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2007 Legislative Session

2007 Legislative Session. Presenters. Cassie Sauer Vice President, Communications WSHA. Randy Revelle Senior Vice President, Policy and Public Affairs WSHA. Claudia Sanders Senior Vice President, Policy Development WSHA. Outline of Presentation. The 2007 Legislature

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2007 Legislative Session

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  1. 2007 Legislative Session

  2. Presenters Cassie Sauer Vice President, Communications WSHA Randy Revelle Senior Vice President, Policy and Public Affairs WSHA Claudia Sanders Senior Vice President, Policy Development WSHA

  3. Outline of Presentation • The 2007 Legislature • Hospital Policy Priorities • State Budget Context • Hospital Budget Priorities

  4. Overall Results of 2006 Session • No significant new investments in health care; no significant budget cuts • No bad health policy bills enacted • Medical liability reforms enacted; no specialty hospital regulations • Hospitals must improve voluntarily: • Reporting quality data • Billing and charity care • Great participation from WSHA members

  5. Washington State Legislature(2006 and 2007) 20062007 State Senate • Democrats 26 32 • Republicans 23 17 State House • Democrats 55 62 • Republicans4336

  6. Democratic Leadership Lisa Brown Senate Majority Leader Margarita Prentice Senate Ways and Means Chair Karen Keiser Senate Health Care Chair Frank Chopp Speaker of the House Helen Sommers House Appropriations Chair Eileen Cody House Health Care Chair

  7. Republican Leadership Mike Hewitt Senate Minority Leader Joe Zarelli Senate Ranking Ways and Means Senate Ranking Health Care Richard DeBoldt House Minority Leader Gary Alexander House Ranking Appropriations Bill Hinkle House Ranking Health Care

  8. Hospital Policy Priorities

  9. PRIORITY Hospital Policy Priorities • Specialty hospital regulations • Certificate of Need improvements • Expand mental health parity • Limit new regulations on hospitals • Public Hospital District legislation • Voluntary efforts: • Billings to the uninsured • Sharing quality and pricing data

  10. Specialty Hospitals • Goal: New requirements on specialty hospitals to assure fair competition • Have a staffed, functional emergency department • Able to do resuscitation and airway management • Provide Medicaid, Medicare, and charity care • Have a transfer agreement with a community hospital • Must notify patients of physician ownership

  11. Certificate of Need • Goal: Improve the Certificate of Need Process • WSHA supports these changes: • License ambulatory surgery centers • Monitor whether CON applicants provide Medicare, Medicaid, and charity care as promised • Consider the … “effect on current providers’ ability to serve the poor” • Help the Department of Health achieve the task force goals and enhance its staffing

  12. Mental Health Parity • Goal: Expand the 2005 parity law • New law being implemented from 2006 to 2010 • Benefits 1.5 million Washington residents covered by large group insurance • Want to cover the small group and individual insurance markets (540,000 more residents) • Minimal cost to insurers • Improved payments to mental health providers, including hospitals

  13. Limit New Regulations • Goal: Stop unnecessary regulations • Nurse staffing plans or ratios • Patient safety reporting that does not improve care or provide useful transparency • Other regulations sure to be proposed

  14. AWPHD Policy Priorities • Continue alternative contracting procedures for large public works projects • Defeat negative bills regarding levy elections • Increase special purpose district commissioner compensation • Explore dropping the supermajority and validation requirements for levies

  15. Billings to the Uninsured • Goal: Voluntary improvements • Patients under 100 percent of poverty get free care • Patients from 100 to 200 percent of poverty get discounts; discounts based on costs • Patients from 200 to 300 percent of poverty get discounts; discounts based on 130 percent of costs • Hospitals provide written charity care notices to all patients • Hospitals have written policies on collections; governing boards/commissioners receive an annual report

  16. Pricing and Quality Data • Goal: Voluntary data sharing • New web site launched mid-January 2007 • Hospital-specific information • Charges for top procedures • Consolidate Washington’s Hospital Compare data • Easy to use • Understanding Your Hospital Billbrochure

  17. State Budget Context

  18. Data Source: Washington State Department of Health, Hospital Fiscal Year-End Reports, 1995-2005. Health Information Program Hospital Operating Margins Bond raters' healthy margin: 4% to 5%

