AWPHD Retreat for Chief Executive Officers and Administrators Only

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AWPHD Retreat for Chief Executive Officers and
Administrators Only
Legal Update
The Lodge at Suncadia May 20-21, 2009
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Additional State Legislation

• Special election date changes (ESHB 1018)
• Changes February date from first Tuesday to
  second Tuesday
• Eliminates election date in March
• Permits use of May date until July 1, 2011 solely
  for levies that failed previously in the same
  calendar year and new bond issues and eliminates
  May election after that date
• Reduces deadline for submission of ballot
  proposition resolution for spring elections from
  52 days to 45 days

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Additional State Legislation (cont.)

• Changes to procedures for unannounced inspections
  of hospitals by the Department of Health (2SHB
  1201)
• DOH cannot issue its final report for an
  unannounced inspection until
• Hospital is given at least two weeks to provide
  any information or documentation requested by DOH
  that was not available at the time of the request
• At least one DOH inspector meets personally with
  CEO or CEO declines meeting

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Additional State Legislation (cont.)

• New reporting requirements (SSB 5056)
• Hospitals must report treatment for bullet,
  gunshot or stab wounds provided to patients who
  are unconscious and requires that evidence be
  preserved
• Imposes similar (although somewhat broader)
  reporting requirements on physicians, EMTs and
  paramedics who provide treatment outside of a
  hospital

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Additional State Legislation (cont.)

• Changes to procedures for filing claims against
  PHDs (ESHB 1553)
• Claims for health care injuries are exempted from
  the claims filing procedures
• Claims must be presented on a special form
  maintained by OFM or special form developed by
  PHD, which must be made available by PHD

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New EMTALA On-Call Options

• Effective October 1, 2008, the EMTALA rules were
  revised to authorize community on-call plans
  that include the following elements set forth in
  a signed agreement
• Delineation of each hospitals responsibility
• Description of geographic area covered
• Inclusion in EMS system protocols
• Confirmation of continuing EMTALA obligations
• Annual review

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New CAH Payments for Lab Tests

• MIPPA of 2008 mandated that effective July 1,
  2009, lab tests furnished by CAH be paid on cost
  basis regardless of whether patient is physically
  present at CAH at the time specimen is collected
• Proposed rules require that lab test be provided
  to individual who is an outpatient of CAH
  (registered at the hospital receives services
  directly from the CAH on same day specimen is
  collected or specimen is collected by employee
  of CAH)

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Capital Markets-Crisis

• Hospitals may have been among the most severely
  affected by dislocations in tax-exempt markets
• Providers have been forced to reassess their
  capital needs and sources of capital
• Credit will be harder to access, cost more and
  carry with it more restrictive terms
• Long-term planning for credit worthiness and
  financial viability are critical

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Capital Markets-Municipal Yields To Treasuries
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Capital Markets-Historical SIFMA Index
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Capital Markets-Looking Ahead

• Fewer players in the municipal market
  underwriters, bond insurers, letter of credit
  banks, etc.
• Emphasis on borrowers credit
• No Bond Insurers
• Limited Letter of Credit availability
• Continued volatility, challenging market
  conditions

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Capital Markets-New Opportunities

• Annual tax-exempt debt limitation for Bank
  Qualification under Section 265(b)(3) is
  increased to 30,000,000 for bond issued in 2009
  and 2010
• Build America Bonds (BABs) for bonds issued in
  2009 and 2010
• FHA Section 242 Insured Mortgage Program for
  Hospital Financings

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Capital Markets-Continuing Disclosure News

• Amendments to SECs Rule 15c2-12 will be
  effective July 1
• All continuing disclosure filings under new
  Continuing Disclosure Undertakings will be made
  to the MSRBs new EMMA system
• SECs No Action letters to existing NRMSIRs will
  be withdrawn effective July 1 and sole NRMSIR
  will be the MSRB via its EMMA system

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Other Topics

• Performance audit update
• Application of IRS Form 990 reporting
  requirements to PHDs
• Audit activities and update requirements relating
  to retirement plans
• Recent court decision expanding reporting
  requirements under HCQIA relating to
  investigations
• Recent court decision raising Stark and
  Anti-kickback concerns for hospital-based
  provider agreements

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Contact Information
Brad BergTelephone 206-447-8970Email
BergB_at_Foster.com Foster Pepper PLLC1111
Third Avenue, Suite 3400Seattle, WA
98101www.foster.com
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