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Health Care Grassroots Webinar, September 22

Health Care Grassroots Webinar, September 22. Happy Anniversary!. 6 month anniversary of health care reform. Several benefits kick in tomorrow Invitation to join in WH call with Wakefield, Vilsack conference call. The positives of health reform.

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Health Care Grassroots Webinar, September 22

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  1. Health Care Grassroots Webinar, September 22

  2. Happy Anniversary! • 6 month anniversary of health care reform. • Several benefits kick in tomorrow • Invitation to join in WH call with Wakefield, Vilsack conference call.

  3. The positives of health reform • Insurance reforms. Sept. 23rd key date. • High risk pools; $5 billion funded • Children with pre-existing conditions • Caps on coverage eliminated • Preventive care benefits • Covering children up to age 26

  4. May be nothing to smile about. • Few candidates are running on health reform platform. Most are running away from it. • Polls still consistently show low approval for health care reform. • Federal and personal health care spending still on rise. • Out of pocket increases expected, at least temporarily. • Federal spending expected to rise as 32 million slowly become insured. • Much Confusion around law, much misinformation

  5. Rural Agenda: the fight continues… • Yesterday’s Fight: Rural victories in health care reform. • Today’s Fight: Making sure programs are properly funded and regulations work for rural providers and patients. • Tomorrow’s Fight: What legislation was left out? What will happen in a new Congress?

  6. The workforce shortage crisis must be abated; Equity in reimbursement must occur; Disparities must be eliminated. Three reforms were crucial:

  7. What’s the latest? • Commissions/Studies • Legislation • Regulations

  8. Commissions/Studies • IOM Study on Geographical Variations • Met last week. • Will prepare two reports for Congress over 24 months (Spring 2011, Spring 2012) • Stakeholder input encouraged • MedPAC Study on Adequacy of Medicare Payments for providers in rural areas. (Met with Dr. Tom Dean last week.) • Study will include: • Analysis of Payment adjustments • Impact on Access to Care • Report to congress on Jan 1, 2011 and report on appropriate modifications needed in rural areas.

  9. HPSA/MUA negotiated rule making • Meeting for first time today. • Alan Morgan, CEO of NRHA is in attendance. • Timeline: 6 months (meet 3 consecutive days each month.)

  10. Medicare Advantage • Despite looming cuts - - New report citing premiums are actually going down due to new regulations • $136 billion in savings projected over 10 years.

  11. Legislation 110th and 111th

  12. The daunting doc problem • Sustainable Growth Rate Fix legislation will occur likely in November • Temporary fix averts crisis until December. 23% cut looms. 30% cut in January, 2011 projected. • 10 times in past 7 years, physicians have faced Medicare payment cuts that were avoided only after Congress intervened. • Each temporary congressional fix, merely put off cuts to some date in the future. • Long term fix - - replacing the formula - - $210 billion. • This will be the one moving health vehicle in the lame duck session.

  13. 340B and orphan drug problem • Senator Franken (D-MN) interested in legislation • Looking for a Republican lead • Important to get bill introduced in 110th Congress • Urgency/FDA concern

  14. Necessary Provider • S. 1171 – new discussions with Senator Pryor’s (D-AK) office • Senator Bayh (D-IN) interested in getting this done before he resigns. • Attempts to fine-tune language to get a reasonable CBO score.

  15. Inpatient Rule/Provider Tax Concerns • Rep. Ron Kind (D-WI) to introduce legislation to address provider tax concerns. • Kind legislation - intention that cost reports couldn’t be reopened retroactively and the rule would be nullified going forward.  • Look for alerts – need cosponsors asap!

  16. Senate Briefing Today • Health Reform and Regulatory Implementation of health reform • Meaningful Use • Goal is to establish foundation for future legislation.

  17. New Congress Legislation to eliminate: • Mandate • IPAB • General “Whittling” • Appropriations

  18. What if I don’t like it? 1) Repeal • Legislation already filed. • Not votes to pass - - and even if it did - - likely not 2/3 votes to override presidential veto. 2) Opt Out – Oklahoma opt out ballot measure. • Preemption Clause of the Constitution prohibits a state from opting out of a constitutional law. 3) Declared unconstitutional by Supreme Court

  19. Constitutional Challenges by various states • State attorneys general filed suit against federal government. • Claims health care overhaul is unconstitutional because federal government does not have constitutional authority to mandate coverage • Additionally claims it mandates unfunded requirements on states.

  20. A Constitutional Battle • 10th Amendment – “powers not delegated to the United States by the Constitution…are reserved to the states respectively, or to the people.” • Article 1 – Commerce Clause, grants authority to regulates interstate commerce has been enshrined in court decisions since Justice Marshall. New Deal tested Commerce Clause. Broadly interpreted. • Likely to be decided by Supreme Court.

  21. Will health reform be a factor in November? • House 253-178 • Senate 59-41

  22. Stay Invovled!Our fight Continues • Implementation in Critical! • Appointments for Workforce Advisory Committee • Appointments for IPAB • Grant opportunities • Appropriations process is critical! • We must fight for what’s left out! • New legislation is coming!

  23. And, don’t forget the regulations • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…” • “Secretary Shall…”

  24. Regulations • CMS Inpatient Prospective Payment System (IPPS) proposed rule for Acute and LTC Hospitals (Provider tax) • Supplemental rule based on ACA requirements (ACA payment bonuses) • Telemedicine Credentialing changes for CAHs • FCC Broadband Rule • Medicare Physician Fee Schedule • Outpatient Prospective Payment System • Many, many, many more to come

  25. Outpatient Proposed Rule • Direct Supervision • comments filed, on our website. • “Direct supervision” at initiation of service”; then “general supervision for duration of service. • Also contains GME/IME provisions in ACA • Final Rule expected in October/November

  26. FTC Broadband Rule Rural Broadband Support Programs • Infrastructure • 85% match concern • Administrative burden • Broadband Services • Replaces current program and sets up broadband speed 4 mbps • Rural providers need sliding scale of support • Proposed tie-in to “meaningful use” • Strongly opposed by NRHA

  27. Meaningful Use changes in Final Rule • Flexibility for Eligible Professionals (EP) and hospitals for demonstrating MU—NPRM was all or nothing • Divides objectives into “core group” of required objectives and a “menu set” of procedures from which providers can choose any 5 to defer to 2011-12 • Hospital-based EP Definition • CAH’s defined as acute care hospitals for purpose of incentive program under Medicaid

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