OPPS Proposed Rule: Congressional Response...Congressional gridlock? Polarized electorate . ... AHA...
Transcript of OPPS Proposed Rule: Congressional Response...Congressional gridlock? Polarized electorate . ... AHA...
Washington Update
Alaska State Hospital & Nursing Home Association2020 Legislative Fly-in
February 26, 2020
2020: The Year Ahead
Congressional Activity
2020 Elections
Regulatory Action
Before we move on to 2020… $1.4 trillion spending bill for FY 2020
Delayed Medicaid DSH cuts through May 22
Used CREATES Act as a pay-forObtain samples to develop generic drugs
Did not include surprise medical bills or hospital offsets
Eliminated ACA taxesCadillac, Health Insurance, Devices
Impact of Impeachment Congressional gridlock? Polarized electorate
President’s Budget – FY 2021
Reminder: budget request is not binding
$478.5 billion in Medicare reductions / 10 years Reduce bad debt payments / $34 B Consolidate Graduate Medical Education (GME) / $52 B Cut uncompensated care payments / $88 B Post-acute Care Payment Cuts / $101 B Long-term Care Hospital (LTCHs) Payment Cuts / $9.4 B Site-neutral Payment Cuts / $164 B
$900 billion in Medicaid reductions / 10 years
Medicaid DSH First year of cuts: $4 billion$8 billion a year for FYs 2021-2025
Delay of ACA cuts in effectSupposed to take effect Oct. 1Now thru May 22
May 22 deadline establishes a vehicle for other health policy changes
What do we mean by “surprise medical bills”?
Typical scenarios are:
Patient accesses emergency services outside oftheir insurance network
Patient receives care from an out-of-network physician providing services in an in-network hospital
Key Issues – Surprise Medical Billing
Everyone supports taking the patient out of the middle; no balance billing in certain scenarios; federal government must act to oversee ERISA plans.
Areas of disagreementRate-SettingArbitration Transparency / contracting provisions
Congressional Activity on Surprise Medical Billing
Senate HELP and House Energy & Commerce “agreement”Protect patient from balance bills• Rate set at “median in-network” for out-of-network
payments• Arbitration for claims above $750• Contracting provisions• Waiting on legislative language
Congressional Activity on Surprise Medical BillingHouse Education and Labor Committee
• Protect patient from balance bills• Rate set at “median contracted rate” for OON payments• Arbitration for claims over $750 / $25k for air ambulance• Passed 32-13
House Ways and Means Committee Protect patient from balance bills No “benchmark rate” for OON payments Negotiation period, with mediated dispute resolution Passed by voice vote AHA Supported HR 5826 / Please Ask Your Member to Cosponsor
SMB ResourcesAlerts
Fact Sheets Talking Points Benchmark Rate Setting / Biased Toward Insurers Rural Impact Arbitration Fiction vs. Fact Provider/Health Plan Contracting Provisions
AHA Letters to Committees Letter of support for Ways and Means bill Letters to other committees of jurisdiction
https://www.aha.org/surprise-billing-resources
May 22
Addressing Rx Drug Prices
Grassley bill vs. Pelosi billPart D inflation cap and an international pricing
index in Part B (Finance approach)OR - Allow Medicare to negotiate lower prices on
most expensive drugs (House approach)What will Pres. Trump support?
Key date: May 22
If no comprehensive approach, move a smaller package?
