Federal Update June 2005

1. Federal Update June 2005

2. Update • Front Burner Legislative • Policy Issues—IPPS; Rehab • Other Issues on your mind

3. Antitrust and Business Practices Retrospective reviews Insurance industry consolidation Group purchasing organizations BCC Billing Collections Charges Executive compensation Class action litigation Public Relations Membership education and tools Beyond current charges Studies Coverage HCCU CTUW III Association health plans Comprehensive approach (UHPP) Delivery system reform Limited service providers Make moratorium permanent Beyond specialty hospitals Improving MD relations Payment options (MEDPAC) Chronic care management Hospital participation in pilot projects (UHPP) Green Bay Packer model Stark II/MD recruitment Emergency Readiness and Public Health Federal appropriations Flu vaccine legislation HRSA readiness grant Fraud and Abuse OIG pricing regulations Health Care Liability Reform Federal MICRA legislation Alternatives State action center Information Technology Interoperability standards MD integration Treatment of regional information networks Federal funding Mental health Medicare psychiatric PPS Coverage parity Payment Federal budget Budget resolution Reconciliation * Medicaid modernization MD payment Indirect medical education adjustment Rural package Regular PPS rule Update factor/quality initiative Area wage index Outlier thresholds Long-term care hospitals Transfer Policy Rehabilitation 75 percent rule SNF rule (RUG refinement) Pay for performance Medicare advantage implementation Health Care as Investmentf ISSUE MANAGEMENT • Quality and Patient Safety • Patient safety legislation • FCC medical telemetry • 8th Scope of Work • JCAHO legislation • COP revisions • Leadership Agenda • Improvement* Use of Evidenced-Based Medicine Practices* Best Practices Clearinghouse • Accountability* Hospital Quality Alliance* Governance Dashboard • Coordination* Organizational redesign/ clinical micro-systems* Chronic care coordination • Racial and Ethnic Priorities • Health Gap/Equality Legislation • Data collection • Membership tools/leadership forum • Regulatory Relief • HIPAA • Model practices • EMTALA • ICD-10 approval • Tax (other) • Pensions • Community benefit • Workforce • Federal appropriations • Foreign workers • Labor relations/organizing • MD supply • Best practices clearinghouse • Work design

4. Immediate Priorities • Organizing Themes • Protecting the safety net • Increasing affordability and improving care • Expanding coverage • Payment • Medicaid • Medicare • Public accountability • Quality and patient safety • BCC • Billing • Charges • Collections • Executive compensation • Tax-exempt status • Liability reform • Limited service providers • Coverage

5. Budget Conference Outcome • Medicaid • $10 billion over five years • No cuts in first year • Commission (presidential appointment) • Short-term vs. long-term (15 voting; 15 non-voting; 8 MOCs– Ds may not play) • Medicare • $1 billion over five years from House Ways and Means Committee • Deadline: September 16

6. Payment Challenges • Medicare exposure • Medicaid…holding hospitals harmless • Rx reimbursement ($5-6 billion) • Physician payment

7. State Association Steering Committee on Medicaid

8. Coalition to Protect America's Health Care COMMUNICATING ABOUT MEDICAID

9. Limited Service Hospitals Challenges • Competition Argument • House Leadership—other R (Barton/Coburn) Opposition • Terry Cloth Robe Factor (Patients like LSHs) • Payment refinements

10. “Special” Coverage Project Project AARP AAFP AFL-CIO AMA ANA APHA BCBSACHA HR Association Johnson & Johnson Kaiser NGA NCSL Pfizer Project Hope • Advisory Group • American Hospital Association • Association of Health Insurance Plans • U.S. Chamber of Commerce • Families USA • Federation of American Hospitals • Heritage Foundation • Health Leadership Council • Service Employees International Union • “A Practical Plan for Expanding Health Care Coverage • As Many People As Possible…As QuicklyAs Possible