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Kansas Hospital Association Legislative Update July 29, 2008 Kansas Hospital Association Medicare Legislation – HR 6331 • Reimbursement for CAH Lab Payments – Beginning 1/1/09 CAHs receive cost-based reimbursement for clinical lab services • Physician Payment Fix – Prevents a reduction and freezes 2008 fee schedule payment rates at current levels • Medicare Rural Hospital “FLEX” Program – Extends FLEX program through Sept 30, 2010. • Ambulance Services – For July 1, 2008 through 2009, reinstates add-on payment for ground ambulance services; 3% for rural and 2% for urban. Kansas Hospital Association HPSA/MUA Proposed Rule • Proposed rule in Feb. 28, 2008 Federal Register • Combines HPSA/MUP formula • Utilized “2 tier formula” – Based upon population to provider ratio of 3,000:1 • Several factors incorporated – Barrier Free Population – Definition of Provider – High Need Indicator – 2nd Tier excludes providers under certain programs • July 23, 2008 Federal Register withdraws proposed rule • New proposed rule to be developed RHC Proposed Rule Kansas Hospital Association • Proposed changes include: – Location Requirements: • Be located in “non-urbanized” area • Be located in a shortage area (HPSA; MUA; Governor’s designated shortage areas) • Provides exceptions to the location requirements – Staffing Requirements: • Eliminates the restrictions on the RHC contracting with nonphysician providers – Payment Requirements: • Revises pymt methodology to be consistent with statutory requirements that set Medicare pymt at 80% of reasonable cost – Health, Safety, and Quality: • Requires RHCs to establish a QAPI program Kansas Hospital Association CAH Relocation Guidelines CMS’ Formal Guidance • 75% Rule – Same Service • Services available under similar terms/times – Same Population • Zip Code Analysis; hospitals may use different methodology – Same Employees • Medical staff, direct employees and FT contract staff count • J-1 visa; NHSC employees may be excluded • High turnover facilities may provide additional documentation • Necessary Provider Designation – must meet same criteria • CMS now provides preliminary determinations based on CAH letters of attestations and projections • Final approval only will be granted once the hospital has relocated and evidence confirming compliance is provided • Contact KHA if considering Relocation; Large Renovation Legislative Outlook - 2009 Kansas Hospital Association • Health Reform (Part II?) – Tobacco tax increase – Statewide smoking ban – Premium Assistance or SCHIP • “Medicaid Transformation” – Identified by KHPA – Subcommittee to discuss possibilities • Workforce Related Issues – Wichita Center for Graduate Medical Education – Nursing/Allied Health Shortages Kansas Hospital Association What Can You Do? • Meet with your Legislator – Invite to hospital – Need help, let KHA know • Find the connections – Trustees – Staff – Other community members