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OHA update Happy Holidays December 7, 2018
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Agenda 2019 OHA Medicare/Payment Updates Ohio Medicaid
2019 Medicare IPPS Brief OHA Price Transparency Toolkit and State Update 2019 Medicare OPPS Brief MBI Update – Wave 7 Ohio Medicaid EAPG Update Fee-for-Service Update Managed Care Update 2019 Proposed BWC OPPS Rule OHA Private Payer Scorecard AAHAM Western Reserve Chapter December 7, 2018
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FFY 2019 MEDICARE IPPS BRIEF
Proposed Rate increase amount of +0.5% for the Coding Offset Adjustment Updates to the Medicare Disproportionate Share (DSH) payment policies Continuance of the Medicare Dependent Hospital & Expanded Low-Volume Hospitals Programs Addition of hospice transfers to the Post-Acute Care Transfer Policy AAHAM Western Reserve Chapter December 7, 2018
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FFY 2019 MEDICARE IPPS BRIEF
Continued... Updates to Value-based Purchasing (VBP) & Hospital –Acquired Condition (HAC) Programs Elimination of 19 measures and a de-publication of an additional 21 measures from IPPS Quality Programs Updates to payment penalties for non-compliance with Hospital IQR and Electronic (HER) Incentive Programs Request for Information on sharing of healthcare data between providers, and separately on how price transparency may be improved AAHAM Western Reserve Chapter December 7, 2018
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OHA Price transparency tool-kit
Transparency Provision Effective Jan. 1, 2019 Requires hospitals to make available a list of current ‘standard charges’ via the internet in a machine-readable format, and to update it at least annually. Requirement can be met in form of chargemaster itself or another form of the hospital’s choice in machine readable format. AAHAM Western Reserve Chapter December 7, 2018
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FFY 2019 MEDICARE oPPS BRIEF
Change rate for biosimilars purchased by hospitals through the 340B program Changes to inpatient only list Payment changes for clinic services furnished in excepted off-campus provider-based departments Extend the 340B drug payment adjustment (ASP-22.5% to non-excepted PBDs AAHAM Western Reserve Chapter December 7, 2018
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FFY 2019 MEDICARE OPPS BRIEF
Continued... Change exceptions to the list of services to be packaged into APCs as opposed to separately paid Update payment rates and policies for Ambulatory Surgical Centers (ASCs) Collecting data on services furnished in off-campus provider-based emergency departments AAHAM Western Reserve Chapter December 7, 2018
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Medicare Beneficiary Number (MBI) update
CMS started mailing new Medicare Cards in Ohio in October MyMedicare.gov or Medicare Check to see if card was mailed Print an official card The Medicare MACS will continue to accept both the HIC & MBI through Dec. 31, 2019. AAHAM Western Reserve Chapter December 7, 2018
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Fun with Ohio Medicaid EAPGs
Covered CPT/HCPCS codes list UB/HE modifiers RT/LT/50 modifiers CCI edits Modifiers Prior Authorization & pre-determination for drugs Review your managed care contracts ODM files on-line Provider administered pharmacy fee schedule Covered/HCPCS code list DME fee schedule EAPG weights AAHAM Western Reserve Chapter December 7, 2018
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Upcoming fun with EAPGs
Reprocessing of claims issues Risk corridor monitoring through July 2019 Re-calibration (weights) & re-basing (rates) within next year Updated 3M grouper version Revised Ohio Administrative Code to sunset carve out provisions AAHAM Western Reserve Chapter December 7, 2018
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Medicaid Fee-for-Service Updates
NDC’s IMD – ‘In Leu Of’ Criteria New Codes for 2019 Reprocessing of old claims Potential Preventable Readmission Update SIM Update AAHAM Western Reserve Chapter December 7, 2018
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Medicaid Managed Care NDC’s IMD – ‘In Leu Of’ Criteria
New Codes for 2019 Operational Issues AAHAM Western Reserve Chapter December 7, 2018
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CY 2019 Proposed BWC OPPS Rule
Maintain statewide reimbursement to cost benchmark of 114% of Medicare allowed cost reimbursement Children’s Payment Adjustment Factor 288.4% Non-Children’s Factor 143.7% Adopt Medicare 2019 Final Rule Updates Adopt lesser of provision Align with Medicare for services priced by another fee schedule Align with inpatient reimbursement for detox services AAHAM Western Reserve Chapter December 7, 2018
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CY 2018 Final BWC OPPS Rule review
OHIO BWC DETOX SERVICE CODES (OAC ) Allows payment of inpatient and outpatient detoxification services without a claim allowance over an 18 month period Per diem = all inclusive rate Appendix table to outpatient rule establishes local level codes for per diem structured programs and services AAHAM Western Reserve Chapter December 7, 2018
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Questions ??? AAHAM Western Reserve Chapter December 7, 2018
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Shawn Stack Director, Health Economics and Policy
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