Author: presidentmississippiruralorg

By Ryan Kelly –

A delegation from Mississippi, including Michael Nester, Tommy Bartlett, Joanie Perkins, Tasha Brown, Alvin Hoover, Paul Gardner and myself, are in Washington D.C. this week to discuss rural health policy and legislation with fellow rural professionals and elected officials and staff.

We had the pleasure of hearing from Senator Tim Kaine (D-VA) and his experience and work to help with rural health improvement.  No doubt, Sen. Kaine has been a rural health champion and has supported good work at improving and supporting many vital programs.

He mentioned a “big idea” program today that I have heard before but not to the depth that he provided.  This program, dubbed Medicare X, would be a public insurance offering from Medicare but offered on the healthcare exchange for non-Medicare beneficiaries.  So essentially, anyone would be eligible to “buy in” to this policy  if they desired to do so.

In brief summary, Medicare X would provide all Medicare benefits plus meet all of the minimum essential benefits provided on the exchange via the requirements of the Affordable Care Act.

I have stated before the concern that we have with the minimum essential benefits of the ACA and the “metal plans” offered through the exchange – which has led to a crisis of “under insurance” in Mississippi.  What I see with Medicare X is a related issue.  Although the coverage of such a policy would be fantastic, I would be very concerned about the affordability of such a policy.

Currently, Mississippi Medicare beneficiaries cost Medicare $11,021 per year in cost, according to the Kaiser Foundation.  This is about the national average.  If we round up a bit for the assumed increase with adding the minimum essential benefits, and if nothing changes for the average cost per beneficiary, then we could naturally assume that the monthly premium for such a policy to be approximately $1,000 per month per beneficiary.

I’m not sure about you, but I don’t know many people that would pay $1,000 per month per person for Medicare X.

To Sen. Kaine’s benefit, it’s an effort to shore-up states like Mississippi where there is only one option on the health insurance exchange.  I admire the effort and understand that there could be a number of factors that, if implemented, could reduce the cost per person.  My recommendation would be to take the minimum essential benefits off of the table, and stagger the cost ratio based on a variety of health-related factors (age, sex, fitness level, etc).  This would help to provide better coverage at a more affordable price and encourage people to live healthier.

There are a number of “big ideas” on the table, alongside ideas including complete Medicare expansion, block granting Medicaid to states, and recreating new insurance plans with greater flexibility.  I think we need to understand the reality of what people need vs. what Washington wants before we make a decision on what direction to go.

Effective Jan. 1, 2019, the Mississippi Division of Medicaid (DOM) is increasing the number of physician visits it covers for Medicaid beneficiaries, the first of a series of changes the agency plans to roll out in the coming year.

The move is part of the new Medicaid EASE Initiative — Enhancing Access to Services and Engagement — a bundle of programmatic changes aimed at bolstering Medicaid beneficiaries’ access to needed services in the most appropriate setting.

With the first phase of the EASE Initiative, DOM will increase the physician visit limit for beneficiaries from 12 to 16 visits per year. This increase supplements limit flexibility already in place for different populations of Medicaid beneficiaries. Beneficiaries in nursing homes, for instance, can receive up to 36 physician visits annually. Individuals who participate in the MississippiCAN program will continue to be eligible for enhanced services offered by the managed care company with which they are enrolled, which include unlimited physician visits. DOM will also continue to offer unlimited medically necessary physician visits for children up to age 21.

DOM plans to announce additional EASE Initiative reforms in the coming months. These projects are still in development and include increases to the monthly prescription drug limit and home health visit limit, behavioral health and substance use disorder reforms, and an effort to reduce potentially preventable hospital readmissions. DOM will share more information about these projects as they are developed.

HRSA’s National Center for Health Workforce Analysis recently conducted analyses on the adult and pediatric mental health and substance abuse disorder workforce.

They have generated national-level projection estimates for the health workforce for the following behavioral health occupations between 2016 and 2030.  Click on the following links to view these estimates.

• Addiction counselors
• Marriage and family therapists
• Mental health and school counselors
• Psychiatric technicians and psychiatric aides
• Psychiatric nurse practitioners and psychiatric physician assistants
• Psychiatrists
• Psychologists
• Social workers
•  State-Level Estimates of Behavioral Health Workforce
• Estimates of New Behavioral Health Grads, 2016 – 2021

The Mississippi Division of Medicaid recently updated their guidelines after a series of conversations and internal discussions for Nurse Practitioners ordering Durable Medical Equipment (DME).  This guideline change is in response to recent CMS reviews of Mississippi’s policies, which were outdated as of the passage of the Affordable Care Act.  CMS required that Mississippi comply with ACA guidelines, which prevented NPs from ordering DME without physician approval.

