s the cost report.

BKD Speaker(s): Derek Pierce, Krystal Creach, Julia Mast, and Steve Parde

Part III: Operational Considerations 

When: Friday, July 31, 2020 at 11:00 AM CST

Description: Hospitals and clinics are eager to resume operations and reach pre-COVID volumes as quickly as possible. However, with threat of a possible COVID resurgence, labor disruptions and community uncertainty, the rebound is slower than expected.

BKD Speaker(s):Kevin Rash and Jaimie Pham

Part IV: Revenue Cycle Strategies 

When: Friday, August 7, 2020 at 11:00 AM CST

Description: BKD will review the revenue cycle strategies rural hospital leaders should be aware of as they determine how to prioritize and address any backlog in revenue cycle. This session will provide leaders example of how to prioritize A/R, opportunities for uninsured COVID reimbursement programs and discuss how to manage remote staff productivity.

BKD Speaker(s): Deb Kozlowski and Brenda Christman

Part V: Physicians: Strategic Planning

When: Friday, August 14, 2020 at 11:00 AM CST

Description: Proper alignment with employed and affiliated physicians continues to present challenges, especially to rural providers. With growing practice subsidies and recruitment and retention difficulties, hospital leaders must engage at a deeper level with the medical staff to achieve sustainable arrangements.

BKD Speaker(s): Randy Biernat and Mark Blessing

Updated June 2020, this manual was developed for use by state Medicare Rural Hospital Flexibility (Flex) Program personnel as well as small rural hospital and clinic staff/boards. The content is designed to be non-technical, and provide answers to frequently asked questions regarding critical access hospital, small rural hospital, and rural health clinic finance and financial performance. Example topics include:

  • Government Health Care Reimbursement
  • CAH Finances
  • Improving CAH Financial Performance
  • Prospective Payment System (PPS) Finances
  • RHC Finances

View the manual here!