IHA Daily Briefing: June 4

Tuesday, June 4, 2019
U.S. Committee Considers Healthcare Extenders
Brief: States Still Suffer from Recession Impact
HFS Update on Inpatient, Outpatient Payment System
Briefly Noted

U.S. Committee Considers Healthcare Extenders
The U.S. Health Subcommittee of the Committee on Energy and Commerce held a hearing today to consider a number of bills to reauthorize public health programs which are set to expire at the end of the fiscal year. During the hearing, entitled, “Investing in America’s Health Care,” one of the key issues discussed was the importance of preventing $4 billion in cuts to the Medicaid Disproportionate Hospital Share (DSH) program. IHA has urged Congress to delay the DSH cuts, which would cut safety net hospitals by $4 billion in 2020, and $8 billion per year in fiscal years 2021 through 2025. 

U.S. Rep. Bobby Rush (IL-1) strongly supported action to prevent the cuts, saying, "It is absolutely critical...that we do not allow these payments to be cut now or in the future. If these cuts were to go into effect....healthcare services [for] those in need would be severely at risk."

Rep. Jan Schakowsky (IL-9) spoke about the importance of strengthening the healthcare workforce as well as increasing its diversity by passing the EMPOWER for Health Act (H.R. 2781). The act would reauthorize Title VII health professions education and training programs in order to increase access to physicians and other providers in underserved areas and to promote training opportunities for physicians. 

Rep. Robin Kelly (IL-2) emphasized the importance of addressing maternal mortality and how the Patient-Centered Outcome Research Institute (PCORI) could help address the crisis.

The committee also considered legislation to increase and extend funding for programs including, Community Health Centers, National Health Service Corps, the Teaching Health Center Graduate Medical Education program, PCORI, National Quality Forum, among several others.


Brief: States Still Suffer from Recession Impact
An issue brief from The Pew Charitable Trust reports that many states, including Illinois, have yet to recover from the 2007-2009 economic downturn. Most notably, several states had rainy day funds that were less than a week’s worth of operating costs in fiscal 2018—Wisconsin (6.8 days), Kentucky (3.0 days), Illinois (0.1 day), and Pennsylvania (less than 0.1 day) and New Jersey (less than 0.1 day).

Other Illinois-specific data also showed that:

  • State funding for education per pupil down was down 22%;
  • State aid to localities increased 2.5%; and
  • An 11% increase in general fund expenditures, after adjusting for inflation for fiscal years 2008-18.

National data showed Medicaid expenses accounted for 17.1 cents of every state-generated dollar in 2016, up from 14.3 cents in 2007, just prior to the recession.  Also, the national state pension funding gap reached its highest level in fiscal year 2016 at $1.35 trillion.


HFS Update on Inpatient, Outpatient Payment System
The Illinois Dept. of Healthcare and Family Services (HFS) recently released a notice to inform hospitals that effective with inpatient discharge dates beginning July 1, 2019, the Department will utilize Grouper Version 36 of the 3M All Patient Refined Diagnosis Related Group (APR-DRG) payment system. Also, effective with outpatient dates of service beginning July 1, 2019, the Department will utilize Grouper Version 3.13 of the Enhanced Ambulatory Patient Groups (EAPG) payment system.  These updates are performed in compliance with 89 Ill. Adm. Code Sections 148.140 and 149.100.

New inpatient and outpatient calculators containing the new rates have been posted on the Department's website.  Rate sheets for individual hospitals will be posted in the near future. Questions regarding rate sheets may be directed to the Bureau of Rate Development and Analysis at 217-785-0710.


Briefly Noted
The Comprehensive Billing Guide for Medical Assistance Program Providers has been updated to include a new section on custom orthotics. The guide was developed by the Illinois Medicaid Managed Care Organizations (MCOs), in collaboration with the Illinois Association of Medicaid Health Plans (IAMHP), to help providers who are contracted with MCOs understand the general MCO billing requirements in a single source location. As different sections of the Comprehensive Billing Guide are finalized and published, providers will be updated via a provider notice of the new sections.