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State and Federal Health Care Legislation Lawrence Massa Minnesota Hospital Association May 17, 2012.

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Presentation on theme: "State and Federal Health Care Legislation Lawrence Massa Minnesota Hospital Association May 17, 2012."— Presentation transcript:

1 State and Federal Health Care Legislation Lawrence Massa Minnesota Hospital Association May 17, 2012

2 The good news continues ….

3 Well … not so fast …

4 Place picture here State Health Care Legislation

5 State Issues: Community benefit  Passed repeal legislation keeping hospitals’ community benefit activities locally determined. Unanimous support in House and Senate Repeal of new rider language from 2011 Funding language for Statewide Health Improvement Project (SHIP) remains

6 State Issues: Provider Peer Grouping  Passed a Provider Peer Grouping “fix-up” language in same bill as community benefit. Allows providers to verify their data Requires better risk adjustment for high cost services like trauma, medical education and neo-natal ICU Creates a stakeholder/expert advisory committee Expands scope of appeals (peer group, calculations, methodology and data) Requires use of most current data available Eliminates requirement that health plans use PPG in product design

7 State Issues: HHS Omnibus Bill  Allow Medicaid coverage for inpatient mental health services delivered by a physician assistant acting under psychiatrist’s supervision  Further restriction on release of medical records Expands liability for unauthorized, intentional access via record locator service Requires study by Department of Health to examine capability of detecting unauthorized attempts to view a patient’s medical records  Establishes a 10-day window for DHS prior authorization for PT/OT, speech, audiology and mental health services, otherwise authorized

8 State Issues: HHS Omnibus Bill  Restores Emergency Medical Assistance coverage for dialysis and cancer treatments  Repeals Minn. Rule that required physician authentication (signature) of verbal/emergency orders within 24 hours

9 State Issues: Radiation Therapy  The current moratorium in 14 counties stays in place until 2014  After 2014, can’t build a new radiation facility within 7 miles from a current facility  Maintained the requirement that any new radiation facility must be built in collaboration with a hospital

10 State Issues: Miscellaneous  Enacted a new felony-level offense for intentional deprivation of a vulnerable adult. Provides affirmative defenses for caregivers acting in good faith  Amended MN’s No-Fault Auto Insurance statute. Restricts the use of “runners and cappers” which can generate inappropriate health care services. $20,000 in medical coverage remains in place.  Newborn screening bill responds to court ruling Opt-out for testing Opt-in for allowing MDH to store sample for 18 years

11 Other policy issues raised but not enacted  Interstate Nurse Licensure Compact  Partial restoration of Medical Education Research Costs (MERC)  Health Insurance Exchange  1-year restoration of 5% cut to outpatient provider rates  Leapfrog mandate

12 Other policy issues raised but not enacted  Mandatory nurse-to-patient staffing ratios Bills introduced (SF 2182; HF 2618) MHA successful at keeping bills from getting hearings in either House or Senate Major, contentious issue for 2012 elections and 2013 session o MN hospitals already provide safest, highest quality care in the country o Mandated ratios not shown to improve care safety or quality o Hospitals need flexibility to staff for patient acuity and caregivers’ experience/skill level o Mandated ratios increase the cost of care significantly

13 Place picture here Attorney General Agreement

14 Current Requirements: Based on 2005 agreement &2007 extension  Cap on charges to uninsured Uninsured pay amount equal to what hospital’s “Most Favored Insurer” pays  Adopt charity care and debt collection policies  Limit debt collection litigation (and litigation-like) Limit on garnishment, contingency fees, credit bureau reports Requires senior corporate officer review at each step of litigation process

15 Modifications in new extension  5-year extension  Modify Attorney General contact information on hospital collection notices so patients contact hospital first, then AG if issue is unresolved  Clarify that hospitals may respond to patient inquiries verbally, not just in writing

16 Place picture here Federal Issues

17 Federal budget not getting any prettier  Rep. Paul Ryan budget proposal Shift Medicare to voucher program Shift Medicaid to block grant  Debt ceiling deal from 2011 called for 2% across-the-board cuts Goes into effect Jan. 1, 2013 Includes Medicare and critical access hospitals Will not apply to Medicaid  President Obama proposed additional hospital and provider cuts

