1. Health Care Policy: What You Should Know American Nephrology Nurses Association (ANNA) Long Island Chapter, Fall Conference November 13, 2013 Carle Place, New York

2. Objectives  Develop an understanding of health care policies that are related to Chronic Kidney Disease (CKD)  Describe health care providers roles in implementing health care policies  Develop an understanding of the current issues in government that relate to the Chronic Kidney Patient

3. Update: ANNA’s Policy Agenda and Activities

4. Washington Update  Health Reform Implementation  Budget and Appropriations Issues  Debt Limit Ceiling  CY 2014 ESRD PPS Proposed Rule

5. ANNA’s Legislative Agenda  Protect the Medicare ESRD Benefit  Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act  Support Increased funding for the Nursing Workforce Development Programs and biomedical research and Patient Safety

6. Kidney Care Partners  Kidney Care Partners (KCP) was founded in May of 2003, as a coalition of patient advocates, dialysis professionals, care providers and manufacturers dedicated to working together to improve quality of care for individuals with Chronic Kidney Disease (CKD).  The goal of KCP is ensure that CKD patients receive optimal care, that Dialysis care is readily accessible to all those in need, and to ensure research and development leads to enhanced therapies and innovative products.

7. Nursing Community  A coalition of 58 national professional nursing associations formed to build consensus and advocate on a wide spectrum of health care and nursing issues.  The Nursing Community is committed to improving the heath and health care of our nation by collaborating to support the education and practice of Registered Nurses and Advanced Practice Registered Nurses.

8. Overview: The Affordable Care Act (ACA)

9. Affordable Care Act  Affordable Care Act was passed by Congress in March 2010.  The law extends insurance coverage and provides additional protections for all consumers. - Subsidies available to help individuals afford coverage in health insurance exchanges.  Greater focus on prevention of disease.  The law has been incrementally implemented since 2010. 9

10. ACA and Role of Nursing  ACA provides additional nursing education funding  Increased need for nurses - Care coordinators - Health care delivery system changes - Primary care providers  Key to meeting the “Triple Aim”: Better health, better care, lower costs

11. Resources on ACA  Enroll America: www.enrollamerica.orgwww.enrollamerica.org  Families USA: www.familiesusa.orgwww.familiesusa.org  Kaiser Family Foundation: www.kff.org/health-reformwww.kff.org/health-reform  Centers for Medicare and Medicaid Services (CMS): http://marketplace.cms.gov http://marketplace.cms.gov 11

12. Medicare ESRD Benefit and Quality Incentive Program

13. Medicare ESRD Overview  Social Security Amendments of 1972: Extended Medicare coverage to ESRD patients.  ESRD Program Amendments of 1978: Implemented a prospective reimbursement method for dialysis.  Omnibus Budget Reconciliation Act of 1981: Established a per-treatment payment rate.

14. Medicare ESRD Overview (Continued)  Medicare Modernization Act of 2003: Augmented the composite rate payments with a drug “add-on” payment and case-mix adjustments for age, body surface area, and low body mass index.  Medicare Improvements for Patients and Providers Act of 2008: Created a “bundle” payment and created the Quality Incentive Program (QIP).  American Taxpayers Relief Act of 2012: Recalculated the bundle payment rate for 2014 to account for changes in use of drugs and biologics. It delayed the inclusion of oral drugs and requires providers to report on bone and mineral metabolism.

15. Changes to the PPS Since 2011 201120132012 Jan 2011: rollout of PPS; base rate: $229.63 Jan 2012: 1.8% market basket update; +$5.18 to base rate Apr 2011: removal of transition adjustment Jan 2013: 2.3% market basket update; +$5.55 to base rate Jan 2013: Legislatively mandated rebasing and oral drugs postponed (ATRA) Apr 2013: Implementation of sequestration (~$4 / tx) Aug 2011: Sequestration created by Budget Control Act of 2011

16. Current QIP Structure Establishing Performance Standards Calculating the Total Performance Score Weighting Measures Public Reporting 16

17. CY 2014 ESRD Proposed Rule  In July, CMS issued their proposed rule for the ESRD PPS for FY 2014.  The proposed rule calls for a nearly 12% cut to the base rate and a market basket update of 2.9%.  These proposed cuts would results in an an average reduction in reimbursement of about $30 to bundled payments (now $246).

18. CY 2014 ESRD Proposed Rule  ANNA joined with KCP in actively advocating to protect kidney patients from these cuts.  ANNA sent a comment letter to CMS emphasizing the following: - negatively impact patient care - limit the availability of services - harm pediatric and Medicaid patients - impact the availability of qualified staff - negatively impact innovation - harm small and rural providers - impede nurses’ education - impact commercial payers

19. CY 2014 ESRD Proposed Rule  ANNA commented on the proposed QIP measures, warning of the burden of additional reporting requirements when considered cumulatively with the proposed PPS cuts.  The final rule was expected to be released on November 1 st but was delayed because of the government shutdown.

20. Comprehensive ESRD Care Model  New Medicare model of care for beneficiaries with ESRD known as ESCOs to test whether a more coordinated system would improve the quality of care of ESRD beneficiaries.  The specific measures have not been defined yet but CMS will measure ESCOs based on several quality measures.  Nephrology nurses who are part of a group practice participating in the ESCOs will be critical in ensuring “seamless” care for patients.  Applications closed out in May 2013. We anticipate an update in the near future.

21. Contact Information Jim Twaddell Government Relations Director Drinker Biddle & Reath Jim.twaddell@dbr.com (202) 230-5130 www.drinkerbiddle.com www.capitolhealthrecord.com 21