Safety Net Meeting April 22, 2008

1. Safety Net MeetingApril 22, 2008 Utah Legislative Update Deb Wynkoop UHA

2. Political Environment

3. Political Environment

4. Political Environment

5. Political Environment What We Know • 3 sitting senators attempting to be Pres • 21 GOP senators up for re-election vs. 12 Dems • 25 GOP and 2 Dem House members retiring • 51- 49 margin in Senate with Dem majority • Historically low congressional approval rating • November 4, 2008

6. Political Environment • Economy/economic stimulus will dominate • President’s budget slashes Medicare • Short legislative year • Lame duck administration • Key markers • May 25: Medicaid • June 30: Medicare • Endgame

7. Political Environment What We Don’t Know • Roadways vs. roadblocks • Impact of presidential nominees on process

8. Utah State Budget Overview • Legislator’s allocated $775 million in new funds for 2008-2009 • $441 million prioritized for new school funding • $100 million for future public education • $72 million for public safety, for corrections, UHP officers, county jails and new prison in Gunnison.

9. Utah State Budget Overview • $60 million to the state’s rainy day funds • $18 million in tax cuts for self employed families who purchase own health ins. • $14 million for Medicaid needs • $12 million for Higher Education

10. Health and Human Services • FY 2009 appropriated budget is $66,929,500 over the 2008 budget • 2.6% increase • General Fund increased by $28,078,200 or 4.3%

11. Major Funding Initiatives • Provider Contract COLAs of 3% based on operating budget • Federal Medical Assistance Rate Change funded • Medicaid Inflation/Provider Reimbursement Rates increased 2-3% • Inpatient Hospital increase 2.7% • Outpatient Hospital increase 3.3%

12. Major Funding Initiatives • Baby Watch Early Intervention reallocation for 6% provider rates and 5% caseloads • Immunization funding for underinsured children one time $500,000 • Medicaid adult dental services • Community Health Centers one-time GF for grants to serve medically uninsured • Medicaid funding decrease utilization

13. Budget Policy Initiatives • HB 326 Children’s Health Insurance Program – Open Enrollment $2,700,000 on going GF for the FY 2010 base with non-lapsing appropriation • HB 133 – Health System Reform - $615,000 on going and $882,000 one-time GF. Creates a multi-agency strategic reform plan & 11 member task force

14. Budget Policy Initiatives • HB 133 provides funding to encourage standard electronic medical records • Additional partnerships to work on health care reform – UHA Health Care Coalition • Members appointed – Sen.Killpack, Knudson, Bell and Davis • Rep. David Clark, Barrus, Daw, Newbold, Painter, Litvak and Biskupsi

15. Failed Bills • HB 168- Health Insurance Market – Allowed insurance companies to offer products without state minimum mandates • HB 491 – Health Plan Exemption for Selected Requirements • Issues may be discussed in the Health Care Task Force

16. Workforce Budgets • Nurse education funding with Utah hospitals paying match $2 million ongoing • Health care initiative $900,000 to Dixie and SLCC for health care workforce • Medical Education Council $220,000 GF to replace dedicated credits lost

17. Other UHA Bills of Interest • HB 121 – County Charges to Incarcerated Persons requires all counties to pay Medicaid rate to hospitals and PEHP rates plus 35% to physicians w/o a contract for services to county inmates • HB 47 – Standards for Exchange of Electronic Health Information. Establishes statewide standards

18. Other UHA Bills of Interest • H.B. 140- Child Restraint Device Amendments – children under 8 in child seats • H.B. 268- Health Facility Committee Membership – adds a hospital affiliated outpatient ASC member • HB 74 – Medicaid 340B Drug Pricing Program – Requires UDOH to explore expanding the program

19. UHA Tracking • HB 82 – Notice of Changes to State Medicaid Plan – Requires UDOH to notify the legislature when changes are made • HB 277 – Pandemic Preparedness Amendments – provides immunity in disasters for use of a building for vaccine distribution • HB 366- Medicaid Long Term Care Amendments – changes bed banking and limits growth without UDOH oversight

20. UHA Tracking • HB 399 – Medication Aide Certified Amendments – ongoing certification by DOPL for medication aides. • SB 66 – Uniform Emergency Volunteer Health Practitioners Act – Outside volunteer registration in response to a declared emergency • SB 93 – Licensed Direct Entry Midwife – defines normal birth, clarifies client transfer requirements for hospitalization

21. UHA Tracking • SB 97 – Immigration Task Force • SB99 Amendments to Sales and Use Tax for Prosthetic Devices – tax exemption for prosthetic devices • SB 146 – Amendment to Uniform Anatomical Gift Act – coordinates directions from a pt. under an advanced directive to declare to make a gift

22. UHA Tracking • SB 161 – Advance Health Care Directive – Describes standards surrogates use when making a health care decision, modifies the POLST form • Training is available from the Utah Bar.

23. 2008 State Elections • Senate Leadership Will Have Some New Faces Next Year • The most influential Senators in the Utah Legislature are resigning, signaling a changing of the guard. Senate Majority Whip, Davis County's Dan Eastman, the Rules Committee Chairman, Senator Bill Hickman, and Minority Leader Mike Dimitrich • Senate President John Valentine isn't worried.

24. Questions? Deb Wynkoop UHA, Utah Hospitals & Health Systems Assn 801-486-9915