MHPCA HOSPICE DAY AT THE CAPITOL February 24, Advocacy Training for a Successful Visit with Your Legislators

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1 MHPCA HOSPICE DAY AT THE CAPITOL February 24, 2016 Advocacy Training for a Successful Visit with Your Legislators

2 MHPCA HOSPICE DAY AT THE CAPITOL YOUR GOALS FOR THE DAY To have a positive discussion with your state representative and senator about the importance of funding hospice programs To discern their interest in and/or experience with hospice and palliative care 2

3 GOALS FOR THIS PRESENTATION Provide background on the issue you will be discussing with your state legislators Provide information about the legislative process Prepare you for your legislative visits 3

4 LOBBYING ISSUE FOR February 24th Appropriations for Department of Social Services Section Rehab and Specialty Services Mo HealthNet Hospice Budget recommended for hospice increase for fiscal year 2017 is $104k General Revenue/$284K total for anticipated Medicare increase. This is part of HB11. The house budget committee has reviewed our increase with no comment. State Medicaid Programs are required to calculate hospice payment rates based on the annual hospice rates established under Medicare. These rates are authorized by section 1814(i)(1)(C)(ii) of the Social Security Act which provides for an annual increase in payment rates for hospice care services.

5 House Budget Health Mental Health, & Social Services Committee Haefner, Marsha, Chair Mims, Bonnaye, Ranking Minority Member Wood, David, Vice Chair Curtis, Courtney Allen Frederick, Keith Kirkton, Jeanne Morris, Lynn Neely, Jim Rehder, Holly Ruth, Becky 5 Wiemann, John

6 2016 Missouri House Budget Committee Flanigan, Tom, Chair Fitzpatrick, Scott, Vice Chair McCann Beatty, Gail, Ranking Minority Member Alferman, Justin Allen, Sue Bahr, Kurt Brown, Cloria Burlison, Eric Butler, Michael Conway, Kathie Dunn, Randy Haefner, Marsha Hough, Lincoln Jones, Caleb Keeney Taylor, Shelley Kendrick, Kip King, Nick Kirkton, Jeanne LaFaver, Jeremy Lichtenegger, Donna Mathews, Kirk May, Karla Messenger, Jeffrey Montecillo, Genise Redmon, Craig Ross, Robert Rowden, Caleb Swan, Kathryn

7 2016 Missouri House Health & Mental Health Committee Frederick, Keith, Chair Kirkton, Jeanne, Ranking Minority Member Morris, Lynn, Vice Chair Arthur, Lauren Entlicher, Sue Haefner, Marsha Hubrecht, Tila Pace, Sharon Rehder, Holly Ruth, Becky White, Bill Zerr, Anne

8 2016 Missouri Senate Appropriations Committee Kurt Schaefer, Chair Ryan Silvey Dan Brown Mike Cunningham David Sater Rob Schaaf Kiki Curls Jamilah Rasheed Gina Walsh

9 Lobbying Issues for Feb 24, 2016 HB Prescription Drug Bill has hospice exemption. MHPCA in favor of bill. HB Establishes Simons Law -MHPCA does not support this bill. It does not advance quality care and regulations are already in place to handle the issues stated in the bill. HB Death with Dignity Act See MHPCA Comment on this bill. Please provide that comment if asked our position on the bill. HB1392- Requires the Department of Health & Senior Services to survey hospice not less than every three years. MHPCA in favor of this bill. HB 1994/SB 635 Establishes the Palliative Care and Quality of Life Interdisciplinary Council and Palliative Care Consumer & Professional Information & Education Program. /bill has passed the Senate In favor of bill. HB 2502 Adult Health Care Decision Act MHPCA worked on this bill for several years, however, due to the nature of the bill we can not support the bill in its current form. We would ask instead for a bill that just spells out the hyeriarcy for when a person is unable to speak for themselves.

10 MHPCA Hospice Day at the Capitol Missouri Hospice Medicaid Project In 2013 Missouri was the first state in the country to have Medicaid data released for study. MHPCA received and analyzed the data from MOHealthNet. This data is invaluable because it gives us concrete data that hospice saves MO Medicaid money. Not only is it great for the patient and family but it is a benefit that should always be approved in the budget. This data shows that Medicaid cost were a mean 42% lower for individuals dying under hospice care than those dying in the hospitals. A copy of the original study released in 2014, can be found at the MHPCA office if anyone asks for a copy. Have the individual contact the office at

11 MHPCA Hospice Day at the Capitol Missouri Hospice Medicaid Project In 2015, MHPCA completed the second year of the Medicaid Project. The two years that were reviewed were 2011 and In 2011 the mean lower cost for hospice was 42% of those dying in a hospital the mean lower cost for hospice was 41% of those dying in a hospital. Once you look at age 60+ the cost savings is even more impressive. In 2011 the cost was 55% lower. In 2012 the cost was 58% lower. Clearly hospice saves Missouri Medicaid a significant amount of money by keeping the benefit. A copy of the 2015 release will be provided for you in 11 your packets to leave with legislators.

