Health Care Grassroots Webinar, September 22

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Health Care Grassroots Webinar,
September 22

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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.

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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

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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

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Rural Agenda the fight continues

• Yesterdays Fight Rural victories in health
  care reform.
• Todays Fight Making sure programs are properly
  funded and regulations work for rural providers
  and patients.
• Tomorrows Fight What legislation was left out?
  What will happen in a new Congress?

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Three reforms were crucial

• The workforce shortage crisis must be abated
• Equity in reimbursement must occur
• Disparities must be eliminated.

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Whats the latest?

• Commissions/Studies
• Legislation
• Regulations

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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.

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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.)

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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.

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Legislation

• 110th and 111th

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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.

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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

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Necessary Provider

• S. 1171 new discussions with Senator Pryors
  (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.

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Inpatient Rule/Provider Tax Concerns

• Rep. Ron Kind (D-WI) to introduce legislation to
  address provider tax concerns.
• Kind legislation - intention that cost reports
  couldnt be reopened retroactively and the rule
  would be nullified going forward. 
• Look for alerts need cosponsors asap!

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Senate Briefing Today

• Health Reform and Regulatory Implementation of
  health reform
• Meaningful Use
• Goal is to establish foundation for future
  legislation.

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New Congress

• Legislation to eliminate
• Mandate
• IPAB
• General Whittling
• Appropriations

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What if I dont 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

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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.

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A Constitutional Battle

• 10th Amendment powers not delegated to the
  United States by the Constitutionare 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.

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Will health reform be a factor in November?

• House 253-178
• Senate 59-41

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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 whats left out!
• New legislation is coming!

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And, dont forget the regulations

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Regulations

• 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

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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

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FTC Broadband Rule

• Rural 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

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Meaningful Use changes in Final Rule

• Flexibility for Eligible Professionals (EP) and
  hospitals for demonstrating MUNPRM 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
• CAHs defined as acute care hospitals for purpose
  of incentive program under Medicaid