Click here to view Medicaid’s updated guidelines, complete with scenarios to better understand how to comply.

By Ryan Kelly –

The Mississippi Division of Medicaid informed us last Friday that there may be a small, technical glitch in their system related to add-on services being billed to Medicaid.  They are working on a resolution to this glitch and are prepared to pay any unpaid claims that have already been submitted.  Please check your statements and reconcile them to your billable encounters to ensure that all payments have been made correctly.

If you see anything that may be missing respective to these add-on services, please contact Joe Jackson at joe.jackson@medicaid.ms.gov.

View an update from this article by the MS Division of Medicaid by clicking here.

Nurse practitioners throughout Mississippi recently received letters from the Mississippi Division of Medicaid stating that they are no longer able to prescribe durable medical equipment (DME) due to a change in the CMS regulations for DME under hospice regulations.  This was a shock to many, and it prompted many meetings throughout the state to figure out the “whats” and “why” behind this.

As we have investigated and been part of the discussions around this, we have learned much.  Here is a brief summary.

The origin of this language appears to stem back to the passage of the Affordable Care Act in 2008.  Language from the ACA changed CMS guidelines to require that only physicians are eligible to order DME – a change from what was previously allowed.  At that time, Mississippi had just recently submitted and received approval for our new Medicaid technical language.

This language had stayed in effect until this year, 2018, where Mississippi Medicaid filed its new State Plan Amendment (SPA) 17-0001 in response to the passage of the 2018 Medicaid technical bill.  This new language this year was approved by CMS with one caveat, that the DME portion of home health is changed to meet their standing guidelines as stated by the ACA in accordance with 42 CFR 440.70.

Representatives from the Mississippi Division of Medicaid had lengthy conversations with CMS to determine the cause of this change, and to fight for the state’s providers.  It turns out that CMS actually asked Mississippi Medicaid to not only enforce the new policy effective immediately, but to actually back-bill providers for a period of time for improperly ordering DME, despite the fact that it was done according to Mississippi-approved policies.  Mississippi Medicaid fought hard for Mississippi providers, and it prompted CMS to compromise on not requiring the retroactive refunded payments, but rather kicked out the effective date to September 1, 2018.  At and after this date, only physicians will be eligible to order DME.

As I mentioned, there have been numerous conversations around this and many considerations of how to fix it.  We are likely looking at a short-term fix and a long-term fix, but more investigate is underway with other states that have already dealt with the issue and found resolution.  In order to not disrupt the work that is being done, I will hold back from detailing the solutions that are being discussed at this time.  I can say that the goal, though, is to find a way that is legal and medically compliant to allow NPs to continue to order DME.

We are monitoring the situation closely and have a “seat at the table” with discussions.

Hopefully there will be headway soon before this takes full effect on September 1, 2018 so that we do not hamper the good work that is being done to treat patients in Mississippi that have a need for basic DME.

Please contact Ryan Kelly at 601.898.3001 for questions or additional information.

By Ryan Kelly –

I think we can all agree that prescription drug prices are often too high.  Of course, there are several key reasons why this is the case: 1) research, 2) litigation defense and payout, 3) shareholder profits, among several others.

So, how will we work to lower these drug prices?

First, it involves leadership.  Recently President Trump delivered a speech in which is called for a lowering of drug prices, whether voluntary or forced.  Being the free-market person that President Trump is, it’s likely that the “behind the scenes work” would involve incentives to companies for lowering the cost.  For patients, though, this could be very positive.

A second effort underway currently is with prescription discount cards.  One that the MRHA uses as a partner is Mississippi Drug Card.  This card is loaded with pre-negotiated pricing that helps patients to lower their burden.  These prices are often competitive to those offered with insurance on many prescription types.  Another unique card is offered by individual pharmaceutical companies.  These cards, or vouchers, will entitle beneficiaries to receive steep discounts on drugs at the counter.  One such from Astra Zeneca, for instance, can be used with 340(b) pricing on diabetes medications like Farxiga, Xigduo XR, and Qtern to allow a patient to receive medication at no cost.  But, these cards cannot be used alongside government-funded insurance plans (Medicare, Medicaid, and Tricare).

We look forward to seeing more efforts on how to reduce the cost burden of prescription drugs for our members.  At the moment, it looks like the tide is starting to turn.