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Legislative Issues

Legislative Issues. August 23, 2006. Federal Issues. CAH Relocation. FY06 inpatient hospital regulation set new rules for when a necessary provider CAH could relocate. Established the “75% rule” – CAH must serve 75% of same population, provide 75% of same services, employ 75% of same staff.

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Legislative Issues

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  1. Legislative Issues August 23, 2006

  2. Federal Issues

  3. CAH Relocation • FY06 inpatient hospital regulation set new rules for when a necessary provider CAH could relocate. Established the “75% rule” – CAH must serve 75% of same population, provide 75% of same services, employ 75% of same staff. • CMS Interpretive Guidelines issued last fall were far more prescriptive… • 75% rule more prescriptive (e.g., mentions policies and procedures, billing codes). Requirements for 75% test are more rigorous for necessary provider CAHs • CMS has up to one year AFTER relocation to do final determination.

  4. Problems and Steps • Problems • Too prescriptive and inflexible • More expensive to build on same site • Uncertainty – trouble securing financing since final determination not made until after relocation • Steps • Commented in FY07 inpatient rule • Congressional House Letter (Rep. Moran, Rep. Ryun) • Congressional Senate Letter (Sen. Roberts, Sen. Brownback)

  5. Medicare AdvantageRural Health Services Preservation Act • H.R. 880: 101% of cost for inpatient and outpatient services at CAH and rural health clinics • S. 2819: Choice of interim rate (101% of cost) and cost reconciliation OR 103% of interim rate for inpatient and outpatient services at CAHs and rural health clinics

  6. Extending MMA • Rural Hospital and Provider Equity (R-HoPE) Act of 2006 (S. 3500) • Would create or increase Medicare payments to rural hospitals and make changes to guidelines for CAHs (such as outpt lab, ambulance). • Medicare Rural Health Provider Payment Extension Act (H.R. 5118) • Similar to R-HoPE and would address outpatient laboratory and 5% rural add-on for home health services.

  7. Other Legislation • CAH Outpatient Lab Reimbursement • Critical Access to Clinical Lab Services Act (S. 236/H.R. 1016) • Cost Based Reimbursement for Ambulance Services • Rural Access to Emergency Services Act of 2005 (S. 1108/H.R. 2525) • 340b Drug Discount • Safety Net Inpatient Drug Affordability Act (S. 1840/H.R. 3547) • Home Health Services • Medicare Rural Home Health Payment Fairness Act (S. 300/H.R. 11) • Expansion of Cost-Based Reimbursement • Rural Community Hospital Assistance Act of 2005 (S. 933/H.R. 2350)

  8. Other Legislation • Rural Health Care Capital Access Act (H.R. 4912) • Provide a 5-year extension of the HUD 242 program • The Comprehensive Immigration Reform Act (S. 2611) • Would extend permanently the State 30/J-1 visa program; allow more qualified, internationally trained nurses to work in U.S. • The Health Information Technology Promotion Act (H.R. 4157) • Accelerate the use of health information technology and would establish national standards on privacy. Offers anti-kickback and physician self-referral exemptions for hospitals that share hardware, software, or information training and support to physicians.

  9. State Issues

  10. Looking Ahead… • Transparency • Pricing, Quality, etc. • Billings and Collections • Medicaid • Health Policy Authority • Uninsured • Concealed Weapons • Fire Mashal and State Surveys • Other legislative issues: • Infection reporting; staff ratios; workforce

  11. The Time is Now.. • DO invest in a relationship with your legislators • DO invite them to the hospital • DO share with them any issues, concerns • DO thank them for their support • DO let us know if you have a personal relationship with your legislators

  12. Questions?

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