KHA has completed distribution of the second quarter’s payments (from October 1 through December 31, 2019) from the new Hospital Rate Improvement Program (HRIP). In the midst of fighting a global pandemic, these payments come at a opportune time for Kentucky's hospitals.

If you have any questions, please contact Carl Herde at KHA (cherde@kyha.com).

The Department of Medicaid Services has issued an emergency regulation (to be replaced by an ordinary regulation making the same changes) on Medicaid copayments. The regulation exempts 1915(c) Medicaid members and those who are in a long-term care facility from Medicaid co-pays, and waives copayments for all Medicaid members under Governor Andy Beshear’s emergency declaration for COVID-19. It also will allow for an MCO to reduce or eliminate copays which would impact enrollees once the emergency is lifted.

907 KAR 1 604E - filed March 13, 2020 907 KAR 1 604 - filed March 13, 2020

On March 10, Governor Beshear issued an executive order...

Anthem Blue Cross and Blue Shield Medicaid (Anthem) is closely monitoring COVID-19 developments and how the novel coronavirus will impact their customers and provider partners. The Anthem clinical team is actively monitoring external queries and reports from the Centers for Disease Control and Prevention (CDC) to help them determine what action is necessary on their part.

To help address providers’ questions, Anthem has developed an FAQ list (https://kyha.memberclicks.net/assets/docs/PreparednessDocs/AKYPECTalkingPointsCOVID19.PDF). Please review this information regarding questions you may have.

The first quarter’s payment ($37 million in gross distributions) from the new Hospital Rate Improvement Program (HRIP) is now history. KHA extends a heartfelt thanks to the Kentucky Department for Medicaid Services and their consultants for their help in bringing this program to fruition.

The process for the second quarter’s claims paid/received (from October 1 through December 31, 2019) will begin March 9 with hospital payouts expected prior to the end of the month.

If you have any questions, please contact Carl Herde at KHA (cherde@kyha.com).

On Friday, KHA submitted comments to the Centers for Medicare and Medicaid Services (CMS) regarding its proposed Medicaid Fiscal Accountability Rule (MFAR), which could jeopardize existing provider tax, inter-governmental transfers (IGT) and supplemental payment programs. KHA urged CMS to withdraw the rule as it would change the review process for supplemental payment programs and provider tax waivers along with granting itself unfettered discretion in evaluating permitted state financing arrangements through vague concepts such as "totality of circumstances," "net effect" and "undue burden."

A copy of the comments is available for members on the comments page of the KHA website at www.kyha.com/comments. If you have any further question, please feel free to contact Nancy Galvagni at KHA (ngalvagni@kyha.com).

The Cabinet for Health and Family Services Released the following statement this morning.

Following a request for proposal (RFP) process and a state procurement procedure through the Finance and Administration Cabinet, the Department for Medicaid Services (DMS) within the Cabinet for Health and Family Services (CHFS) has been notified of five new statewide contract awards for managed care organizations (MCOs). Aetna Better Health of Kentucky, Humana Health Plan, Inc., Molina Healthcare of Kentucky, UnitedHealthcare DBA UnitedHealthcare Community Plan of Kentucky and WellCare Health Insurance of Kentucky have been selected to serve Kentucky’s approximately 1.3 million Medicaid beneficiaries beginning July 1, 2020, when the current contracts expire.

New with this procurement, one MCO, WellCare, has been awarded the contract to serve all children in Kentucky’s foster care system, including some children who have been adopted from foster care, as well as children dually committed to...

Hospitals should have already received a notice indicating the expected amount of State Fiscal Year (SFY) 2020 Disproportionate Share Hospital (DSH) distribution. The allotment for the pools assume full funding by the Centers for Medicare and Medicaid Services (CMS) — it anticipates that the cuts scheduled for this year will be permanently delayed until a future period.If the cuts are not delayed, the total funding will be reduced by approximately 37%.

For the acute care pool, no monies were transferred from the University pool this year (which results in a reduction in the pool compared to last year).

Disbursements are expected on November 27, 2019.

If you have any questions, please contact Carl Herde at KHA (cherde@kyha.com).

KHA is excited to announce the Centers for Medicare and Medicaid Services (CMS) has approved Kentucky's submission of a proposal for the Hospital Rate Improvement Program (HRIP) — a delivery system and payment initiative under Mediaid managed care plan contracts.

According to the Cabinet for Health and Family Services (CHFS), they have included a request for the funds with the Cabinet's draw from CMS that will happen in the first quarter of calendar year 2020. KHA expects the review of data files will be finalized in the next several weeks. Once these are approved, KHA hopes CHFS will commence its official process in January or February.

See the CMS approval letter for the official announcement.

After months of discussions with the Cabinet for Health and Family Services (CHFS) via the KHA Medicaid Technical Advisory Committee (TAC) meetings, monthly Medicaid managed care organization (MCO) issue list meetings, individual meetings with CHFS and presentations to the Medicaid Advisory Committee (MAC), the Cabinet has made a final decision regarding sepsis.

