Medical Care Advisory Committee April 20, 2018 Responsibly - - PowerPoint PPT Presentation

Responsibly providing access to quality health coverage for vulnerable Mississippians 1

Medical Care Advisory Committee

April 20, 2018

Responsibly providing access to quality health coverage for vulnerable Mississippians 2

State Plan Amendment (SPA) Updates

SPA 17-0001 Home Health

• CMS submission 8/14/2017
• CMS Request for Additional Information (RAI)

Response (9/1/18) SPA 17-0004 Tribal Notification

• Approved, Effective 10/1/17

SPA 17-0015 DME and Medical Supply Reimbursement

• Approved, Effective 11/9/17

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SPA Updates

SPA 18-0001 LTC Updates

• Public Notice Posted 12/28/2017
• CMS Submission 3/22/18

SPA 18-0002 Physician UPL

• Public Notice Posted 12/28/2017
• CMS Submission 3/22/18

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SPA Updates

SPA 18-0003 Medicaid Administration

• CMS Submission 3/30/18

SPA 18-0006 1915(i) Community Support Program (CSP)

• Finalizing Public Notice
• Expires 10/31/18

CHIP SPA #10

• CMS Submission 1/9/18
• RAI Issued 2/8/18

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Waiver Updates

Healthier Mississippi Waiver Renewal

• CMS Submission 9/28/2017

1115 Workforce Training Initiative

• Completeness Letter 1/22/18
• Ongoing Discussions with CMS

Intellectual Disabilities/Developmental Disabilities (ID/DD) Waiver Renewal

• Expires 6/30/18
• Drafting Public Notice and Tribal Notification

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Waiver Updates

Assisted Living (AL) Waiver

• Expires 9/30/18
• Renewal due to CMS 6/30/18

Statewide Transition Plan

• Completing final draft to send to CMS

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Administrative Code Updates

AC 18-001 Therapeutic Leave

• In Process

AC 18-002 Speech Therapy

• Effective 5/1/18
• Revised provider requirements for speech therapists

AC 18-005 BCBA Telehealth

• In Process

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Administrative Code Updates

AC 18-008 and 18-009 – Pharmacy Reimbursement and 340B

• Revising language to mirror SPA 17-0002

AC 18-014 Search Fee

• In Process

AC 18-015 Program Integrity

• In Process

AC 18-016 Home Health

• Revising language to mirror SPA 17-0001

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Administrative Code Updates

AC 18-017 DME

• Revising language to mirror SPA 17-0001

AC 18-018 Transportation

• In Process

AC 18-019 Respiratory Therapy

• In Process
• Adding language to mirror SPA 18-0001

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Potential Future Filings

2018 Legislative Session

• Language Revision

SPA 18-0009 APR-DRG Updates

• Under Executive Review

SPA 18-0005 Change of Ownership (CHOW) and Appeals

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Physician Reimbursement

Top 5 CPT Physician E&M Codes Reimbursement by State Mississippi Florida Georgia Alabama Louisiana Arkansas 99202 $62.12 $35.98 $54.57 $53.00 $42.77 $45.10 99203 $89.69 $53.55 $76.53 $78.00 $62.18 $64.90 99212 $36.02 $21.84 $29.67 $31.00 $24.83 $27.50 99213 $61.01 $26.61 $40.70 $42.00 $41.53 $36.30 $38.40 99214 $90.08 $41.46 $62.71 $67.00 $62.65 $70.05

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*Florida, Louisiana, and Arkansas reported that they did not plan to continue the Affordable Care Act (ACA) primary care increase after the 100% federal funding ended on December 31, 2014.

Physician Reimbursement Primary Care Physician (PCP) Increase

Top 5 CPT Physician E&M Codes Reimbursement by State Mississippi Florida Georgia Alabama Louisiana Arkansas 99202 $69.02 *N/A $64.20 $69.27 *N/A *N/A 99203 $99.66 *N/A $93.42 $100.52 *N/A *N/A 99212 $40.02 *N/A $37.47 $40.36 *N/A *N/A 99213 $67.79 *N/A $63.14 $68.17 *N/A *N/A 99214 $100.09 *N/A $93.35 $100.91 *N/A *N/A

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Medicaid Enrollment by State

Mississippi 1 in 4 Alabama 1 in 5 Arkansas 1 in 3 Florida 1 in 6 Georgia 1 in 6 Louisiana 1 in 3

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The Division of Medicaid pays for all medically necessary services for EPSDT-eligible beneficiaries in accordance with MS Administrative Code Title 23, Part 223, without regard to service limitations and with prior authorization.

Preventive Health Screenings/Services

Adults (21+) Pregnant Women Children (0-21) Annual Physical Examinations    Anticipatory Guidance  Autism Screening  Bone Density Studies    Cardiovascular Screening    Cervical and Vaginal Cancer Screening    Cervical Dysplasia Screening    Colorectal Cancer Screening   Dental Assessment and Counseling  Depression Screening   Development/Behavioral Assessment  Developmental Surveillance  Diabetes Screening    Dyslipidemia Screening    Hematocrit and/or Hemoglobin    Immunizations    Influenza and Pneumonia Vaccines    Laboratory Testing    Lead Screening and Testing    Mammography   Newborn Metabolic/Hemoglobin Screening  Nutritional Assessment  Prostate Cancer Screening  Psychosocial/Behavioral Assessment  Sexually Transmitted Infection/Disease Screening    Tobacco Cessation Counseling   Tobacco Cessation Products    Tuberculin Testing    Vision and Glaucoma Screening Eye Exams   

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U.S. Department of Health & Human Services Best Practices

• Agency for Healthcare Research and Quality (AHRQ) authorized by

Congress to convene U.S. Preventive Services Task Force

• Panel of national experts in prevention and medicine make evidence-

based recommendations about clinical preventive services, screenings, counseling services, and preventive medications

• All recommendations published on Task Force’s Web site and/or in peer-

reviewed journal

• Recommendations assigned a letter grade based on strength of evidence

and balance of benefits and harms

• Task Force does not consider costs of preventive service when

determining recommendation

• Annual report to Congress

https://www.uspreventiveservicestaskforce.org/BrowseRec/Index/browse- recommendations

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