Transcript PowerPoint Template

FROM DOME TO DOME
STATE & FEDERAL UPDATE
DON MCBEATH
Director of Government Relations
Texas Organization of Rural & Community Hospitals
CROSSROADS CONFERENCE – June 6,2013
Page  1
YOUR HEALTH FUTURE IS IN THEIR HANDS!
Page  2
TEXAS LEGISLATIVE SESSION AT A GLANCE
Focus was on restoring budget cuts from two years
ago – mostly in education.
Funding for water
although the
development –
water is still murky.
Approving more
reductions –
businesses.
than $1B in tax
mostly to
Expanded the number of charter schools allowed.
Reductions in required school tests and graduation
requirements.
Page  3
TEXAS LEGISLATIVE SESSION AT A GLANCE
Combined UT Pan American and UT Brownsville into
UT Rio Grande Valley.
Lots of gun
concealed
no concealed
related and
carry bills – but
carry on campus.
House filed 4,323 bills and passed 885.
Senate filed 2,055 bills and passed 741.
Governor has vetoed 2 thus far.
He has until June 16 to veto bills and parts of the
budget.
Page  4
STATE BUDGET SNAPSHOT
Final two year budget of almost $197 B compared to
original current budget of $174 B.
They did add $7.2 B in state funds
($14.3 B with federal) to current
budget to cover Medicaid and
school funding shortfalls.
($1
some
Removed many of the one time accounting tricks from
last session.
Increased revenue attributed to oil/gas boom and
increased sales tax (and some revenue
underestimates).
Page  5
STATE BUDGET
Biennium
State GR Funds
2008-09
79,951,538,140
167,787,202,100
2010-11
80,614,169,010
182,187,966,800
2012-13 (original) 81,290,441,830
173,484,200,600
2012-13 (adjusted)88,504,993,972
187,829,669,182
2014-15
196,951,273,067
94,609,033,340
Total Budget*
*Includes all sources - state general revenue, dedicated state, federal, & other
Page  6
MEDICAID EXPANSION
Texas Legislature snubbed the federal government
on Medicaid expansion.
Governor Rick Perry started saying “no” to Medicaid
expansion the day the US Supreme Court gave
states an option (June 2012).
Chatter during session was
Texas would find a way to
expand but nothing passed
except a law saying only the
Legislature can expand Medicaid (and they didn’t).
Page  7
MEDICAID EXPANSION
ACA allows states to expand Medicaid to 133% of
federal poverty level and feds pick up the tab (for
three years and then covers 90%).
Medicaid expansion alone could drop Texas
uninsured from 26% to 15-18%.
Full ACA with expansion, mandates and exchanges
could drop Texas uninsured to less than 10%.
Expansion could give counties and hospitals districts
a tax break with less uninsured/indigents and allow
for funding of previously unmet needs.
Page  8
MEDICAID EXPANSION
Challenge is most Texans are “against Obama care”
and don’t see the pocketbook advantage they could
gain.
Supplemental federal funding to hospitals for
uncompensated care (known as Disproportionate
Share Hospital funding) will soon decrease under
the assumption there is less uncompensated care
because of Medicaid expansion – except Texas
didn’t!
Lots of unknowns for Texas and none are
financially good!
Page  9
OTHER BUDGET NEWS
Medicaid cost saving provisions – calls for Medicaid
to find more than $400 M in savings (The Devil is in
the rules).
Full funding of physician loan repayment program
(150+ across the next two years).
Use of reserved trauma funds for DSH state match.
No increase in trauma fund payments to RACs and
hospitals.
Another directive to address non-urgent ER use.
Page  10
MEDICAID HOSPITAL PAYMENTS
Rural hospitals will continue to be paid near their
cost for services rather than standardized rates for
inpatient.
New provision for rural hospitals calling for them to
be paid under an alternative outpatient system
(current single system for urban and rural tends to
pay rural hospitals far less than cost).
