Department of Insurance Reviews Rate Increase Requests by Joe Furia

Debbie Johnston, Senior Vice President of Policy Development

This week, the Department of Insurance posted rate increase requests from three major health insurers in Arizona, as follows:

  • Blue Cross Blue Shield of Arizona is requesting a 19.3% increase affecting PPO coverage for individual health insurance sold off the Exchange, effective May 1, 2018.
  • United Healthcare of Arizona is requesting a 13.9% increase affecting HMO coverage for small group health insurance sold off the Exchange, effective April 1, 2018.
  • All Savers Insurance Company is requesting a 12.6% increase affecting PPO coverage for small group health insurance sold off the Exchange, effective April 1, 2018.

The public can comment on the proposed rate filings by emailing Ratereview@azinsurance.gov 

CMS Clarifies Rules on Texting Patient Health Information by Joe Furia

 Ann-Marie Alameddin, Vice President of Strategy and General Counsel

In a recent memo to state survey agency directors, the Centers for Medicare & Medicaid Services (CMS) made clear that texting patient information is allowed as long as a secure texting platform is used. Providers must comply with HIPAA and meet the applicable conditions of participation to ensure that patient confidentiality is upheld and documentation requirements are met. CMS highlights the need to:

  • use secure, encrypted platforms to limit the risk of exposing patient information
  • develop and adhere to policies and procedures that ensure the security and integrity of the secure texting platform

CMS also restated its prohibition on texting orders, stating that orders should be entered into the patient medical record via a handwritten order or via CPOE.

CMS Proposes Risk Adjustment Changes for MA Part C Plans by Joe Furia

Debbie Johnston, Senior Vice President of Policy Development

Last week, the Centers for Medicare & Medicaid Services (CMS) announced proposed changes to the risk adjustment model for aged and disabled beneficiaries enrolled in Medicare Advantage Part C plans beginning calendar year 2019 over the course of four years. For 2019, the agency proposes adding mental health, substance use disorder and chronic kidney disease conditions to the risk adjustment model and taking into account the number of conditions that a beneficiary has under the payment model. The advance notice also discusses an alternative risk adjustment model that would take into account all conditions that a beneficiary has, including those outside the payment model. CMS is accepting comments on the advance notice through March 2nd and expects to propose changes to other MA payment methodologies for 2019 in a separate advance notice.

Webinar: Hospitals Against Violence - Partnering With Law Enforcement by Joe Furia

 

Laura Dix, Director of Policy and Community Health

As part of the Hospitals Against Violence (HAV) initiative, the American Hospital Association has developed the Hospitals Against Violence - Partnering With Law Enforcement webinar. The 1- hour webinar will be held January 10th from 1 – 2 p.m. ET. This webinar will help participants explore how hospitals can establish mutually effective partnerships with law enforcement in their communities to maximize the safety of their patients and providers. Click here, for more information or to register.  

Webinar: 2018 CPT Update for HIM Professionals by Joe Furia

John Koeneke, Vice President of Business Development

Missed the 2018 CPT Update for HIM Professionals last month? Good news! NJHA Business Solutions will be offering the 2-hour, interactive webinar on January 17th from 11:00 a.m. to 1:00 p.m. CT. This webinar will review all of the additions, deletions and modifications to the CPT Manual which are essential to know and understand in order to avoid payment denials and assure accurate reimbursement. To register for the webinar, click here.

Point of Pride: Maricopa Integrated Health System by Joe Furia

Congratulations to Maricopa Integrated Health System’s (MIHS)Trauma Center for receiving national verification by the American College of Surgeons (ACS). Last month, ACS reaffirmed MIHS’s status as the only Trauma Center in Arizona to nationally be verified to provide adult and pediatric trauma services. MIHS's trauma services were thoroughly evaluated using ACS guidelines, where more than 200 standards related to trauma resources, care processes, and continuous performance improvement were met.