On Wednesday, Department for Medicaid Services (DMS) Medical Director Judy Ann Theriot released a memo detailing coding and reimbursement guidelines for sepsis. CHFS will follow the CMS DRG and ICD-10 definitions of sepsis. MCOs are directed to "...base utilization management for sepsis on sepsis-2 criteria until such time that CMS adopts sepsis-3 criteria."

View the memo for more details.

Earlier today, KHA President Nancy Galvagni and Barbourville ARH Hospital Community Chief Executive Officer Charles Lovell, FACHE testified before the Kentucky Medicaid Oversight and Advisory Committee in Frankfort. The two discussed the pressures facing Kentucky's rural hospitals.

Their testimony covered the importance of Kentucky's rural hospitals, risks of hospital closures, the financial stability of rural health and cuts to hospitals. They went on to identify ways Kentucky could help alleviate some of the stresses hospitals are currently facing.

View the PowerPoint presentation for today's testimony for full details.

Earlier today, KHA submitted comments to the Cabinet for Health and Family Services (CHFS) Department of Medicaid Services (DMS) on the proposed changes to the 340B Policy and Procedures Manual.

KHA's comments outline how the proposed changes would impose additional and substantial burdens upon Kentucky hospitals without any corresponding benefit. Kentucky hospitals are in full support of assuring program integrity and expanded access to lower cost drugs to Covered Entities and their patients; however, the proposed changes, as written, should be delayed until clarified and improved

A full copy of the comment letter is available to members on the Policy page on the Advocacy section of KHA's website, www.kyha.com.

KHA was successful in achieving favorable amendments to the Medicaid telehealth regulation. The Department for Medicaid Services (DMS) has issued revisions to its proposed regulation on telehealth service coverage and reimbursement.

KHA is very pleased that the regulation maintains payment parity. DMS will pay for telehealth services at 100% of the amount payable for an in-person service. Medicaid managed care organizations (MCOs) must reimburse the same amount as the department unless the MCO and provider have negotiated a different rate. DMS made several changes to their proposed rule in response to comments from KHA and other organizations.

A copy of the revised rule is available at http://www.new-kyha.com/Portals/5/NewsDocs/907KAR3_170.pdf. The revised rule must be reviewed by two legislative committees before it becomes final and effective which should occur by early November.

...

Hospital system presidents from across the state met last week to learn details on the issues KHA is addressing on behalf of member hospitals.

Attendees heard a summary of the findings from KHA’s Value of Certificate of Need (CON) report. KHA will provide the results of the CON study to all members at the upcoming District Meetings, so please plan to attend one of those meetings.

The system presidents also received an update on the Medicaid Hospital Rate Improvement Program (HRIP) — formerly known as the upper payment limit (UPL) program. Carl Herde, KHA vice president of financial policy and Wes Butler, KHA’s legal counsel, will be conduct a webinar for all members on Wednesday, September 25 at 10:00 a.m. (ET) to discuss HRIP. Every hospital should attend this webinar to hear an update on the timetable and process for implementation....

The Kentucky Department for Medicaid Services (DMS) has entered into 12-month MCO contracts for State Fiscal Year 2020 effective July 1, 2019, to provide health care services to Kentuckians who meet eligibility requirements for Medicaid. The contracts below have been submitted to the Centers for Medicare and Medicaid Services (CMS) for approval.

Please note, the files below are large and will take additional time to load.

Aetna

Anthem

Humana

...

The Kentucky Department for Medicaid Services (DMS) is requesting feedback on the proposed DMS 340B Policy and Procedures Manual. The Department is extending the deadline for all feedback to October 3. The effective date of the proposed policy will be set to January 1, 2020.

Please email all feedback to jade.range@ky.gov.

The Kentucky Medicaid Partner Portal Application (KY MPPA) is now a web-based application that streamlines the process of applying to become a new Medicaid Service Provider. KY MPPA was created for Individuals, Groups and Entities applying for a Kentucky Medicaid ID, and allows current Medicaid providers to perform maintenance, revalidation and change of ownership online.

Due to the number of boards with license renewals coming up, the Kentucky Department of Medicaid Services (DMS) wants to remind everyone that KY MPPA is open to all Provider Types. To help save time, they recommend uploading a copy of the license renewal directly into KY MPPA. This will replace the previous process of sending in a paper copy of the license renewal to DMS.

To help you become more familiar with KY MPPA and its benefits:

Register for your KY MPPA Account

You can register for your KY MPPA account...

On August 6, DeLoitte hosted a briefing webinar to familiarize the KHA Waiver Implementation Workgroup with the Kentucky Integrated Health Insurance Premium Payment Program (KI-HIPP) program. KI-HIPP is a voluntary Medicaid program that helps eligible Medicaid members cover the cost of an employer-sponsored insurance (ESI) plan. Members who choose to enroll in the program do not lose their Medicaid benefits.

KHA members are urged to view the presentation deck from the webinar to familiarize themselves with the program. You can also visit the KI-HIPP webpage...

