2015 Legislative Update - PowerPoint Presentation

Slide1

2015 Legislative Update

AAHAM

April 24

,

2015

Bruce Rieker, J.D.

Vice President, AdvocacySlide2

HHS CommitteeKathy Campbell, Chair – Lincoln Sara Howard, Vice Chair – Omaha

Roy Baker – Lincoln

Tanya Cook – Omaha

Sue Crawford – Bellevue

Mark Kolterman – Seward

Merv Riepe – Ralston Slide3

Appropriations CommitteeHeath Mello, Chair – Omaha Bob Hilkemann, Vice Chair – Omaha

Kate Bolz – Lincoln

Ken Haar – Malcom

Bill Kintner – Papillion

John Kuehn – Heartwell

Jeremy Nordquist – Omaha

John Stinner – Gering

Dan Watermeier – Syracuse Slide4

2015 Legislative Session90 daysTuesday is Day 70

Adjourns June 5

663

bills

Biennial

budget

Transformation of health care

Health and Human Services

Executive leadership

Functionality

Medicaid

RedesignSlide5

Principles of TransformationEnsure all

have

access to

coverage

Optimize

public and private

funding

Support

effective models of

delivery

,

financing

and

payments

Reduce

per-patient

cost through

transparent

pricing and

payment

linked to outcomes Slide6

Principles of TransformationTransparency of

quality

and

safety

Ensure consumer choice

Transition assessment

of quality

to

outcomes-based

measures

S

tatewide database

for

collection

and analysis of health

and delivery

data, including all

payers and patient outcomesSlide7

Principles of TransformationUtilize interventions to

influence outcomes

of

populations

E

mphasize

public health and

prevention

R

educe burden

of chronic

disease

Promote

personal responsibility

Improve

health

literacy

Incent

personal health improvement Slide8

Principles of TransformationAttract workers to

underserved

areas

C

reate new

categories of health care

teams

E

nhance telemedicine

and

internet-capable care

E

stablish profile

of

care, quality goals and

reduce

disparitiesSlide9

Biennial BudgetGovernor’s recommendations$63.1 million

for Medicaid related

to

participation

in

federal

Medicaid

program

$350,000/year for

a seventh

FQHC

$500,000/year reduction for NEHII

$360,000/year

reduction

for Medical

Student Assistance

ProgramSlide10

Governor’s Recommendations$1,484,435 state/$

4,453,304 federal

in

second year

for Medicaid

eligibility system

$1,296,515 state/$3,889,543 federal for Medicaid

provider screening and

enrollment

$171,370 state/$511,880 federal for real-time

connectivity for Medicaid eligibility

and

claim

statusSlide11

Governor’s RecommendationsTwenty-Four Hour Care Facilities

$1,130,497 state/$328,043 federal for

inflationary increases for food, prescription drugs, medical supplies and medical

services

$849,592 state/$96,451

federal

for

rent, maintenance and

depreciationSlide12

Governor’s RecommendationsVeterans’ Homes$

1,361,800 to convert twelve assisted living beds at the Western Nebraska

Veterans’

Home to skilled nursing

bedsSlide13

Governor’s RecommendationsNorfolk Sex Offender Treatment Facility

$800,000

General Funds and

$800,000 Personal Services Limitation

funds

over two years for sex

offender treatment program for additional staffing and operating costs associated with increased

censusSlide14

Governor’s RecommendationsProvider Rates2% annual

increase

$

20,113,655

state/$

21,552,740 federal

in

year one, and $40,435,528

state/$

43,730,591 federal

in

year

two

Programs include

Medicaid, Children’s Health Insurance Program, Public Assistance, Child Welfare Aid, Behavioral Health Aid, Developmental Disabilities Aid and Aging Slide15

Governor’s RecommendationsFederal Medical Assistance Percentage (FMAP)

53.27

% to 51.16%

reduction Oct.

