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March 1, 2013

LEGISLATIVE NOTES
Legislative Notes for ASHNHA members; compiled from hearings, reports, news accounts and good old fashioned face to face discussion in the Capital City

Parnell Announces Delay in Medicaid Expansion Decision


Your morning news today may have alerted you to the fact that Governor Sean Parnell had a news conference yesterday in which he announced he is not going to ask the Legislature for funding this year for the Medicaid expansion. And that he has serious concerns about federal fiscal stability.   Some press stories have sensationalized this –trying to put Parnell into a solid NO category. My belief is this thing is far from over and the Governor has left the door open for factual and solid debate on the merits of the issue.
 
Hey, what the Governor said is not new information nor is it a surprise to ASHNHA.  What is new is the Governor is speaking out to the press and the public about what he privately told ASHNHA’s Executive Committee last week.
 
Reporters had various takes on the story- from Parnell turns down federal funds to Parnell opposing expansion this year to Parnell delays his decision.  
 
What is new and what cannot be ignored is the fiscal chaos in Washington DC.  The Governor had his press conference on the heels of attending the National Governor’s Association meeting and a meeting with Secretary Sebelius.  With the Sequestration going into effect today, there are real questions about the State’s fiscal exposure across a range of areas and it is a very unstable time.
 
Ultimately, we will need to make the case that this will be a good investment, and is or nearly is cost neutral or even better-saves the State money. Another of our arguments is that the fiscal cliff issue cuts both ways-- it will offset other federal reductions we are taking in Medicare and other areas. And of course, it will help our poorest citizens at the same time.
 
You can watch Governor Parnell’s press conference for yourself by clicking on this link. It’s not really long and would be worth viewing. For one thing the Governor expresses a real commitment to the current Alaskans who depend on Medicaid today.

KAREN PERDUE
President / CEO
IN SESSION
426 Main Street
Juneau, AK 99801
907.586.1790
----
1049 W 5th Ave, Ste 100
Anchorage, AK 99501
907.646.1444

EMAIL
karen@ashnha.com

Parnell meets with Hospital and Nursing Home Industry


During the ASHNHA Winter Fly-In last week, the ASHNHA  Executive Committee met with the Governor, his top advisors, and Commissioner Streur.  We discussed the Medicaid expansion and other industry trends.  Kudos to Annie Holt, Liz Woodyard, Rick Davis and Roald Helgesen for taking the lead in the meeting.
We heard the following salient information from the Governor:
  • He finds it valuable to consult with our industry
  • He has not made up his mind regarding the Medicaid expansion, although if he had to decide today it would be a negative decision
  • He is determined to take his time and study the Medicaid expansion
  • He understands it is a significant decision for the State and its citizens
  • He has many questions which are unanswered and the Department of Health and Social Services is researching these questions. He has not seen research yet and he is focused on many legislative matters.
  • He has concerns about the long term reliability of the federal government in keeping their promises regarding match rates and other rules and has concerns about the effects of sequestration and other federal fiscal reductions.
  • May be a one year to three year study process
  • The next decision point would be his budget submission on December 15 2013.
Thanks to our lobbyists Kent Dawson and Pat Carter for assisting us with this meeting and preparation. 

What Now?


The governor specifically asked ASHNHA to take the time between now and the Fall to educate our stakeholders and our communities about the expansion.  These educational sessions have already begun and we encourage you to talk with your Boards and key stakeholders about this issue.  We are happy to provide you with back up materials.  These materials draw heavily from the ANTHC reports. When we receive Departmental data we can incorporate that material.
 
Next we await the DHSS analysis which Commissioner Streur is working on. In our meeting with the Governor, ASHNHA pledged support to help with the analysis and feedback to the department and the Governor regarding this material.
 
Timing is the issue here.  While the expansion first begins in January of 2014—there is no deadline for the State to sign up.  If the Governor were to follow the December 15 budget submission, the expansion could begin by July 2014.  At this time, it appears budgetary rather than statutory authority is needed. 
 
We are not minimizing the tasks in front of us on this subject, but wanted to give you insight that the decisions are not made yet.

House Proposes Significant Cuts to DHSS Programs


This morning the House Finance Subcommittee in charge of the HSS budget took a significant whack at the proposed 2014 budget.  The committee proposed a $21 million reduction in spending in the department for next year. 

