By AzHHA Communications ● Dec. 21, 2023
Smart Brevity® count: 5 mins...1328 words
- An update on the ADHS ground ambulance rules package.
- AzHHA filing an amicus to preserve civil liability protections.
- The start of Arizona bill pre-filing.
Editor’s note: Due to the winter holidays, there won’t be a Connection newsletter on Thursday, Dec. 28, 2023. We’ll be back on Thursday, Jan. 4, 2024. Wishing you a happy and healthy holiday season!
Update on ADHS ground ambulance rules package
This week, the Arizona Department of Health Services (ADHS) announced the last round of changes to the ground ambulance rules package they’ve been working on for the past several months.
Why it matters: The changes include:
- Clarifying rate definitions and rate setting considerations to ensure there are no negative financial impacts.
- Clarifying other requirements to ensure there are no negative unintended consequence on existing certificate holders.
- Delaying the effective date for additional requirements to allow more time to address stakeholder concerns.
What’s next: ADHS will hold stakeholder information sessions on these changes the week of Jan. 8, 2024. All of the sessions will be virtual. You can find more information on how to participate here.
- ADHS will take these final rules to the Governor’s Regulatory Review Council (GRRC), who will review them and give final approval, or not, as the case may be. We anticipate that will take place in early February.
- AzHHA will submit comments on the newest revisions to GRRC when that meeting takes place.
- If you have any feedback on this final rules package, please send to Debbie Johnston and Meghan McCabe.
AzHHA files amicus to preserve civil liability protections granted during the pandemic
On Tuesday, Dec. 19, 2023, AzHHA filed a brief in the Arizona Supreme Court to urge the Court to consider an important legal issue to Arizona’s healthcare providers.
The big picture: During the COVID-19 pandemic, the Arizona Legislature enacted A.R.S. § 12-516 to encourage healthcare providers to provide healthcare services to patients with COVID-19.
- This protected healthcare providers from civil liability unless they provided healthcare services with “willful misconduct or gross negligence” rather than the traditional “ordinary negligence” standard of care.
Why it matters: The Arizona Court of Appeals recently held that this statute violates the Arizona Constitution’s anti-abrogation clause which states that the right of action to recover damages for injuries shall never be revoked.
- AzHHA argued that the Arizona Supreme Court should reverse the Court of Appeals’ decision or, at a minimum, apply any new legal principle on a going forward basis to protect healthcare providers who already provided services in support of Arizona’s response to the pandemic.
As the brief explained: “These healthcare heroes deserve our thanks, not the back of the hand.”
Arizona bill pre-filing begins
Arizona bill pre-filing is underway as we ramp up preparations for the upcoming Second Regular Session of Arizona’s Fifty-sixth Legislature, set to begin on Monday, Jan. 8, 2024.
- As of Tuesday, Dec. 19, 2023, 74 bills have been pre-filed, and we anticipate this number to increase significantly over the coming weeks.
One notable return is health plan accountability. Representative David Cook has introduced HB2035 (formerly HB2290 from 2023). The bill has the same intentions, including three main items we want to accomplish:
- Improve transparency – when a claim is denied, health plans would be required to provide sufficient information and contact information for a designated person who can respond to questions about the claim denials.
- Promote fairness – this bill guarantees all healthcare providers can dispute a payment denial or downgrade from commercial health plans to a neutral third party.
- Impart reasonableness – the bill seeks to shorten the time frame for credentialing and loading physicians and other healthcare providers to 45 calendar days from the current 100 days.
Member note: AzHHA will begin its weekly member Legislative Update calls on Friday, Jan. 12, 2024. Please be on the lookout for a calendar invite and further communications.
The challenges of getting paid is wreaking havoc on providers’ revenue
Earlier this month, Kodiak RCA (formerly Crow healthcare consulting) released its quarterly benchmarking analysis.
Why it matters: According to Kodiak RCA, the delays in payments are “wreaking havoc on providers’ revenue cycle performance with cash flow and accounts receivable metrics heading in the wrong direction.”
Among its findings:
- Aged accounts receivable greater than 90 days as a percentage of claim value rose to 36% for commercial plans and 27% for Medicare Advantage. Kodiak RCA describes this as “growing at an alarming rate” considering that just three years prior, the figures were 27% and 19%, respectively.
- Aged accounts receivables is being driven, in part, by initial denial rates which are at 11.99%, up from 10.15% three years earlier. This increase is being driven by each type of initial claim denial – request for more information, prior authorizations and medical necessity.
- Health insurance practices are also leading to lower payments from patients. Because health insurers are now taking longer to resolve payment issues to providers, they are also taking longer to bill patients. The longer the time lapse between when a patient receives a bill, the less likely a provider is to get paid.
2023 merger guidelines released
On Monday, Dec. 18, 2023, the Justice Department and the Federal Trade Commission jointly issued the 2023 merger guidelines.
Why it matters: These guidelines describe how the agencies review mergers and acquisitions to determine compliance with federal antitrust laws.
- Like the prior horizontal and vertical merger guidelines they replace, the 2023 merger guidelines are not themselves legally binding, but provide transparency into the agencies’ decision-making process.
Recommendations to enhance cybersecurity protection
On Friday, Dec. 15, 2023, the Cybersecurity and Infrastructure Security Agency (CISA) released an advisory on ways healthcare organizations can enhance their cybersecurity protection.
- Using longer and more complex passwords, and training users against password reuse.
- Ensure only ports, protocols and services with validated business needs are running on each system.
- Discontinue reuse or sharing of administration credentials among systems.
- Implement a security awareness program.
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. DataGen generates hospital-specific reports which are sent to AzHHA hospital members as part of their membership.
Why it matters: This data helps 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.
The below reports were recently sent to members:
- CY 2024 Home health final rule (sent 12/6/23)
- Q3 2023 Quality measure trends analysis (sent 12/13/23)
- Q3 2023 Value-based purchasing analysis (sent 12/20/23)
Wednesday, Jan. 10 - Hospital assessments and HEALTHII payments 101
AzHHA will host this annual event for members interested in learning about the two hospital assessments and the quarterly HEALTHII payments. Learn why the assessments were created, which types of hospitals are exempt from the assessments, how the amounts have changed over time, why hospitals receive quarterly HEALTHII payments, HEALTHII reconciliations and HEALTHII quality metrics. AzHHA members who have not received an invitation but are interested in attending may contact Amy Upston, director of financial policy and reimbursement, at [email protected].
Jan. 23, 24 and 30 - Crisis Standards of Care tabletop exercise
AzCHER will conduct three tabletop exercises that will address Crisis Standards of Care in Arizona. Each exercise will discuss the same emergency scenario. Sessions will be held in Phoenix, Tucson and virtually. Learn more and register.
Tuesday, Feb. 6 - Arizona Rural and Public Health Policy Forum 2024
Each year, this forum focuses on issues of the day that are affecting the health of rural Arizonans. The event will be held at the Virginia G. Piper Auditorium located at 600 E. Van Buren Street in Phoenix. Register now.