www.nebraskahospitals.org 2015 legislative update aaham april 24, 2015 bruce rieker, j.d. vice...
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www.nebraskahospitals.org
2015 Legislative Update
AAHAMApril 24, 2015
Bruce Rieker, J.D. Vice President, Advocacy
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HHS Committee Kathy Campbell, Chair – Lincoln Sara Howard, Vice Chair – Omaha Roy Baker – Lincoln Tanya Cook – Omaha Sue Crawford – Bellevue Mark Kolterman – Seward Merv Riepe – Ralston
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Appropriations Committee Heath Mello, Chair – Omaha Bob Hilkemann, Vice Chair – Omaha Kate Bolz – Lincoln Ken Haar – Malcom Bill Kintner – Papillion John Kuehn – Heartwell Jeremy Nordquist – Omaha John Stinner – Gering Dan Watermeier – Syracuse
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2015 Legislative Session 90 days
Tuesday is Day 70 Adjourns June 5 663 bills Biennial budget Transformation of health care
Health and Human Services Executive leadership Functionality Medicaid Redesign
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Principles of Transformation
Ensure all have access to coverage Optimize public and private funding Support effective models of delivery, financing
and payments Reduce per-patient cost through transparent
pricing and payment linked to outcomes
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Principles of Transformation
Transparency of quality and safety Ensure consumer choice Transition assessment of quality to outcomes-
based measures Statewide database for collection and analysis
of health and delivery data, including all payers and patient outcomes
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Principles of Transformation
Utilize interventions to influence outcomes of populations
Emphasize public health and prevention Reduce burden of chronic disease Promote personal responsibility Improve health literacy Incent personal health improvement
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Principles of Transformation
Attract workers to underserved areas Create new categories of health care teams Enhance telemedicine and internet-capable
care Establish profile of care, quality goals and
reduce disparities
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Biennial Budget Governor’s recommendations
$63.1 million for Medicaid related to participation in federal Medicaid program
$350,000/year for a seventh FQHC $500,000/year reduction for NEHII $360,000/year reduction for Medical Student
Assistance Program
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Governor’s Recommendations
$1,484,435 state/$4,453,304 federal in second year for Medicaid eligibility system
$1,296,515 state/$3,889,543 federal for Medicaid provider screening and enrollment
$171,370 state/$511,880 federal for real-time connectivity for Medicaid eligibility and claim status
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Governor’s Recommendations
Twenty-Four Hour Care Facilities $1,130,497 state/$328,043 federal for inflationary
increases for food, prescription drugs, medical supplies and medical services
$849,592 state/$96,451 federal for rent, maintenance and depreciation
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Governor’s Recommendations
Veterans’ Homes $1,361,800 to convert twelve assisted living beds
at the Western Nebraska Veterans’ Home to skilled nursing beds
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Governor’s Recommendations
Norfolk Sex Offender Treatment Facility $800,000 General Funds and $800,000 Personal
Services Limitation funds over two years for sex offender treatment program for additional staffing and operating costs associated with increased census
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Governor’s Recommendations
Provider Rates 2% annual increase
$20,113,655 state/$21,552,740 federal in year one, and $40,435,528 state/$43,730,591 federal in year two
Programs include Medicaid, Children’s Health Insurance Program, Public Assistance, Child Welfare Aid, Behavioral Health Aid, Developmental Disabilities Aid and Aging
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Governor’s Recommendations
Federal Medical Assistance Percentage (FMAP) 53.27% to 51.16% reduction Oct. 1, 2015 Enhanced FMAP available for Children’s Health
Insurance Program (CHIP), including 23% expanded FMAP from ACA for federal fiscal years 2016 through 2019 Increases from 67.29% to 88.81% effective Oct. 1
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Governor’s Recommendations
Medicaid $167,391,234 over two years for growth in utilization, a
2% increase for provider rates and a reduced FMAP Increase of $6,509,050 over two years for prescription
drugs, including new drugs for Hepatitis C $17,832,696 over two years for payment of minimum
wage, overtime and travel costs for workers providing home-based care
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Governor’s Recommendations
Children’s Health Insurance Program (CHIP) $15,157,370 and $21,035,087 reductions for years
one and two, respectively, for CHIP Reduced GFs of $15,786,958 in year one and
$21,897,034 in year two from adding 23% enhanced FMAP as provided by ACA
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Governor’s Recommendations
LB 593 - $250,000 to UNMC Study current data systems Make recommendations to increase efficiency and
effectiveness of public’s health care dollars NHA alternative to LB 593
Independent, third-party analysis Utilize RFP process for consultant selection
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Bills of Interest Data Analytics Study
$250,000 for independent study of current health data systems in Nebraska
Facilitate transformation of health care through [open] access to actionable data analysis Profiles patient populations Maps utilization and spending patterns Measures performance
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Bills of Interest Data Analytics Study
Review current: Agency collection of health care information Health reporting systems Programming capabilities Data warehouse usage
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Bills of Interest Data Analytics Recommendations
Access to timely data and transparent data Medicaid eligibility and claims data Linking existing data sources Reporting system participants Data portals allowing actionable data analysis Privacy protections and quality assurance
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Behavioral Health Statewide Needs Assessment