12 QUESTIONS LEGISLATORS MAY ASK What is hospice and palliative care? Why is it important? What does it cost? What would be the result if funding is reduced or eliminated? 12

13 FUNDING FOR MISSOURI S HOSPICE PROGRAM Appropriations for DSS Section is the Rehab and Specialty part of the Budget. Hospice appropriation recommended by the Governor for SFY 2017 is this increase which is established under Medicare, Section 1814(j)(1)(ii). 13

14 NEXT STEPS HB 11 for the Department of Social Services Next: House Budget Committee House Floor Senate Appropriations Committee 14

15 Questions? Contact the MHPCA Office 15

16 THE APPROPRIATIONS PROCESS The Governor s budget is filed as House Bills 1-15 The House and Senate draft their own budgets for the state The Governor can reduce or eliminate a line item but can be overridden 16

17 Griffin and Associates 17

18 APPROPRIATIONS COMMITTEES House Budget Committee Rep. Chair Tom Flannigan, MO 163 rd, Carthage House Appropriations Committee on Health, Mental Health and Social Services - Rep. Chair Marsha Haefner, MO 95 th. St. Louis County Senate Appropriations Committee Sen. Chair Kurt Schaefer, 19 th District Boone & Randolph 18

19 CONFERENCE COMMITTEES After passage in House and the Senate, bills go to Conference Committees Conference Committees made up of chairs and members of Budget and Appropriations Conference Committees resolve the differences between House and Senate versions 19

20 CONFERENCE PROCESS Conference Committee Substitutes are sent to the House and Senate for vote House and Senate must pass identical bills Governor may reduce or veto any and all line items but may not increase Legislature may override veto with a 2/3 vote of both chambers 20

21 Questions? Contact the MHPCA Office 21

22 BEFORE YOUR TRIP TO THE CAPITOL Look up the Representatives and Senators for your home and your agency You can go to the MHPCA website to our advocacy page to look up your representative at Advocacy. Make for appointments online! Look up their committee assignments, office number and JC phone number. 22

23 BEFORE YOUR TRIP TO THE CAPITOL Ideal size for groups is 2-4 If you have not done so, call now for an appointment between the time you will arrive and noon. Practice your visit with your team 23

24 GETTING STARTED Check in at 3 rd floor rotunda alcove Packet will include Legislative Visit forms and a Fact Sheet to leave with the legislators Information booth in 1 st floor rotunda can provide direction to offices 24

25 SPECIAL INTRODUCTION IN HOUSE AND SENATE AT 10:00 am Go to North Gallery on the 4 th Floor in the House Go to Central Gallery on the 4 th Floor in the Senate Please DO NOT allow introductions of individual centers before MHPCA is introduced 25

26 THE LEGISLATIVE VISIT Introduce Converse Ask for the money! Invite Thank Leave Fact Sheet with contact information 26

27 YOUR VISIT POSSIBILITIES Easy You go to the office and your legislator is waiting for you! Harder (The Hunt) You are directed by the assistant to find your legislator. Hardest Nothing works! You leave your materials with a short note. 27

28 LEGISLATIVE VISIT FORM Information is important to MHPCA Legislator s position on issue Next steps for MHPCA PLEASE turn in at lunch 28

29 FOLLOW UP The next day write thank you notes to your legislators Reiterate your message of full funding and no cuts for the Hospice Benefit Invite them to visit your facility Send your brochure 29

30 Questions? Contact the MHPCA Office

31 MHPCA HOSPICE DAY AT THE CAPITOL Have a great Legislative Day Wear your RED THANK YOU 31

KYNA IMAN, LLC 124 East High Street P.O. Box 1483 Jefferson City, MO fax

KYNA IMAN, LLC 124 East High Street P.O. Box 1483 Jefferson City, MO 65102 314-651-1185 573-635-2858-fax kynaiman@earthlink.net TO: MISSOURI NURSES ASSOCIATION FROM: Kyna Iman and Tricia Workman DATE: