4/4/2014. Affordable Care Act Update. Affordable Care Act Update Federal Issues State Issues Election
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1 New Jersey State Association of Medical Staff Services 21st Annual Education Conference April 11, 2014 John Slotman VP, GME Policy and Teaching Hospital Issues New Jersey Hospital Association Affordable Care Act Update Federal Issues State Issues Election Affordable Care Act Update Healthcare.gov rollout Initial rollout beset with delays and design flaws 2014: much stronger enrollment numbers Strong March yielded 7 million marketplace sign-ups, 3 million Medicaid by 3/31 deadline NJ estimates: 74k marketplace; 86k Medicaid 1
2 Notable ACA Delivery System Reforms Bundling Medicare Shared Savings Program ACOs Independent Payment Advisory Board (IPAB) Gainsharing Self-referral Value-based purchasing (VBP) Center for Medicare and Medicaid Innovation Readmissions Medicare Shared Savings Program (SSP) ACA Section /1/2014: 343 established nationally Over 4 million total beneficiaries MedPAC Scrutiny More one-sided risk? Niche ACOs NJ and Medicare ACOs: Perfect Together MSSP ACOs As of 1/1/14: 18 ACOs serving NJ beneficiaries; 12 hospital led or co-led, 11 NJHA members Data released 1/30/14 54 of 114 lower expenditures than expected 29 ACOs generated $126 million in shared savings; 2 generated losses; $128 million in net savings to Medicare NJ: 4 ACOs in 2012 cohort; 2 shared savings generators Additional, ACO-specific data release later this year SOURCE: NEW JERSEY HOSPITAL ASSOCIATION 2
3 Hospital-Specific Federal Issues Two-Midnight Rule Imputed Wage Index Floor RACs PAC GME SGR Budget Hospital-Specific State Issues 3
4 SFY 2015 Budget $34.4 Billion budget (up from $32.9 Billion in SFY 2014) Largest budget in state history. Considered a status quo budget No new taxes / No tax cuts. $2.25 Billion payment to pension system Largest payment in state history. SFY 2015 Budget $9 Billion in direct aid for school. $2.3 Billion for higher education, an increase of $159 Million. $313 Million projected surplus Current budget has a $331 Million shortfall. SFY 2015 Budget - Overall Hospital Funding Maintained at $985 Million Charity Care- $650 Million ($25 Million) Graduate Medical Education - $100 Million DSRIP - $166.6 Million Mental Health Subsidy Fund - $24.7 Million An increase in Medicaid spending, from $3.95 Billion to $4.16 Billion Rutgers Biomedical and Health Sciences, University Hospital and Rutgers Camden to join with Medicaid managed care organizations to help the administration devise a program to innovate and improve healthcare delivery under Medicaid and Family Care. Pursue a three year accountable care organization pilot program. Flat funding for nursing homes. 4
5 Charity Care $650 Million allocated through three separate pools: First pool = prior year s distribution; will account for 78.5% of the overall distribution ($ million.) Second pool = increases and decreases in charity care documentation over calendar years 2011 and 2012; will account for 20% of the overall distribution ($130 million.) Third pool = bonus pool, hospitals will have to show consecutive growth in documented charity care claims from 2010 to 2011 and then again from 2011 and 2012; will account for 1.5% of the overall distribution ($9.75 million.) Funding distribution levels subject to a $1.10 cap. Legislative Priorities ** Access to Care ** A-2161 (Huttle; D-Englewood) / S-1204 (Weinberg; D-Teaneck) service requirements for FQHC s. A-1918 (Conaway) affidavit of merit / expert witness. A-1071 (Schaer; D-Passaic) healthcare provider priority in power outages. A-2033 (Greenwald; D-Voorhees) / S-88 (Singer; R-Lakewood) - physician loan redemption. Legislative Priorities A-1069 (Schaer; D-Passaic) / S-869 (Vitale; D-Woodbridge) out of network. A-647 (Moriarty; D-Turnersville) / S-1183 (Vitale; D-Woodbridge) mandated nurse staffing ratios. A-2554 (Garcia, D-Hoboken) / S-1153 (Weinberg; D-Teaneck) hospital reporting. 5
6 Election Postmortem 2013 Behind Us Up Next: 2014 NJ: 3 vacancies (Andrews, Runyan, Holt) Senate: Sen. Booker running for full term U.S. House: GOP expected to maintain control U.S. Senate: Up for grabs? GOP needs 6 seats for control Races to watch include CO, NC, AK, AR, KY, LA 538: GOP 60% chance Questions John Slotman jslotman@njha.com
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