At the Task Force for Examining Statewide Medicaid Delivery Models’ final meeting of 2015, the Mo HealthNet Director presented on Missouri’s current managed care program. Medicaid in Missouri is delivered through both fee-for-service (FFS) and managed care models. Dr. Joe Parks provided task force members with a comparison of these systems based on cost, utilization, and performance. Between FY2010 and FY2013, managed care saved an average of 1.7% compared to fee-for-service.
Mo HealthNet’s policy regarding wrap-around payments to provider-based and independent rural health clinics is changing in 2016. Beginning in January, Mo HealthNet will process Supplemental Managed Care Interim Payment Requests quarterly and will only accept one request per quarter for each fiscal year. Requests should not contain dates of service from more than one fiscal year. Supplemental Managed Care Interim Payment Requests will be due to Mo HealthNet the first day of ea
The Affordable Care Act requires issuers of Qualified Health Plans to include Essential Community Providers in their networks. ECPs care for predominantly low-income patients in medically underserved areas. To ensure timely access to care for low-income patients, the US Department of Health and Human Services has established standards for the number and geographic distribution of ECPs in a plan’s network. HHS has a non-exhaustive list of ECPs, but it is collecting and updatin
If your clinic missed today's technical assistance webinar on benchmarking for RHCs, you can find the presentation information here. Bechmarking is the practice of comparing one's performance measures and business models to those of others in the industry. This webinar, hosted by the National Association of Rural Health Clinics, discussed the role of benchmarking in the changing landscape of RHC management. Benchmarking can help RHCs answer important management questions, suc
Beginning on January 1, 2016, RHCs may receive additional payment for the cost of chronic care management (CCM) services. To be eligible for payment, these services must be provided to Medicare beneficiaries with multiple chronic conditions that are expected to last at least 12 months. The conditions must place the patient at significant risk of death, acute exacerbation, or functional decline. CMS has finalized its MLN Matters article for Rural Health Clinics submitting clai
The Missouri Task Force for Examining Statewide Medicaid Delivery Models held its second hearing on December 1 in Jefferson City. This task force, which is comprised of legislators and health professionals, was created to develop a strategy for implementing a statewide model of healthcare delivery. Once the task force has finished conducting hearings, it will present recommendations to the General Assembly. At the December 1 hearing, the task force heard testimony from Justin
Clinics are invited to attend a technical assistance webinar on RHC financial benchmarking hosted by the National Association of Rural Health Clinics (NARHC). Financial benchmarking helps you better understand your clinic’s costs and shows how your clinic's specific costs compare to other independent or provider-based RHCs in your state, region and nationally. The December 14th webinar will explain benchmarking, why it is important and how to interpret information on a benchm
CMS has announced the Independent Rural Health Clinic (RHC) upper payment limit per visit will increase to $81.32 effective January 1, 2016 through December 31, 2016. This rate increase reflects a 1.1 percent increase over the 2015 upper payment limit of $80.44 per visit. Click here for more information from CMS on the change.