offensive strategy

Transcription

1 offensive strategy

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4 possible threats to CON Philosophy of free market for healthcare Replacement of entire state health planning committee Elimination of funding in DHEC budget for operations Bill to eliminate CON Bill to significantly change CON Major high profile battle in a local market where a Senator or Representative lives

5 recent changes to the CON law Application & review process improvements: Better defines when CON review is required and removes some items from CON review entirely. Reduces and limits DHEC staff s review time to 120 days and can only be extended to 150 days if a public hearing is required. During review process, requires that a person provide written notice to DHEC staff to indicate that he is an affected person and stating his opposition to an application or he cannot request a review by the DHEC Board.

6 recent changes to the CON law Application & review process improvements continued: Prohibits communication and influence by state and federal elected officials once a CON application has been filed with DHEC. To reduce paper processing, all CONs are now valid for 1 year, and extensions can be granted for up to 18 months.

7 contested cases & appeals process improvements Act 387 in 2006: Established uniform procedure for contested cases and appeals for all administrative agencies, including DHEC. Streamlined the handling of contested cases by DHEC Board. Act 278 in 2010 Added further definitions of a timeline to request a final review by the DHEC Board, and if desired by the Administrative Law Court. Also significantly limits the number of witnesses, depositions, interrogatories, requests for admission, and requests for production when a contested case is brought to the ALC. ALC now required to issue final decision within 18 months.

8 contested cases & appeals process improvements Act 278: Added new requirement to post a bond up to $1.5 million if a decision is appealed to the SC Court of Appeals. If Court affirms ALC decision, or dismisses the case, bond is automatically awarded to the party whose case is being appealed. Both the ALC and Court of Appeals are authorized to award damages and attorney fees and costs to a party whose project was delayed by a frivolous appeal which is done for delaying or harassment purposes.

9 working assumption: protect CON as it now exists Efforts in progress: updating 2006 CON white paper creating talking points creating graphics on new timelines CEO visits with DHEC Board members Could other changes be made to CON law?

10 what must we protect in CON? Most important? Least important?

11 medicaid past, present and future

12 review of the sfy 2012 medicaid budget original request $636 million reduced growth projections to 8% enrollment and inflation reduced request by $75 million in efficiencies and cost reductions and $125 million in provider line reductions

13 medicaid s 2011 legislative journey House ways and means committee endorsed Keck reductions House accepted committee budget Senate finance committee little if any change Senate floor debate kaboom! Senator s Davis and McConnell debate Medicaid

14 senate amendment: davis, shoopman & rose reduce Medicaid budget by $100 million hospital services portion: eliminate graduate medical education - $21.2 m additional 5% rate reduction - $22.7 m total hospital services - $43.9 m state funds

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16 schhs actions to date announced rate reduction in april published public notice July 8 of decrease in medicaid expenditures of approximately $238 million scha members and staff met with scdhhs staff to discuss cost savings in lieu of additional rate reductions

17 hospital services rate reductions Description of reductions 3% rate reduction in April 4% additional reduction in July Changes to GME payment structure State general funds Total funds $ 4,582,400 $ 16,000,000 $15,757,032 $ 52,858,210 $10,200,000 $ 34,216,706 In-state DSH reduction $ 4,600,000 $ 15,431,063 Out of state DSH reduction $ 225,000 $ 754,780 Subtotal $35,364,432 $119,260,759

18 hospital services savings Description of Savings HAC s and Readmissions Birth Outcome /Vaginal Deliveries Birth Outcome/NICU LOS State Funds Total Funds $ 1,255,144 $ 4,210,479 $ 949,355 $ 3,184,688 $ 7,059,564 $ 23,681,865 Subtotal $ 9,264,063 $ 31,077,032 Total Hospital Services $44,628,496 $150,337,791

19 where are we now? Waiting on response to comment letter: how will various savings initiatives be tracked? how can we be assured that missed enrollment projections will not impact hospitals? when will a new reimbursement mechanism be implemented? with respect to mcos, will they receive the same rate reductions and when? will the mco admin fee be considered for additional reduction? how will the reduction in snf beds be monitored?

20 future threats current year and beyond Projected savings not realized in sfy 2012 Enrollment projections are wrong Still ~ $15 million of the $125 not identified Federal budget cuts Continued anti-medicaid political philosophy

21 federal budget update changes by the hour currently cuts to medicaid and medicare are not in the most recent plans low probability of avoiding cuts in the longterm plan

22 federal medicare proposals eliminate medicare bad debt reimbursement impact on sc hospitals ~ $46.2 million/year reduce medicare support for health care professional training (ime & dgme) sc teaching hospitals ~ $41.7 million/year

23 federal medicaid proposals eliminate or reduce cap on medicaid provider tax (at proposed 3.5%, sc just under) restructure fmap formula with a lower single blended rate for each state would save $100 billion over 10 years block grants proposed to save $771 billion over 10 years scdhhs estimates an additional $100 million impact on state budget

24 near-term decision points payment reform lower costs = lower payments? what parameters do we set in negotiating a new system? leverage? dsh dsh or rates? changing the threshold (1%)? reduced dsh/reduced tax? winners and losers?

25 near-term decision points federal budget advocacy future cuts will come through congressional actions can scha members have an impact? is there a sense of futility in working with our delegation? if so, can we change it and how do we change it?

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