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.

...

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.

...

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...