Last week the Washington State Health Care Authority (HCA) sent providers an alert clarifying that HCA will not be adopting a policy adopted for Medicare Part B contractors regarding specificity of diagnosis coding of claims under the new International Classification of Diseases, Version 10 (ICD-10). HCA will require that as of the October 1, 2015 implementation date, claims be coded to the appropriate level of specificity in ICD-10 format. This is in contrast to the guidance adopted by the Centers for Medicare & Medicaid Services (CMS) and the American Medical Association, where for 12 months, ICD-10 coding will be considered valid as long as it is in the correct family. The CMS guidance is binding for Medicare Part B Administrative Contractors but not for state Medicaid programs or commercial insurers. Hospitals and providers should check with their local health plans to determine if they plan to adopt the CMS guidance policy.
To assist providers with their ICD-10 preparation, HCA posted on its ICD-10 Implementation webpage general equivalency mappings between ICD-9 and ICD-10. While no direct crosswalk exists between ICD-9 and ICD-10, the mappings may be useful to providers as they show the range of the specific conditions and coding options within the relevant ICD-10 category. HCA has also posted on the webpage information regarding opportunity for providers to test claims submission with the Authority.
A local workgroup of providers and health plans has been working on ICD-10 implementation and transition issues for more than a year and has additional information and resources on a page of the OneHealthPort website. (Andrew Busz, andrewb@wsha.org)
WSHA Comments on Draft Readmissions Policy Rules
On August 18, WSHA submitted a comment letter on a Health Care Authority stakeholder draft of rule changes to its readmissions policy. The new readmissions policy will replace HCA’s current policy of review and denial of individual readmission claims. Instead, HCA will use 3M Corporation software to compare each hospital’s readmission rates with an expected rate based upon its mix and severity of cases, and will apply a prospective adjustment factor to prospective payment hospitals’ inpatient payment rates. Under the draft rule, the adjustment factors would be applied to inpatient services as of January 1, 2016. Hospitals will also receive periodic reports from HCA regarding their readmission rates to enable care improvements and improved coordination of post-discharge services. Critical Access Hospitals will also receive data regarding their readmission cases but will not be subject to payment penalties.
HCA and Navigant staff have met with and received input from a WSHA task force of finance and quality leaders from member hospitals. In its comments, WSHA requested that HCA include in the rule specific details and protections discussed with the task force. More information is available in our recent Fiscal Watch article.(Andrew Busz, andrewb@wsha.org)
Sign of Big Changes Coming: RFP Out for Integrated Medicaid Contract
Last week, the Health Care Authority released a request for proposal (RFP) for the integrated Medicaid contract for Clark and Skamania Counties (see it here). At this time, the southwest region is the only regional service area pursing the early adopter approach. Effective April 1, 2016, the new contract for includes all mental health, substance abuse, and physical health benefits for Medicaid plans.
This contract will serve as a model for the rest of the state that will move to this integrated contract by 2020.The historic functions managed by the Regional Support Network will cease for Medicaid clients on March 31.
Plans that bid on the contract will be scored regarding management and coordination of services, as well as their provider network. The RFP also identifies “essential behavioral health providers” that plans must demonstrate capacity through including community mental health agencies, hospital and non-hospital evaluation and treatment facilities to serve involuntary detained patients, substance abuse providers, and residential providers for post-acute care. Announcement of successful bidders will be in mid-November. (Chelene Whiteaker, Chelene Whiteaker)
