Fiscal Watch for hospitals and health systems

August 11, 2016

Every other week, WSHA reports on key issues that affect the fiscal health of hospitals. Being able to provide continuous care to our communities means providing fiscal stability in a quickly changing health care world.

Here are a few key articles from our most recent edition of Fiscal Watch:

  • Hospitals Receive Medicaid Quality Incentive Payments; Check that Your Managed Care Payments Are Accurate: Effective July 1, 2016, the majority of Washington hospitals  paid under prospective payment system became eligible for a one-percent quality incentive increase to their Medicaid inpatient payment rates (for both inpatient APRDRG and per diem rates).  This is a significant increase in the number of hospitals qualifying. Hospitals that received the increase last year will not see any change in their rate, but hospitals that are newly qualifying should see a rate change.
  • OIC Begins Process to More Carefully Regulate Prior Authorization Rules: The Office of the Insurance Commissioner (OIC) recently released a stakeholder draft of rules pertaining to prior authorizations, the first step in the rule making process.  WSHA, WSMA, and many of our members have been asking the OIC to more carefully regulate this process in order to reduce administrative overhead for providers.  OIC will be accepting comments on the stakeholder draft through August 17.
  • CMS Issues Final Inpatient Payment Rule; Delays Implementation of Medicare Observation Notification Requirements: As part of its inpatient final rule released yesterday, the Centers for Medicare and Medicaid Services (CMS) is delaying the implementation of the Medicare Outpatient Observation Notification requirements originally scheduled to go into effect August 6, 2016. Hospitals were awaiting the final CMS rule before implementing the new requirement.
  • State Work group Considers Hospital Cuts to Offset Medicaid Managed Care Rate Increases: The State’s Health Care Oversight Joint Select Committee met last Wednesday to hear an update on a study looking at ways to deliver a zero increase rate for Medicaid managed care plans in the upcoming fiscal year.  Staff from the Health Care Authority recommended three areas of focus based on the recommendations from its workgroup, composed of state staff and the managed care plans.

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