federal and state advocacy: how are they different? what are the big issues? cassie sauer, senior...
TRANSCRIPT
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Federal and State Advocacy: How are They Different? What are the Big Issues?
Cassie Sauer, Senior VP, Advocacy and Government AffairsChelene Whiteaker, Policy Director, Member Advocacy
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• Increase your understanding of issues on the advocacy agenda at the state and federal level
• Get you more engaged in advocacy at the federal level, especially with our Senators
• Answer any questions you may have about our work
Goals
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Washington State vs. Washington D.C.
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Advocacy in Washington, D.C.
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• Further away, less time in district – but more recesses
• Full-time job• Slower process with unclear beginnings,
middles, and ends• Larger geographic area to serve• Sometimes more issue specialization• Every vote counts
Washington D.C.
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Important Partnerships
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“A House Divided”
1982
1997
2012
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U.S. Senators
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U.S. Representatives: Democrats
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U.S. Representatives: Republicans
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• Problem: CMS decided only hospital stays that span over two midnights will be considered inpatient stays
• Legislation: Delays enforcement of “Two-Midnight” policy Tasks CMS with new payment policy
• Co-sponsors: Representatives DelBene, Larsen, Kilmer, McMorris Rodgers, Reichert
• Neither Senator has co-sponsored the bill
Two Midnight Rule: S. 2082 and H.R. 3698
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• Problem: As part of the CMS conditions of payment, physicians at CAHs must certify that a Medicare beneficiary is reasonably expected to be at the hospital less than 96 hours. Patients would have to be transferred if they require more than 96 hours of care.
• Legislation: Repeals the 96-hour rule for payment purposes
• Cosponsors: Representatives McMorris Rodgers, Hastings, and Kilmer
• Neither Senator has co-sponsored the bill
96-Hour Rule: S. 2037 and H.R. 3991
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Physician Supervision: S. 1143 H.R. 2801• Problem: CMS changed the physician supervision
requirement for therapeutic outpatient services to “direct” instead of “general”
• Legislation: Adopts a “general” supervision requirement for therapeutic outpatient services
• Cosponsors: Representatives McMorris Rodgers, Heck
• Neither Senator has co-sponsored the bill• Senate passed a delay for one year
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• Program provides steep discounts to safety-net providers, including CAHs
• Problem: The pharmaceutical industry would like to see it scaled back
• A few hospitals may be abusing the program, making it vulnerable
• WSHA recently met with key Republicans about its importance
340B Drug Discount Program
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Reducing Cost, Improving Quality: Early Elective Deliveries
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Reducing Cost, Improving Quality: Central Line Bloodstream Infections
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Reducing Cost, Improving Quality: Pressure Ulcers
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Federal Advocacy Resources: WSHA Website
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• Respond to requests for action• Consider a trip with us to D.C.• Let us know your interest in an in-district
meeting with your colleagues• Host a Congressional staff member• Deliver a PAC check
How You Can Get Involved
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Montana Demonstration: Frontier Community Health Integration Demonstration Project
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A new provider type and a new COP under which all services would be integrated
A single payment system Incentives to improve the quality of care such as pay-for-
performance and shared savings Increased use of telehealth and electronic medical records Increased emphasis on care transitions and care coordination Additional beds for long-term care services by raising the CAH
bed limit from 25 to 35 Incentives to increase community-based care by utilizing
visiting nurses and strengthening home health services
Montana Demonstration: What the Association Wanted
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Cost-based payment of the originating CAH’s facility fee for telemedicine services
Medicare reimbursement to a CAH originating site and a distant site provider tor telehealth services furnished using asynchronous “store and forward” technology
Waiving the 35-mile rule for cost-base reimbursement of ambulance services furnished by a CAH
An increase in the bed limit for CAHs from 25 to 35 for SNF or NF-level services
Enhanced payment rates for home health providers to account for the costs of traveling extended distances to provide services
Montana Demonstration: What the Association Got
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13 applicants in four states Washington not eligible Not as far as advocates hoped, but an
interesting start Took a lot of Congressional pressure
Montana Demonstration: Status
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• Associations would need to bring member task force together
• Use our legislative leadership to shepherd it through
• Requires legislation and funding
• Might happen, might not
• Interest?
How Could We Move a Washington/Oregon Demonstration?
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Advocacy in Olympia
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• Closer, lots of time in district• Sometimes have another job• Speedy process with clear deadlines and
adjournment dates• Smaller geographic area to serve• Tend to want to know about more issues• Every vote counts
Olympia
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• Long session• New leadership (4/5 of key players) has
more experience• Majority Coalition – interesting political
dynamics• Who wins the Senate?
Coming State Legislative Session
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• Budget-writing session – House and Senate will likely differ on willingness to spend
• Revenue forecast likely better, but not great• Supreme Court mandates:– more education funding – threatening ruling
recently– more mental health funding?
• Smoke pot!
State Budget Overview
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• Telemedicine
• Mental health investments and system improvements
• Increasing transparency
• Inmates and suspects
• Crisis standards of care
What We’ll Work On - Proactive
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• Nurse staffing bills
• Clinic fees
• Partnerships and affiliations (particularly PHDs)
What We’ll Work On - Defensive
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• Lawsuit over new Certificate of Need rule• Judge ruled in favor of WSHA• Revert to current Certificate of Need rule• Unclear if the case will be appealed• Do we want to reform CON?
WSHA v. DOH
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• Respond to requests for action• Come to Olympia to testify or meet with your
legislators• Schedule an in-district meeting by yourself or
with your colleagues• Don’t forget to highlight care improvements
here too!• Deliver a PAC check
How You Can Get Involved
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It is an honor to represent you.
Thank you for all your help in making our advocacy program successful!
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Cassie SauerSenior Vice President, Advocacy & Government Affairs
[email protected] 206/216-2538
Chelene WhiteakerDirector, Member Policy
[email protected] 206/216-2545