March 22, 2013

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

Mayor of Kenai Peninsula Borough Testifies on Medicaid Expansion

Mayor and former State House Representative Mike Navarre spent an hour with House HSS Committee talking about the challenges facing small community hospitals in his borough, what’s ahead in health care, and the need for the Medicaid expansion.  

Mayor Navarre gave a no nonsense overview that health care costs are unsustainable and cost shifting is a big problem.  Providing more coverage to individuals on Medicaid would prevent cost shifting to private payers and help local hospitals meet their commitment to community needs.
Thanks to Mayor Navarre for his work. 

Click here for powerpoint from the presentation.

Bruce Richards, Central Peninsula Hospital &
Mike Navarre, Kenai Peninsula Borough Mayor

President / CEO
426 Main Street
Juneau, AK 99801
1049 W 5th Ave, Ste 100
Anchorage, AK 99501


Trauma Fund Revived from Near Death

The Senate budget writers brought the trauma fund back to life after it was killed in the House version of the budget. The full $2 million is restored.  Now we have to wait until April to see if the money survives the rest of the process. Senator John Coghill, the driving force behind the statute and the fund, will be a vociferous defender of the program. The Senate also added $565.2 (a 20% increase) to Emergency Medical Services grants.  If adopted, this will make up for years of flat funding and enhances volunteer services in communities. 

Behavioral Health Cuts Fixed, but Innovation Funds Wiped Out

Nearly 200 people testified against the $8.4 million in cuts to community behavioral health grants so the Senate reversed the cuts this week. This was followed by a cut of similar services from Medicaid, but backfilled with one-time capital funds appropriated last year for innovative approaches to treatment.  If you didn’t follow this, you are not alone.  Basically what this means is the innovation fund is wiped out but the current services remain the same. 

Anchorage Medicare Clinic gets a Financial Boost in Senate

The Anchorage Medicare Clinic, spearheaded by Dr George Ryhneer and a consortium of physician groups and hospitals, has been open 20 months and is seeing thousands of patients who would otherwise not get primary care. Last year the clinic saw over 2500 individual patients and now employs two providers to keep up with the demand.  In total the clinic has set up over 10,000 individual appointments and calls for new appointments keep up at a continuous pace.
The idea of the clinic was to test whether a new clinic model in Alaska could be sustained on Medicare reimbursement alone with start up costs paid for by the State through legislative appropriations.  After two years the answer is --  no, it can’t – so lawmakers in the Senate appropriated $1 million to keep the doors open by providing operating funds for the upcoming fiscal year.  While the money must still be approved by the House, Finance Co-Chair Representative Bill Stoltze has already expressed his support for the clinic and worked with Senator Meyer to secure the needed start up funds.  

Alaska’s Federally Facilitated Exchange -- Coming to Life?

The feds have been ominously quiet about how to build and implement an exchange in the states like Alaska where the Governor has turned the job back to the feds. It has been so silent you may not have noticed that they changed the name from Exchange to Marketplace.
The feds began a series of outreach calls this week. The main message was—we will be open for business on October 1, 2013 when enrollment in the Marketplace will begin. State officials have been saying publically for some time that they doubt the feds ability to meet these deadlines. Rules and guidance are starting to come out.  Last week, the feds quietly released for comment the draft application consumers will use in the Marketplace. The application is 15 pages long and has 21 steps to complete.  So it is getting a lot of criticism from consumer groups. The federal government estimates it will take 30-45 minutes to complete.
The idea is if you apply online you should get near-instant verification of your eligibility because the government clearinghouse called the Data Services Hub will ping Social Security for birth records, IRS for income data and Homeland Security for immigration status.
Remember, Alaskans with incomes up to 400% of poverty level who want to buy insurance through the Marketplace will get an advanced premium tax credit to offset the cost of their insurance.  This premium subsidy is only available for insurance purchased through the exchange.

