American Association of Healthcare Administrative Management

1. American Association of Healthcare Administrative Management Mark Gamble, FACHE Chief of Advocacy and Operations Hospital Association of Southern California September 19, 2019

2. HASC Background • The Hospital Association of Southern California (HASC), founded in 1923, has 181 member hospitals and 40 health systems in Los Angeles, Orange, Riverside, San Bernardino, Santa Barbara and Ventura counties • Our mission is to lead, represent and serve hospitals and their related organizations, working collaboratively with our members and other stakeholders to improve health and health care in the communities we serve.

3. Main Point of Contacts • George Greene, CEO/President • Mark Gamble, Chief of Advocacy and Operations • Paul Young, SVP of Public Policy and Reimbursement • Four Regional Vice Presidents • Adam Blackstone, VP External Affairs and Strategic Communication • Susan Harrington, Executive Director of Communities Lifting Communities

4. HASC Public Policy Priorities Behavioral Health Medi-Cal Reimbursement Medicare Reimbursement Governmental Regulations Quality and Patient Safety Access to Care Workforce Shortages Commercially Insured Reimbursement Other Reimbursement Issues Cybersecurity

5. 2019 Legislative Highlights • Expand Coverage and Access Advanced several key issues, including expansion of Medi-Cal undocumented adults 19-25; subsidies for families earning between 400 and 600% of the federal poverty level; and a state-level individual mandate for coverage. • Hospital Rate Regulation Halted momentum on a bill that would have banned surprise billing for patients (a measure that hospitals support), but also included a harmful provision that would have set rates for insurance companies to pay hospitals for out-of-network emergency care. This bill will resurface in 2020, and CHA will continue to oppose rate regulation while supporting patient billing protections. • Hospital Seismic Safety Advanced a bill that would offer relief from the state’s outdated and stringent 2030 hospital seismic standards. At our request, the bill has been extended into 2020 to fine-tune language.

6. 2019 Legislative Highlights • Behavioral Health Investments Secured significant investments in treatment for mental health and substance use disorders, including: $150 million for workforce development programs for mental health practitioners; $100 million for whole person pilot care programs to provide housing for people with mental illness; $70 million for Medi-Cal behavioral health integration programs; and more.  • Workers’ Compensation Claims Defeated a bill that would have given workers’ compensation benefits to hospital employees with certain illnesses and injuries — including cancer, asthma, musculoskeletal injuries, and others — unless the hospital could provide evidence the employee did not contract the illness or injury at work.  • Health Care Coverage During Disasters Secured passage of a bill that would ensure hospitals are reimbursed for Medi-Cal managed care beneficiaries' extended stays when no post-acute facilities are available following a declared emergency.

7. 2019 Legislative Highlights • SB 227 (CHA Veto Request) • Secured amendments that created significant flexibility for hospitals to meet nurse staffing ratios when encountering “unpredictable” and “uncontrollable” circumstances. Also removed a prescriptive mandate on how hospitals should attempt to fill vacant spots. In spite of these changes, excessive penalties for noncompliance remain. • AB 5 (Signed) • Codifies the Dynamex decision, which restricts independent contractor status. However, hospitals may still be impeded from contracting with other individual health care professionals, as well as short- and long-term staffing businesses. This is sweeping legislation that affects virtually all business sectors in California, and we will join with them to consider legislative and legal remedies in 2020 and beyond. • AB 204 (On the Governor's desk) • Would require hospitals to report community benefits at the hospital level rather than the system level.

8. 2019 Legislative Highlights • AB 962 (On the Governor's desk) Would require hospitals with operating expenses of $50 million or more to annually submit a report to OSHPD on their minority (women; LGBT; and disabled veteran) business procurement efforts. Implementation delayed until July 2021. Systems permitted to report at the system level rather than by hospital. Can only include suppliers with 50%+ of employees in CA, which ignores purchasing patterns of multi-state systems and GPOs. • SB 382 (On the Governor's desk) Would require Medi-Cal Managed Care plans to reimburse hospitals for caring for patients until a hospital discharge/transition to a post-acute care setting is possible, when access to post-acute care services is limited as a result of a natural disaster. • SB 464 (On the Governor's desk) Would require hospitals that provide perinatal care, alternative birthing centers and specified primary clinics to implement an implicit bias training program for health care providers involved in perinatal care.

9. Federal Issues • Wage index • Surprise billing • President Trump vs. California

10. Local Advocacy • Behavioral Health • Homelessness and SB 1152 • Medi-Cal Managed Care • Public Health Trust Fund • Emergency Medical Services • Communities Lifting Communities

11. Questions