  19. 2005 Hospital Operating Margins • 58 of 94 hospitals have higher margins • Wide range in margins (from negative 16.5% to positive 25.5%) • 26 hospitals have negative margins • 24 hospitals have positive margins less than 4% • 44 hospitals have positive margins greater than 4%

  20. Data Source: Washington State Department of Health, Hospital Fiscal Year-End Reports, 1995-2005. Health Information Program Cost Shift is Growing Percent of Costs Reimbursed by Payers

  21. Source: Vicki Wilson, Ph.D., Director, Washington State Planning Grant, Access to Health Insurance Project. Washington’s Uninsured (1993-2006) Percent Uninsured Adults (19-64) Total Population Children (0-18)

  22. Source: Vicki Wilson, Ph.D., Director, Washington State Planning Grant, Access to Health Insurance Project. Washington’s Uninsured

  23. Low Income Insured by State Health Care TOTAL 982,000

  24. Data Source: Washington State Department of Health, Hospital Fiscal Year-End Reports, 1995-2005. Health Information Program Uncompensated Care Uncompensated Care as a Percentage of Total Patient Revenue

  25. 2005-2007 Operating BudgetNear-General Fund (NGF) Expenditures* Health Care Expenditures $ 4.2 Billion All Other Expenditures $ 24.0 Billion Total NGF Expenditures $ 28.2 Billion * Near General Fund includes General Fund-State, Education Legacy Account, Health Services Account, Public Safety and Education Account, Violence Reduction and Drug Enforcement Account, and Water Quality Account.

  26. ? Data Source: Washington State Office of Financial Management and Washington State Hospital Association Legislative Summary Health Information Program Washington State Budgets Budget Deficit / Surplus and Health Care Funding (In $ Millions)

  27. Hospital Budget Priorities

  28. Medicaid Hospital Rates • No increases in hospitals’ basic Medicaid payment rates in 2003-2005 • Successfully lobbied for $37 million increase for 2006 and 2007 • Funding followed WSHA’s distribution formula for a 1.3% average annual increase • Legislature mandated a study on the distribution of Medicaid hospital inpatient payments

  29. Medicaid Hospital Rates Study • Work done by state’s consultant, Navigant • Devises a more equitable system for Medicaid hospital payments • Recommends annual inflation updates • Creates problems for selected special areas: neonatal, psychiatric, and outliers (exceptionally expensive cases)

  30. Medicaid Hospital Rates: WSHA Goal • Goal: Implement the new system fairly • Provide annual inflation updates • Fix problems with the new system • Redistribute dollars equitably among hospitals • Transition payments to hardest hit hospitals

  31. Inpatient Mental Health • Goal: $17.2 million for inpatient mental health • Hospitals have been reducing/closing units • State hospital bed reductions increase demand • Low payments for state-funded patients • Bring state-funded patients to Medicaid payment level

  32. Certified Public Expenditures (CPEs) • Goal: Provide adequate payment and sunset the program • Payment program for public hospitals • Brings in federal funds to subsidize Medicaid and Basic Health • Ensure hospitals in the program receive full payments for 2005-2007 • Eliminate the program as of July 2007 • Very complex to administer • Significant risk to participating hospitals • Revenue gain to the state is eroding

  33. Insure More Washington Residents • Goal: Cover all kids by 2010: • Expand to 300% of poverty • Streamline application and enrollment processes • Outreach to families • Simplify programs to include all children • $40 million • Goal: Add at least 10,000 Basic Health slots for uninsured adults at a cost of $20 million

  34. Train More Workers • Goal: Advanced training for entry-level health care workers at a cost of $5 million • Health work force shortage looming • Entry-level health care workers want to advance

  35. Governor’s Budget • Medicaid rates: $10 million in transition funding • Inpatient mental health: only $7.3 million • CPEs: provides current biennium funding, but continues the program • Cover all kids: very good proposal • Basic Health: no new funding • Training: expands high demand slots; no targeted funding

  36. WSHA Resources • Issue briefs • Policy papers • Inpatient mental health • Financial assistance • Inside Olympia • www.wsha.org • Staff available to speak at council, board, and staff meetings

  37. We Need Your Help! • Stay in contact with your legislators • Answer calls for action in Inside Olympia • Talk to leaders in your community about what health care spending means • Highlight good things government accomplishes • Educate reporters and editorial boards

  38. Questions and Comments Contact Information:cassies@wsha.orgor 206-216-2538

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