The Health Care Authority (HCA) recently sent hospitals new agreements to provide protections from reductions to regular Medicaid payment for the period when hospitals are participating in the Hospital Safety Net Assessment program. The new safety net law, passed during the most recent legislative session, requires HCA to offer hospitals an agreement giving the hospital a remedy should the state reduce payments under the program.
WSHA identified some incorrect references in the agreements sent earlier by HCA. At WSHA’s request, HCA agreed to rescind and reissue the agreements. WSHA legal staff has reviewed the corrected agreements, confirmed that the errors have been corrected, and recommends that hospitals sign and return the revised agreements. (Andrew Busz, firstname.lastname@example.org)
WSHA Requests Additional Information on Recent HCA Hospital Payment Budget Neutrality Reductions
WSHA has been working hard to verify the appropriateness of the recent HCA proposed reductions for payment rates for Prospective Payment System (PPS) hospitals. HCA recently sent PPS hospitals notices of new Medicaid inpatient and outpatient payment rates, effective November 1, 2015. The rates include an 8 percent reduction for inpatient rates and an 8 percent reduction for outpatient. These changes are due to state calculations to ensure budget neutrality with the payment rates in effect prior to the July 1, 2014 rebasing. We are investigating the reductions to determine if the calculations have been done correctly. In the meantime, WSHA recommends that PPS hospitals appeal the new rates to preserve the right to have corrections made if it is determined the new rates are in error.
For more information see our recent Bulletin.
WSHA has requested that HCA and its consultant, Navigant, provide additional information regarding the calculations. WSHA has also hired Analysis Group, WSHA’s consultant for the safety net assessment program, to review the state’s methodology and calculations for reasonableness. WSHA will inform members of the results of the review. In the meantime, we believe hospitals should file a rate appeal with HCA. WSHA is working on draft appeal language. (Andrew Busz, email@example.com)
Hospitals and Providers Seek Relief of Prior Authorization Issues
WSHA staff met recently with representatives of member hospitals and representatives of the Washington State Medical Association to see if there are ways to work together to obtain relief from health plan prior authorization processes. These often present a significant barrier to patients receiving timely care. Current prior authorization and pre-service requirements add significant delay of care for patients and administrative cost for both providers and health plans, yet such services ultimately are nearly always approved. Potential approaches for relief include collaboration on more cost-effective approaches with payers and regulatory or legislative changes.
Among the items discussed:
- Allowance for expedited review of prior-authorization requests for services in cases meeting agreed-on extenuating circumstances.
- Greater transparency of plan clinical requirements and pre-service requirements for specific services.
- Establishing the medical need for new prior authorization requirements before implementing a new requirement.
- Providing an opportunity to review and respond to new requirements before hospitals are contractually subject to them.
WSHA requests your comments and suggestions concerning this issue. Please contact Andrew Busz, WSHA Policy Director, Finance at firstname.lastname@example.org or (206) 216-2533.