However, these cuts are not final because the budget is now brought to the full Finance Committee for consideration and once passed out of the committee, then moves to the House floor for a vote. 

Once that is completed, the budget is passed to the Senate for their consideration.  This is the first step in the process and there is hope that some of the funding may get restored as the budget moves through the process.
 
Here is a brief overview of the cuts:

Unallocated Reductions in the following two allocations
  • Behavioral Health: $8,368,800
  • Medicaid Services: $8,368,800 (this will be 16 million dollar cut because of the lost federal match)

Behavioral Health
  • $200,000 for the Bridge Home Program and Expansion Grant in Services to the Seriously Mentally Ill
  • $100,000 for the Assisted Living Home Training and Targeted Capacity for Development in Behavioral Health Grants
Children’s Services
  • $400,000 Early Intervention for Young Children in Infant Learning Program Grant
  • $250,000 Strengthening Families through Early Care and Education in Family Preservation
Juvenile Justice
  • $400,000 for McLaughlin Youth Center in Health Services for Youth in Juvenile Justice
Public Assistance  
  • $3,629,000 in Energy Assistance to replace FY13 Energy Assistance Program
Senior and Disabilities Services
  • $150,000 for Health Promotion, Disease Prevention for Older Alaskans (HPDP): “Senior Fall Prevention” in Senior Community Based Grants 

Tweener Hospitals are Surprised by Congressional Action on Extenders


Alaska’s two “tweener” hospitals Central Peninsula Hospital and Bartlett Regional Hospital received a significant hit in Medicare reimbursement when several Medicare extenders lapsed in December. (Tweener hospitals are facilities that fall between larger tertiary hospitals and smaller CAHs. Central Peninsula and Bartlett both have fewer than 50 beds but more than 25 CAH beds).  Approximately $4 million in annual Medicare revenue will be cut from these hospitals.  CPH is leading an effort to educate the delegation about the impact of the extenders, and potential mitigation strategies.

Transitions


Dave Cote, Director of Alaska Pioneer Homes left the Department last week.  While a new director is being recruited, the Division will be managed by Phil Welsh, the Sitka Home Administrator.

Legislative Hearings for the week of March 4th - March 8th


Monday, March 4th @ 8:30am – House Finance Committee – Introduction and adoption of subcommittee recommendations into a new committee substitute for the operating budget.
 
Monday, March 4th @ 1:30pm – Senate Judiciary – SB 49 Medicaid Payment For Abortions; Terms – Public testimony
 
Tuesday, March 5th @ 1:30pm House Finance Committee – Public testimony on operating budget. 
  • 1:30pm – 2:30pm – Juneau
  • 2:45pm – 3:45pm – Cordova, Bethel, Kotzebue, Nome, Valdez & Wrangell
  • 4:00pm – 5:15pm – Anchorage (2 minute time limit per speaker)
             
Tuesday, March 5th @ 1:30pm – Senate Judiciary – SB 49 Medicaid Payment For Abortions; Terms – Public testimony
 
Wednesday, March 6th @ 1:30pm House Finance Committee – Public testimony on operating budget. 
  • 1:30pm – 2:45pm – Fairbanks
  • 3:00pm – 4:00-pm – Sitka, Petersburg, Barrow, Dillingham, Unalaska & Delta Junction
  • 4:15pm – 5:15pm – Homer, Kenai, Ketchikan, Kodiak, Mat-su, Glennallen, Tok & Seward

- No further hearings for the week due to Energy Break -
 

Florida Governor Scott Agrees To Expand Medicaid


Last week, Florida Governor Rick Scott agreed to expand Medicaid coverage to approximately 900,000 additional people under the provisions of the Affordable Health Care Act (ACA).  Prior to this decision, Governor Scott was a vocal opponent of the ACA.
 
Under the terms of the legislation Governor Scott will send to Florida’s Legislature, the expansion of Medicaid will expire in three years and that coincides with the timeframe for the federal government covering 100% of the costs for the expansion.  Governor Scott said that he will use this time to measure how the expansion impacts healthcare costs, quality and access in Florida.
 
While Governor Scott still maintains his opposition to the ACA, supporting the expansion is a “compassionate, common sense step forward.”  In addition, Governor Scott said that he in good conscience, cannot deny the uninsured access to care.
 