1,

2015

Enhanced

FMAP available for

Children’s

Health Insurance Program (CHIP), including

23

% expanded FMAP

from

ACA for federal fiscal years 2016 through

2019

I

ncreases

from 67.29% to 88.81% effective

Oct. 1 Slide16

Governor’s RecommendationsMedicaid

$167,391,234 over two years

for

growth in utilization

, a 2% increase for provider rates and a reduced

FMAP

Increase of $6,509,050 over two years

for prescription drugs, including new drugs

for Hepatitis C

$17,832,696 over two years

for

payment

of minimum wage, overtime and travel costs for

workers providing

home-based

careSlide17

Governor’s RecommendationsChildren’s Health Insurance Program (CHIP)

$15,157,370

and

$21,035,087

reductions

for

years one and two, respectively,

for

CHIP

Reduced

GFs

of $15,786,958

in

year one and $21,897,034

in

year two

from

adding

23

% enhanced FMAP as provided by

ACASlide18

Governor’s RecommendationsLB 593 - $250,000 to UNMC Study current data

systems

Make

recommendations

to increase

efficiency and effectiveness of

public’s

health care dollars

NHA

alternative to LB 593

Independent

, third-party analysis

Utilize RFP process for consultant selectionSlide19

Bills of InterestData Analytics Study$250,000 for independent

study of current health data systems in

Nebraska

Facilitate transformation

of

health care through

[open] access to actionable data

analysis

Profiles

patient

populations

Maps

utilization and spending

patterns

Measures

performanceSlide20

Bills of InterestData Analytics StudyReview current

:

Agency collection of health care information

Health reporting systems

Programming capabilities

Data warehouse usageSlide21

Bills of InterestData Analytics RecommendationsAccess to timely data

and transparent data

Medicaid

eligibility

and

claims

data

Linking

existing data

sources

Reporting

system

participants

Data portals allowing

actionable data analysis

Privacy protections and quality assurance Slide22

Behavioral HealthStatewide Needs AssessmentB

ehavioral

health conditions require

comprehensive

array of physical

, behavioral

and other support

services

88 counties

are

federal- and

state-designated shortage areas

for psychiatric

and mental health

services

Nebraska

would benefit from comprehensive delivery

through

integration of behavioral and physical

care Slide23

Behavioral HealthStatewide Needs Assessment

Examination of data for population health

Infrastructure, reporting standards and

data

access

Provider

rates,

integration and coordination

of

behavioral and

primary care

services, and risk-based

and no-risk

models

Provider shortages

and

workforce needs

Institutional

placement

and community alternatives

Ratio

of qualified facilities to state

populationSlide24

Medicaid RedesignComponents

Medicaid

Redesign Task Force

Demonstration

pilot project

P

ersonal

financial contribution

Value-based

payments for

PCMHs

C

ircuit

breaker

if federal

funding

falls

below 90%

Health

Care Access and Support FundSlide25

Redesign Task ForceComprehensive review C

ost

savings and improved

quality

Real-time

, evidence-based approaches

Q

uality measurement to drive innovation

Interventions for

super-utilizers and

those with exceptional

medical

conditions

E

ffectiveness

of managed

careSlide26

Redesign Coverage100%-133% FPL in premium assistance

50

%-99

%

FPL in existing program

Medically

frail,

super-utilizers and individuals with exceptional health needs

in

health homes

No co-pays, except

for

inappropriate use of ERSlide27

Redesign and Responsibility100%-133% of FPL contribute

up to 2% of

monthly

income,

except:

F

irst year,

and

S

econd

year

upon

completion of

program

of required

prevent

care services and wellness activities during

initial

year Slide28

Redesign and PCMHsWaiver will be demonstration pilot project Patient-centered medical homes

Health homes for super-utilizers

Value-based payments

Per-member

, per-month basis

Payment

incentives for

participation

Attainment

of specific

outcomes

that promote wellness, prevention, chronic-disease management, immunizations,

care management and EHR

useSlide29

RedesignCircuit breakerIf federal funding falls below 90%, coverage for individuals

shall terminate

Health

Care Access and Support Fund

Created to

support

Medicaid programSlide30

Bills of InterestMedicaid Management Information System (MMIS)

