President Trump Signs Executive Order for ACA Modification

By Ryan Kelly –

A Wall Street Journal article today well captures the changes announced by the White House yesterday: View Article

I won’t add any additional detail to the article as it lays out both sides of the argument nicely.  What I will say is that healthcare professionals and community members have all remarked how poor our marketplace is at the moment.  Not the fault of the insurers participating, ACA regulations have forced bloated insurance plans at unaffordable costs.  But, these plans still do not provide full coverage, resulting in a large increase in ‘bad debt’ patricianly among our state hospitals.  Reform is needed in one form or another.  And, this is a belief that is shared by elected officials on both sides of the isle.

It seems as though the identified reforms will be enforced by appointed agencies (CMS, HHS, etc), so it’s a big early to tell the specific impact.  But, considering the challenges that most of our population has had with the marketplace, any change could be a good thing so long as it does not significantly cause negative disruption in the overall healthcare system.

Just my two cents anyway…



CMS Proposal for 340(b) Payment Changes

By Ryan Kelly –

The latest issue of which we have focused is the proposed CMS change to 340(b) pharmacy reimbursement.  Currently facilities can charge up to 6% above the Average Sales Price (ASP).  The proposed rule change would modify this reimbursement structure to 22.5% below ASP.
We have had discussions with members across Mississippi to determine the perceived impact of such a change, and we have sent this information to Sen. Cochran and Wicker’s offices.  This, along with feedback from facilities and action through the open comment period, has caused both Sen. Cochran and Wicker to sign-on to a letter produced by Sen. John Thune requesting a rejection of the proposed rule and a continuation of the payment methodology for 340(b) as we’ve seen it in the past years.
Based on our analysis of impact, we agree with this action and applaud Senators Cochran and Wicker for their pragmatic approach and for listening to their constituents.
This House of Representatives also has a matching letter that is being distributed, but we do not have a status update as to who has signed it at this time.
We will keep you posted as we learn more.  It is my assumption (and hope) at this point that CMS will view comments and the pressure from the legislature against the measure, and they will rescind it accordingly.

Could Apple Finally Make a Move into the EHR World?

By Ryan Kelly –

We’ve talked about it for years, but not speculation may be reality as Apple, Inc. is looking to release a new generation iPhone in the near future.  A recent article by Modern Healthcare goes slightly beyond speculation and actually predicts that the new phone will take healthcare integration to the next level with interoperability with hospitals and clinics for patient records.

This merger of self reported data along with HIPAA-compliant health data exchange would be revolutionary for interoperability, and it may finally take us where we all thought we could go in the healthcare industry.

Or, maybe it’s just hype.  We may find out soon when Apple unveils its latest round of products as tomorrow’s expo.

Hurricanes Remind Us About Emergency Preparedness Needs

By Ryan Kelly –

With the recent hurricane hitting the East coast of Texas and another heading straight for Florida this weekend, it is a sober reminder of why we need some measure of emergency preparedness guidelines and procedures.

The MRHA recently sent tools and resource for members to access and a summary of the guidelines that will be enforced for RHCs and FQHCs beginning November 15, 2017.

The following represents these new guidelines.  Resources available to you to help meet these needs is located below.  Remember that regardless of guidelines or requirements, it’s always a good idea to know how your facility can / should be part of a holistic plan of disaster management and recovery in your community!

Emergency Plan §491.12 (a)

The first step to creating an emergency preparedness plan is to create what CMS calls an “all hazards approach” to emergency preparedness. An “all-hazards approach” to emergency planning focuses on the preparedness of providers for a full range of emergencies. This could mean preparing for natural disasters or considering risks around the area of a RHCs. CMS leaves it up to RHCs to develop their own process for creating a risk assessment. However, CMS does expect that the participation of all staff including an administrator, physician, a nurse practitioner or physician assistance and a registered nurse to be involved in assessing the risk of the RHC.

The plan must include strategies for addressing emergency events identified by the risk assessments and identify what services the RHC would be able to provide during an emergency.