KHA submitted comments on proposed changes to 907 KAR 3:170 establishing payment rules for Medicaid coverage of telehealth services. Due to a filing error, 907 KAR 3:170 was withdrawn. As a result of this error, the Statement of Consideration of received comments will not be prepared or filed.

This administrative regulation will be refiled before July 1, 2019. DMS has shared that that several parts of the administrative regulation will be changed from the previous version, some reflecting comments received from KHA and members.

KHA is pleased with these anticipated improvements and will keep the membership updated.

If you have any questions, contact Elizabeth G. Cobb, MPH at KHA (ecobb@kyha.com).

The Department for Medicaid Services (DMS) responded to the comments submitted by KHA on proposed changes to the regulation governing hospital disproportionate share distributions, and they have agreed to revise the regulation in the most critical areas as recommended by KHA .

Specifically, and most importantly, the proposed rule would have denied a hospital from receiving a final DSH payment if that hospital failed to submit an updated DSH survey. KHA took issue with this proposal since there is no statutory authority to eliminate a DSH payment so long as the hospital has submitted a DSH survey. The only statutory penalty is a reduction of 20% in the amount of the final payment if the survey is submitted late. KHA also commented that resubmission of an original DSH survey would be burdensome if there were no changes. KHA is pleased that DMS agreed to amend the regulation to (1) delete its proposal to suspend or recoup a DSH payment if a DSH survey was not updated and (2) allow a hospital...

In correspondence dated December 31, 2018, in light of four recent appellate court decisions, the Centers for Medicare and Medicaid Services (CMS) is withdrawing questions 33 & 34 from the Medicaid Disproportionate Share Hospital (DSH) guidance that was issued in January 2010 titled, “Additional Information on the DSH Reporting and Audit Requirements,” available at: https://www.medicaid.gov/medicaid/finance/downloads/part-1-additional-info-on-dsh-reporting-and-auditing.pdf.

As a result, frequently asked questions (FAQs) 33 and 34 are no longer operative, which means payments received from third-party payors on claims for Medicaid eligible patients will no longer be offset in determining Uncompensated Care.

CMS will accept revised DSH audits that cover hospitals' services furnished before June 2, 2017. CMS has not yet given up arguing their case for the periods...

The next Kentucky HEALTH (Section 1115 Medicaid Waiver) Stakeholder Advisory Forum presented by the Cabinet for Health and Family Services is Thursday, March 7 from 1:00 p.m. to 3:00 p.m. (ET) at the Foundation for a Healthy Kentucky, 1640 Lyndon Farm Court, Suite 100, Louisville, Kentucky 40223.

If you have any questions about the forum, please contact CHFS Director of Provider Relations David Gray (davidl.gray@ky.gov). Thanks so much, David

On January 29, KHA submitted comments to the Kentucky Department for Medicaid Services (DMS) in regards to how DMS should choose Medicaid managed care organizations (MCOs).

The suggestions included requiring reviewing past performance, coding guidelines, a one-year time for claims filing and prohibiting MCOs from applying Medicare edits to outpatient claims. The Department should also require each MCO to provide EDI response to providers, provide better information on when preauthorization is needed (and limit changes to preauthorization requirements). In addition, DMS should create more prohibitions on what can be denied.

To see all the recommendations KHA submitted, please visit the Policy page of the KHA website. You must log in to view this page. Your user name is your email address and your password can be reset via the website if needed.

If you have any questions about the comments, please...

After receiving input from the KHA Hospital Reimbursement Committee, the Association submitted comments to the Office of Legislative and Regulatory Affairs regarding disproportionate share hospital (DSH) distributions.

After KHA's collaboration with hospitals and the Department for Medicaid Services (DMS) to modernize the DSH payment program, KHA members subsequently identified concerns once they had an opportunity to review the Department's proposed changes to the regulation. Some changes simply need clarification while others are not in keeping with the prior agreement on how the DSH program will operate.

The new regulation allows the DMS to adjust a hospital's total uncompensated care costs reported on the hospital's base year Medicaid DSH survey used to make the initial DSH payment. This gives very broad authority to allow the Department to adjust a hospital's total uncompensated care costs "if the amount reported appears likely to result in a substantial redistribution of DSH funds that...

Open Enrollment for the 2019 Medicaid Plan Year will take place from November 1 - November 30, 2018. While new beneficiaries can enroll in Medicaid at any time, Open Enrollment is the only chance for beneficiaries who are already receiving Medicaid to switch their Managed Care Organization (MCO).

The Open Enrollment period gives beneficiaries the opportunity to consider what MCO offers the best plan for their family's needs and situation.

If beneficiaries want to change their MCO during Open Enrollment, they can visit benefind.ky.gov, visit their local Department for Community Based Services (DCBS) office or talk to their local Assister.

KHA hosted a well-attended webinar today to update the membership on key information surrounding the implementation of the Kentucky HEALTH Medicaid 1115 waiver. A recording is available on the Waiver Resources page of KHA's website. The page can be found under the Advocacy tab at www.kyha.com. You must log in to access these resources. Your user id is usually your email address.

