Bob Olsen, vice president Montana Hospital Association April 21, 2017
Legislative Session Recap State Advocacy Issues Looking forward to 2017-19 Federal Advocacy ACA and the Trump Administration Other Issues Regulatory Relief
Full funding of Medicaid program Preservation of Medicaid expansion Funding the true Medicaid growth rate Provider rates Medical education WWAMI and Residency funding Increase Physician loan repayment program Air Ambulance
Immunizations opt-in Suicide Prevention Primary seat belt law Telemedicine Violence against Care Workers Care Act - AARP
Tax-exempt status Raising age for tobacco purchases from 18 to 21 Pricing Transparency - hope to avoid Dementia/Guardianship Community-based mental health services (especially crisis services) Drug-addicted babies Pain Patient Bill of Rights (re: chronic pain management) Role and scope of Medical Assistant Community paramedicine
Public very frustrated by high health care costs and increasing insurance premiums Some payers worked hard to pin blame on hospitals some legislators bought the argument Hospital practices and community relationships were easy targets After all said and done, we came out okay, but with a lot of work to do
Medicaid growth rate funding levels are reasonable, but unsure whether funds are adequate for 2 years No rate increases for hospitals, others CAH continues at 101% of cost HUF funded NF bed tax increase to provide Medicaid pay hike Medicaid expansion fully funded ($82 million gf) WWAMI adopts a claw back policy Residency funding increased MRPIP increased to $150K
HB 17 Increased Home/Community Waiver HB 70 Guardianship/WINGS group HJ 20 Study transparency (passed House) SB 92 Proxy decision making in health care SB 166 Update interstate nursing compact (Senate) HB 618 Increase NF utilization fee HB 237 Behavioral Health/Crisis intervention team HB 163 Montana Care Giver Act (AARP)
SB 44 Mediation of balance bill for out-of-network air transportation sent to Governor for approval HB 73 Regulate ambulance membership plans as insurance sent to Governor for approval SB 353 Excise tax on air ambulance charges above 275% of rural Medicare amount TABLED SJR 13 Urge Congress to allow State regulation of air ambulance (ADA Issue) SB 292 Limit reporting balance bill delinquency to credit rating agencies sent to Governor
HB 331 Executive pay over $250K lose property tax exemption SB 364 340B hospital refuse to contract with community pharmacy lose tax exempt status and pay income tax on pharmacy revenue HB 395 Place hospitals under PSC review for charges above 250% of Medicare allowed HB 634 Levy hospital fee equal to executive pay to fund medical education HB 667 Study reference based pricing to determine if mandate on hospitals reduce costs
What does this term mean? Something different to everyone! HB 123 Surprise bills and network status HB 400 Price transparency and penalty SB 96 Price transparency with penalty and insurance requirement to pay incentives to shop for health services SB 362 Price transparency with penalty and insurance requirement to pay incentives to shop for health services
HBs 123 and 400 merged with SB 96 New disclosure and consumer assistance requirements for providers, payers Insurance companies mandated to offer incentives to shop for services No new penalty SB 362 (passed Senate, on House floor) New disclosure and consumer assistance requirements for providers, payers No mandate to offer incentives to shop Modest penalty for failure to provide estimate
SB 9 primary seat belt law Tabled HB 293 Release of Immunization information HB 430 Allow exception for tavern in senior living facility
Implement 2017 legislative changes Continue to measure and publicize Medicaid expansion impacts Provide members with resources and administrative tools to: Improve price transparency and other patient financial assistance Improve community public relations about hospital operations Improve public understanding of health care costs
President Trump and Congressman Ryan lead the effort at ACA repeal and replace Medicaid reform Per capita cap and block grants State flexibility Future of Medicaid expansion Regulatory relief do you believe it? Secretary Price actions (tbd) Innovation Center and payment reforms Support or undermine federal exchanges?
April 28: Continuing spending resolution expires April May: Trump sends budget detail to Congress May June: Congress action on FY 2018 budget resolution September 1: Committees report FY 2018 reconciliation bills October 1: FY 2018 begins
GOP American Health Care Act Repealed individual/employer mandates, penalties for no coverage, insurance subsidies, taxes that paid for coverage Phase out Medicaid expansion beginning in 2020 Phase in per-enrollee cap on federal Medicaid spending in 2020 Replace income/geographic subsidies with agerelated tax credits ranging from $2,000 to $4,000
Warring factions within Republican Party Freedom Caucus vs the Tuesday Group Lack of leadership/engagement by Trump administration AHCA was a bad bill CBO estimated 24 million people lose coverage by 2026 Medicaid expansion rolled back reform to block grant with a 25% reduction Bill drafted behind closed doors/public approval just 17% Tax credits based on age $2000 - $4000 inadequate Next steps unclear as talks continue
Let the individual market/exchanges collapse Make the AHCA more conservative Straight repeal as in 2015 bill Package of fixes Bipartisan deal
What ACA regulatory changes will Trump WH propose? Will Trump administration take steps to stabilize insurance market or let it drift? How Congress-WH handle cost-sharing reductions Outcome of House lawsuit charging that funds weren t appropriated Will WH-Congress seek to appropriate funds in April 28 CR? How many insurers will participate in 2018 June 21 deadline for first filing
Questions about future of ACA created uncertainty among providers difficult to make long-term strategic decisions If ACA is repealed: Any new plan should ensure coverage levels achieved under the ACA are maintained or improved Any new plan should ensure adequate coverage for enrollees Congress should act simultaneously to replace If repeal and replace are not simultaneous, payment reductions to providers in the ACA should be restored and further Medicare/Medicaid cuts should not occur
Medicaid restructuring should ensure high-quality care and sufficient funding, and treat all states equitably Significant regulatory reform is needed to address the burden faced by hospitals and systems Continue efforts to move to fee-for-value payment that provides incentives for clinically-integrated coordinated care
April 28: Fund government through September 30 Deficit reduction tied to debt ceiling or FY 2018 funding Future of rural health AHA TF recommendations October 1: CHIP reauthorization Tax reform 501(c)3 status Routine business 96 hours, direct supervision, workforce October 1: Fund government for FY 2018