No specific Medicaid rates cuts ordered in budget to
hospitals, assisted livings, and other Medicaid
providers.
Page  11
HOSPITAL NEONATAL/MATERNAL
DESIGNATIONS
New three-tiered designation system for hospitals
providing neonatal and maternal services.
▪ Hospitals must only provide the level
of services associated with their
designation or transfer patient.
▪ Pursuit of designation is optional
with hospital but must have to
provide the services.
Effective Aug 2017 for neonatal designations and
Aug 2019 for maternal designations.
Page  12
THIS, THAT, & THE OTHER
SB 7 redesigns long-term and acute care services
for the elderly, which are among the most costly
services provided by Medicaid, with a shift to
managed care.
Expanded GME slots.
Tightened EMS service license requirements
including a local government determination of need.
Page  13
BILLS THAT DIED
A bill that would have barred any payment to a
hospital for non-urgent care provided to a Medicaid
recipient in hospital emergency room.
A bill to raise daily fine for hospital
rule violations from $1,000 to $25,000.
A bill dictating nurse staffing ratios in
various areas of a hospital.
Removed language in a bill that would have required
three person patient movement teams on any patient
over 50 pounds.
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REMAINING UNKNOWNS
Language from lots of dead bills was amended into
other bills during the last week of session.
Veto period still open.
Page  15
HOW IS THE WEATHER IN DC?
Page  16
KILLING ‘EM IN CONGRESS
2% Medicare payment reduction to all
providers started in April from
sequestration.
Medicare bad debt allowance for
hospitals reduced in early 2012 from 70 to 65%
(100 to 65% for CAHs) - costing Texas rural hospitals
collectively $2 M a year.
Medicare outpatient hold harmless eliminated in Jan
2013 - costing 50 Texas rural hospitals $10 M a year.
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KILLING ‘EM IN CONGRESS
RAC audits - more and more providers having to
return Medicare payments without the ability to rebill.
Medicare payment contractor audits.
Medicare Value Based Purchasing started in Oct
2012 for hospitals - payments (except for CAH) now
based on quality system which is expected to cost
many hospitals 1-3% of their Medicare payment
amount.
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KILLING ‘EM IN CONGRESS
Readmission penalties for hospitals started Oct 2012
(except for CAH) which will adversely impact rural
hospitals who deal with a higher percentage of
Medicare patients.
Electronic health records - Medicare bonus
payments will not cover the cost of conversion for
most hospitals and other providers.
Conversion to ICD10.
Doc-Fix (sustainable-growth-rate (SGR) formula
…..again). 24.4% next time.
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LINGERING FEDERAL ISSUES
Medicare Low Volume Adjustment could expire in
October collectively costing 80 Texas rural hospitals
$45 M a year.
Medicare Low Volume Adjustment could expire in
October collectively costing 15 Texas rural hospitals
$3 million a year.
Medicare rural ambulance 3% payment bump could
expire in December.
CAH mileage separation change on the table again.
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LINGERING FEDERAL ISSUES
Undocumented aliens – MMA Section 1011 funds
gone since 2008 and never replaced – pushed
further back by immigration debate.
Emergency Medical Treatment and Active Labor Act
(EMTALA).
Expansion of Medicare Advantage and negative
financial impact in rural areas.
DSH reduction under ACA.
Budget cuts.
Page  21
THEY DON’T GET IT!!!!
AN EXAMPLE:
New Texas MSA counties: Falls County, Hood
County, Hudspeth County, Lynn County, Martin
County, Newton County, Oldham County, Somervell
County
Page  22
THE RURAL CHALLENGE AHEAD
Rural areas have less and less representation each
time the State House, State Senate, and US
Congress lines are redrawn.
Rural health providers must continue to educate
lawmakers and staff that “rural is different” and
deserves to be treated as such.
Remind them “one size fits all” does not work and
why rural health care rules and payment
methodologies must be different.
Rural health advocates must step up their efforts.
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QUESTIONS??
Don McBeath
[email protected]
806-543-1992
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