Free Webinar Series for Rural Health Clinic Finance and Revenue Cycle
Rural health clinic staff are invited to participate in a seven-part webinar series focused on finance and revenue cycle for rural health clinics (RHCs). The series will occur weekly between July 12 and July 31. While much of the material is designed for independent RHCs, there will also be specific content for provider-based RHCs. Topics will include cost report basics, financial policies, revenue cycle, and financial performance indicators. A complete agenda of topics and dates is here. The series is being organized through the Washington State Department of Rural Health, the National Organization of State Offices of Rural Health (NOSORH), the National Association of Rural Health Clinics (NARHC) and Stroudwater Associates.
WSHA Comments on Medicare Proposed Inpatient Prospective Payment Hospital Rule for 2025
On June 10, WSHA submitted comments on the Centers for Medicare and Medicaid Services’ (CMS) proposed Inpatient Prospective Payment System rule for FY 2025 after receiving feedback from hospital Chief Financial Officers and Government Affairs staff.
Our comments included:
The proposed marketbasket increase does not reflect the increased costs of providing hospital care. CMS should increase the proposed marketbasket increase and reduce or eliminate the productivity adjustment.
The proposed mandatory TEAM model has many problematic design elements and assumptions that will create unreasonable financial risk for hospitals. CMS should delay implementation until these issues are rectified or, at a minimum, make hospital participation voluntary.
WSHA appreciates the proposal to provide some additional funding to specified small independent PPS hospitals for purposes of maintaining buffer stock of essential drugs, but much more is needed to ensure drug manufacturers provide equitable access to drug supply for vulnerable hospitals.
WSHA and member hospitals are concerned that the proposal to impact access and delivery of obstetrical services through changes to hospital conditions of participation will reduce financial sustainability and access to obstetrical services unless accompanied by additional funding and resources. This is a particular concern for smaller hospitals that already face financial issues due to a low volume of labor and deliveries.
We support CMS review of the Medicare methodology and payment weights for obstetrical services. Medicare weights are often used by commercial payors and impact payment and sustainability of obstetrical services.
The final rule will be published on or around August 1 and take effect October 1.
(Andrew Busz, andrewb@wsha.org)
OIC Begins Rulemaking on Prior Authorizations, Ground Ambulance Balance Billing, and Pharmacy Benefit Managers
The Office of the Insurance Commissioner (OIC) has begun the rulemaking process for several bills passed during recent legislative sessions:
Prior Authorizations: OIC began rulemaking for provisions of 2023’s House Bill 1357, which reduces the time periods for carriers to respond to prior authorization requests and requires carriers to implement application programming interfaces to standardize and streamline the prior authorization request and response process. The rulemaking will also address certain provisions of Senate Bill 6228 that affect prior authorizations for behavioral health services.
Ground Ambulance Balance Billing: OIC began rulemaking related to Senate Bill 5986, which adds ground ambulance services to the state’s existing Balance Billing Protection Act. WSHA is also planning to provide a separate bulletin for this bill.
Pharmacy Benefit Managers: OIC began rulemaking for Senate Bill 5213, which creates a regulatory structure for Pharmacy Benefit Managers and adds important protections for pharmacies and patients. WSHA is also planning to provide a separate bulletin for this bill.
WSHA will be participating in each rulemaking process and encourages other interested parties to contact the appropriate person listed in each notice for updates and scheduled hearings. A comprehensive listing of rulemaking WSHA is participating or monitoring is on our Regulatory Issues page and Top Priority Rules Tracker.
