Health Care Grassroots Webinar, September 22

Happy Anniversary!

• 6 month anniversary of health care reform.

• Several benefits kick in tomorrow

• Invitation to join in WH

call with Wakefield, Vilsack

conference call.

The positives of health reform

• Insurance reforms. Sept. 23rd key date.– High risk pools; $5 billion funded – Children with pre-existing conditions – Caps on coverage eliminated

• Preventive care benefits • Covering children up to age 26

May be nothing to smile about.

• Few candidates are running on health reform platform. Most are running away from it.

• Polls still consistently show low approval for health care reform.

• Federal and personal health care spending still on rise.

– Out of pocket increases expected, at least temporarily.

– Federal spending expected to rise as 32 million slowly become insured.

• Much Confusion around law, much misinformation

Rural Agenda: the fight continues…

• Yesterday’s Fight: Rural victories in health care reform.

• Today’s Fight: Making sure programs are properly funded and regulations work for rural providers and patients.

• Tomorrow’s Fight: What legislation was left out? What will happen in a new Congress?

Three reforms were crucial:

–The workforce shortage crisis must be abated;

–Equity in reimbursement must occur;

–Disparities must be eliminated.

What’s the latest?

• Commissions/Studies

• Legislation

• Regulations

Commissions/Studies

• IOM Study on Geographical Variations– Met last week.– Will prepare two reports for Congress over 24 months

(Spring 2011, Spring 2012)– Stakeholder input encouraged

• MedPAC Study on Adequacy of Medicare Payments for providers in rural areas. (Met with Dr. Tom Dean last week.)– Study will include:

• Analysis of Payment adjustments

• Impact on Access to Care

• Report to congress on Jan 1, 2011 and report on appropriate modifications needed in rural areas.

HPSA/MUA negotiated rule making

• Meeting for first time today.

• Alan Morgan, CEO of NRHA is in attendance.

• Timeline: 6 months (meet 3 consecutive days each month.)

Medicare Advantage

• Despite looming cuts - - New report citing premiums are actually going down due to new regulations

• $136 billion in savings projected over 10 years.

Legislation

110th and 111th

The daunting doc problem

• Sustainable Growth Rate Fix legislation will occur likely in November

• Temporary fix averts crisis until December. 23% cut looms. 30% cut in January, 2011 projected.

– 10 times in past 7 years, physicians have faced Medicare payment cuts that were avoided only after Congress intervened.

– Each temporary congressional fix, merely put off cuts to some date in the future.– Long term fix - - replacing the formula - - $210 billion.

• This will be the one moving health vehicle in the lame duck session.

340B and orphan drug problem

• Senator Franken (D-MN) interested in legislation

• Looking for a Republican lead

• Important to get bill introduced in 110th Congress

• Urgency/FDA concern

Necessary Provider

• S. 1171 – new discussions with Senator Pryor’s (D-AK) office

• Senator Bayh (D-IN) interested in getting this done before he resigns.

• Attempts to fine-tune language to get a reasonable CBO score.

Inpatient Rule/Provider Tax Concerns

• Rep. Ron Kind (D-WI) to introduce legislation to address provider tax concerns.

• Kind legislation - intention that cost reports couldn’t be reopened retroactively and the rule would be nullified going forward. 

• Look for alerts – need cosponsors asap!

Senate Briefing Today

• Health Reform and Regulatory Implementation of health reform

• Meaningful Use

• Goal is to establish foundation for future legislation.

New Congress Legislation to eliminate:

• Mandate

• IPAB

• General “Whittling”

• Appropriations

What if I don’t like it?1) Repeal

– Legislation already filed.– Not votes to pass - - and even if it did - - likely not

2/3 votes to override presidential veto.

2) Opt Out – Oklahoma opt out ballot measure.– Preemption Clause of the Constitution prohibits a

state from opting out of a constitutional law.

3) Declared unconstitutional by Supreme Court

Constitutional Challenges by various states

• State attorneys general filed suit against federal government.

• Claims health care overhaul is unconstitutional because federal government does not have constitutional authority to mandate coverage

• Additionally claims it mandates unfunded requirements on states.

A Constitutional Battle• 10th Amendment – “powers not delegated to the

United States by the Constitution…are reserved to the states respectively, or to the people.”

• Article 1 – Commerce Clause, grants authority to regulates interstate commerce has been enshrined in court decisions since Justice Marshall. New Deal tested Commerce Clause. Broadly interpreted.

• Likely to be decided by

Supreme Court.

Will health reform be a factor in November?

• House 253-178• Senate 59-41

Stay Invovled!Our fight Continues

• Implementation in Critical!– Appointments for Workforce Advisory Committee– Appointments for IPAB– Grant opportunities

• Appropriations process is critical!• We must fight for what’s left out!• New legislation is coming!

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And, don’t forget the regulations

- “Secretary Shall…”- “Secretary Shall…”- “Secretary Shall…”- “Secretary Shall…”- “Secretary Shall…”- “Secretary Shall…”- “Secretary Shall…”- “Secretary Shall…”- “Secretary Shall…”- “Secretary Shall…”- “Secretary Shall…”- “Secretary Shall…”- “Secretary Shall…”- “Secretary Shall…”- “Secretary Shall…”- “Secretary Shall…”- “Secretary Shall…”- “Secretary Shall…”

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- “Secretary Shall…”- “Secretary Shall…”- “Secretary Shall…”- “Secretary Shall…”- “Secretary Shall…”- “Secretary Shall…”- “Secretary Shall…”- “Secretary Shall…”- “Secretary Shall…”- “Secretary Shall…”- “Secretary Shall…”- “Secretary Shall…”- “Secretary Shall…”- “Secretary Shall…”- “Secretary Shall…”- “Secretary Shall…”- “Secretary Shall…”- “Secretary Shall…”- “Secretary Shall…”

• CMS Inpatient Prospective Payment System (IPPS) proposed rule for Acute and LTC Hospitals (Provider tax)

• Supplemental rule based on ACA requirements (ACA payment bonuses)

• Telemedicine Credentialing changes for CAHs • FCC Broadband Rule• Medicare Physician Fee Schedule • Outpatient Prospective Payment System• Many, many, many more to come

Regulations

Outpatient Proposed Rule

• Direct Supervision– comments filed, on our website.– “Direct supervision” at initiation of service”;

then “general supervision for duration of service.

• Also contains GME/IME provisions in ACA• Final Rule expected in October/November

FTC Broadband RuleRural Broadband Support Programs• Infrastructure

– 85% match concern– Administrative burden

• Broadband Services– Replaces current program and sets up broadband

speed 4 mbps– Rural providers need sliding scale of support

• Proposed tie-in to “meaningful use”– Strongly opposed by NRHA

Meaningful Use changes in Final Rule

• Flexibility for Eligible Professionals (EP) and hospitals for demonstrating MU—NPRM was all or nothing

• Divides objectives into “core group” of required objectives and a “menu set” of procedures from which providers can choose any 5 to defer to 2011-12

• Hospital-based EP Definition • CAH’s defined as acute care hospitals for

purpose of incentive program under Medicaid