Remembering Jack Nielson

Jack Nielson, long time executive director of the Medicaid Rate Commission, passed away on March 12, 2013.  Jack was instrumental in the Medicaid rate setting process for facilities for 20+ years.   Jack was relied on for his knowledge of the federal/state partnership for Medicaid services.  He had a ready smile and a willing ear when working with the ASHNHA members.  His decisions did not always reflect the facility desires, but he strove to be fair and principled.
His leadership will be missed by the ASHNHA members.  Jack leaves behind his wife, Helen, 4 sons and his daughter, Marie.  In lieu of flowers, the family requests that donations be made to the Providence Alaska Foundation for Palliative Care.
Click here to read more about Jack’s life

Federal Regulatory Updates

  • DHSS will release Disproportionate Share Hospital (DSH) regulations in April or May with the DSH reallocations outlined in the ACA scheduled to take effect in October. ASHNHA is preparing to analyze these regulations which affect PPS hospitals. Alaska hospitals receive about $15 million in Medicare DSH and $20 million in Medicaid DSH.  25% of the DSH funds will remain on the same formula while 75% will be redistributed based on changes in non-elderly uninsured and uncompensated care.  The details and formula are to be determined by the Secretary.
  • CMS has backed off on the requirement that a hospital governing board must have one medical staff member. Instead, governing boards would be required to have twice-yearly consultations with medical staffs.
  • About 40% of all hospitals nationwide have attested to meaningful use and have received a Medicare incentive. About 25% or 314 critical access hospitals nationwide have met the requirement. Incentive payments will be affected by the 2% cut from sequestration.

80th Percentile Insurance Rule being Reviewed

Tim Bradner reports in his Economic Report that the Alaska Division of Insurance is reviewing the rule requiring payments to health providers at the 80th percentile of usual and customary charges in a region pertaining to private insurance.  Public employers and self-insured firms are not covered by the rule.

Bradner reports that a rulemaking process to revise the regulations may be announced in mid-April. This would relate to professional fees, not hospital reimbursement.  It would affect physicians and other providers employed by hospitals.

ASHNHA speculates that the regulations would lower the percentile, remove it entirely, or set a benchmark based on profiles of professional fees that have grown moderately such as family practice.  Any change to the regulation is likely to mean significantly less reimbursement for some provider types.

Bradner also confirms an announcement we heard from the State Medicaid agency at our meeting in Juneau; DHSS will require pre-approvals for non-hospital radiology procedures beginning in April for Medicaid patients. 

Expansion in Long Term Care across the State

Long term care facilities across the state are building to meet the needs of Alaska’s aging population. Here are the latest highlights showcasing the excellent work of our members.
On February 25, 2013, the State of Alaska approved the Kodiak Island Borough's application for the Certificate of Need to replace the current long term care center. Built in 1975 to serve as temporary housing for discharged acute care patients, the aging facility has one private room and 18 semi-private rooms, with four residents sharing one small, non-ADA half bath.
The new facility will be a licensed 22 bed long term care center co-located on the medical center campus. Designed as a duplex residential home, the interior space will consist of 18,708 square feet with eleven private bedrooms and bathrooms in each duplex unit.  A central core of administrative and support services will connect each side of the duplex.  Site preparation will begin in March 2013 with construction expected to begin in April.  The projected completion and occupancy date is is set for Spring 2014.
The estimated project cost is $17.6 million and will be funded through revenue bonds issued by the Kodiak Island Borough.  Providence Health and Services will operate the facility under a long term lease agreement similar to the current arrangement between Kodiak Island Borough and Providence.

The Yukon Kuskokwim Health Corporation is building a new 18 bed long-term care facility in Bethel. It is a congregate residential setting with personal and health care services. There are two areas that mirror each other, each area will have nine beds and a common gathering area. All rooms are private with the exception of two double rooms. One bed will be dedicated to end of life care.  The facility will have wider doors for bariatric chairs and hospital beds and patient lifts built into each room. The goal is to help frail and cognitively impaired elders and people with disabilities maintain independence and dignity.  The process has started to develop an electronic health record that will be ready for use upon opening.  The facility is expected to open October 2013. 

Model of the new LTC facility in Bethel

  Progress continues on the home for future LTC residents – March 13, 2013

Nome - Norton Sound Regional Hospital Moves Patients into New Facility
Years of prepping and planning are over: Norton Sound Health Corporation moved Quyanna Care Center (QCC) to its new facility on March 5, 2013.  The old facility, which was inside the hospital, housed 15 residents in shared rooms. The new facility which is adjacent to the new Norton Sound Regional Hospital, includes private rooms for each resident and the addition of a salon, spa, and ceiling lifts.  The upgrades to the QCC will enhance the comfort for every resident. QCC received over $1 million from the Denali Commission and over $14.5 million from the State of Alaska. QCC is one of 15 Native Nursing Homes in the nation and ranked in the top 39 for quality, among 15,000 surveyed in 2011.