If you have any questions, please contact Nancy Galvagni at KHA (ngalvagni@kyha.com).

With the Medicaid 1115 waiver on hold, hospitals now have more time to prepare for the waiver's implementation. KHA will provide a one-hour webinar on Tuesday, July 10 at 10:00 a.m. (ET) to update the membership on key information surrounding the implementation of the Kentucky HEALTH Medicaid 1115 waiver.

A workgroup of hospital representatives has been meeting with the state and KHA wants to assure that the full membership has the most up-to-date information. The webinar will cover how premiums will work and payments by third parties, including considerations for your hospital.

Please invite your business office or other staff to participate.

In addition, there is a wealth of information on waiver implementation on the KHA website (www.kyha.com) under the Advocacy tab. Simply log in with your email address to access the resources.

If you have any questions or would like login...

There are now Kentucky Medicaid Waiver resources for hospitals available on the KHA website, www.kyha.com. You must be signed in to view the page, which you can reach directly at https://www.kyha.com/1115-waiver-resources or via the Advocacy page of the website.

If you have any questions, please contact Nancy Galvagni at KHA.

The Kentucky Medicaid Electronic Health Record (EHR) Incentive Program will accept attestations for Program Year 2017 Meaningful Use beginning Thursday, November 30 at 8:00 a.m. (ET). 

The user manual for Program Year 2017 is located on the EHR website at http://chfs.ky.gov/dms/EHR.htm under the Manuals section. The deadline to submit an attestation for Program Year 2017 is 11:59 p.m. (ET), March 31, 2018. Any attestation that is in process after that time will be closed out and not eligible for participation.

If you have any questions or concerns, please contact the Kentucky Medicaid EHR team (EHRIncentives@ky.gov...

The status of the Disproportionate Share Hospital (DSH) surveys for respective State Fiscal Years (SFY) is now available. Several facilities are listed for the 2014 reviews and are requested to submit their information as soon as possible if they have not. 

Final settlements and resolution of appeals of prior SFYs are currently underway in abeyance pending the result of ongoing litigation at the federal level regarding payments from Third-party Payors.

The Kentucky Department for Medicaid Services and the 5 Medicaid managed care organizations (MCOs) are hosting provider forums across the state. These forums are designed to allow any and all health care providers (including behavioral health and substance use providers) who have contracts with MCOs and serve Medicaid consumers to meet face-to-face and discuss concerns about proper billing, prior authorizations, prompt pay, appeals processes or any other specific issues related to the continued implementation of Managed Care.

In attendance will be senior level staff from each Managed Care Organization, senior staff from the Department of Insurance (DOI), Office of Inspector General, Department for Medicaid Services, Department for Public Health, Department for Behavioral Health, Developmental and Intellectual Disabilities, and the Office of the Secretary.

October 17 in Hopkinsville October 23 in Louisville October 25 in Morehead October 31 in Somerset November 3 in Highland...

If you have participated in the Kentucky Medicaid Electronic Health Record (EHR) Incentive program in the past and have not been paid through program year 6, the Kentucky Regional Extension Center (REC) can you achieve Meaningful Use and earn the remaining incentive monies. The Kentucky Medicaid EHR Incentive program will continue through 2021.

The Kentucky REC Health IT advisors will assist you through this process by reviewing your Meaningful Use reports, completing a gap analysis and action plan, and assisting with the submission of your attestation. They will also educate and guide you along the way.

The reporting period for 2017 is any continuous 90 days in the calendar year. So, the last 90 days of the year will begin on October 3, 2017. The deadline to submit your attestation is March 31, 2018.

If you registered for the Medicaid Meaningful Use Program in the past, but have only attested to AIU the first year, you will need to attest by October 1, 2017, using a 90-day reporting period in calendar year 2017 to...

Yesterday, Kentucky Medicaid Commissioner Steve Miller announced a one-month delay to the implementation of a new Medicaid policy to no longer pay for early elective deliveries (EEDs) unless certain documentation is provided. This will also apply to Medicaid managed care organizations (MCOs). KHA requested the delay to provide additional time for hospitals to obtain more details about the policy and the required documentation, and to implement process changes in their facilities.

Notice of the policy change was initially provided through a June 23, 2017, letter to hospitals, which had a start date of September 1, 2017. Under the addendum, denials will start for claims with dates of service beginning on or after November 1, 2017. Also, hospitals will get a reminder notice of the November 1 effective date on claims paid with dates of service through October 31, 2017, that do not meet the new requirements.

KHA is working with the Department for Medicaid Services to provide a webinar...

The Kentucky Department for Medicaid Services (KY DMS) is clarifying coverage for early elective deliveries (EED) including non-medically necessary inductions and cesarean deliveries. Claims submitted for labor inductions or cesarean sections on or before 39 weeks gestation that are not properly documented as medically necessary will be denied by Kentucky Medicaid including Kentucky Medicaid Managed Care Organizations (MCOs).

