1. W. Thomas Deweese, FACHE Regional Executive American Hospital Association Center for Rural Health Annual Summer Meeting August 7- 9, 2013

2. AHA Membership AHA Members 5000 Hospitals, Health Systems 43,000 Individual Members Rural Hospital AHA Members USA 980 CAHs GA34 151 RRC12 151 MDH 6 253 SCH11 109 SCH/RRC 4

4. AGENDA Washington Update Advocacy Agenda Action Items Resources

5. Washington Update House and Senate are on August Recess Return September 9, 2013 Facing them when they return:

6. Washington Update Proposed Budget – President $374 Billion reduction Medicare –$306 billion from providers –$18.9billion from Medicaid Eliminate CAH, MDH, SCH ($ -62B) Reduce CAH payments from 101% to 100% of reasonable costs ($ -1.43B) Eliminate CAH for hospitals less than 10 miles from nearest hospital ($ -69M) Cut rural health programs such as SHIP, telehealth, network grants, etc.

7. Washington Update Proposed Budget - House –Cuts $4.6 trillion from government spending (sequester was $1.2T) $2.7T from healthcare Convert Medicaid to block grants and cut $756 billion over the next 10 years Means testing for Medicare Parts B & D Deficit neutral reserve fund to address the SGR (doc fix)

8. Washington Update Proposed Budget – Senate –$1.85 Trillion in savings over 10 years Equal combination of tax revenues and spending cuts $275 billion in unspecified healthcare cuts

9. Washington Update Fiscal Cliff –January, Congress agreed to raise the nations debt ceiling until May 19 to $16.4 trillion. –Improving economy pushed back the date October or November

10. Washington Update Physician Fix –January 2014 physicians fees cut 25% –Current projection $139 billion Down from $300 billion a few years ago

11. Advocacy Agenda Washington Update Advocacy Agenda

12. DSH Reduction Act (HR 1920 & S 1012) –Amends Medicare to delay from FY2014 to FY2016 cuts to any "subsection (d) hospital": 1.25% of the amount of the DSH payment that would otherwise be made to it for the fiscal year, plus 2.any additional payment amount according to a specified formula.

13. Advocacy Agenda John Lewis, Sponsor Sanford Bishop, Jr Henry “Hank” Johnson

14. Advocacy Agenda RAC - Medicare Audit Improvement Act (HR 1250)  Medicare Recovery Auditor Contractors (RACs)  Medicare Administrative Contractors (MACs) and  Comprehensive Error Rate Testing (CERT) auditors Establish a Consolidated Limit for Medical Record Requests Improve Auditor Performance Improve Recovery Auditor Transparency Accurate Payment for Rebilled Claims Physician Review for Medicare Denials Assuring Due Process for Reopening.

15. Advocacy Agenda John Barrow Sanford Bishop, Jr. Tom Graves Austin Scott David Scott

16. Advocacy Agenda Rural Hospital Access Act (HR 1787 & S 842) –Extends Medicare dependent hospital (MDH) program –Increases payments to Medicare low-volume hospitals for one year thru Sept 30, 2014

17. Advocacy Agenda NO GA co-sponsors

18. Advocacy Agenda Protecting Access to Rural Therapy Services (S 1143) –Adopt a default standard of “general supervision” –Create an exemption process –Ensure that for CAHs, the definition of “direct supervision” is consistent with the CAH conditions of participation –Hold hospitals and CAHs harmless from civil or criminal action regarding the CMS’s retroactive reinterpretation

19. Advocacy Agenda No GA Co-sponsor

20. Advocacy Agenda TOPS - Rural Hospital Fairness Act (HR 2578) –Hold harmless transitional outpatient payments (additional payment adjustments Rural hospitals 100 or less beds Expired Mar 1 for SCH > 100 beds Expire Dec 31 rural hospital and SCH 100 beds or less

21. Advocacy Agenda NO GA Co-sponsors HR 2578

22. Advocacy Agenda The Fairness in Health Care Claims, Guidance and Investigations Act (HR 2931) –Amend the False Claims Act Require federal agencies to review –Own regulations and determine »If a billing dispute should be pursued as fraud before launching an investigation »Assure that unintentional billing disputes aren’t penalized as harshly as fraud

23. Advocacy Agenda David Scott

24. Advocacy Items Attack on 340B drug program Sen Grassley inquires WSJ July 31 article AHA Response letter Aug 6

25. Action Items Washington Update Advocacy Agenda Action Items

26. Contact your Senators and Representatives Ask them to sign on to legislation –DSH Bill HR 1920 & S 1012 –RAC Bill HR1250 –Rural Hospital Advocacy Act HR 1787 & S 842 –Therapy Caps S 1143 –Rural Hospital Fairness Act (TOPS) HR 2578 –Fairness in Health Care Claims, Guidance, and Investigations HR 2931 –340B Drug Program

27. Resources Washington Update Advocacy Agenda Action Items Resources

31. W. Thomas Deweese, FACHE Regional Executive American Hospital Association tdeweese@aha.org 800-864-4678 Center for Rural Health Annual Summer Meeting August 7- 9,2013