IHA Daily Briefing: July 11

Wednesday, July 11, 2018

CMS Proposes Medicaid Provider Payment Change
CMS: $10M Available for Exchange Navigator Program
Former HHS Leader to Deliver Summit Keynote
Revenue Integrity and Chargemaster Training July 23-26

CMS Proposes Medicaid Provider Payment Change
Yesterday, the Centers for Medicare & Medicaid Services (CMS) announced proposed changes to the Medicaid Provider Reassignment regulation that would eliminate a state’s ability to divert Medicaid payments away from providers, with the exception of payment arrangements explicitly authorized by statute. In 2014, the regulation was revised to provide an exemption to the direct payment requirement for certain providers, which primarily include independent in-home personal care workers. This new regulatory exception authorized a state to divert part of the Medicaid payment to third parties that could then be used to fund other costs on behalf of the provider.

CMS is seeking comments to assist with the development of CMS guidance and help explain which payment arrangements would be considered acceptable assignments of Medicaid payments under the current law, especially those between the states and providers. Comments are due no later than 30 days after publication in the Federal Register.

CMS: $10M Available for Exchange Navigator Program
A total of $10 million will be available for the federally-facilitated exchange (FFE) navigator program for the 2019 open enrollment, according to the Centers for Medicare & Medicaid Services (CMS). A minimum of $100,000 will be awarded in each of the 34 FFE (including Illinois) states to provide assistance to exchange consumers, starting in the fall 2018. Awards will go to eligible grantees, such as chambers of commerce, small businesses, trade associations, and faith-based organizations. The grant opportunity (93.332) can be found here.

In a press release, CMS said that enrollment data from prior years showed that navigators failed to enroll a meaningful amount of people through the FFE, and not nearly enough to justify the millions of federal dollars spent on the program. Specifically, during the plan year 2018 open enrollment period, navigators received $36 million in federal grants, but enrolled less than 1 percent of the entire FFE enrollment population. Navigators similarly enrolled less than 1 percent for plan year 2017, despite receiving a much larger $63 million in federal grants.

In its 2019 Payment Notice, CMS finalized changes to the navigator program by removing the requirement that each exchange must have at least two navigator entities and that navigator entities must maintain a physical presence in the exchange service area.

Former HHS Leader to Deliver Summit Keynote
Public health expert Karen DeSalvo, MD, MPH, MSc, will present Getting to Health: A New Vision for Connected, Secure, Accessible Care, the keynote address at the 2018 IHA Leadership Summit, on Sept. 25, the first day of the 1½-day event in Lombard.

From 2014-2017, Dr. DeSalvo served as a top administrator at the U.S. Dept. of Health and Human Services. She was:

  • Acting assistant secretary for health, overseeing 12 core public health offices and 10 regional health offices across the nation; and
  • National coordinator for health information technology, developing national strategy and policy for health IT and focusing on interoperability.

Dr. DeSalvo's Summit address will explore the key ways healthcare leaders can meet patient needs in today's consumer-driven healthcare marketplace. She'll discuss opportunities to achieve success and spread by:

  • Embracing digital health technologies;
  • Supporting clinical excellence across the care continuum; and
  • Addressing the social determinants of health.

Currently at the University of Texas Dell Medical School, Dr. DeSalvo is a professor of internal medicine and population health. She works on projects in community health, medical care and social determinants of health. She also leads efforts to apply technology and digital health to traditional public health programs and strategies.

Dr. DeSalvo's experience in community health and innovation runs deep. As New Orleans Health Commissioner from 2011-2014, she built an award-winning model of neighborhood-based community health services after Hurricane Katrina.

This year's Summit, BE HERE, will be held at The Westin Lombard Yorktown Center. It also features sessions on politics and healthcare policy and breakouts on key healthcare transformation challenges—digital, cost and care delivery transformation.

We encourage CEOs, C-suite leaders and board members, as well as clinical, administrative, physician and emerging leaders, to attend. We've reduced registration fees for full meeting attendance and added a special rate for board members. Register today.

Revenue Integrity and Chargemaster Training July 23-26
In less than two weeks, managers and staff from hospitals across Illinois will gather together for an intensive four-day course on reducing compliance risk, minimizing revenue leakage and overcoming reimbursement struggles. Join your colleagues July 23-26 for the HCPro Revenue Integrity and Chargemaster Boot Camp®, a program designed to help participants relate chargemaster maintenance and functions to cost reporting, revenue integrity processes and key operational issues such as clinical documentation, charge capture and health information management (HIM) coding. These critical insights can help teams avoid denials and improve clean claim rates.

For more information about session topics, expert faculty, fees, continuing education credits, and registration, click here.