C

laims

processing

system should maximize

information retrieval for monitoring and

analysis

Benefit coordination, management

and utilization analysis

Modernization will reduce

waste and

inefficiencies

DHHS

in

planning

phase of

replacement

NHA

supports

continued

funding Slide31

Bills of InterestLB 98 - $7 million/year for smoking cessation

Status: In Appropriations Committee

LB

196 - Change Rural Health Systems and Professional Incentive Act to establish loan repayment program that will incent residents to practice in designated shortage area - $40,000/year, not exceed $

120,000

Status: On General File and a Speaker Priority BillSlide32

Bills of InterestIn Appropriations CommitteeLB 110 - $500,000/year for pediatric cancer specialists

LB 233 - $100,000/year for UNMC for

Perinatal

Quality Improvement Collaborative

LB 417 - $1,800,000/year for pediatric cancer research

LB 436 -

$425,000

to

UNMC to establish pilot program and expand pediatric dental residents from

8 to 10

LB 418 - $

2,000,000/year

in HCCF for

bio-researchSlide33

Bills of InterestLB 21 - Rate increases for BH providers

Status: General File

LB 37 - Adopt Prescription Drug Safety Act

Status: Signed into law

LB 46 - Change Statewide Trauma System

Act

Status: Signed into law

LB 125 - Funds for FQHCs and HHs for underserved

– 25% of tobacco settlement funds

Status: In Appropriations CommitteeSlide34

Bills of InterestLB 148 - Medicaid for youth formerly in foster

care

Status: In HHS Committee

LB 471 -

PDMP to prohibit

patients from opting out;

require

all prescriptions

entered

;

allow

all prescribers or dispensers

free access;

and

include

all

payers

Status: In HHS Committee

LB

625 -

Interstate

Placement for Involuntarily Admitted

Patients

Status: In Judiciary CommitteeSlide35

Bills of InterestLB 107 - Eliminate

Integrated Practice Agreements and

create

Transition to Practice Agreements for

NPs

Status: Signed into law

LB

108

- $

250,000

/year for 12

one-year

BH master's

level internships in rural and underserved

areas

Status: In Appropriations Committee

LB

258 - Adopt

Interstate

Medical Licensure

Compact

Status: In HHS CommitteeSlide36

Bills of InterestLB 264 - I

ssuance

of credentials under

UCA

based on military education,

training

or

experience

Status: General File

LB

353

- Credentialing for

nursing home

administrators

Status: In HHS Committee

LB

543 - C

ertification

of community paramedics

Status: In HHS Committee

LB

548 - Adopt

Surgical

Assistant Practice

Act

Status: In HHS CommitteeSlide37

Bills of InterestLB 257 - I

nsurers must

provide descriptions

for telehealth

Status: General File

LB

315 -

Medicaid

recovery audit

contractors

Status: General File and Speaker Priority Bill

LB

332

- $600,000 for prescription

drug

disposal

Status: In Appropriations Committee

LB

333

- Create Program

of Health Care

Transformation administered

by

Division

of Public Health

Status: In HHS CommitteeSlide38

Bills of InterestLB 511 - R

eturn-to-learn

protocols for pediatric cancer

survivors

Status: General File

LB

549 - Adopt

Health

Care Transformation

Act

Status: In HHS Committee

LB

573

-

C

reate

health enterprise zones

to reduce disparities

,

costs, admissions

and readmissions

Status: In Revenue CommitteeSlide39

Bills of InterestLB 584 -

$

16.2 million

for dental

clinic and oral health training

facility

Status: In Appropriations Committee

LB

652

-

Establishes

911

Emergency Services Communications Act to

ensure

all

have

comparable accessibility

Status: In Transportation and Telecommunications CommitteeSlide40

Questions?Bruce RiekerVice President, Advocacy

(402) 742-8146

brieker@nebraskahospitals.org