Polling and Health Care
Polling and Health Care
Polling and Health CarePublic’s top domestic priorities the President and
Congress1. lower the cost of health care2. lower prescription drug prices
2020 Elections
Trends to Watch Changing demographics in key
states
Suburban districts remain important
Trump’s approval ratings high in red states, lower in swing states
MI, PA, WI
Senate Outlook
- Alabama - Doug Jones (D)
- Colorado - Cory Gardner (R)
- Arizona - Martha McSally (R)
- North Carolina - Thom Tillis (R)
- Maine - Susan Collins (R)
- Michigan - Gary Peters (D)
- Georgia (Special) - Kelly Loeffler (R)
- Kansas - open (R)
Seats Most Likely to Flip
House Outlook
Party House
Republican 197
Democrat 232
Independents 1
Vacancies 5
GA-6 Lucy McBathGA-7 Rob Woodall (open)IA-1 Abby FinkenauerIA-2 Steve Loebsack (open)IA-3 Cindy AxneIL-13 Rodney DavisIL-14 Lauren UnderwoodME-2 Jared GoldenMI-8 Elissa SlotkinMN-7 Colin PetersonNJ-3 Andy KimNM-2 Xochtil Torres SmallNY-11 Max RoseNY-19 Antonio DelgadoNY-22 Anthony BrindisiOK-5 Kendra HornPA-8 CartwrightPA-10 Scott PerrySC-1 Joe CunninghamTX-22 Pete Olson (open)TX-24 Kenny Marchant (open)UT-4 Ben McAdamsVA-2 Elaine Luria
Toss Up Seats
Source: Cook Political Report; 2/5/20
Campaign 2020• ApproachPresidential Resource to all candidates
CongressionalGood citizenshipEarly primary statesTargeted advertising
• Issue focusDrug pricingAffordabilityRural health careProtecting coverage
We Care… We VoteStrategies and Tactics Voter registration
Key questions for candidates
Hospital and employee engagement
Outreach to presidential campaigns
Website with tools and resources
Advertising in key states
Update from the Administration
Medicaid Fiscal Accountability Regulation: MFARCMS: Issued proposed rule to “promote
accountability and transparency” in how states finance their Medicaid program and fund their provider supplemental payments Makes significant changes to how states finance
non-federal share including changes to:
Provider taxes; bona fide donations; intergovernmental transfers (IGTs); and certified public expenditures (CPEs)
Increase CMS review of tax and donation arrangements
Establishes provider level reporting on Upper Payment Limit (UPL) supplemental payments
MFAR: Strategy• Develop impact data
• Comment periodAHA model comment letterEngage with other organizationsEngage Republican states and members
of Congress
• Continue outreach to Republican governors, state and congressional leaders
MFAR DataAHA Analysis The proposed rule is likely to
substantially reduce funding for the Medicaid program
Potential total program reductions between $37 to $49 billion, or 6% to 8% of total Medicaid spending
Potential hospital payment reductions between $23 to $31 billion, or 13% to 17% of Medicaid payments
AHA MFAR Comment Letter/Joint Release with AHCA
“Given that the proposal would severely curtail the availability of health care services to millions of
individuals and because many of its provisions are not legally permissible, the AHA requests that the agency
withdraw the proposed rule in its entirety.”
“CMS has provided little to no analysis to justify these policy changes, nor has the agency assessed the impact on providers and the patients they serve. Many of the proposed changes would also violate federal laws, including the current Medicaid statute. The AHA and AHCA request that the agency withdraw the proposed rule n its entirety.”
Stakeholders Voice Concern over MFAR Over 4,000 comment letters…
“…Governors request that CMS not move forward with the current proposed rule, as written…… “
“ NAMD encourages CMS to take additional time to open dialogue with states to refine the rule’s provisions going forward …………The broad impacts of MFAR cannot be overstated…. “
“…because of our significant concerns regarding the detrimental effect the proposal will have on communities, employers, and state economies, we urge CMS to withdraw the Proposed Rule.”
“…the Commission urges CMS not to implement new limits for supplemental payments and financing arrangements at this time because CMS has not fully assessed the effects of these changes.”
“Healthy Adult Opportunity” Waivers (Medicaid Block Grant)Optional for states Aggregate or per capita funding option Non-disabled, optional adult groups only Flexibilities: Higher cost sharing Different benefit packages Work requirements/other eligibility requirements Less oversight Shared savings with feds Partial expansions Enrollment Caps
Expect legal challenges
Department of Homeland Security Public Charge Rule DHS Final Rule implementation began Feb 24
(all injunctions lifted)
Numerous court challenges by states continue
Rule expands current public charge policy to include Medicaid (with exceptions), Food Stamps, Public Housing
AHA released a Member Advisory and Member Resource to help hospital staff assist patients and members of the community
(Note: AHA documents not intended as legal advice.)
Health Care in the Courts Texas v. USAmicus brief
AHA lawsuits340B Outpatient Cuts
Site Neutral Cuts to Protected Facilities
Disclosure of Negotiated Rates
Other lawsuitsassociation health plans, short-term plans, ACA’s cost-sharing
reductions, Medicaid work requirements, conscience rule and public charge
CoronavirusMajor hospital issues: Ensuring readiness/ability to treat Potential shortages of personal protective
equipment (e.g. masks) and drugsAHA actions: Coordination with federal agencies Advocating for hospitals to get info, tools,
resources Alerts on PPE, drug concerns Policy changes to conserve resources
Keep members informed: Daily updates, advisories, webinars
Medical Supply Chain Fragility Recent events causing concern: Novel coronavirus outbreak Cardinal Health surgical gown recall Efforts to limit ethylene oxide sterilization
Increased reliance on foreign countriesPotentially significant impact on PPEand pharmaceutical suppliesVery small margin for error -- even a minor adverse event can
result in major, prolonged disruptionsCommunication, mitigation and redundancy are key
Washington Update
Alaska State Hospital & Nursing Home Association2020 Legislative Fly-in
February 26, 2020