2016 Annual Legislative Update WisHHRA

Transcription

1 2016 Annual Legislative Update WisHHRA Kyle O Brien Senior Vice President Government Relations Wisconsin Hospital Association April 22,

2 Perception of Lobbyists? In a January 2013 poll about the approval ratings for Congress, Public Policy Polling found the following: *26 questions When asked if they had a higher opinion of Congress or lobbyists, people said: Congress 48% (Congress had a 9% favorability rating) Lobbyists 30% Not sure 22% Lobbyists scored worse than: Telemarketers, Kardashians, Nickleback, Lindsey Lohan, Fidel Castro, and Carnies. Lobbyists only scored better than: North Korea, Ebola, Meth Labs, and Communism. *4 out of 26 questions Source:

3 Perception of Lobbyists? Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the Government for a redress of grievances. YOU have a right to be represented and have your voice heard in state and federal government. That is our job, to be your eyes and ears under the capitol domes in Madison and Wisconsin. We take that job very seriously and, with your help and partnership, we have had great results!

4 WHA s State Advocacy Priorities & Legislative Review Health Care Policy Changes Biennial State Budget - Interstate Medical Licensure Compact - Behavioral Health Medicaid Pilots and Bed Tracker - Legislative Oversight of State Employee Health Plan - WI Health Care Data Modernization Act HR Focused Issues - Prohibiting Mandatory Flu Vaccine Policies - Changes to Work Comp Law - Organ Donation Leave and Harmonizing WI FMLA - HOPE Agenda 4

5 Medicaid Funding Budget Governor s Budget Cost-to-Continue $647 million GPR ($1.7 billion AF) DSH - $30 million GPR ($71.8 million AF), two years Medicaid Cost-to-Continue (All Funds) FY Base FY FY $8.4 billion $9.2 billion $9.5 billion Joint Finance Committee Medicaid Provisions Bipartisan support to make DSH a base appropriation JFC funded cost-to-continue, no hospital or physician cuts Delayed payment cuts to Federally Qualified Health Centers

6 Where does budget go from here? Medicaid 26% State Budget $18.7 Billion General Fund Tax Revenues MA $158 Million 840, , , , , , , , ,000 Jan-14 Feb-14 Mar-14 Apr-14 May-14 BadgerCare Plus Enrollment Jun-14 Average Increase of 60,241 Enrollees Between March 2014 and February 2016 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16

7 Where does budget go from here? Where will lawmakers look to invest? - K-12 Education - Medicaid/Health Care MA - Property Tax Relief - Income Taxes - Higher Education - Workforce Development - Transportation Or maybe the question is.will they be able to invest? - Political pressures to spend less dollars in the budget - Tax cuts are viewed as spending by some, competing priorities - Most recent state revenue estimates were lower than previously projected

8 Where does budget go from here? State Budget Revenues & Appropriations % MA 6.00% 5.00% % 3.00% % % All Funds Dollars (In Billions) General Purposes Revenues Annual Change 0.00%

9 Interstate Medical Licensure Compact Signed into law as 2015 Wisconsin Act 116!

10 Interstate Medical Licensure Compact Signed into law as 2015 Wisconsin Act 116! Next steps - Interstate Commission has had three meetings to discuss implementation - Wisconsin MEB has selected MEB chair, Dr. Ken Simons, and MEB member Mr. Robert Zondag - Commission is targeting first license to be processed by early 2017 Sen. Vukmir Amendment - Creates a sunset and requires the Compact be reauthorized within four years of the effective date of AB Requires Senate confirmation of Commissioners, but leaves selection up to the MEB - Requires rules developed by the Commission to be reported to JFC Professional Advocacy Was Critical To Passing This Bill - Many hospital leaders engaged directly with their local legislator on this issue. WHA s strategic member engagement was essential to passing this bill in This was a textbook example of strategic advocacy and lobbying with member hospitals.

11 Interstate Medical Licensure Compact Singed into law as 2015 Wisconsin Act 116!

12 Group Insurance Board Oversight Walker calls in stakeholders after indicating veto WHA President/CEO Eric Borgerding, WHA SVP Joanne Alig, along with WHA Board Members meet with Gov. Walker on October 28 th Negotiations Ensue Until Senate Passes Bill - Governor Walker s policy team was negotiating with Representative Nygren and Senator Darling in the week leading up to the Senate s vote on AB 394 in extraordinary session Signed into law on Dec. 16 th! Authors Amend Bill with Veto Assurance Amendment limits the scope and authority of oversight to executing a contract to provide self-insured group health plans on a regional or statewide basis.

13 Medicaid Behavioral Health Pilots & Mental Health Bed Tracker Behavioral Health Care Coordination Pilot $600,000 GPR ($1.5 million+ AF) Psychiatric Consult Reimbursement Pilot 200,000 GPR ($500,000+ AF) Online Mental Health Bed Tracker 110,000 GPR Total: $910,000 GPR There are two outcomes of this. The first and primary outcome that we are looking for from this is better quality of life for people who suffer from mental health issues. The second priority is for taxpayer dollars, we need to make sure that the dollars going into these programs are being spent in the best way and we can get the most services and resources to the people that really need them. Rep. Mary Czaja

14 Care Coordination Pilot Concept of Proposal - Pilot potential payment models that incent providers to coordinate care for individuals with chronic mental illness, preventing mental and physical health conditions. - Prevent ED utilization, inpatient admissions and keep patients cared for in the community - Target specific population that are super-utilizers of non-behavioral health services while also suffering from significant or chronic mental illness. Policy Requirements - Pay hospitals/health systems that can provide the full gamut of care, including inpatient/outpatient psychiatry, primary care, ED, care coordination and social services - Measure results in a 3 year pilot in at least two pilots across the state - Test whether or not Medicaid should pay to incent providers to do this work - Require entities awarded grant funding to submit two reports analyzing project results

15 Care Coordination Pilot Concept of Proposal - Pilot potential payment models that incent providers to coordinate care for individuals with chronic mental illness, preventing mental and physical health conditions. - Prevent ED utilization, inpatient admissions and keep patients cared for in the community - Target specific population that are super-utilizers of non-behavioral health services while also suffering from significant or chronic mental illness. Policy Requirements - Pay hospitals/health systems that can provide the full gamut of care, including inpatient/outpatient psychiatry, primary care, ED, care coordination and social services - Measure results in a 3 year pilot in at least two pilots across the state - Test whether or not Medicaid should pay to incent providers to do this work - Require entities awarded grant funding to submit two reports analyzing project results

16 Psychiatric Consult Reimbursement Pilot Concept of Proposal - Allows entities, including physician groups, to test systematic reimbursement changes - This proposal would impact adults, as well as children, served in the Medicaid program - Instead of employing a few psychiatrists to interact with hundreds of different providers, this proposal incentivizes team-based collaboration within existing physician resources Policy Requirements: - Targets physicians treating individuals with mild to moderate mental illness along with physical health conditions - Requires the provider to deliver outpatient psychiatric services and primary and specialty care outpatient services for physical health conditions - Requires the entity/entities to report to the state comparing utilization and Medicaid expenditures between a control group and the target group

17 Online Mental Health Bed Tracker Principles of Proposal - Create efficiencies for hospital staff to more easily identify open psych inpatient beds - Based off of a Minnesota model, Wisconsin would create a voluntary system for hospitals to report information about open psychiatric beds Policy Requirements: - Provide $50,000 in one-time startup costs and $30,000 a year to the Wisconsin Hospital Association Information Center (WHAIC) to run the program. - WHAIC would be required to display the number of available child, adolescent, adult and geriatric inpatient psych beds. - Bill would also require the display of any specialty information, contact for admission coordination and the date the hospital updated its record.

18

19 Wisconsin Health Care Data Modernization Act Background on the Wisconsin Hospital Association Information Center (WHAIC) - Started in 2004, formerly was work done by Bureau of Health Information at DHFS - Created efficiencies for the program, resulting in savings to hospitals Challenges Associated with Current Regulations - State law and administrative code has antiquated paper-based publication requirements, restricts the ability for WHAIC to provide information that is specific enough within a community and prohibits IC from providing race/ethnicity to data users. Opportunities to Expand Utility of Data to Meet Evolving Health Care Needs - Provide patient condition and diagnosis related data at the neighborhood level to educate population health initiatives and strategies of member hospitals. - Provide specific information to member hospitals and other data users (e.g. public health) on where to locate preventive care intervention strategies.

20 Wisconsin Health Care Data Modernization Act Elements of the Act: 1. Allow WHAIC to align the collection of hospital and ASC data elements with the insurance industry s standard format the American National Standards Institute (ANSI 837). 2. Eliminate the requirement that paper publications of certain reports be created and distributed to various entities, including the Governor and Chief Clerks of legislature. 3. Allow IC to collect a patient s street address to convert that information to a census block group, then require the destruction of the patient s street address. 4. Allow WHAIC to make a notification for physician review of data online, instead of in paper format. 5. Allow WHAIC to distribute data on race/ethnicity to data users.

21 Signed into law at WHA Advocacy Day!

22 Prohibiting Mandatory Influenza Policies Legislation introduced to prohibit mandatory policies - Rep. Jeremy Thiesfeldt, a sophomore Republican from Fond du Lac, introduced legislation again. - WHA called in by Speaker Vos to meet on the bill. Vos says bill might receive support in caucus. WHA commits to letter, Thiesfeldt agrees to withdraw legislation - WHA worked to educate Representative Thiesfeldt about the current exemption guidelines from the Equal Employment Opportunities Commission (EEOC). - Thiesfeldt said that if WHA reminded members via letter about exemption recommendations, then he would agree to withdraw bill. - Clear understanding between WHA/Thiesfeldt that this is not a new or different recommendation from WHA s previous toolkit released in 2013.

23 Prohibiting Mandatory Influenza Policies Legislation introduced to prohibit mandatory policies - Rep. Jeremy Thiesfeldt, a sophomore Republican from Fond du Lac, introduced legislation again. - WHA called in by Speaker Vos to meet on the bill. Vos says bill might receive support in caucus. WHA commits to letter, Thiesfeldt agrees to withdraw legislation - WHA worked to educate Representative Thiesfeldt about the current exemption guidelines from the Equal Employment Opportunities Commission (EEOC). - Thiesfeldt said that if WHA reminded members via letter about exemption recommendations, then he would agree to withdraw bill. - Clear understanding between WHA/Thiesfeldt that this is not a new or different recommendation from WHA s previous toolkit released in 2013.

24 Worker s Compensation Changes Act 180 Agreed-To Bill Process Produces Changes - Management reps: most significant changes in over 20 years - Does not include medical fee schedule or limitation on injured worker s choice for medical care. Changes include: - Reduction of statute of limitations from 12 years to 6 years - Apportionment of permanent disability based on pre-existing injury - No offset for part-time wages during retraining - Temp disability denied if employee returns to light duty work and is suspended or terminated due to misconduct or substantial fault - No recovery of indemnity or death benefits when employee violates drug/alcohol policy and there is direct causation.

25 Organ Donation Leave Law Act 345 Bipartisan Bill from Sen. Darling and Rep. Mason - Law allows employees to take up to six weeks of leave a year to serve as an organ or bone marrow donor. State s Chamber Neutral, Hospitals Support - State s chamber WMC - neutral on the bill, because the provision was created outside Wisconsin s FMLA law, , Wis. Stats. - Health systems including Aurora Health Care, Children s Hospital of Wisconsin, Columbia St. Mary s, Froedtert, MCW, Ministry Health Care and Wheaton supported the legislation. - WMC and WHA still aiming to federalize Wisconsin s FMLA law for those with 50 or more employees.

26 HOPE Legislation Rep. John Nygren Leads Addiction Prevention Effort - Eight pieces of legislation signed at four different hospital/health system facilities across the state of Wisconsin part of HOPE Outlaw Possession, Use and Distribution of Masking Agent - PDMP Changes for Prescribers and Law Enforcement - Certification requirements for methadone clinics & prevent pill mills - Data collection requirements for effectives of the PDMP - Opioid prescribing guidelines by Medical Examining Board

27 2016 Wisconsin Presidential Primary MU Law School Poll February March Cruz 19% 40% Kasich Most likely to be the nominee? 8% (March) 21% Trump Trump 65% 30% of GOP 30% Undecided Clinton 77% ---of Democrats 8%

28 2016 Wisconsin Presidential Primary MU Law School Poll February March Cruz 19% 40% Kasich Most likely to be the nominee? 8% (March) 21% Trump Trump 65% 30% of GOP 30% Undecided Clinton 77% ---of Democrats 8%

29 2016 Wisconsin Supreme Court Race Recently appointed Supreme Court Justice Rebecca Bradley beat Appeals Court Judge Joanne Kloppenburg by a 4% margin. Nearly 100,000 more people voted in the GOP Presidential primary than the Democratic Presidential primary. Drop off roughly 7%, which means 93% of people voting in presidential primaries voted in Supreme Court election total votes cast = 1,943, Justice Ann Walsh Bradley (no relation) won. Total votes cast = 798,203 Week before election, 1/3 of likely voters did not know enough about Supreme Court candidates to form a favorable or unfavorable opinion. 29

30 2016 Wisconsin General Election GOP Candidate Secretary Clinton Cruz 0 Kasich + 9% Trump - 10% GOP Candidate Sen. Sanders Cruz - 13% Kasich - 2% Trump - 19% US Senate (Reg Voters) January February March March (Likely) Feingold (D) Johnson (R) US House Races - 8 th Congressional District shaping up to be competitive with GOP candidates Gallagher and Sen. Lasee. Dem candidate Tom Nelson. - All others not expected to be competitive. 30

31 2016 Wisconsin General Election State Senate - GOP currently has 3 seat majority (19-16) - 18 th Senate District (Fond du Lac, Oshkosh) will be competitive - GOP and Dems targeting other districts around the state - Other Senators up for re-election have won several races before State Assembly - Republicans currently have 63 seat majority (39 Democrats) - More difficult for Republicans to hold onto seats in Presidential cycle - All 99 members up for re-election. Many GOP members retired last cycle Issue Fall 2014 Fall 2015 Feb 2016 Right Track 51% 46% 44% Budget (Better) 43% 30% 28% 31

32 WHA Advocacy Day SAVE THE DATE WHA ADVOCACY DAY 2017! April 19, 2017 Help us break another attendance record! 32

33 Enroll in HEAT Today! If you are not at the table, you are on the menu. 33

34 Wisconsin Hospitals State PAC & Conduit If any of these statements describe your situation, you should learn more about joining the Wisconsin Hospitals State PAC & Conduit: I already contribute to candidate campaigns, but I want to make sure that my candidate of choice knows I support my hospital. I ve never contributed to candidates before, but I believe it is important to support candidates that support issues that are important to me. A candidate regularly calls or s asking me to contribute to their campaign, but I m not always sure where they stand on hospital issues. I like to direct where my campaign dollars are spent and be recognized by the candidate of my choosing for my contribution. I like to contribute to support candidates that value hospitals, but I do not want to select a specific candidate to support and wish to be anonymous. I enjoy attending fundraising events for state lawmakers. I want to contribute $1. I want to contribute $100. I want to contribute $1,

35 Questions? Learn more about what the Wisconsin Hospital Association is doing to protect access to high quality, high value health care by visiting 35