Court Victory May Impact Medicaid DSH Payments

January 29, 2015

Court Victory May Impact Medicaid DSH Payments

A recent court victory by Seattle Children’s Hospital and Texas Children’s Hospital may significantly impact how Medicaid Disproportionate Share Hospital (DSH) payments are distributed by Washington State and other states. The Washington State Health Care Authority is in the process of analyzing the details of the injunction.
The two hospitals won a preliminary injunction against the Centers for Medicare and Medicaid Services (CMS), preventing the enforcement of a change to definitions used to calculate DSH eligibility and payments. The new definition applied payments from private insurance to services provided to Medicaid enrollees, even if the hospitals did not bill or receive Medicaid payment for the patient. The effect of this was to offset the losses incurred on patients where Medicaid was the payor. The ruling initially may impact the results of a recent audit of the 2011 DSH payment distribution and the DSH payment calculation process for 2015, but could ultimately include the distributions made during 2012-2014. (Andrew Busz, 

HHS Announces Ambitious Timeline for Alternative Payment Models

On Monday, U.S. Health and Human Services (HHS) Secretary Sylvia Mathews Burwell announced an ambitious timeline that would require at least 30 percent of Medicare payments to be made through alternative payment models such as Accountable Care Organizations, bundled payments, and other models by the end of 2016, and at least 50 percent by 2018. An even larger proportion, 90 percent of payments, would be subject to quality programs such as the Hospital Value-Based Purchasing and the Hospital Readmissions Reduction Programs by 2018. While CMS has for years encouraged innovation and a move from volume to quality and value, this marks the first time HHS has set explicit goals for alternative payment models and value-based payments. While the requirements and timeline apply to Medicare services, HHS intends to also encourage adoption by state Medicaid programs and private payors. (Andrew Busz, 

WSHA Focusing on Legislative Bills Impacting Hospitals

Though we are still early in the legislative session, WSHA is already involved in a number of bills with financial impacts to hospitals.  Bills on which WSHA staff will be testifying this week include:
SB 5175: Telemedicine (Senate Health Care). WSHA is again actively working and supporting this year’s telemedicine bill. The bill requires commercial and Medicaid health plans to reimburse providers for health care services delivered through audio and video technology if they would have covered the services as an in-person visit. The bill would enhance access to care, particularly in rural areas, and ensuring payment would help providers with their investment in technology. (Chelene Whiteaker, 206-216-2545)
SB 5010: Loan Repayment (Senate Health Care). WSHA is part of a broad coalition working to support state loan repayment for primary care providers as a way to increase access in underserved areas. This bill would restore funding to the state Health Professional Loan Repayment Program to 2010 levels. WSHA is advocating that behavioral health providers be eligible for loan repayment. (Ian Corbridge, 206-216-2514) 
HB 1105: State Supplemental Budget (House Appropriations). WSHA testified on January 26 in support of including substantial funding for mental health beds to address the State Supreme Court case on psychiatric boarding. (Chelene Whiteaker, 206-216-2545)
Work session: Degrees and Credentials that Lead to Good Jobs: Rural Primary Care Shortage (House Higher Education). WSHA was invited to present at this work session on who provides rural primary care and how the state can help. (Cassie Sauer, 206-216-2538)
HB 1340: Work Force Development (House Health Care & Wellness). This bill would create a structured process to allow pilot programs for health care professionals to learn new skills or roles, use existing skills in new circumstances, and accelerate training, which could result in the ability to make more efficient use of available staff. (Ian Corbridge, 206-216-2514)
HB 1080: Loan Repayment (House Health Care & Wellness). This is the companion bill to SB 5010, referenced above.
SB 5593: Delivery and payment for health care services by hospitals for inmates and persons detained by law enforcement (Senate Law & Justice). WSHA supports this bill. (Andrew Busz, 206-216-2533)
SB 5049: Education Requirements for Surgical Technologists (Senate Health Care). The current version of this bill puts additional requirements on surgical techs and hospitals in a way that is burdensome and with little benefit. WSHA will testify against the current version of the bill and continue to work with sponsors and interested parties to create a version that is more beneficial to systems and patients. (Ian Corbridge, 206-216-2514)
HB 1403: Telemedicine (House Health Care & Wellness). Companion bill to SB 5175.
HB 1437: All Payer Claims Database (House Health Care & Wellness). This bill modifies the all-payer claims database to improve health care quality and cost transparency. (Claudia Sanders, 206-216-2508)


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