The 2016 legislative session is now underway, and this year’s session is slated to be a short one. This year, a supplemental budget year, our top budget priority is mental health, which Governor Jay Inslee also identified as a major need in his December supplemental budget. We are hoping to continue the gains in mental health funding that began last year.... Read More >>

The Health Care Authority has revised both its inpatient hospital and physician-related services provider billing guides to reflect changes to its policy regarding payment for elective early deliveries. Effective January 1, 2016, HCA will not pay for professional or hospital charges related to elective early deliveries before 39 weeks gestation, unless the physician documents that the early delivery is medically necessary. ... Read More >>

Under a federal law passed last summer, hospitals may need to provide written and oral notification to Medicare patients placed in observation status as early as August 2016. Unfortunately, the federal rulemaking process may leave little time for hospitals to implement the requirements once the specific requirements are known. The Centers for Medicare and Medicaid Services (CMS) has not yet released its proposed rule for comment.... Read More >>

The Health Care Authority has extended its deadline to February 1 for providers to apply to offer total joint replacements using bundled payments for its coverage for state employees. The proposal, based on the episode of care established by the Bree Collaborative, includes establishment of patient disability and failure of more conservative treatment, determination of fitness for surgery, use of evidence-based surgical practices, and standardized post-operative care.... Read More >>

Medicaid inpatient hospital payment rates for Washington hospitals paid on the prospective payment system now incorporate penalties based on “excessive” rates of hospital readmissions. A number of hospitals will see small reductions in payment because of this change – with penalties ranging from 0.0 percent to a maximum of 1.0 percent. The new policy from the Health Care Authority penalizes hospitals that appear to have an excessive number of potentially preventable admissions, based on an HCA analysis using 3M Corporation software.... Read More >>

On November 1, 2015 the Washington State Health Care Authority (HCA) made an 8 percent reduction in inpatient Medicaid payment rates. There appears to be material errors in the November calculation. As a result of questions that WSHA raised, HCA informed us it discovered an error in the inpatient calculation related to how it priced payments for certified public expenditure hospitals.... Read More >>

Hospitals and health systems, health care practices, community-based organizations and others can apply until March 31 to participate in a new Center for Medicare and Medicaid Innovation model that will test whether access to health-related social services reduces health care costs and use of inpatient and outpatient health care services for Medicare and Medicaid beneficiaries, the Centers for Medicare & Medicaid Services announced Jan. 5.... Read More >>

The Washington Health Benefit Exchange has announced that nearly 174,000 Washington State residents have signed up for or renewed their health coverage as of Jan. 2. The deadline to select a Qualified Health Plan is Jan. 31 for coverage beginning March 1.... Read More >>

We are getting ready for the 2016 legislative session, and are excited to invite you to our legislative session kickoff webcast. Cassie Sauer, Claudia Sanders and Mary Kay Clunies-Ross will talk about WSHA’s top priorities for the session, as well as how recent leadership changes might affect health care legislation this year.... Read More >>

U.S. spending on health care grew 5.3% in 2014 – largely due to coverage expansion associated with the Affordable Care Act (ACA) and rapidly rising prescription drug prices – following five straight years of historically low growth, the Centers for Medicare & Medicaid Services (CMS) reported Dec. 2 in an article published online in Health Affairs. ... Read More >>