You can read the entire article from Fox News by clicking here.
 

New Jersey Governor Christie Agrees To Expand Medicaid


Following Florida Governor Scott’s decision to expand Medicaid, New Jersey Governor Christie became the latest Republican Governor to agree to an expansion under the provisions of the Affordable Health Care Act.  Governor Christie remains opposed to the ACA but said the expansion will extend care to the neediest in New Jersey, help stabilize the financial health of hospitals, and ultimately save the state of New Jersey money.
 
Perhaps the most compelling reason for Governor Christie’s acceptance of the expansion was the idea that rejecting the federal money would force New Jersey’s citizens to subside a federal program for other states and strip its own population of these new benefits.  In addition, Governor Christie promised to rethink his decision immediately if the federal government does not hold up their end of the deal. 
 
You can read more about Governor Christie’s decision here by clicking here.

Quirk in Sequester Rules Delays Medicare’s 2% Cut Until April 1st


With sequester cuts now starting, there will be a one-month reprieve with regard to the 2% cut to providers and insurers under Medicare.  Instead of the 2% cut going into effect immediately, the cuts to Medicare won’t take place until April 1.  Some health care provider advocates say it may give lawmakers enough time to reach a deal before the cuts to Medicare begin. CMS will notify providers of the cuts.
 
Additionally, many advocates assume there will be public reaction to the sequester cuts which will push Congress reach a deal to end the sequester cuts.  However, there is still the unknown of how Congress will deal with the budget and if there will be looming cuts to provider programs.  Please click here for more information on the article.

Rep. Olson Introduces Workers Compensation Fee Bill for Medical Treatment or Services Performed Outside the State 


Rep. Kurt Olson (R-Soldotna) has introduced legislation addressing the workers compensation fee schedule for medical treatment out of state, limiting the amount of time a provider has to submit a bill, and limiting the time for appealing an employer’s denial or reduction of a bill.  House Bill 141 was introduced Monday, February 25th.  HB 141 has been referred only to the Labor and Commerce Committee and no hearing is currently scheduled. 
 
Under the terms of the legislation, the fee or charge for treatment or services rendered in another state may not exceed the fee or charge for a treatment or service set by the workers’ compensation statutes of the state where the services are rendered.  This is an area that was not previously addressed in Alaska statutes.
 
In addition, the legislation adds a new provision that a provider of medical treatment or services may receive payment for medical treatment and services only if the bill for services is received by the employer within 180 days after the date of service or after the date that the provider knew of the claim and knew the claim related to employment.
 
Finally, this legislation allows the provider to file an appeal with the board within 60 days after receiving notice of the denial or reduction of the claim payment made to the provider.
 
You can view the entire legislation here by clicking here.

ASHNHA Announces Money Available for Small Hospital HIT Initiatives 


Funding up to $40,000 is available for ASHNHA Small Hospital Members to support Health Information Technology (HIT) Initiatives. The funding encourages collaboration among small hospitals for HIT Training, EHR hardware and/or software, interface development, consulting, system configuration, and privacy & security. The application can be accessed by clicking here. 
 
Application Deadline: March 15
Awards Announced: April 15
Award Amounts:
            Up to $10,000 for an individual hospital
            Up to $25,000 for 2 hospitals
            Up to $40,000 for 3 or more hospitals
For more information contact Connie Kanen at connie@ashnha.com or 907-646-1444.

We are Taking a Break Next Week


The Legislature will be on light duty next week, with minimal hearings.  So ASHNHA staff will be working on other matters across the State. No Legislative Notes next week. 

ASHNHA February Legislative Fly-In Board Meeting A Success




Representative Cathy Munoz; Christine Harff, Bartlett Regional Hospital and Ruth Johnson, Wildflower Court at the ASHNHA dinner in Juneau




Jodi Phelan
Alaska Communication Systems




Greg Puckett, Alaska VA Healthcare System 




Lee Bennett, Sitka Community Hospital
 





Bob Letson and Karen Perdue share a laugh with Dale Kirby, AHA Region 9




Dee Dahmann and Andrew Korbel
Korbrien Medical Management  
 




Hallway Networking
Dennis Murray and Marty Grasmeder





Annie Holt, Ron Hale, and Rep. Shelley Hughes





Dr. Andrew Mayo, Rep. Les Gara and Ray Gillespie
 


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