May 13, 2010
- The Hospital Safety Net Assessment: What Happens Next?
- Health Reform Act Reduces Outpatient PPS Payment
- State Forms Workgroup on Balanced Billing for Emergency Services
- ProviderOne Conversion: So Far, So Good
The Hospital Safety Net Assessment: What Happens Next?
House Bill 2956, establishing a Hospital Safety Net Assessment, passed the legislature and was signed by the Governor. While the passage of the bill is a huge milestone, additional steps must occur before it is implemented and additional funds flow to Washington hospitals.
Before the assessment and enhanced rates become effective, a new State Plan Amendment (SPA) filed by the state must be approved by the Centers for Medicare and Medicaid Services (CMS). The SPA has been submitted by the state and most members of Washington’s congressional delegation have signed a letter urging CMS to promptly review and approve the SPA and the assessment program. Once CMS approval is obtained, the enhanced rates and assessments will be effective retroactively to the dates established by the legislation. Under the bill, restoration of the 4 percent payment cut from the 2009 legislative session will occur as of July 1, 2009. The additional payment rate increases will occur as of February 1, 2010. Payment and assessments for any retroactive periods will occur closely together to avoid cash flow issues for both the state and hospitals. The bill also makes provisions for Medicaid managed care (Healthy Options, Apple Health, Basic Health Plus) payments. Upon CMS approval, the state will adjust plan premiums and provide additional funding to plans in hospital-specific amounts to pass on to hospitals for any retroactive periods. The assessment provides additional funding for Title XIX Medicaid services only and does not provide any funding or rate increases for the Basic Health subsidized program, Disability Lifeline, or other state-only programs.
WSHA staff are working closely with the state to ensure the program is implemented in a way that works for hospitals. WSHA has sent hospital CEOs and CFOs information estimating the impact for their specific facilities. Additional information regarding the Hospital Safety Net Assessment, including a link to the final bill, is available on the WSHA website. (andrewb@wsha.org)
Health Reform Act Reduces Outpatient PPS Payment
The Patient Protection and Affordable Care Act (PPACA) signed by President Obama on March 23 has provisions that will have an immediate impact on Medicare payment rates. In our previous Fiscal Watch, we reported that Inpatient Prospective Payment System (IPPS) hospitals, Long Term Care (LTC) hospitals, and Inpatient Rehabilitation Facilities (IRFs) were subject to a 0.25 percent reduction as of April 1, 2010 through September 30 when new IPPS, LTC, and IRF rules go into effect.
The PPACA also imposes a retroactive 0.25 reduction to the Outpatient Prospective Payment System (OPPS) market basket for Calendar Year 2010. The reduction is for OPPS services incurred between January 1 and September 30 of 2010 and will begin to be applied by FI/MACs in late May or early June.
WSHA staff are currently analyzing and will provide additional information on this and other PPACA impacts as more data becomes available. (andrewb@wsha.org)
State Forms Workgroup on Balanced Billing for Emergency Services
Several bills were introduced during the 2010 legislative session to help protect patients from unexpected high out-of-pocket expenses when they have used a hospital emergency room. At issue is the fact that insured patients who use an in-network emergency hospital can end up paying out-of-network expenses for physicians. This happens in cases where the physician providing the emergency service is not a contracted physician from the insurance plan. National efforts have been focused on disclosure and making sure the patient has appropriate information regarding providers’ contract status in advance of services. This is effective only when patients have a choice of facilities, not always an option in emergency circumstances.
State legislative efforts seek to virtually eliminate the occasions where such balanced billing would occur. House Bill 2779, sponsored by Representative Eileen Cody, and other bills proposed during the 2010 legislative session sought to remedy this situation by requiring that plans pay a certain specified rate for their services and the non-contracted physicians accept that rate as payment in full. WSHA opposed the bills because of our concern about the effect an artificially imposed rate would have on the availability of providers and possible impact on call coverage arrangements. The bills did not progress during the 2010 session due to a lack of consensus on the proper solution. The problem does remain, and a workgroup, being formed by Representative Cody, will meet during the legislative interim and will include representatives from health plans, hospitals, physician groups, consumers, and state agencies. We expect some type of legislation to be proposed during the 2011 legislative session. (andrewb@wsha.org)
ProviderOne Conversion: So Far, So Good
ProviderOne, the state’s new Medicaid claims and information management system, was implemented last weekend. So far there have been no major unexpected issues and most defects have been remedied quickly. A daily status bulletin is available on the ProviderOne website.
Unfortunately, we are hearing one of the Medicaid managed care plans is still having significant issues with their conversion to a new TPA at the beginning of this year. We have been in contact with them and are committed to doing all we can to help resolve any outstanding delays in claims payment. If you are experiencing significant payment issues with any payor, please contact Andrew Busz, WSHA Director of Financial Policy. (andrewb@wsha.org)