Federal Update John T. Supplitt, Sr. Director. February 24, 2017

Transcription

1 Federal Update John T. Supplitt, Sr. Director February 24, 2017

2 Agenda 1.Political Environment a) New Congress b) New Administration 2.Repeal and Replace 3.Legislative Advocacy 4.Regulatory Policy 5.Ensuring Access

3 Political Environment

4 The 115 th Congress Republican House Leadership Speaker of the House: Paul Ryan (R-WI) Majority Leader: Kevin McCarthy (R-CA) Majority Whip: Steve Scalise (R-LA) Conference Chair: Cathy McMorris Rodgers (R-WA) Republican Senate Leadership Majority Leader: Mitch McConnell (R-KY) Whip: John Cornyn (R-TX) Conference Chairman: John Thune (R-SD) Policy Committee Chairman: John Barrasso (R-WY) Conference Vice Chairman: Roy Blunt (R-MO)

5 The 115 th Congress Committee of Jurisdiction for Health U.S. Senate Republicans Committee on Finance Orrin Hatch, Chairman Subcommittee on Health Care Pat Toomey, Pa., Chairman Chuck Grassley, Iowa Pat Roberts, Kan. Michael B. Enzi, Wyo. John Thune, S.D. Richard Burr, N.C. Johnny Isakson, Ga. Rob Portman, Ohio Dean Heller, Nev. Bill Cassidy, La.

6 The 115 th Congress Committees of Jurisdiction for Health U.S. House Republicans Committee on Energy and Commerce Greg Walden, OR 2 Subcommittee on Health Michael Burgess, TX 26 - Chairman Brett Guthrie, KY 2 Joe Barton, TX 6 Fred Upton, MI 6 John Shimkus, IL 15 Tim Murphy, PA 18 Marsha Blackburn, TN 7 Cathy McMorris Rodgers, WA 5 Leonard Lance, NJ 7 Morgan Griffith, VA 9 Gus Bilirakis, FL 12 Billy Long, MO 7 Larry Bucshon, IN 8 Susan Brooks, IN 5 Markwayne Mullin, OK 2 Richard Hudson, NC 8 Chris Collins, NY 27 Buddy Carter, GA 1 Committee on Ways & Means Kevin Brady TX-8 Subcommittee on Health Pat Tiberi, OH 12, Chairman Sam Johnson, TX 3 Devin Nunes, CA 22 Peter Roskam, IL 6 Vern Buchanan, FL 16 Adrian Smith, NE 3 Lynn Jenkins, KS 2 Kenny Marchant, TX 24 Diane Black, TN 6 Erik Paulsen, MN 3

7 The Trump Administration Rep. Mick Mulvaney, Director OMB Tom Price, M.D., Sec. HHS Seema Verma, Administrator CMS

8 Priorities of the New Administration Tax reform Infrastructure Trade reform Regulatory reform Immigration ACA repeal and replace

9 Power of the Parliamentarian Process Reconciliation FY 2017 instructions FY 2018 instructions Byrd rule implications Elizabeth MacDonough Senate Parliamentarian Procedure Parliamentary rules

10 Fiscal Cliffs and FY 2018 Mid-January January 27 February 20 March 15 April 28 Congress adopts FY 2017 budget resolution with reconciliation instructions to repeal ACA Committees must report 2017 reconciliation bills Target date for reconciliation bill repealing ACA to White House DEBT CEILING SUSPENSION EXPIRES CONTINUING RESOLUTION EXPIRES May?? Pres. Trump sends FY 2018 budget to Congress June 30 Congress adopts budget resolution September?? Committees must report FY 2018 reconciliation bills September 30 FY 2018 reconciliation bill to White House October 1 FY 2018 begins

11 Repeal & Replace

12 2017 Schedule ACA Repeal & Replace 2017 Reconciliation Replacement Proposals 2018 Reconciliation Tax Reform Medicaid Funding the Government (April 28) Debt Ceiling (March 15) CHIP Reauthorization (Sept 30) Other Priorities - Infrastructure

