IHA Daily Briefing: June 7

Thursday, June 8, 2018

HFS Notice: Payment Changes for New Assessment Program
FDA Warns Against Unapproved Opioids, Hosts Summit
ICAHN to Host Opioid Crisis Workshop June 27
Briefly Noted

HFS Notice: Payment Changes for New Assessment Program
As the state seeks final federal approval of the redesigned Hospital Assessment Program, the Dept. of Healthcare and Family Services (HFS) today issued a notice on “Proposed Changes in Methods and Standards for Establishing Medical Assistance Payment Rates” for the resigned program as called for under state legislation (Senate Bill 1573/PA100-0580 and Senate Bill 1773/PA100-0581).

According to the notice, current hospital inpatient and outpatient static payments funded through assessment will be repealed and replaced with new payments. The annual spending for these new payments is estimated to be $1.999 billion for inpatient services, and $915.8 million for outpatient services. The base year data set used for calculation of the new payments will be 2015.

Hospital inpatient reimbursement under the Illinois Medical Assistance program will be increased as follows:

  • Certain APR-DRGs will be added to those eligible for the Trauma Center policy adjustor;
  • Perinatal level II and II+ hospitals will be included in the eligibility for the Perinatal Services policy adjustor; and
  • Hospital inpatient base rates will be increased.

The annual spending for these new inpatient payments is estimated to be $250.3 million.

Hospital outpatient reimbursement under the Illinois Medical Assistance program will be increased as follows:

  • Outlier payments will be increased to account for expensive drugs and devices;
  • High Outpatient Volume Hospital adjustment factor will be increased;
  • Hospital outpatient base rates will be increased; and
  • Small Public hospitals will be eligible for high Outpatient Volume Hospital adjustment factor.

The annual spending for these new outpatient payments is estimated to be $321.5 million.

The static and claims reimbursement changes above result in $360 million in additional annual hospital payments with overall inpatient reimbursement increasing by $370 million and overall outpatient reimbursement decreasing by $10 million. These overall changes are inclusive of the movement away from static payments to claims reimbursement by $250 million on inpatient services and $321 million on outpatient services.

The proposed changes will be effective for dates of service on or after July 1, 2018, subject to approval by the Centers for Medicare & Medicaid Services.

Also today, HFS issued a separate notice concerning the calculations and amounts for hospital Affordable Care Act (ACA) Access Payments for the month of June.


FDA Warns Against Unapproved Opioids, Hosts Summit
The U.S. Food and Drug Administration (FDA) this week announced that it has warned nine online networks, operating a total of 53 websites, that they must stop illegally marketing potentially dangerous, unapproved and misbranded versions of opioid medications, including tramadol and oxycodone. As outlined in the warning letters, companies that fail to correct the violations may be subject to enforcement action, including product seizure or injunction.

Patients who buy prescription medicines from illegal online pharmacies may be putting their health at risk because the products, while being marketed as authentic, may be counterfeit, contaminated, expired, or otherwise unsafe. The FDA requested responses from each of the companies within 10 working days informing the agency of specific actions taken to address its concerns.

In addition, FDA Commissioner Scott Gottlieb, M.D., has invited internet stakeholders and thought-leaders, government entities, academic researchers, and advocacy groups to an Online Opioid Summit on June 27 to discuss ways to collaboratively take stronger action in combatting the opioid crisis by reducing the availability of illicit opioids online. Topics to be addressed during the Summit include: research into the ease with which illicit opioids can be purchased online and industry approaches to addressing opioids marketed online, followed by a roundtable discussion to identify gaps and new solutions.


ICAHN to Host Opioid Crisis Workshop June 27
Illinois Critical Access Hospital Network (ICAHN) is holding a June 27th Opioid Crisis Next Door workshop in Springfield. The program—Keeping the Momentum: Are We Hitting the Mark?—will focus on efforts to prevent and treat substance use disorders and information on the new opioid prescription guidelines and treatment options, including the use of medication-assisted treatment for recovery.

IHA is a program supporter of this workshop which features numerous speakers including Adam Kohlrus, B.S., M.S., C.P.H.Q, C.P.P.S, assistant vice president of quality, safety and health policy, IHA’s Institute for Innovations in Care and Quality, who will discuss “Southern Illinois University-IHA Opioid ECHO Hub” program; and Michael Wahl, M.D., F.A.C.E.P, F.A.C.M.T, senior clinician educator and medical director, Illinois Poison Center, who will discuss “Emergency Department Prescribing Guidelines: How do we make them work?”.

IHA members are welcome to attend. Continuing education credits are available for nurses, licensed clinical social workers and licensed clinical professional counselor. The program fee is $40 per person. Click here to register.


Briefly Noted
KEPRO, the Beneficiary and Family Centered Care Quality Improvement Organization for Illinois (BFCC-QIO), recently released new tools and resources aimed at educating Medicare beneficiaries about their rights and free resources available through Medicare. The organization encourages providers to share with seniors: an informational beneficiary video; a Medicare rights poster available in both English and Spanish; a newsletter insert; and public service announcements.