Learn about the newly released analysis of claims denials and appeals in the Affordable Care Act (ACA) Marketplace health plans in 2020.  

AHA calls on Congress to protect Medicare Advantage beneficiaries’ care

Last week the Kaiser Family Foundation (KFF) released an analysis of claims denials and appeals in the Affordable Care Act (ACA) Marketplace health plans in 2020. The report found that on average 18% of nationwide in-network claims and 21% of Arizona in-network claims were denied. Rates by insurers differed significantly, ranging from a low of 1% to a high of 80%. KFF reports that “consumers rarely appeal denied claims and when they do, insurers usually uphold their original decision.” 

Rural Emergency Hospital and Critical Access Hospital conditions of participation

On July 1, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule for establishing the Conditions of Participation (CoP) for Rural Emergency Hospitals (REHs) which included several updates for Critical Access Hospitals (CAHs). Certain rural and CAH's will soon have the option to convert to a REH, potentially helping reduce the number of closures of small rural hospitals. REHs are permitted to provide emergency room services, observation care, and other services which do not exceed a per patient average stay of 24 hours. Providers will be able to receive payment for REH services beginning on January 1, 2023.

The proposed rule also proposes to add a definition of “primary roads” to its current distance and location requirements for CAHs and establish a patients’ rights condition of participation. Comments on the proposed rule must be submitted to CMS by August 29, 2022. 

Pima County, ADHS Announce Arizona’s First Monkeypox Case Beyond Maricopa County

The Arizona Department of Health Services announced Tuesday the state’s “first probable monkeypox case beyond the Phoenix area.” ADHS said Arizona has one confirmed and seven other probable cases pending confirmation from the Centers for Disease Control and Prevention (CDC), all of them in Maricopa County. Read more here.

CDC issues health alert on Human Parechovirus

The CDC Tuesday issued a health alert to warn of the spread of parechovirus (PeV) in the United States. The CDC says since May 2022, it has received reports from healthcare providers in multiple states of PeV infections in neonates and young infants. Parechoviruses are a group of viruses known to cause a spectrum of disease in humans. Read more here.

Member webinars now available

Recently, AzHHA staff have held two informational webinars that might be of interest to you or members of hospital staff.

Dobbs v. Jackson Women’s Health: Implications for Hospitals and Health Systems

This webinar was presented by Debbie Johnston, AzHHA Executive Vice President, and Karen Owens, partner at Coppersmith Brockelman and AzHHA outside counsel. Content includes how the Dobbs decision may impact hospital operations and outstanding questions hospitals will need to address in updating policies and procedures.

2022 Legislative Session Summary

This webinar was presented by AzHHA Director of Government Relations Meghan McCabe. It includes information on the outcome of legislation AzHHA tracked during the legislative session, as well as the next steps for the year, including 2022 election information.

If you’d like to review the recording or the slide deck from either presentation, you can reach out to the AzHHA team at [email protected].

ICYMI: COVID-19 supportive care program concludes

As we fulfill the end of our grant for AzHHA’s COVID-19 Supportive Care program, services will conclude at the end of June. Since January 2021, the grant provided patients with acute or chronic COVID-19 symptoms and related complications free access to palliative care via telehealth. AzHHA thanks its partners including the Area Agency on Aging, Arizona Complete Health, EIRIO and AzHHA members including Havasu Regional Medical Center, Mt. Graham Regional Medical Center, Summit Healthcare and Blue Cross Blue Shield for contributing to the program’s success through patient referrals and education. 

Upcoming events

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.

Click on your preferred date to register for the virtual workshop:

• Wednesday, July 27, 10 a.m.
• Wednesday, August 10, 10 a.m.
• Tuesday, September 27, 10 a.m.

September 22 – AIM Collaborative Conference

Registration is now open for the 2022 AIM Collaborative Conference on September 22, 2022, at Creighton University School of Medicine-Phoenix campus. This year’s conference theme, Push for Change, will focus on the Alliance for Innovation on Maternal Health (AIM)’s maternal hypertension bundle. Attendees will learn about the newest evidence and strategies for timely treatment of hypertensive disorders of pregnancy and integration of health equity into patient care. Register by September 8, 2022, to secure your seat.

October 19-21 – 2022 Annual Leadership Conference

Mark your calendar for AzHHA’s premiere event - the 2022 Annual Leadership Conference October 19-21, 2022. After two years of putting the conference on pause to focus on the pandemic response, we will meet in the majestic Lowes Ventana Canyon in Tucson. The AzHHA Annual Leadership Conference brings together hundreds of healthcare CEOs, leaders, legislators and community partners from across the state for two and a half days of education, recognition and networking. Registration will become available in the coming months.

Sponsorship opportunities are now available. Download the sponsorship prospectus, here. Questions about sponsorship may be sent to Laura Dickscheid at [email protected].

In the news

Claims Denials and Appeals in ACA Marketplace Plans in 2020
KFF

Healthcare sees most job cuts of any industry in 2022
Becker’s Healthcare

988 becomes the new 3-digit suicide prevention hotline on July 16: What to know
USA Today