KY DMS's goals are to: 1) guide providers and hospitals to sound practice recommendations made by AGOG; 2) reduce morbidity in neonates from birth trauma and fetal immaturity; 3) reduce non-medically necessary deliveries less than 39 weeks gestation and; 4) encourage greater collaborations between hospitals and their physicians in developing quality improvement initiatives aimed at improving birth outcomes in Kentucky.

Medicaid delivery claims submitted, with dates of service on or after 9/1/2017, from enrolled hospitals and practitioners for elective inductions...

Anthem Blue Cross and Blue Shield Medicaid is inviting all network providers, coders, billers and practice managers to participate in coding education webinars throughout the month of August. The webinars provide an opportunity to:

Explore risk adjustment and how it impacts all patient types, payers and risk-sharing contracts Discover the connection between documentation, coding, risk adjustment and quality care Discuss guidelines for documentation and common electronic health record issues Earn 1.5 CEU and 1.5 CME units Sessions will be held on Thursdays:

August 10 August 17 August 24 August 31 Online registration is available now. Providers are also welcome to complete this form...

KHA released a report today on the performance of the five Medicaid Managed Care Organizations (MCOs) operating in Kentucky The report was compiled from public data from 2016. The report provides information on medical loss ratios, utilization review denial rates, quality scores, corrective action and prompt payment.

If you have any questions, please contact Nancy Galvagni at KHA (ngalvagni@kyha.com).

With the implementation of the Affordable Care Act (ACA), the Centers for Medicare and Medicaid Services (CMS) requires all ordering, referring and prescribing providers to be enrolled in the state Medicaid program. Further, all Attending Providers must also be enrolled in Kentucky Medicaid and be eligible on the claim's date of service.

The Department for Medicaid Services implemented new claim editing to monitor this requirement on April 1, 2017. As such, this requirement is applicable to all claims with dates of service beginning on that date and going forward. In order to allow providers time to comply with this requirement, claims with dates of service between April 1. 2017, and July 1, 2017, that do not meet this requirement will continue to be paid and providers will receive an "informational" EOB indicating that incorrect Attending Provider data has been submitted. 

Claims submitted for dates of service beginning on and after July 1, 2017, that do not comply with this...

The Kentucky Department for Medicaid Services (DMS) will host its 2017 Spring Webinar in May. One of the topics this session will be the federally mandated Ordering Referring and Prescribing (ORP) changes.

You must register at http://www.kymmis.com/ in order to participate in this webinar. There a several scheduled workshops to accommodate all providers, and each workshop is exactly the same.

Choose a time: 

• 10:00 a.m. (ET)
• 3: 00 p.m. (ET)

Choose a date:

• Monday, May 15
• Wednesday, May 17 
• Tuesday, May 23 
• Tuesday, May 30 

If you have any questions regarding the webinars, contact DMS Provider Inquiry (800-807-1232).

The Kentucky Department for Medicaid Services, in conjunction with Hewlett Packard Enterprise will host a 2016 Fall Webinar for Medicaid Providers on the following dates:

Monday, November 14 Wednesday, November 16 Friday, November 18 Monday, November 28 Each workshop is exactly the same and is for all provider types. There will be two sessions on each date - 10:00 a.m. or 3:00 p.m. (ET).

Attendees are encouraged to print or download the webinar materials for reference during the webinar. The materials will be available prior to the workshop at www.kymmis.com under the Provider Relations/Provider Workshop heading.

You MUST REGISTER in order to attend the workshop. Find the date and time you would like to attend at http://www.kymmis.com/workshop/default.aspx and follow the link to register....

The comment period for Kentucky's proposed Medicaid Waiver has been extended to August 14. The extension was posted by the Administration to the web yesterday.

Visit http://chfs.ky.gov/dms/kh for instructions on how to submit your comments if you missed the original July 22 deadline.

Recently, the Health and Human Services Office of the Inspector General (HHS OIG) released its mid-year update to its fiscal year (FY) 2016 work plan. New initiatives are indicated in the following list of Medicaid-related work:

KHA will host a members only seminar on July 28 at the Louisville Marriott East regarding the newly proposed Medicaid waiver program. This program will feature presentations from key architects of the proposed demonstration project, which is part of an overall initiative to transform the Kentucky Medicaid program. Speakers will address eligibility, benefits, costs, incentives and delivery system reforms.

In addition, the program will feature presenters familiar with the revamped Indiana Medicaid program, which has been underway since 2013 and has many features similar to those proposed in Kentucky HEALTH. Indiana hospital representatives will share insight on the effect the Indiana program has had on hospital and other health services from a practical standpoint of implementation and compliance.

View the brochure for details and register today...

On Tuesday, June 28, Spring View Hospital in Lebanon hosted a ceremonial signing for SB 20, KHA's top priority for the 2016 legislative session. KHA is grateful for Governor Matt Bevin's insight into the issues facing hospitals and is pleased to have this new Medicaid managed care organization appeals process in place.

KHA President Mike Rust represented the Association at the event and was joined by Lieutenant Governor Jenean Hampton and Senator Jimmy Higdon as the Governor signed this important legislation.

Governor Matt Bevin held a news conference Wednesday morning to announce his plan to replace Kentucky's expanded Medicaid program.