Finally, the emergency plan should include a process for cooperation with local, state and federal emergency preparedness officials in a case of an emergency. The regulations specify that the RHC should document attempts to contact such officials for certification purposes.

It is important to note, that unlike hospitals CMS did not require RHCs to have a system to track the location of staff and patients in the facility’s care during and after emergency (although the regulations do seem to contradict themselves a bit in §491.12(c)(4). Furthermore, RHCs do not have to provide for basic subsistence needs for staff and patients.

Policies and Procedures §491.12 (b)

After an RHC creates an emergency plan, RHCs must then develop policies and procedures to address possible emergencies. RHCs must plan for safe evacuation from the RHC which includes the appropriate placement of exit signs and responsibilities of staff members.

There must be a way to shelter in place for people who remain in the facility. RHCs must also preserve their medical documentation. Finally RHCs must have a plan to use volunteers and other emergency personnel during an emergency.

Communication Plan §491.12 (c)

RHCs must develop and maintain an emergency preparedness communication plan. The plan should comply with federal and state laws and must be updated at least annually. The communication plan must include all relevant contact information and alternative means of communicating with staff and local emergency agencies.

The RHC must also have a way to provide information about the condition and location of the patients in the clinic at the time of the emergency. Finally, an RHC must have a way to indicate their needs and ability to provide assistance to the emergency authority.

Training and Testing §491.12 (d)

RHCs must develop and maintain a training and testing program based on the risk assessment, emergency plan and communication plan. This training program must include a documented initial training with all new and existing staff which is performed annually.

Furthermore, RHCs must test their emergency plan at least annually. CMS will consider a plan properly tested if the RHC performs and analyzes either two full scale community based exercises or one full scale community based exercise and a tabletop exercise.

Integrated healthcare systems §491.12 (e)

It is important to note that under this regulation there is an option to develop an emergency preparedness plan as an entire health system or independently as an RHC. If an RHC is part of a healthcare system it may elect to participate in the healthcare system’s coordinated emergency preparedness program instead of creating their own.

Resources Available to You

The Mississippi Rural Health Association has been working with clinics to help them meet these new demands.

MSDH Emergency Management Contacts

We encourage you to contact your respective emergency management contact in the Mississippi State Department of Health.  These contacts may be found on the Association resource page by clicking here.  This map will show each individual contact per public health area, and these contacts may assist you in navigating many of the direct contacts needed for policy implementation.

Two Rivers Emergency Management

Second, the Association has negotiated a service with Two Rivers Emergency Management.  They are a professional consulting firm that can assist you in developing and sustaining and emergency preparedness plan.  The following is the direct contact information for Two Rivers:

Two Rivers Emergency Management

Mr. Michael Morlan, CEO


On-Demand Webinar

The Association hosted a webinar recently on the topic of emergency preparedness. Presented by the afore mentioned Michael Morlan, this webinar covers the basic requirements of the new plan and a basic understanding of how to meet those demands.  Click here to register for this on-demand webinar, free for Association members.

Rural Health Receives Positive Funding Increase

– By Ryan Kelly

The National Rural Health Association reported to all state associations this afternoon that the Senate is considering a budget that will include a $160.6M budget for rural health.  Although it is not clear at this moment what constitutes “rural health” in the budget, this would be a $4.5M increase over the previous year’s allocation.

This funding increase matches the rhetoric that has been coming from the Senate, the House, and the White House regarding their focus on rural America.  Our elected officials recognize that rural health is vital to the infrastructure of our nation, and this budget reflects this recognition.

Also important to note in the budget is an $816M budget for opioid treatment, which is a 440% increase over the previous year.  Efforts have been underway in Mississippi between the Department of Mental Health and the Department of Corrections on training and education on best practices for handling opioid-addicted patients.

There are also several bills upcoming which are important to watch, including 340(b) regulations and new funding for outpatient PPS hospitals, extenders for the CHIP program, and a variety of Medicare extenders.

We are beginning to see a series of bi-partisan discussions on the Senate Public Health Committee, which is a welcome change from the many years of partisan politics.  Is this is a shift in the paradigm of DC?  We shall see…

Respective to the budget, we would like to thank Sen. Thad Cochran and his team for keeping rural health a primary focus as per their promises to us over the years.

