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Northeastern New York Chapter HFMA

Stay updated on the state and federal budget updates that affect healthcare, including nurse staffing ratios and Medicare payment rules for 2020. Learn about the impact on hospitals and the need for advocacy.

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Northeastern New York Chapter HFMA

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  1. Northeastern New York ChapterHFMA April 10, 2019 Melanie Graham. Director of Federal Fiscal Policy Bob McLeod, Director of State Fiscal Policy and Special Studies

  2. Agenda State Update • State budget update • Nurse Staffing Ratios Review Federal Update • President’s Budget. • HANYS federal priorities • What to expect in the Medicare payment rules for 2020

  3. 2019-20 budget

  4. Key hospital issues to be studied or moved to commission • No new investments • Significant cuts • $2.3 B revenue gap announced post-budget release (30 day amendments)

  5. Top 10Budget Outcome on Major Fiscal-Related Healthcare Topics

  6. Top 10Budget Outcome on Major Fiscal-Related Healthcare Topics

  7. Current scope of state-funded capital and capital related investments Capital/Capital-Related Investments

  8. Indigent care pool Full ICP method expires Executive budget -Jan: no policies -30 day: $285M cut • Final - current distribution methodology, including transition adjustment extended (1 year) through Dec. 31, 2020. Increases the maximum percentage transition loss by 2.5%, from 17.5% to 20%. • HANYS advocating against federal DSH cuts Federal Medicaid DSH cuts begin Final Budget - no ICP cuts Jan. 2019 April 2019 Dec 2020 Oct. 2019 Feb. 2019

  9. And Many Other Provisions… Available at: https://www.hanys.org/fetch/?file=/communications/elerts/attachments/5c84049a-9667-482-2019-2020-final-state-budget-chart.pdf

  10. Nurse staffing ratios review

  11. Nurse Staffing Ratios Update • Surveys and studies • HANYS’ approach • Timeline

  12. Surveys and Studies

  13. Supported by: HANYS’ Approach • Hospital engagement • Nurse recruitment • Coalition building to help press legislators Far-reaching and diverse (business organizations, nursing and health care groups, advocacy organizations) • Communicating impact of cost on access to care Localizing and contextualizing impacts of nurse staffing ratios

  14. Timeline

  15. Federal update

  16. President’s budget for FFY 2020 Key healthcare issues: • Site Neutral • 340B • GME • DSH • Medicaid Expansion • Unified PAC

  17. Impact of enacted federal cuts on NYS hospitals (2019-2028)

  18. Federal priorities

  19. 2019 federal advocacy priorities

  20. Medicaid DSH: cuts looming • Cuts set to begin Oct. 1 • $44 billion in cuts nationally; $7 billion in cuts to NYS over the next decade

  21. Medicaid DSH: NYS exposure • This SFY, hospitals face $330 M in Medicaid DSH cuts ($660 M on a FFY basis) • In just the first two years, NY would see a nearly 70% reduction in its federal Medicaid DSH support, reducing available federal DSH funds from $1.8 B annually to around $600 M annually • Top state penalized by policy

  22. Bipartisan letter: delay Medicaid DSH for 2-years

  23. Medicare DSH: S-10 transition

  24. Medicare DSH: S-10 audits Fall of 2018 – 1st round of S-10 audits for selected hospitals

  25. Overview of S-10 audit questions • Q1-3: Charity care policy • Q4-5: Logic and process to identify charges and payments for line 20 and 22 • Q6: Detailed listing of claimed charity care and payments • Q7-9: Back-up for the detailed listing above • Q10-11: Comparison with prior year and explanation for variance • Q12-15: Bad debt info. Including detailed listing and reconciliation • Q16-17: F/S and trial balance for audit year and prior year

  26. S-10 audits: issues • Only 600(25%) hospitals nationally were selected • Only 2015 S-10 data was reviewed • Administrative burden to answer 17 detailed questions • No standardization among MACs nationally • Inconsistencies with how & what adj. were made (i.e. line 22 actual vs. expected payments) • Unsure how the data will be used

  27. Site-neutral policy update

  28. 340B drug discount program update

  29. Medicare payment rules for 2020 • Proposed Rules • IPPS; IRF; IPF; SNF • Final Rules • IPPS; IRF; IPF; SNF • Proposed Rules • OPPS; HH; PFS • Final Rules • OPPS; HH; PFS Jan. April Dec. Oct. Nov. Aug. Sept. July June May Effective date Effective date

  30. Potential changes we could see. . .

  31. Melanie Graham, Director Federal Fiscal Policy mgrahan@hanys.org 518/431-7687 Bob McLeod, Director State Fiscal Policy and Special Studies bmcleod@hanys.org 518/431-7908

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