Title: Health Care Grassroots Webinar, September 22
1Health Care Grassroots Webinar,
September 22
2Happy Anniversary!
- 6 month anniversary of health care reform.
- Several benefits kick in tomorrow
- Invitation to join in WH
- call with Wakefield, Vilsack
- conference call.
3 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
4 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
5Rural 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?
6Three reforms were crucial
- The workforce shortage crisis must be abated
- Equity in reimbursement must occur
- Disparities must be eliminated.
-
7Whats the latest?
- Commissions/Studies
- Legislation
- Regulations
8Commissions/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.
9HPSA/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.)
10Medicare Advantage
- Despite looming cuts - - New report citing
premiums are actually going down due to new
regulations - 136 billion in savings projected over 10 years.
11Legislation
12The 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.
13340B 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
14Necessary 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.
15Inpatient 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!
16Senate Briefing Today
- Health Reform and Regulatory Implementation of
health reform - Meaningful Use
- Goal is to establish foundation for future
legislation.
17New Congress
- Legislation to eliminate
- Mandate
- IPAB
- General Whittling
- Appropriations
18What 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
19Constitutional 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.
20A 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.
21Will health reform be a factor in November?
- House 253-178
- Senate 59-41
22Stay 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!
23And, dont forget the regulations
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24Regulations
- 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
25Outpatient 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
26FTC 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
27Meaningful 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