Healthcare Bill is Dead…for now

By Ryan Kelly –

It was announced recently that leadership in the US Senate would not pursue a vote on the recently proposed healthcare bill, the Better Care Reconciliation Act of 2017,  to match the American Health Care Act passed out of the US House of Representatives last month.

It is reported that the Senate will not take up a vote because the do not have the necessary 51 votes to have the bill pass.  The Senate consists of 52 Republicans (including the Vice President) and 49 Democrats.  It is widely believed that a vote would be made down partisan lines.

So why did the bill fail to gather votes?  Essentially, it’s because we are a divided country that reflects a divided party system.  Far right Republicans do not believe that the bill went far enough to privatize insurance and move away from policies of The Affordable Care Act.  Moderate Republicans believe the legislation went too far at reducing Medicaid funding and punishing states that expanded Medicaid.

So essentially, it modified Medicaid too much and it did not open the markets far enough.  These represent two extreme issues and stances that did not work for both sides of a GOP body that needed it to work for everyone in order to pass.

What would the two bills have done in Mississippi?

The insurance marketplace would not have had the freedom needed for insurance plans to openly determine the risk of clients and assign premiums based on this risk.  The marketplace, rather would have been opened more than under the ACA but not enough to significantly reduce individual cost.

Secondly, Medicaid would have been transitioned from an unlimited federal match payment program to either a per capita rate per enrollee or a bundled payment to each state.  The greatest concern of this transition is that states would bear the greatest cost of paying for Medicaid patients, which means that most states would try to find some way to cut programs or services to save cash.  Since Mississippi receives the highest federal match of any state in the union, this would have likely affected Mississippi more than anyone else.  Although the specific impact in Mississippi has yet to be determined due to a lack of information about the specific amount of funding that would be block-granted or supplied per enrollee, the consensus is largely that it would not be good for Mississippi.  This likely would result in reduced payments for services and a reduction of covered services.  It would also likely result in a tax increase to cover the expected state shortfalls.

But, this is not done.  At the time of this writing, legislators are working on a true “repeal bill” that would take away all aspects of the Affordable Care Act.  No details have been released at this time, and many believe that such an effort would fail for the same reason that the afore mentioned legislation failed.  There is also rumor of additional healthcare legislation being crafted that attempt different ways to reform the ACA or replace it with alternative ways to care for patients.

There is large consensus on one thing – the Affordable Care Act was not perfect and further reform is needed.  Whether that involves repealing and replacing or simply modifying the ACA is open for debate.  As the Association is a 501(c)3 organization that does not take a partisan stance, our desire is to see a bill that improves healthcare for all rural citizens and providers.  We want expansion of markets, reduced cost, greater access, and financial stability of the healthcare system.
It seems like the pieces are in place, we just need to find a way to make smart reforms and bring everyone to the table for a consensus on our direction moving forward.

President Trump’s Budget Takes Too Much from Rural

by Ryan Kelly –

The recently released budget from the Oval Office appears to do too much in the way of cutting important programs for rural health.

Taken from an article from ModernHealthcare, several items are targeted.

The Rural Hospital Flexibility Grant, at $42 million, is proposed for elimination. The Obama administration previously had recommended cutting the program, saying it was duplicative.

The new budget also zeroes out grants to state offices of rural health, a $9 million program.

The Rural Hospital Outreach Grant, which helps small rural hospitals get resources to create collaboratives with long-term care facilities or with ambulance services, is slated for a reduction of $13 million, to $51 million annually.

The total savings for eliminating these funds are very minimal…essentially a rounding error in the federal budget.  But the impact on their elimination could be big, cutting out needed training, education, and support services to assist our rural facilities around the country, including Mississippi.

As an Association, we will wait temporarily to see how the president’s budget plays out. It’s likely that as in years past when these items were on the block for cuts, they will be replaced by the House and Senate who realize their essential nature in their districts.  If they don’t restore these proposed cuts, though, we’ll be sure to weigh-in…