Bevin would like to launch a program called “Helping to Engage and Achieve Long Term Health” (HEALTH). It would be a waiver application process for people wanting Medicaid coverage. This plan is a 1115 waiver from the Centers for Medicare and Medicaid Services (CMS) for a demonstration project designed to "provide dignity to individuals as they move towards self-reliability, accountability and ultimately independence from public assistance." It is only for the Medicaid expansion population — those between 100-138% of the Federal Poverty Level (FP)L. Governor Bevin stressed that this program is for able-bodied participants, and not the frail or elderly.

“This proposal is modeled after the very same health plan offered to Kentucky state employees including incentives to promote healthy lifestyles. This plan offers common sense strategies to help our citizens...

As the 2016 Kentucky General Assembly session is coming to a close, KHA is excited to share the news that Governor Matt Bevin has signed SB 20 into law. This was KHA’s top priority during this legislative session and its passage is a huge victory for Kentucky’s hospitals. This legislative session could not have been a success without the hard work of all the Association's membership. Your advocacy was invaluable.

Additionally, KHA extends special thanks to KHA Legislative Committee Chair Joe Koch and the Association's diligent lobbying team – Sarah S. Nicholson, Ronny Pryor, Renee Craddock and Gene McClean. KHA is also grateful to Senate President Robert Stivers and House Speaker Greg Stumbo for their work on this issue. Finally, the Association is extremely appreciative of Dr. Ralph Alvarado for sponsoring...

SB 20, KHA’s priority legislation, passed the House yesterday by a unanimous vote. The legislation gives Kentucky’s medical providers a pathway to external, independent appeals of denied Medicaid managed-care claims. The bill is now on its way to Governor Matt Bevin for his signature. Please, take a moment to contact your legislator personally and thank him or her for their support. 

SB 20, sponsored by Senator Ralph Alvarado (R-Winchester) would allow medical providers to receive an independent third-party review of claims denied by Medicaid managed care organizations (MCOs). The decision of the third-party reviewer could then be appealed to the Cabinet for Health and Family Services, where the decision of an administrative hearing tribunal would be the last step before judicial review. This includes situations when a provider has continued to render care after a denial because, in their medical judgment, continued care was in the patient’s best interest. The process is needed to assure patients get...

The Centers for Medicare and Medicaid Services (CMS) has submitted a 653-page finalized rule governing Medicaid managed care to the Office of Management and Budget (OMB) for review, according to Modern Healthcare. Reports indicate that the rule will take a step to reduce the institution for mental diseases (IMD) prohibition on treating adult Medicaid patients in freestanding psychiatric hospitals by permitting states to pay managed care organizations (MCOs) for behavioral care to beneficiaries who stay 15 days or less in an IMD. Additionally, the rule is reported to contain a medical loss ratio of at least 85%, which would allow 15% to be paid to MCOs for administration, marketing and profit. The rule also contains requirements for improving network adequacy through time and distance standards for certain types of providers, including hospitals and physicians.

OMB can take up to 90 days to review the rule, therefore, it could be published sometime in May. KHA’s comments were among the 900 comment letters CMS received on proposed rule....

KHA's priority legislation, SB 20, addresses the need for a Medicaid managed care organization (MCO) appeals process. Nina Eisner, CEO of Ridge Behavioral Health System in Lexington, testified before the Senate Health and Welfare Committee on January 13 and gave examples of why this legislation is desperately needed.

Gene Dodaro, Comptroller General of the United States at the Government Accountability Office (GAO), testified before the Senate Finance Committee on Thursday during a hearing on improper payments in federal programs. He stated that the improper payment estimate, attributable to 124 programs across 22 agencies in fiscal year 2014 was $124.7 billion, up from $105.8 billion in fiscal year 2013. Dodaro continued that the almost $19 billion increase was primarily due to the Medicare, Medicaid and Earned Income Tax Credit (EITC) programs, which account for over 75 percent of the government-wide improper payment estimate. (Medicare accounted for $60 billion, and Medicaid for $17.5 billion in 2014.) The Department of Defense does not report improper payments however, as Senator Tom Carper (D-Delaware) pointed out, so these statistics are actually higher.

Improper payments are defined in statute by Congress. They include any payment that should not have been made or that was made in an incorrect amount (including...

On the August 17 episode of Kentucky Tonight on KET, guests discussed the state of health care in Kentucky. Guests included Cabinet for Health and Family Services Secretary Audrey Tayse Haynes; John Garen, a University of Kentucky economics professor; Dr. Monalisa Tailor, an internist and an assistant professor of medicine at the University of Louisville; and Dr. Neal Moser, a pulmonary/critical care physician in Edgewood.

The Cabinet for Health and Family Services (CHFS) in partnership with the Medicaid managed care organizations (MCOs) is once again sponsoring forums across Kentucky in August and September. These forums are designed to allow any and all health care providers (including behavioral health and substance use providers) who have contracts with MCOs and serve Medicaid consumers to meet face-to-face and discuss concerns about proper billing, prior authorizations, prompt pay, appeals processes or any other specific issues related to the continued implementation of Managed Care. In attendance will be senior level staff from each MCO, senior staff from the Department for Medicaid Services and Department for Behavioral Health, Developmental and Intellectual Disabilities.

