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AWPHD Retreat for Chief Executive Officers and Administrators Only

AWPHD Retreat for Chief Executive Officers and Administrators Only. Legal Update. The Lodge at Suncadia May 20-21, 2009. Additional State Legislation. Special election date changes (ESHB 1018) Changes February date from first Tuesday to second Tuesday Eliminates election date in March

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AWPHD Retreat for Chief Executive Officers and Administrators Only

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  1. AWPHD Retreat for Chief Executive Officers and Administrators Only Legal Update The Lodge at Suncadia May 20-21, 2009

  2. Additional State Legislation Special election date changes (ESHB 1018) • Changes February date from first Tuesday to second Tuesday • Eliminates election date in March • Permits use of May date until July 1, 2011 solely for levies that failed previously in the same calendar year and new bond issues and eliminates May election after that date • Reduces deadline for submission of ballot proposition resolution for spring elections from 52 days to 45 days

  3. Additional State Legislation (cont.) Changes to procedures for unannounced inspections of hospitals by the Department of Health (2SHB 1201) • DOH cannot issue its final report for an unannounced inspection until: • Hospital is given at least two weeks to provide any information or documentation requested by DOH that was not available at the time of the request • At least one DOH inspector meets personally with CEO or CEO declines meeting

  4. Additional State Legislation (cont.) New reporting requirements (SSB 5056) • Hospitals must report treatment for bullet, gunshot or stab wounds provided to patients who are unconscious and requires that evidence be preserved • Imposes similar (although somewhat broader) reporting requirements on physicians, EMTs and paramedics who provide treatment outside of a hospital

  5. Additional State Legislation (cont.) Changes to procedures for filing claims against PHDs (ESHB 1553) • Claims for health care injuries are exempted from the claims filing procedures • Claims must be presented on a special form maintained by OFM or special form developed by PHD, which must be made available by PHD

  6. New EMTALA On-Call Options Effective October 1, 2008, the EMTALA rules were revised to authorize “community on-call plans” that include the following elements set forth in a signed agreement: • Delineation of each hospital’s responsibility • Description of geographic area covered • Inclusion in EMS system protocols • Confirmation of continuing EMTALA obligations • Annual review

  7. New CAH Payments for Lab Tests • MIPPA of 2008 mandated that effective July 1, 2009, lab tests furnished by CAH be paid on cost basis regardless of whether patient is physically present at CAH at the time specimen is collected • Proposed rules require that lab test be provided to individual who is “an outpatient of CAH” (registered at the hospital; receives services directly from the CAH on same day specimen is collected; or specimen is collected by employee of CAH)

  8. Capital Markets-Crisis • Hospitals may have been among the most severely affected by dislocations in tax-exempt markets • Providers have been forced to reassess their capital needs and sources of capital • Credit will be harder to access, cost more and carry with it more restrictive terms • Long-term planning for credit worthiness and financial viability are critical

  9. Capital Markets-Municipal Yields To Treasuries

  10. Capital Markets-Historical SIFMA Index

  11. Capital Markets-Looking Ahead • Fewer players in the municipal market: underwriters, bond insurers, letter of credit banks, etc. • Emphasis on borrower’s credit • No Bond Insurers • Limited Letter of Credit availability • Continued volatility, challenging market conditions

  12. Capital Markets-New Opportunities • Annual tax-exempt debt limitation for Bank Qualification under Section 265(b)(3) is increased to $30,000,000 for bond issued in 2009 and 2010 • Build America Bonds (“BABs”) for bonds issued in 2009 and 2010 • FHA Section 242 Insured Mortgage Program for Hospital Financings

  13. Capital Markets-Continuing Disclosure News • Amendments to SEC’s Rule 15c2-12 will be effective July 1 • All continuing disclosure filings under new Continuing Disclosure Undertakings will be made to the MSRB’s new EMMA system • SEC’s No Action letters to existing NRMSIRs will be withdrawn effective July 1 and sole NRMSIR will be the MSRB via its EMMA system

  14. Other Topics • Performance audit update • Application of IRS Form 990 reporting requirements to PHDs • Audit activities and update requirements relating to retirement plans • Recent court decision expanding reporting requirements under HCQIA relating to “investigations” • Recent court decision raising Stark and Anti-kickback concerns for hospital-based provider agreements

  15. Contact Information Brad BergTelephone: 206-447-8970Email: BergB@Foster.com Foster Pepper PLLC1111 Third Avenue, Suite 3400Seattle, WA 98101www.foster.com 15

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