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Connection Newsletter - Senate bill introduced establishing prior authorization requirements under MA plans

This bill would streamline and standardize the prior authorization process which would help eliminate burdensome paperwork and help providers focus on patients.

Senate bill introduced establishing prior authorization requirements under MA plans

Arizona Senator Kyrsten Sinema along with Senators Roger Marshall, R-Kansas, and John Thune, R-South Dakota, have introduced a Senate companion to a U.S. House of Representatives bill that would establish requirements for the use of prior authorization under Medicare Advantage (MA) plans. The American Hospital Association (AHA) strongly supports this bill, stating it would streamline and standardize the prior authorization process which would, in turn, help care providers focus on patients instead of burdensome paperwork.

Additionally, in a letter to the Centers for Medicare & Medicaid Services (CMS), the AHA urges the agency to address prior authorization issues affecting MA patients. The AHA notes how the current prior authorization process causes delays in care as well as unnecessary denials. In its letter, the AHA also asks CMS to revise and reissue recently proposed regulations streamlining prior authorization requirements within certain coverage programs; consider additional regulations to limit care delays and conduct oversight and enforcement for plans that have demonstrated problematic prior authorization usage in the past.

HHS extends shelf-life of monoclonal antibody, Etesevimab

U.S. Department of Health and Human Services announced on October 22 the extension of etesevimab’s shelf-life. The monoclonal antibody, which is administered with bamlanivimab, may be stored for an additional six months from the labeled date of expiration as long as the vial is unopened. In addition to being unopened, the vials of etesevimab must have been stored as detailed in the fact sheet for healthcare providers and emergency use authorization.

AHCCCS updates for AzHHA members

Arizona Health Care Cost Containment System Director Jami Snyder spoke to AzHHA members Wednesday, providing program updates and an outlook on the agency’s budget proposals and initiatives for next year. Director Snyder shared details on the agency’s growing enrollment, as well as projections for the next two years. “Flexibility” was a leading theme as both Arizona and the federal government manage budgets and respond to the ongoing COVID-19 pandemic. AHCCCS programs and priorities are closely linked to rules and directives from CMS, and much remains to be seen as CMS navigates the federal public health emergency as it is extended in 60-day time frames. Director Snyder also acknowledged AzHHA member input saying it has been a critical source of guidance and thanked our healthcare workforce for their tireless work throughout the pandemic. AzHHA members interested in more detail on this presentation may contact [email protected].

AzHHA releases DataGen reports

In relationship with DataGen, AzHHA distributes reports to hospitals based on information submitted to the Centers for Medicare and Medicaid Services. This data can help hospitals understand the financial impact of proposed changes and annual updates. The reports can also assist in preparing budgets or benchmarking results with other similar organizations. DataGen generates hospital-specific reports which are sent to AzHHA hospital members as part of their membership. Below is the list of reports recently sent to members.

  • 2021 Hospital-Acquired Condition Analysis - Sent 9/8/2021

  • 2021 Quality Measure Trends Analysis - Sent 9/27/2021

  • 2021 Financial Indicators Analysis - Sent 10/11/2021

  • 2021 Cost Report Model - Sent 10/14/2021

  • Critical Access Hospital and Small Rural Prospective Payment System Utilization Analysis - Sent 10/26/2021

A recording of the Federal Fiscal Year (FFY) 2022 In Patient Prospective Payment System Final Rule Analysis webinar and the Key Takeaways from CMS’ FFY 2022 Rules webinar are available to members. Email [email protected] to obtain a link to the recording.

Ask your U.S. State Representatives to sign the Dear Colleague letter on surprise billing regulation

A Dear Colleague letter continues to circulate the U.S. House of Representatives urging the U.S. Departments of Health and Human Services, Treasury and Labor to amend the interim final rule issued September 30 known as “Part 2” of implementation of the No Surprises Act. The letter, led by Representatives Tom Suozzi (D-New York), and Brad Wenstrup (R-Ohio), maintains the parameters of the independent dispute resolution (IDR) process in the interim final rule are inconsistent with the Act and do not create a balanced process to settle payment disputes. The letter urges the Administration to revise the interim final rule to align with the Act by specifying that the certified IDR entity should not default to the median in-network rate as the appropriate payment for out-of-network services and should instead consider all the factors outlined in the statute without disproportionately weighting one factor. The American Hospital Association and AzHHA encourage hospitals to reach out to their representatives today and urge them to sign the letter by October 29.

Updates to ASIIS portal

Starting November 1, the Arizona State Immunization Information System portal will have a new look and updated security. The Arizona Department of Health Services, Arizona Immunization Office announced the new updates will require users to update their passwords. The update process will begin November 1 and be live by November 2.

AHA releases Cost of Caring report

AHA released its 2021 Cost of Caring report Monday, examining what is driving healthcare spending growth and the role hospitals and health systems play in caring for the nation’s most complex and resource-intensive patients. COVID-19 heightened a number of challenges as hospitals faced steep financial losses estimated at $54 billion in net income in 2021, with more than a third of hospitals expected to have negative operating margins through year’s end. In addition, the report highlights how hospitals have also experienced increases in expenses due to supply chain and labor shortages, travel nurses, vaccine testing and distribution and other pandemic-related expenses.

Multistate outbreak of non-travel associated Burkholderia pseudomallei infections (Melioidosis) in four Patients: Georgia, Kansas, Minnesota and Texas

The contaminated product identified by positive polymerase chain reaction (PCR) assay is the Better Homes and Gardens-branded Essential Oil Infused Aromatherapy Room Spray with Gemstones “Lavender & Chamomile” scent, manufactured in India. The spray was sold at Walmart between February and October 21, 2021, and was distributed in a limited number of stores and online nationwide. To date, no cases have been identified in Arizona.

Download AzHHA's 2021 Legislative Report

Upcoming Events

November 11 and December 2 - Introduction to POLST

Interested in learning how to use the Arizona POLST form with your patients? The one-hour Introduction to POLST workshop equips healthcare professionals with knowledge and resources to begin using POLST, Physician Orders for Life-Sustaining Treatment, in Arizona. The objectives are to describe what POLST is at the state and national level, explain why POLST is important, define the population for POLST, when to begin the conversation and who completes POLST, describe the process for completing, reviewing and updating POLST and learn the process of submitting healthcare planning documents to the Arizona Healthcare Directive Registry. To register for a workshop, click on a date below.

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