State Network Council Meting Salina, KS August 29, 2011 View from Washington

Paul Muraca Regional Executive Phone: Who am I?

1.Funding the government in FY 2011 Continuing Resolutions on Appropriations Vehicle for reducing discretionary spending 2.Debt limit extensions Vehicle for longer term deficit reduction 3.Expiring provisions – H.R of 2010 Taxes Unemployment compensation benefits Medicare physician payment cuts “Must Do” Measures

Where We Are Stage 1 Immediate budget reductions of $917 billion...extends debt limit by $900 billion to February/March –No cuts in Medicare, Medicaid and Social Security (except fraud and abuse initiative) –No new revenues

Stage 2 ThanksgivingSpecial bipartisan congressional committee to make additional $1.5 trillion in deficit reduction recommendations by Thanksgiving –Guaranteed up-or-down vote (and no filibuster) on recommendations if majority of panel support them by Christmas –Enforcement process…debt limit extended by another $1.5 trillion thru 2012 IF:  Recommendations of special committee adopted with resolution of disapproval; OR  Congress passes a Balanced Budget Amendment; OR  Automatic across-the-board cuts…sequester o f $1.2 billion evenly divided between defense and domestic programs: o No revenue o Medicaid exempt o Medicare and Social Security “benefits” exempt o Special rules for Medicare providers and insurers (2 percent or $137 billion over 9 years starting in 2013…$45 billion from hospitals) Where We Are

Special Committee Options Medicaid…total of $100 billion Provider taxes (assessments) Blending rates (FMAP) Medicare…total of $250 billion IME ($14 billion) Bad debt ($14-26 billion) Rural adjustment cuts ($14-16 billion)Rural adjustment cuts ($14-16 billion) Post acute care services ($50 billion) Medicare IPPS coding adjustments ($4 billion) Expansion of IPAB

Increase retirement age ($125 billion) Means-testing ($38 billion) Reform and increase copays for Part A & B ($110 billion) Medigap restrictions ($53 billion) Home health copays ($40 billion) SNF copayments ($50 billion) Special Committee Options

Advocacy Agenda Rural Hospital Leadership Coalition and Caucus Reorganizing − House: Mike Thompson, D-CA and Cathy McMorris Rogers, R-WA − Senate: Tom Harkin, IA and Pat Roberts KS Legislative Priorities Medicare extenders Independent Payment Advisory Board Provider taxes as allowable costs Physician Supervision of Outpatient Services 101% to CAH for Medicare Advantage CAH Flexibility Act pending, need CBO Score CRNA pass through and standby for CAHs

Questions or Comments? Paul Muraca AHA Regional Executive