W. Thomas Deweese, FACHE Regional Executive American Hospital Association

1. Center for Rural Health Annual Summer Meeting August 7- 9, 2013 W. Thomas Deweese, FACHE Regional Executive American Hospital Association

2. AHA Membership • AHA Members • 5000 Hospitals, Health Systems • 43,000 Individual Members • Rural Hospital AHA Members • USA980 CAHs GA 34 • 151 RRC 12 • 151 MDH 6 • 253 SCH 11 • 109 SCH/RRC 4

4. AGENDA • Washington Update • Advocacy Agenda • Action Items • Resources

5. Washington Update • House and Senate are on August Recess • Return September 9, 2013 • Facing them when they return:

6. Washington Update • Proposed Budget – President • $374 Billion reduction Medicare • $306 billion from providers • $18.9billion from Medicaid • Eliminate CAH, MDH, SCH ($ -62B) • Reduce CAH payments from 101% to 100% of reasonable costs ($ -1.43B) • Eliminate CAH for hospitals less than 10 miles from nearest hospital ($ -69M) • Cut rural health programs such as SHIP, telehealth, network grants, etc.

7. Washington Update • Proposed Budget - House • Cuts $4.6 trillion from government spending (sequester was $1.2T) • $2.7T from healthcare • Convert Medicaid to block grants and cut $756 billion over the next 10 years • Means testing for Medicare Parts B& D • Deficit neutral reserve fund to address the SGR (doc fix)

8. Washington Update • Proposed Budget – Senate • $1.85 Trillion in savings over 10 years • Equal combination of tax revenues and spending cuts • $275 billion in unspecified healthcare cuts

9. Washington Update • Fiscal Cliff • January, Congress agreed to raise the nations debt ceiling until May 19 to $16.4 trillion. • Improving economy pushed back the date • October or November

10. Washington Update • Physician Fix • January 2014 • physicians fees cut 25% • Current projection • $139 billion • Down from $300 billion a few years ago

11. Advocacy Agenda • Washington Update • Advocacy Agenda

12. Advocacy Agenda • DSH Reduction Act (HR 1920 & S 1012) • Amends Medicare to delay from FY2014 to FY2016 cuts to any "subsection (d) hospital": • 25% of the amount of the DSH payment that would otherwise be made to it for the fiscal year, plus • any additional payment amount according to a specified formula.

13. Advocacy Agenda • John Lewis, Sponsor • Sanford Bishop, Jr • Henry “Hank” Johnson

14. Advocacy Agenda • RAC - Medicare Audit Improvement Act (HR 1250) • Medicare Recovery Auditor Contractors (RACs) • Medicare Administrative Contractors (MACs) and • Comprehensive Error Rate Testing (CERT) auditors • Establish a Consolidated Limit for Medical Record Requests • Improve Auditor Performance • Improve Recovery Auditor Transparency • Accurate Payment for Rebilled Claims • Physician Review for Medicare Denials • Assuring Due Process for Reopening.

15. Advocacy Agenda John Barrow Sanford Bishop, Jr. Tom Graves Austin Scott David Scott

16. Advocacy Agenda • Rural Hospital Access Act (HR 1787 & S 842) • Extends Medicare dependent hospital (MDH) program • Increases payments to Medicare low-volume hospitals for one year thru Sept 30, 2014

17. Advocacy Agenda NO GA co-sponsors

18. Advocacy Agenda • Protecting Access to Rural Therapy Services (S 1143) • Adopt a default standard of “general supervision” • Create an exemption process • Ensure that for CAHs, the definition of “direct supervision” is consistent with the CAH conditions of participation • Hold hospitals and CAHs harmless from civil or criminal action regarding the CMS’s retroactive reinterpretation

19. Advocacy Agenda No GA Co-sponsor

20. Advocacy Agenda • TOPS - Rural Hospital Fairness Act(HR 2578) • Hold harmless transitional outpatient payments (additional payment adjustments • Rural hospitals 100 or less beds • Expired Mar 1 for SCH > 100 beds • Expire Dec 31 rural hospital and SCH 100 beds or less

21. Advocacy Agenda NO GA Co-sponsors HR 2578

22. Advocacy Agenda • The Fairness in Health Care Claims, Guidance and Investigations Act (HR 2931) • Amend the False Claims Act • Require federal agencies to review • Own regulations and determine • If a billing dispute should be pursued as fraud before launching an investigation • Assure that unintentional billing disputes aren’t penalized as harshly as fraud

23. Advocacy Agenda DavidScott

24. Advocacy Items Attack on 340B drug program • Sen Grassley inquires • WSJ July 31 article • AHA Response letter Aug 6

25. Action Items • Washington Update • Advocacy Agenda • Action Items

26. Action Items • Contact your Senators and Representatives • Ask them to sign on to legislation • DSH Bill HR 1920 & S 1012 • RAC Bill HR1250 • Rural Hospital Advocacy Act HR 1787 & S 842 • Therapy Caps S 1143 • Rural Hospital Fairness Act (TOPS) HR 2578 • Fairness in Health Care Claims, Guidance, and Investigations HR 2931 • 340B Drug Program

27. Resources • Washington Update • Advocacy Agenda • Action Items • Resources

28. Resources

29. Resources

30. Resources

31. Center for Rural Health Annual Summer Meeting August 7- 9,2013 W. Thomas Deweese, FACHE Regional Executive American Hospital Association tdeweese@aha.org 800-864-4678