New Safety Net Assessment Program Successfully Completes First Year
The Washington State Hospital Association (WSHA) is pleased to report that payments to hospitals for Medicaid services under the Hospital Safety Net Assessment program have been made by the state and the managed care plans for state fiscal year (SFY) 2014. WSHA has worked with the Washington Health Care Authority (HCA) and the plans to ensure payments are made in a timely manner.
We understand payments for the first quarter of SFY 2015 have also been paid or are in process by the HCA and managed care plans to prospective payment and certified public expenditure hospitals. The timing of payments and assessments under the program was arranged to minimize cash flow issues for hospitals. We strongly urge hospitals to ensure they have remitted to the state all assessments due for the time periods which they have received payment. (Andrew Busz, firstname.lastname@example.org)
Hospitals Prepare for ACA Open Enrollment 2014-2015
Washington hospitals are gearing up to help as many individuals as possible enroll in affordable coverage. On Friday, September 26, WSHA brought hospital representatives together with the Health Benefit Exchange (Exchange) and HCA staff to discuss the upcoming open enrollment period for health insurance coverage provided by the Affordable Care Act (ACA). This meeting was an opportunity to build on the successes and lessons learned during the last open enrollment period and prepare for the next open enrollment period November 15, 2014 to February 15, 2015. While patients that meet the expanded ACA Medicaid criteria can be enrolled into Apple Health at any time, individuals can only be enrolled into qualified health plans in the Exchange during open enrollment.
All enrollment staff must be recertified by November 30, 2014 in order to continue to be In-Person Assisters (IPAs) or Certified Application Counselors (CACs). Hospital enrollment staff may choose to be trained as either an IPA by their Lead IPA organization, or to be trained as a CAC by the Exchange. CAC training is conducted entirely online, and will be offered between October 1, 2014 and November 30, 2014. The new CAC certification instructions and training materials are expected to be ready in early October. This information can be accessed here. Use the username client and the password Cl1#nt! The Exchange tells us Chrome works better than Internet Explorer for this website. (Barbara Gorham, email@example.com)
Washington State Moving Forward with Hospital Presumptive Eligibility
To obtain coverage and Medicaid payments for patients as soon as possible, the HCA has submitted a request to the Centers for Medicare and Medicaid Services (CMS) to implement Hospital Presumptive Eligibility in our state. This program allows hospitals to enroll clients in Medicaid for up to 60 days based on the hospital’s determinations, without going through the state’s systems. Once CMS approves the proposal, the HCA will distribute the necessary contracts and training materials to hospitals. Hospitals are not required to offer this eligibility, but may want to do so because it will streamline the Medicaid application process for some clients, especially in cases where there are “glitches” with the application process. (Barbara Gorham, firstname.lastname@example.org, 206-216-2512)
Project Access Northwest Seeking Hospitals to Participate in Exchange Premium Sponsorship Program
The Seattle-based nonprofit Project Access Northwest is inviting Washington State hospitals to participate in a program to subsidize Exchange premiums for eligible individuals. This is part of an effort to cover individuals who do not qualify for Medicaid and also cannot afford the premiums for the qualified health plans under the Exchange. Project Access Northwest launched a pilot program earlier this year with contributions from three Seattle-area hospitals. To date, this program has subsidized Exchange premiums for over 100 individuals. The program serves individuals who make 200% or less of the federal poverty level. While earlier communications from the CMS discouraged premium subsidies, the agency has since determined that providers can contribute to subsidy programs that are set up though foundations, such as Project Access Northwest. For more information, view this recent WSHA Bulletin or contact WSHA Policy Director Barbara Gorham. (Barbara Gorham, email@example.com)
Alliance Releases Choosing Wisely Report
WSHA is working with other organizations on a national initiative to reduce services that may not be medically necessary. This is an important component of efforts to reduce health care costs. Recently the Washington Health Alliance released county-level data to show opportunity to reduce potential overuse of certain tests or medication. Variation between counties is considerable. The first of its kind report is part of Choosing Wisely®, an initiative of the American Board of Internal Medicine Foundation to help providers and patients engage in conversations about the overuse of tests and procedures and support efforts to help patients make smart and effective care choices. (Tanya Carroccio, firstname.lastname@example.org)
State to Add Benign Tumor Treatment to Alien Emergency Medical Covered Services
The HCA recently announced rulemaking to add life-threatening benign tumors as a covered service under its Alien Emergency Medical (AEM) program. AEM pays hospitals for emergency services to patients that meet Medicaid eligibility requirements other than citizenship. Current covered services include emergency visits and related admissions, dialysis, and cancer treatment. The number of patients eligible under the AEM program has grown significantly this year as the eligibility criteria have expanded with implementation of the ACA. (Andrew Busz, email@example.com)
State Seeks to Clarify Process for FQHC and RHC Clinic Payment Adjustments
The HCA plans to submit state plan amendments to CMS on how it pays federally qualified health centers (FQHCs) and rural health clinics (RHCs). The amendment would allow these centers to request adjustments to their encounter rates to reflect the scope of services they provide. (Andrew Busz, firstname.lastname@example.org)