13 Affordable Care Act AHA Principles for ACA Re-examination Maintain coverage for those covered Replacement of coverage should be simultaneous with any repeal, protecting people s coverage Any effort to repeal should restore funding reductions to hospitals Support continued efforts to transform delivery system from FFS to FFV using coordinated care and integrated delivery mechanisms

14 Impact of Repeal on Hospitals The financial impact on hospitals include: A net negative impact of $165.8 billion regarding coverage losses; A loss of $289.5 billion in Medicare inflation updates if the payment reductions in the ACA are not restored; and Suffering $102.9 billion in cuts if the ACA s Medicare and Medicaid DSH payment reductions are not restored.

15 Repeal and Replace The emerging GOP blueprint includes Republican mainstays like: Expanding Health Savings Accounts Enacting high-risk insurance pools Reforming Medicaid Tax credits to help Americans buy insurance policies.

16 Repeal and Replace

17 Legislative Advocacy

18 Letters to the President-elect Five objectives: 1. Reduce the regulatory burden; 2. Enhance affordability and value; 3. Continue to promote quality and patient safety; 4. Ensure access to care and coverage; and 5. Continue to advance health system transformation and innovation.

19 2017 AHA Rural Advocacy Agenda Make Medicare extensions from SGR permanent: Medicare-dependent Hospital (MDH) program; Enhanced adjustment for certain low-volume hospitals Ambulance add-on payments for ground ambulance and super-rural areas, Therapy cap exceptions process, and Rural home-health add-on

20 2017 Rural Advocacy Agenda Reintroduce fixes for rural hospitals: Extend enforcement moratorium for direct supervision (S. 243/H.R. 741) Remove the 96-hour condition of payment 340B program stabilization IT and meaningful use stage 3 Care coordination Vulnerable community models

21 2017 AHA Rural Advocacy Agenda Telehealth. Expand Medicare coverage and payment and support research Behavioral Health. Improve access to services, address workforce issues; and improve parity. Medicare DSH. Relieve hospitals from cuts to Medicare disproportionate share hospitals. CAH payments. Ensure CAHs are paid 101 percent of costs by Medicare and are paid at least the same by Medicare Advantage plans. CAH designation. Maintain CAH designation, as currently defined. IPAB. Exempt CAHs from the Independent Payment Advisory Board. Provider taxes. Allow claim the full cost of provider taxes as allowable costs.

22 Rural Advocacy Resources Rural Advocacy Agenda Rural Infographics Action Alerts Social Media

23 Advocacy Useful Tips Coordinate with your Government Relations Representative if a system hospital and State Association Tell Your Hospital Story Use Hospital-Specific Data Useful Anecdotes that Help Make the Case Build a Relationship with the Congressional Staff Offer Yourself and the Hospital Team as a Resource

24 Rural Hospital Policy Forum 2017 July 20, 2017 Annual AHA Rural Hospital Policy Forum on Capitol Hill

25 Regulatory Policy and Advocacy

26 Regulatory Relief Actions AHA identified 33 rules including; Suspending star ratings, Canceling stage 3 of meaningful use, Rescind 96-hour rule, Allow visiting specialists to share space in HOPDs, Suspend e-cqm Remove faulty quality measures Expand telehealth coverage

27 Regulatory Highlights Two-midnight policy ALJ litigation decision Medicare Outpatient Observation Notice MACRA Final Rule Site Neutral Regulations Hospital Co-Location Issue Hospital/CAH Conditions of Participation 340B Program CJR and Cardiac Bundles Regulatory Outlook - Freeze

28 Regulatory Highlights Two-midnight policy Eliminates two-midnight cut Prospective and retrospective elimination provides $3.1 Billion to hospitals over 10 years Policy changes, effective Jan. 1, 2016 Stays expected to cross at least two midnights are inpatient No changes to two-midnight presumption or benchmark Stays less than two midnights may now be payable as inpatient based on the clinical judgment of the admitting physician and medical record support for that determination