CHFS encourages pre-registration 5 days in advance of the forum of your choice. You may also register on-site. Online registration is available at http://chfs.ky.gov/forumreg.

The forums will be held at the dates and locations listed below....

On Tuesday, July 14, KHA will host a two-hour Members Only Webinar from 10:30 a.m. to 12:30 p.m. (ET) to present the results of a year-long project involving analysis of Medicaid claims data across all sites of service. As part of the Association's Medicaid Reform Strategy, KHA engaged the national consulting firms of Dobson/DaVanzo and Milliman to obtain Kentucky’s Medicaid claims data from the Centers for Medicare and Medicaid Services (CMS) and perform this analysis to assist the membership as they consider new risk-based approaches to Medicaid payment. The analysis and an accompanying chartbook, which will later be made available to the membership, can be used as hospitals work to improve efficiencies in care delivery and negotiate with the MCOs.

Al Dobson of Dobson/DaVanzo and Rebecca Johnson of Milliman will conduct the webinar. Below is an overview of the presentation. Please make note of the presentation of data on episodic payments, which is something being considered by the Cabinet for...

The next meeting of the Medicaid Oversight and Advisory Committee will be on Wednesday, June 17 at 10:00 a.m. in Room 131 of the Capitol Annex in Frankfort.

The agenda includes a Medicaid overview and update from Cabinet for Health and Family Services Secretary Audrey Haynes and Department for Medicaid Services Commissioner Lisa Lee, who will also give an overview of the Medicaid Waiver Program.

On Tuesday, May 26, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule that would update Medicaid and Children’s Health Insurance Program (CHIP) managed care regulations to better align them with existing commercial, Marketplace and Medicare Advantage regulations. The proposed rule, which is the first major update to Medicaid and CHIP managed care regulations in more than a decade, includes updates to managed care provider networks, quality measures, external quality review, and beneficiary rights and protections.

KHA staff is analyzing the rule for comments, which are due to CMS by July 27. KHA also submitted issues to CMS via AHA for their consideration in drafting the proposed rule to address problems experienced with managed care in Kentucky.

The regulation proposes a minimum medical loss ratio (MLR) of 85 percent beginning in 2017, standards around actuarial soundness of capitation rates, contracting standards and consumer protections. To read the entire rule, see...

On Friday, May 8, KHA hosted a press conference to announce the publication of a new report outlining the changes Kentucky hospitals are facing in the wake of the nearly $7 billion in federal cuts they will suffer through 2024.

The report details an analysis, by the national consulting firm of Dobson/DaVanzo, of the impact these payment cuts will have on the financial bottom line of Kentucky hospitals. The analysis found Kentucky hospitals will lose more money than they gain in new revenue from expanded health insurance coverage. KHA supports the governor’s decision to expand Medicaid and the significant revenue it generates; however, the new expansion revenue is less than the cuts Kentucky hospitals will experience in order to finance the Affordable Care Act (ACA).

KHA also released the results of a survey...

On April 30, KHA submitted comments to the Kentucky Office of Legal Services regarding 907 KAR 10:830 on the proposed diagnosis-related group (DRG) reimbursement methodology for the Medicaid fee-for-service population. The Association's comments addressed a long-standing concern and request by the Medicaid Hospital Technical Advisory Committee (TAC) for providing a transition period to new rates and retaining the existing rate appeal process. KHA also requested changes to maintain budget neutrality in updating rates and clarification on several other aspects of the proposed new methodology.

A copy of the comments is available on the Policy page of the Members Only section of www.kyha.com.

If you have any questions, please contact Nancy Galvagni at KHA (502-426-6220 or 800-945-4542 or via email at ngalvagni@kyha.com).

On Wednesday, July 16, the Interim Joint Health and Welfare Committee met in Frankfort. Kentucky Medicaid Commissioner Lawrence Kissner spoke at the meeting to provide an update on Affordable Care Act (ACA) activities in Kentucky.

During his presentation, Kissner told the committee that the federal government has kept the disproportionate share hospital (DSH) payments as they have been from federal fiscal year (FFY) 2009 to 2013 – the same as before the ACA. He stated that some hospitals have received more additional Medicaid payments from Medicaid expansion than others. He said that 78-79 hospitals are getting paid more in Medicaid expansion payments plus they are still receiving DSH payments (not counting UK Chandler Medical Center, University of Louisville Hospital and the psychiatric hospitals).

Representative Robert Benvenuti (R-Lexington) pointed out to Commissioner Kissner that hospitals are seeing more self pay patients and those with high deductible plans in addition to the losses hospitals...

On July 7, Medicaid regulations became final and took effect to cover occupational therapy on an outpatient basis in hospitals as well as outpatient behavioral health services including intensive outpatient, partial hospitalization, individual and group therapy. KHA worked with the Department for Medicaid Services to achieve positive amendments to the regulations for these services to be covered in an outpatient hospital setting.

