legislative agenda – past and future

1. legislative agenda – past and future regulatory legislative acts legislation pending Leadership Summit July 29, 2016

2. recap of 2015 – 2016 legislation • federal update • con post mortem • legislative and regulatory issues relative to strategic plan

3. 2015-2016 enacted legislation • Budget issues • Medicaid – no hospital rate cuts • HOP – primary care provider fund reduction • DSH rural hospital cap removed • Rural health initiative – 24/7/365 rural ED • DHEC – stroke prevention coordinator • DMH – crisis stabilization units • Healthcare decisions • Behavioral health – emergency admission – gravely disabled

4. enacted continued • CPR training high school requirement • Safe haven posting • Hope’s law – dense breast tissue reporting • SC telemedicine act • Coordinating council for workforce development

5. legislation not adopted • Abolish DHEC • Nurse Discipline Act • Birthing Centers • Infant CPR training • Concealed Weapons Permits • Assaulting Healthcare Workers • Tort Reform Changes • Nursing Scope of Practice • Medicaid Expansion study • CON

6. federal update • stark & anti-kickback law reform • provider relationships under new payment models • provider – patient relationship to meet new standards • proposed opps rule (site-neutral provisions) • stars ratings • hospital bill

7. con reform – in memoriam

8. 7 year timeline • 2010 • Senator Cleary reform bill passed • Vetoed • Overridden • 2011 • Gov. Haley vetoes revision bill re: methodone clinics – overridden • Gov. Haley vetoes con program in budget bill – overridden • SCHA forms con workgroup to look at reform

9. 2012 • DHEC review panel established • Peeler hearing on con repeal • Gov. Haley again vetoes funding in budget – overridden • December – Gov. Haley fy 13-14 budget – no con • 2013 • DHEC approves study committee recommendations on reform • Sen. Peeler files S.568 to enact DHEC recommendations • Bill stalls on senate floor – equipment threshold • Gov. Haley again vetoes con budget – sustained • DHEC suspends CON permitting process • SCHA/SCHCA file suit in Supreme Court

10. 2014 • Supreme Court rules for con • Programs established during suspension become main focus – “grandfather clause” – home health • No consensus – reform bills die • Ways and Means establishes reform subcommittee • SCHA testifies supporting consensus position • https://www.youtube.com/watch?v=2msbfN81Gm0 • H.3250 pre-filed for 2015 – 2016 session • 2015 • Ways and Means reports bill to floor with sunset provision • House passes overwhelmingly with sunset • Senate Medical Affairs reports out – no hearing – minority report

11. 2016 • Sen. Cleary holds hearing – agrees to remove sunset • H.3250 stays on senate calendar • https://www.youtube.com/watch?v=rdlL65LD6I4&feature=youtu.be&t=114 • Bill dies at end of session – no reform – no repeal • future of con • will remain a contentious issue for Governor and many legislators • consensus hospital position will remain elusive – will need unanimity • devour political capital

12. advancing your legislative agenda

13. behavioral health • rank potential solutions by effectiveness and probability of accomplishment • divide actions into agency and legislative (imd exclusion, funding) • identify partner groups and develop an action plan with specific items and targets • recruit legislative “champions”

14. graduate medical and nursing education • develop plan for administering state funded residency positions • update one voice, one plan data to reflect current status of faculty shortages

15. scope of practice • Examine research and data to determine potential level of care possible within certain parameters • Look for consensus among physician and non-physician providers • Adjust statutory limits for each non-physician provider to allow facilities flexibility in credentialing • Work to adjust government and private payers reimbursement policies based on changes to non-physician permitted services

16. coverage expansion • pray!!! • 100% commitment from major systems • outcome of national election • engage local government and law enforcement • behavioral health – dmh • garner key republican support • leverage disconnect between executive and legislative

17. telemedicine and licensure compacts • support sc board of nursing and llr in passing revisions to the nurse compact • Seek support from the sc board of medical examiners to support legislation enacting the interstate medical licensure compact • Work with telehealth partners to develop legislative support for passage • Work with the sc board of medical examiners to seek grant funding to lower the costs associated with implementation

18. Con • reform to the lowest common denominator • bunker strategy – fight repeal efforts • stay out of the fight all together