29 Regulatory Highlights ALJ litigation decision Decision issued on Dec. 5, 2016 HHS ordered to eliminate the backlog of Medicare claims appeals pending at the ALJ level within four years 30% by Dec. 31, 2017; 60% by Dec. 31, 2018; 90% by Dec. 31, 2019; and 100% by Dec. 31, 2020 Court upholds timeline on Feb. 9 Appeals settlement reopened

30 Outpatient Observation Services Medicare Outpatient Observation Notice

31 Medicare Access & CHIP Reauthorization Act MACRA abolished the SGR formula for Medicare physician payment and replaced it with: Stable payment updates physician fee schedule Two-track payment system effective in 2019: 1. Merit-Based Incentive Payment System (MIPS), and 2. The Alternative Payment Model (APM) track AHA MACRA resources:

32 Regulatory Highlights MACRA Final Rule Started Jan. 1, 2017, clinicians pick their own pace Few advanced APMs qualify for incentives in 2017 More data reported in 2017 means better chance of payment increase Fewer clinicians than expected subject to MIPS in the first year Expectations will ramp up over time

33 Regulatory Highlights Site Neutral Regulations Outpatient PPS final rule implements siteneutral provisions Establishes site-neutral payment rates for certain off-campus provider-based hospital outpatient departments (HOPDs) In 2017, these HOPDs will be paid under the physician fee schedule at newly established rates (generally 50 percent of the outpatient PPS rate) Legislative extension for effective date for some HOPDs Does not apply to CAHs

34 Regulatory Highlights Hospital Co-Location Issue A number of current regulations affect how hospitals may share: Space Services Staff Satellite rules, HwH, CoPs, providerbased rules These rules lack specificity CMS has expressed several precise interpretations of these rules that differ from prior understanding Status update

35 Hospital/CAH Conditions of Participation Implement antibiotic stewardship programs Augment infection prevention and control regulation Update QAPI requirements, including QAPI for CAHs; Make changes related to the content of hospital medical records; Allow qualified dieticians/nutrition professionals in CAHs to order patient diets Require hospitals and CAHs to implement written policies to prohibit discrimination and to inform patients of their right to be free from discrimination.

36 340B Program

37 CJR and Cardiac Bundles Comprehensive Care for Joint Replacement (CJR) Cardiac Bundle Payment Models Acute care hospitals control the bundle Required of most hospitals in certain markets Hospitals would be responsible for quality and costs for all Medicare Part A & B services for 90 days post discharge Heart attack and cardiac bypass surgery services Surgical treatments for hip and femur fractures beyond hip replacement New bundles go into effect July 2017

38 2017 Regulatory Outlook Executive Orders Regulatory freeze - New regulations - Regulations currently at Federal Register - Those that have not taken effect Regulatory relief - One in, Two out

39 Regulatory Tracker

40 Ensuring Access to Health Care

41 AHA Board Task Force Report Ensuring Access to Health Care in Vulnerable Communities Task Force Confirm the characteristics and parameters of vulnerable rural and urban communities Identify emerging strategies, delivery models and payment models for health care services in rural and urban areas Identify policies/issues at the federal level that impede, or could create, an appropriate climate for transitioning

42 AHA Board Task Force Report

43 AHA Board Task Force Report

44 AHA Board Task Force Report Public Policy Changes Creation of new Medicare payment methodologies and transitional payments; Creation of new and expansion of existing federal demonstration projects; Modification of existing Medicare Conditions of Participation to allow for the formation of the strategies; Modification of laws that prevent integration of health care providers and the provision of health services; Modification of the existing Medicare payment rules that stymie health care providers to coordinate care; and Expansion of Medicare coverage and payment for telehealth. To learn more about the work of the AHA Task Force on Ensuring Access in Vulnerable Communities, please visit

45 Task Force Action Plan

46 Task Force Action Plan Draft schedule for the release of new tools: Jan Indian Health Service Feb Inpatient/Outpatient Transformation Model Mar EMC/FSED April Virtual care strategies May Social determinants of health June Global budgets July Frontier health system Aug Rural hospital Rural health clinic Sept Urgent care

47 Discussion Questions and Comments

48 Contact Information John Supplitt Senior Director AHA Constituency Sections

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