18 Critical Access Hospitals no longer “under the radar”  President proposed cutting payments 1%  President proposed eliminating CAH status for hospitals within ten miles of another hospital Others proposed 20 miles  Independent Payment Advisory Board pending 15 members appointed by the President Required to cut $13 billion in six years from CAHs, physicians or other non-hospital providers (while physician sustainable growth rate cuts remain unresolved)

19 Health Reform: Trends and Speculations

20 ACA in Limbo

21 Meanwhile...  States are spending hundreds of millions of dollars in federal grant funds to construct health insurance exchanges  Insurance plans extended coverage to dependent children up to age 26  Minnesota expanded Medicaid to cover childless adults up to 75% of FPL All dependent on legality of ACA

22 Health care reform initiatives in Minnesota  Gov. Dayton began early Medicaid enrollment 100,000+ people eligible for Medicaid coverage Decrease uninsured population by 28,000; decrease underinsured population by 75,000 Medicaid is more meaningful coverage with statewide access to providers  Gov. Dayton building health insurance exchange Using more than $36 million in federal grants Controversy with GOP legislators over authority to spend federal grants without enabling legislation State must make substantial progress on Exchange by 2013 or federal government will run MN’s Exchange

23 Health Care Home: Minnesota’s medical home model  Requires certification by the state  Multiple payers participating Medicaid State employees Medicare Commercial  Care coordination fee varies based on number of chronic/complex conditions from $10/month for 2 conditions to $60 (Medicaid) or $45/month (Medicare) for 10 conditions

24 Health Care Home: Minnesota’s medical home model  150 clinics certified in MN so far Provide care for 438,000 non-Medicare patients, although many, many fewer have enrolled to receive health care home services Total Medicaid care coordination fee payments to providers are much smaller than predicted because of lower-than expected enrollment

25 Bundled payments  Lump payment for services patient receives from multiple providers for same episode or condition  Flexibility in program Benefits providers assembling bundles Makes it more difficult to for other providers to discern what works, best practices, etc.  Integrated or collaborative providers have better opportunity to succeed

26 Bundled Payments  MHA members applying for CMS’ Bundled Payment program MHA-led consortium of 8 hospitals CentraCareFairview SouthdaleFairview Ridges Fairview UMMCNorth MemorialRegions Park NicolletSt. Luke’s Other MHA members submitting applications Essentia HealthEast Mayo

27 Accountable Care Organizations  Group of providers that agree to care for an entire population of patients & achieve quality and cost thresholds  Medicare proposed Shared Savings Program Min. 5,000 Medicare beneficiaries 33 quality measures required to be reported 2-4% savings threshold before eligible for shared savings bonus Withhold of 25% of any savings bonus soon Accountable Care Organizations

28 MHA seeking rural ACO models from CMS Center for Innovation  Micro-ACOs Specify smaller region, subpopulation of patients (e.g., dual eligibles), and less financial risk Focus on total cost of care coordination, not necessarily total cost of care delivery  Uncoupled-ACOs Non-hospital-provider ACO within community/region Allow CAH to retain cost-based reimbursement Create financial rewards for ACO/community providers based on total cost (including hospitalization) and quality

29  Three Minnesota health systems certified as Pioneer ACOs by CMS Allina Hospitals & Clinics Fairview Health Services Park Nicollet Health Services (also participated in Physician Group Practice demonstration) Accountable Care Organizations

30 Accountable Care Organizations Medicaid  Demonstration projects on the horizon State issued Request for Proposals (RFP), which gave hospitals more flexibility Contract negotiations on-going Nine applicants CentraCare Children’s HospitalsEssentia Fairview FQHCs in Twin CitiesMayo Clinic North Memorial Park NicolletAllina  Hennepin County has similar, ambitious project Includes corrections, social services, courts, etc. as well as health care in total cost of care calculation

31 Examples of ACO considerations for potential partnerships  Potential provider/partner must Meet defined performance measures on quality, experience and cost Have capability to use ACO network’s resources and optimize transitions of care Share clinical and financial data with ACO Commit to use ACO’s analytics, metrics Participate in case review and performance improvement discussions Use or refer to other ACO network providers Help reduce ACO network’s readmissions

32 Health systems are responding to demand for more integrated care delivery and financing

33 Questions & Discussion


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