Behavioral health conditions require comprehensive array of physical, behavioral and other support services
88 counties are federal- and state-designated shortage areas for psychiatric and mental health services
Nebraska would benefit from comprehensive delivery through integration of behavioral and physical care
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Behavioral Health Statewide Needs Assessment
Examination of data for population health Infrastructure, reporting standards and data access Provider rates, integration and coordination of
behavioral and primary care services, and risk-based and no-risk models
Provider shortages and workforce needs Institutional placement and community alternatives Ratio of qualified facilities to state population
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Medicaid Redesign Components
Medicaid Redesign Task Force Demonstration pilot project Personal financial contribution Value-based payments for PCMHs Circuit breaker if federal funding falls below 90% Health Care Access and Support Fund
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Redesign Task Force Comprehensive review
Cost savings and improved quality Real-time, evidence-based approaches Quality measurement to drive innovation Interventions for super-utilizers and those with
exceptional medical conditions Effectiveness of managed care
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Redesign Coverage 100%-133% FPL in premium assistance 50%-99% FPL in existing program Medically frail, super-utilizers and individuals
with exceptional health needs in health homes No co-pays, except for inappropriate use of ER
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Redesign and Responsibility
100%-133% of FPL contribute up to 2% of monthly income, except: First year, and Second year upon completion of program of
required prevent care services and wellness activities during initial year
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Redesign and PCMHs Waiver will be demonstration pilot project
Patient-centered medical homes Health homes for super-utilizers Value-based payments
Per-member, per-month basis Payment incentives for participation Attainment of specific outcomes that promote wellness,
prevention, chronic-disease management, immunizations, care management and EHR use
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Redesign Circuit breaker
If federal funding falls below 90%, coverage for individuals shall terminate
Health Care Access and Support Fund Created to support Medicaid program
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Bills of Interest Medicaid Management Information System (MMIS)
Claims processing system should maximize information retrieval for monitoring and analysis Benefit coordination, management and utilization analysis
Modernization will reduce waste and inefficiencies DHHS in planning phase of replacement NHA supports continued funding
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Bills of Interest LB 98 - $7 million/year for smoking cessation
Status: In Appropriations Committee LB 196 - Change Rural Health Systems and
Professional Incentive Act to establish loan repayment program that will incent residents to practice in designated shortage area - $40,000/year, not exceed $120,000 Status: On General File and a Speaker Priority Bill
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Bills of Interest In Appropriations Committee
LB 110 - $500,000/year for pediatric cancer specialists LB 233 - $100,000/year for UNMC for Perinatal Quality
Improvement Collaborative LB 417 - $1,800,000/year for pediatric cancer research LB 436 - $425,000 to UNMC to establish pilot program
and expand pediatric dental residents from 8 to 10 LB 418 - $2,000,000/year in HCCF for bio-research
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Bills of Interest LB 21 - Rate increases for BH providers
Status: General File LB 37 - Adopt Prescription Drug Safety Act
Status: Signed into law LB 46 - Change Statewide Trauma System Act
Status: Signed into law LB 125 - Funds for FQHCs and HHs for underserved –
25% of tobacco settlement funds Status: In Appropriations Committee
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Bills of Interest LB 148 - Medicaid for youth formerly in foster care
Status: In HHS Committee LB 471 - PDMP to prohibit patients from opting out;
require all prescriptions entered; allow all prescribers or dispensers free access; and include all payers Status: In HHS Committee
LB 625 - Interstate Placement for Involuntarily Admitted Patients Status: In Judiciary Committee
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Bills of Interest LB 107 - Eliminate Integrated Practice Agreements
and create Transition to Practice Agreements for NPs Status: Signed into law
LB 108 - $250,000 /year for 12 one-year BH master's level internships in rural and underserved areas Status: In Appropriations Committee
LB 258 - Adopt Interstate Medical Licensure Compact Status: In HHS Committee
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Bills of Interest LB 264 - Issuance of credentials under UCA based on
military education, training or experience Status: General File
LB 353 - Credentialing for nursing home administrators Status: In HHS Committee
LB 543 - Certification of community paramedics Status: In HHS Committee
LB 548 - Adopt Surgical Assistant Practice Act Status: In HHS Committee
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Bills of Interest LB 257 - Insurers must provide descriptions for telehealth
Status: General File LB 315 - Medicaid recovery audit contractors
Status: General File and Speaker Priority Bill LB 332 - $600,000 for prescription drug disposal
Status: In Appropriations Committee LB 333 - Create Program of Health Care Transformation
administered by Division of Public Health Status: In HHS Committee
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Bills of Interest LB 511 - Return-to-learn protocols for pediatric
cancer survivors Status: General File
LB 549 - Adopt Health Care Transformation Act Status: In HHS Committee
LB 573 - Create health enterprise zones to reduce disparities, costs, admissions and readmissions Status: In Revenue Committee
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Bills of Interest LB 584 - $16.2 million for dental clinic and oral
health training facility Status: In Appropriations Committee
LB 652 - Establishes 911 Emergency Services Communications Act to ensure all have comparable accessibility Status: In Transportation and Telecommunications
Committee