Task Force Hears Testimony on MO Managed Care

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. Patients in managed care had fewer hospital admissions and shorter hospital stays but more hospital readmissions and emergency room visits. Managed care performed better on eight of the clinical quality measures, and fe

Medicaid Wrap-Around Payment Changes

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 each quarter. The requests should include prior dates of service for which the facility has received health plan payment. MHD will process payments in the first financial cycle of the second month of each quarter. The wrap

2017 Essential Community Provider List Petition Process

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 updating data on ECPs to make its list more accurate. Qualified ECPs can complete HHS' petition to be added to the list for 2017 or to update their existing information here. Petitions must be completed by January 8, 2016. All

Benchmarking For RHCs

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, such as whether their costs are comprable to other providers and whether practitioners have the capacity to serve more patients. Prsenters also walked through two examples of benchmarking. If you are a NARHC member, you can

CMS Guidance on Chronic Care Management

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 claims for CCM services. This a helpful official resource to reference for clinics that are interested in beginning CCM services. You can view the article here. NARHC plans to hold a technical assistance call on CCM with CMS

Task Force Hears Testimony on Managed Care Trends

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 Senior, Medicaid Director at Florida’s Agency for Health Care Administration, and Dr. Vernon Smith of Health Management Associates. Senior discussed Florida’s transition to statewide managed care and outlined several pr

NARHC RHC Benchmarking Webinar

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 benchmarking report. The presenter will also discuss how you can get a report comparing your clinic's costs to those of other RHCs in our state. The webinar will be held on December 14 at 1:00 pm ET. You can join using the lin

2016 RHC Upper Payment Limit Rate

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.

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