Federal Advocacy 2009
description
Transcript of Federal Advocacy 2009
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Federal Advocacy
2009
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Congressional Activity on Reform
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ProcessSenate
Currently debating bill
House Approved reform bill on
November 7
Alternatively, a bill approved by either chamber could be “ping-
ponged” between each chamber
until an identical bill is passed by
both.
Option 2
Option 1
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Comparing Reform Proposals
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Coverage Expansion
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Coverage Expansion–How?
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Major Financing ComponentsSenate: Cost = $848 billion. Fully offset over ten years. *
House: Cost = $1.052 trillion. Fully offset over ten years. *
* Reflects gross cost of coverage expansions based on CBO
scores.
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Hospital and Health System Reductions
House and Senate are generally consistent on the level of hospital cuts, with approximately $155 billion in Medicare
and Medicaid reductions over ten years.
House: $258 billion over ten years.
Senate: $244 billion over ten years.
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Key Hospital and Health System Provisions
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Medicare Update Factor Reductions
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DSH Reductions
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Hospital Readmissions
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Hospital Value-Based Purchasing
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Geographic Variation
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Independent Medicare Advisory Board
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340B Drug Discount Program
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Medicare Payment Bundling
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Accountable Care Organizations
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Medicaid Payment Demos
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Additional Provisions in Both House and Senate Bills
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Rural Provisions in Senate Version Only
• Rural Community Hospital Demonstration Project– Extends demonstration project for two additional years and
expands eligibility to all states
• Medicare Rural Hospital Flexibility Program– Extends the FLEX program through 2012
• Clinical Diagnostic Laboratory Services– Reinstates provision that pays rural hospitals with less than 50
beds reasonable cost for clinical diagnostic laboratory services
• Other provisions:– Extend MDH classification for two additional years– MedPAC review of Medicare payments for rural areas– Expansion of community health integration models in rural areas
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State Advocacy
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What’s the Focus for 2010…
• State of Kansas Budget
• State of Kansas Budget
• State of Kansas Budget
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Status of the Kansas State General FundFY 2009-2012
-$1,000
-$800
-$600
-$400
-$200
$0
$200
FY 2009 FY 2010 FY 2011 FY 2012
Mil
lio
ns
ARRA Funding Ends
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Governor’s Budget Adjustment for SFY 2010 Total: $258.9M SGF
1. Targeted, strategic budget reductions in individual agencies
2. Reduce highway maintenance funds by $50M3. Reduce state funding to Bioscience Authority by $5M4. Reduce K-12 funding by $36M; Board of Regents
funding by $2M5. Move unspent funds from prior years to SGF6. Reduce Medicaid reimbursement rates by 10% ($22M
savings)
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Governor’s Medicaid Cuts SFY 2010
• Across-the-board Medicaid rate decrease of 10 percent
– Rate reduction expected to be carried into SFY 2011
• Impacted Agencies:
– KHPA
– Ks Dept on Aging
– SRS
– Juvenile Justice Authority
• Each agency may have some discretion
KHPA
Targeted Rate Reduction Amount:
$40.4 M (AF)
Hospital $19 M (AF)
Physician $4.7M (AF)
Pharmacy $8.5 M (AF)
Dental $2.2 M (AF)
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KHA Advocacy Strategy
• Legislature unlikely to address SFY 2010 budget• Legislative focus will be on SFY 2011 budget• Continue discussions with KHPA, elected officials• Discuss impact and strategy with other health care
associations• Develop advocacy materials
– Model cuts for individual hospitals– Share examples of the impact on hospital operations– Economic impact of cuts
• Review all options– Revenue enhancements– Focused budget cuts
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Nursing Home Provider Tax
• Purpose is somewhat unclear...– To improve quality?– To improve payments?– To improve access?– To improve non-NH services?– Just cause…
• Variety of legislation introduced since 2003• KHPA requested workgroup to consider
– Disagreement between Nursing Home Associations• Issues to consider
– Who’s included in the tax– How is the tax calculated – How are the funds used
• KHPA Board to consider possible legislation
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Tort Reform – Awaiting the Decision
• Current law has been in place since 1980’s– Limits cap on non-economic damages at $250K
• Two court cases are challenging the “constitutionality” of the law
• Kansas Supreme Court will decide• Possible Rulings
– “Unconstitutional” – “Constitutional”– Legislative action needed
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Health Care Data Transparency
Community Benefit
Pricing
Quality
•CMS’ Price Release
•MedPAR DRG Report
•Negotiated Insurance Rates
•Individual Hospital Estimates
•American Hospital Directory
•Consumer Checkbook
•Insurance Database
•Top 25 Inpatient/Outpatient Procedures
•CMS’ Hospital Compare
•AHRQ Quality Indicators
•JCAHO’s Quality Check
•HFAP
•Leapfrog
•Health Grades
•WI CheckPoint
•Insurance Initiatives (BC/BS Distinction Hospitals)
•Healthcare Acquired Infections
•Kansas Healthcare Collaborative
•IRS 990 Form
•CHA/VHA Model
•CBISA
•Rural Health Works
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Statewide Smoking Ban
2007:Clean Indoor Air Legislation Introduced
- No hearing or action taken
2008:Clean Indoor Air Legislation Heard in Senate Committee
- KHPA announces support
-Two bills heard; but no action taken by either committee
2009:Clean Indoor Air Legislation re-Introduced
-Senate passes legislation twice
-Legislation stalls in House
2010:Focus on the House
- Will a compromise be reached?
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Questions…