Quyanna Care Center perches on the open tundra

Providence Extended Care
Providence Extended Care (PEC) began operations at 920 Compassion Circle (corner of Debarr and Boniface) in a brand new campus that features eight homes with 12 private rooms and bathrooms and a common building with support services.   The eight cottages features names of Alaskan rivers and will house a total of 96 people.

 Pictured above right is Judy Howorth and key PEC staff.
Providence Transitional Care
In early March, Providence Health & Services Alaska was granted an extension on a certificate of need for its 50-bed Transitional Care Center. This is a replacement project for the current Providence Transitional Care Center (PTCC) at 4900 Eagle St. in Midtown Anchorage. The new PTCC will be located on the new Providence Extended Care Campus in East Anchorage at Debarr and Boniface. Construction will begin in early spring and it is scheduled to be complete March of 2014. At this time, the future purpose of the current building on Eagle Street, which was built in the 1960s, has not been determined.
Prestige Care and Rehabilitation
Construction has started on a 12 bed expansion utilizing space within the current facility. Target for completion is April 2014. Prestige will have 102 beds when the expansion is completed an increase over the current 90 beds.

2014 Operating Budget Public Hearing Schedule

The Senate is listening to their constituents around the state this Friday and Saturday as they take public testimony on the operating and mental health budget.  This is your opportunity to tell the committee what you think of their plans for the 2014 Operating Budget.  You can testify at your local Legislative Information Office (LIO).  Here is the public testimony schedule:
Friday             9:00am            Bethel, Nome Kotzebue, Unalasaka
                       9:30am            Barrow, Tok, Delta Junction
                       10:00am          Ketchikan, Wrangell, Petersburg
                       10:30am          Sitka, Cordova, Valdez
                       1:30pm            Fairbanks, Mat-su
                       2:30pm            Anchorage
                       4:00pm            Glennallen, Seward, Homer
Saturday          10:00am          Juneau
                        11:30am          Kenai, Kodiak, Dillingham
                        12:30pm          Statewide Teleconference – Offnet Sits
Once the Senate Finance Committee finalizes their budget it then goes to the Senate floor for a vote.  Once the budget passes the Senate it is returned to the House for concurrence.  Since that never happens, the Senate and House form a conference committee to finalize the budget.

Don't Miss Out on the CNO Committee and CFO Collaborative Joint Meeting
April 18-19, 2013 – Anchorage

Meeting Location: Alaska Regional Medical Plaza, 1200 Airport Heights Dr, Classrooms 1 & 2

Time:  8:30 am - 4:30 pm: (A light breakfast will be available starting at 8:00 am.) An evening networking dinner is planned for Thursday.

The first day will feature a joint meeting with CNOs and CFOs focused on improving collaboration between clinical and financial staff in hospitals and will address areas of mutual interest.  The second day will provide an opportunity for CFOs and CNOs to meet separately for networking and discussion of common issues.
Click here for more information on the agenda.

There is no charge to attend this meeting, but registration is requested. Travel funds will be available for ASHNHA Small/Rural Hospital members to support the CNO and CFO to attend (2 people from each small hospital). 
Click here to register for the event.

Hotel: Residence Inn Marriott at 1025 E 35th Ave (907)-563-9844. Make a reservation by April 1st and mention “ASHNHA” for a discounted rate of $109 for studio or $119 for 1 bedroom.
For more information contact or call ASHNHA at 907-586-1790.

Sixty Percent of States, including Alaska, Flunk Transparency Test

A report card on price transparency released this week gives 29 states a 'F' and seven states a 'D' for not adopting policies judged to promote price transparency. Only two states get an A from the Health Care Incentives Improvement Institute report.  Those two states- Massachusetts and New Hampshire are the ones profiled most prominently in the Health Care Commission’s recently released report on the All Payer Claims Database. 

Click here for full report.

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