Legislative Update

1. Legislative Update November 30, 2007

2. 2008 Legislature • House of Representatives • 125 Members • 78 Republicans/47 Democrats • Speaker Melvin Neufeld (R-Ingalls) • Senate • 40 Members • 30 Republicans/10 Democrats • Senate President Stephen Morris (R-Hugoton) • Governor’s Office

3. 2008 Potential Topics • Health Reform • Limited Service Facilities • Health Care Data Transparency • Health Care Workforce • Health Insurance/Hospital Reimbursement • Other Issues

4. Kansas Health Policy Authority’s Health Reform Recommendations • Transparency for consumers: Health care cost & quality transparency project • Promote health literacy • Define medical home • Increase Medicaid provider reimbursement • Implement statewide Community Health Record • Promote insurance card standardization

5. Kansas Health Policy Authority’s Health Reform Recommendations • Increase tobacco user fee • Statewide ban on smoking in public places • Partner with community organizations • Include Commissioner of Education on KHPA Board • Collect information on health/fitness of Kansas schoolchildren • Promote healthy food choices in schools • Increase Physical Education • Wellness grant program for small businesses

6. Kansas Health Policy Authority’s Health Reform Recommendations • Healthier food options for state employees • Provide dental care for pregnant women • Improve tobacco cessation within Medicaid • Expand cancer screenings • Cover more kids through aggressive marketing and outreach to enroll already eligible children • Expand premium assistance to include childless adults up to 100% of federal poverty level • Assisting small businesses by establishing a health insurance clearinghouse and other strategies. Total costs are $86.3 million SGF and $159.8 million all funds.

7. Kansas Hospital Licensure Laws General Hospital must: have a dedicated emergency department participate in the statewide trauma system plan and any plan for the delivery of emergency medical services applicable to its region not have more than 44% of its discharges in one or 65% in two areas that focus on cardiac, ortho- or surgical cases participate in the Kansas Medicaid program Phase-in until Dec 31, 2009 Expected to be discussed early next session

8. Healthcare Transparency 2007: • Pricing Transparency • S.B. 181: Post hospital room charges; top 25 procedures • H.B. 2272: Make available negotiated rates • Quality Transparency • H.B. 2271: Disclose quality and performance data • H.B. 2342: Collection/reporting of infection rates 2007 Interim: • Meetings w/ Legislators, KHPA, KFMC • Discussion w/ KHA Board; Policy groups 2008 Outlook: • Legislative interest seems to be growing

9. KHA Guiding Principles for Transparency The information should: Be compliant with federal and state laws Use existing data Be capable of benchmarking Provide national and regional comparisons Be timely Utilize reliable and valid data Be readily accessible to consumers Used to advance the hospital field and not by an individual organization for competitive purposes Serve as a model for other provider groups

10. Health Care Workforce • Nurse-Patient Ratios • HB 2258 (2005) • KSNA bill anticipated • Standardized acuity-based patient classification plan would be required with mandated ratios if plan not followed • Whistle blower protection • Pharmacy School Expansion • 30 counties have just 1 pharmacist • Expand Lawrence campus; add Wichita campus • Funding is needed

11. Health Care Workforce Wichita Center for Graduate Medical Education Issue: Sustaining (and increasing) the number of primary care physicians in Kansas Total graduates since formation of WGME: 1289 349 in last five years; 55% retention in KS

12. Sustaining the Wichita Graduate Medical Education Program Challenges: Accreditation Mandates: The Accreditation Council for Graduate Medical Education (ACGME) has increased accreditation standards by mandating paid time for faculty research, teaching and administration The WCGME Model is out of compliance because it has relied on 70-80% volunteer faculty who donate clinical supervision services, but cannot provide extended research, teaching and administrative free time Funding: Medicare (the primary source of GME funding) has stopped funding off-site monthly rotations and educational, vacation and sick leave for 272 residents annually

13. Reimbursement for Telemedicine Services (HB 2065) What are the Benefits of Telemedicine? Empowering rural health facilities Providing greater access to specialty care and intensive care for patients in rural areas Reducing the number of patient transfers to urban areas Enhancing rural economic development Reducing the costs of medical care Next Steps… Finalize the Impact Report Work with Stakeholders Hospitals KU Medical School Legislators Insurance Carriers Kansas Insurance Dept. Potential non-Legislative solution Educate All Legislators on the benefits

14. Federal Issues

15. Relevant Federal Legislation • H.R. 2860 - Health Care Access and Rural Equity Act (H-CARE) • CAH outpatient lab • Cost base ambulance services • Alternative to 25 bed limit • S.B. 1605 - Craig Thomas Rural Hospital and Equity Act (R-HoPE) of 2007 • CAH outpatient lab • Cost based ambulance services • Authorizes HIT grants for rural practitioners • Ensures adequate rural representation on MedPAC

16. Outpatient PPS Rule Provider-Based Facilities Provision • All CAHs acquiring or creating provider based facilities must meet the 35-mile requirement • Effective after 1/1/2008 • Final OPPS Rule excluded Rural Health Clinics Co-Location Provision (only NP CAHs) • No longer allowing NP CAHs to enter into co-location arrangements after 1/1/2008 • Type and scope of services offered by the co-located facility must not change Penalty – Loss of CAH Designation

17. Inpatient PPS Rule • Physician On-Site Disclosure Requirement • Must disclose to all in- and out-patients that a physician may not be on staff 24/7 • Must state how they would handle an emergency when a physician is not "on-site"  • No Guidance has been provided by Central CMS Office • Regional Office states that hospital must create policy and procedures • Surveyors will: • Make observations • Interview patients, visitors, and staff • Review documents • CMS Regional Office has reiterated that guidance will be provided at some point in time.  • Expected that the guidance will include some requirement that the hospital provide the notification through written documentation. 

18. CAH Relocation Guidelines CMS Released Formal Guidance • 75% Rule • Same Service • Services available under similar terms/times • Same Population • Zip Code Analysis; hospitals may use different methodology • Same Employees • Medical staff, direct employees and FT contract staff count • J-1 visa; NHSC employees may be excluded • High turnover facilities may provide additional documentation • CMS now will provide preliminary determinations based on CAH letters of attestations and projections; • Final approval only will be granted once the hospital has relocated and evidence confirming compliance is provided. • Contact KHA if considering Relocation; Large Renovation

19. What Can You Do? • Meet with your Legislator • Invite to hospital • Need help, let KHA know • Find the connections • Trustees • Staff • Other community members • Attend KHA Advocacy Day Luncheon • January 16, 2008; Noon to 1:30 pm • The Great Overland Station, Topeka