Also becoming effective on that date were new regulations covering behavioral health services and occupational, physical and speech therapy services provided by independent providers.

If you have any questions concerning the new regulations, please contact Nancy Galvagni at KHA (502-426-6220 or 800-945-4542 or via email at ngalvagni@kyha.com).

Last year, Governor Steve Beshear directed the Cabinet for Health and Family Services (CHFS) to initiate enhanced educational efforts to improve the continued implementation of Medicaid managed care. CHFS, in partnership with the managed care organizations (MCOs), is sponsoring the second round of these forums across Kentucky in August and September. These forums are designed to allow any and all health care providers who have contracts with MCOs and serve Medicaid consumers to meet face-to-face and discuss concerns about proper billing, prior authorizations, prompt pay, appeals processes or any other specific issues related to managed care.

In attendance will be senior level staff from each MCO, senior staff from the Department of Insurance (DOI), Office of the Inspector General, Department for Medicaid Services, Department for Public Health, Department for Behavioral Health, Developmental and Intellectual Disabilities and the Office of the Secretary.

Pre-registration (at least five days in advance...

On July 11, the Centers for Medicare and Medicaid Services (CMS) released its monthly report on applications, eligibility determinations and enrollment for May 2014. As of the end of May, 6.7 million more individuals were enrolled nationwide in Medicaid or the Children's Health Insurance Program (CHIP) as compared to the baseline period from July through September 2013, an increase of 11.4 percent. Growth was more pronounced in the 26 states (including the District of Columbia) that had adopted and implemented the Medicaid expansion by the end of May. Enrollment in those states rose by 17 percent, while states that have not expanded reported only a 3 percent increase.

This monthly report on state Medicaid and the Children’s Health Insurance Program (CHIP) data represents state Medicaid and CHIP agencies’ eligibility activity for the calendar month of May 2014 . The data included in this report were submitted to CMS from state Medicaid and CHIP agencies as part of the Medicaid and CHIP Performance Indicator process.

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Under the Affordable Care Act (ACA) and regulations revised by the Cabinet for Health and Family Services (CHFS) in January, hospitals can grant presumptive Medicaid eligibility to individuals who qualify under the new Medicaid income eligibility criteria or to pregnant women. In February, the Cabinet’s contractor, HP, conducted webinar training programs for hospital staff. Since that time, KHA has worked with the Department for Medicaid Services (DMS) to obtain answers to additional questions involving presumptive eligibility. The questions and answers are provided below. Please distribute this information to your staff.

Question: If a hospital grants presumptive eligibility (PE) to an individual, is the individual limited to receiving hospital services only from the hospital which granted the PE or may they receive covered services at any hospital? (KHA was advised this was stated in the HP training program.)

DMS Answer: (Lee Guice, DMS) PE coverage is not limited to the hospital which assisted the PE member.

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On February 28, KHA, on behalf of its members, submitted comments to the Kentucky Department for Medicaid Services (DMS). The comments addressed the DMS’ proposed amendments to the regulation which outlines cost sharing requirements for Medicaid recipients. KHA has specific concerns related to the changes proposed on copayments for nonemergency visits to the hospital emergency room.

The amendments specifically make two significant changes with respect to services provided in hospital emergency rooms. First, the copayment amount will increase from a maximum of $6.00 to $8.00 for a nonemergency visit in an emergency room. Second, the regulation will require that this copayment be deducted from the Medicaid payment the hospital receives when, previously, the copay was collected without deducting it from the hospital’s total Medicaid reimbursement for the service. These changes are very problematic and will only add to reduced hospital payment for the services they provide to low income patients at a time...

On February 28, KHA, on behalf of its members, submitted comments to the Kentucky Department for Medicaid Services (DMS). The comments addressed the DMS’ proposed amendments to the outpatient hospital coverage regulation. The Association is concerned with some of the proposals and objects to the exclusion of coverage for occupational therapy provided in a hospital outpatient setting and requested that this be reversed.

For details, view the copy of KHA’s full comments. The document includes a notated copy of the Schedule of Benefits.

If you have questions, please contact Nancy Galvagni at KHA (502-426-6220 or 800-945-4542 or via e-mail at ngalvagni@kyha.com).

The Kentucky Department for Medicaid Services (DMS) has announced expanded services that are covered under Presumptive Eligibility (PE) as part of the Affordable Care Act (ACA). Qualified hospitals will be allowed to determine eligibility for temporary coverage for those who do not have insurance coverage.

HP Enterprises will conduct webinars, in conjunction with DMS, for hospitals to become qualified in determining temporary eligibility under the PE program. The webinar is designed to offer instruction and assistance to providers in determining who is eligible for temporary coverage and how to submit a PE request. Your registration and completion of this training constitutes your election to make PE determinations.

Hospital chief executive officers are encouraged to forward this information to the appropriate staff members in their facility who will be screening for Medicaid eligibility. Please read the final regulation for additional details on PE.

Choose one of the three sessions below...