While operational challenges will undoubtedly unfold after last week’s Washington State Supreme Court decision to end the practice of psychiatric boarding through Single Bed Certifications (SBCs) for patients without medical comorbidities, we may also see impacts to hospital payments authorized through SBCs. The Washington State Hospital Association (WSHA) is aware that some hospitals provide psychiatric treatment and care while patients wait to find appropriate placement in a certified evaluation and treatment facility. Even with the court’s decision, some acutely ill psychiatric patients may remain in hospitals because of hospital obligations under EMTALA. It is unclear to us at this point whether Regional Support Networks (RSNs) will continue to pay those inpatient claims. We encourage you to reach out to your RSN to discuss the implications of the court’s decision.
WSHA would like to know:
- Does your hospital/health system receive payment through Single Bed Certifications?
- How many claims did your hospital bill last year?
- What is the response from the RSN on continuing these payments?
The court’s decision takes effect on August 27. (Chelene Whiteaker, CheleneW@wsha.org)
WSHA Comments on Apple Health Draft Managed Care Contract
|WSHA has submitted detailed comments in response to the Health Care Authority’s (HCA’s) draft of the new Apple Health Contract between HCA and the managed care plans for Medicaid services. This is scheduled to go into effect January 1, 2015. In its comments, WSHA advocated for strengthened access to care and network adequacy requirements, coverage for services delivered through telemedicine, and more robust information to enrollees regarding network providers. WSHA also asked for clarity on plan participation in initiatives of outside entities such the Foundation for Healthcare Quality and the Bree Collaborative, and commented that the language omitted other entities whose initiatives have been proven effective and broadly adopted. The draft contract can be found here and WSHA’s complete comments can be found here.|
(Andrew Busz, AndrewB@wsha.org)
Health Care Authority Cuts Clinic Obstetrical Payments, Dental Payments
The Health Care Authority (HCA) announced that it will cut payments for certain services to meet legislative requirements of the 2015 operating budget. A budget proviso requires $40 million in total state savings for State Fiscal Year 2015, $11.5 million of it through the HCA. Among the cuts:
- Elimination of the delivery rate enhancement and S-Kicker payments paid to Federally Qualified Health Centers (FQHCs) and Rural Health Clinics, effective October 1 ($2 million state/$4 million total cut). HCA paid these enhancements directly to clinics where the provider performed an obstetrical delivery on a Medicaid patient or the clinic was wholly at financial risk for the OB service. Loss of these payments could seriously jeopardize the ability of clinics to provide access to OB services in rural and underserved areas. The cut does not affect the delivery case rate paid to managed care plans or the payments from the plans to providers for OB related services.
- Cut to payment rate for Medicaid orthodontia services effective October 1 ($2 million state/$4 million total cut).
- Change to payment to FQHCs for dental fluoride and sealants ($2 million state/$4.8 million total cut). Effective July 1, HCA is paying for fluoride treatment and sealants provided by FQHCs at the fee-for-service dental fee schedule rate when they are the only services performed. Previously, HCA paid for the services at the clinics’ dental encounter rate.
HCA has not yet announced any additional planned cuts needed to meet the budget requirement. (Andrew Busz, AndrewB@wsha.org)
WSHA Encourages Comments on Bree Collaborative Draft Report
The Dr. Robert Bree Collaborative (Bree Collaborative) recently released for public comment its draft report on Lumbar Fusion Surgery Bundle and the companion report on Spinal Fusion Warranty. The reports aim to improve patient safety and reduce costs associated with lumbar fusions. Recommendations from the Bree Collaborative will be considered by the Washington Health Care Authority and could impact public and private purchasing for lumbar fusions.
At a national level, lumbar fusion surgeries have been on the rise and represent a high cost to patients and purchasers when compared to non-surgical interventions. A WSHA review of 2013 hospital discharge data (CHARS) found approximately 5,000 lumbar fusions performed in Washington State totaling about $700 million in billable charges.
The potentially unnecessary overuse of lumbar fusion surgery is a serious issue, and WSHA fully supports efforts to improve care and reduce costs. This being said, WSHA has identified several specific issues with the proposed Bree lumbar fusion surgery bundle that may merit comment and additional consideration. Please refer to the WSHA Bulletin for more information on the bundle, warranty, and key issues identified by WSHA staff. We encourage you to review the Bulletin and submit comments to the Bree Collaborative on the report as appropriate. Comments are due Tuesday, August 19, 2014 and can be submitted to the Bree Collaborative here. (Ian Corbridge, IanC@wsha.org)