Www.nebraskahospitals.org 2015 Legislative Update AAHAM April 24, 2015 Bruce Rieker, J.D. Vice President, Advocacy.

www.nebraskahospitals.org

2015 Legislative Update

AAHAMApril 24, 2015

Bruce Rieker, J.D. Vice President, Advocacy


HHS Committee Kathy Campbell, Chair – Lincoln Sara Howard, Vice Chair – Omaha Roy Baker – Lincoln Tanya Cook – Omaha Sue Crawford – Bellevue Mark Kolterman – Seward Merv Riepe – Ralston


Appropriations Committee Heath 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


2015 Legislative Session 90 days

Tuesday is Day 70 Adjourns June 5 663 bills Biennial budget Transformation of health care

Health and Human Services Executive leadership Functionality Medicaid Redesign


Principles of Transformation

Ensure 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



Transparency of quality and safety Ensure consumer choice Transition assessment of quality to outcomes-

based measures Statewide database for collection and analysis

of health and delivery data, including all payers and patient outcomes



Utilize interventions to influence outcomes of populations

Emphasize public health and prevention Reduce burden of chronic disease Promote personal responsibility Improve health literacy Incent personal health improvement



Attract workers to underserved areas Create new categories of health care teams Enhance telemedicine and internet-capable

care Establish profile of care, quality goals and

reduce disparities


Biennial Budget Governor’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 Program


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 status



Twenty-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 depreciation



Veterans’ Homes $1,361,800 to convert twelve assisted living beds

at the Western Nebraska Veterans’ Home to skilled nursing beds



Norfolk 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 census



Provider Rates 2% 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



Federal 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 Increases from 67.29% to 88.81% effective Oct. 1



Medicaid $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 care



Children’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 ACA



LB 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 selection


Bills of Interest Data 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 performance


Bills of Interest Data Analytics Study

Review current: Agency collection of health care information Health reporting systems Programming capabilities Data warehouse usage


Bills of Interest Data Analytics Recommendations

Access 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


Behavioral Health Statewide Needs Assessment

Behavioral 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


Behavioral Health Statewide 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 population


Medicaid Redesign Components

Medicaid Redesign Task Force Demonstration pilot project Personal financial contribution Value-based payments for PCMHs Circuit breaker if federal funding falls below 90% Health Care Access and Support Fund


Redesign Task Force Comprehensive review

Cost savings and improved quality Real-time, evidence-based approaches Quality measurement to drive innovation Interventions for super-utilizers and those with

exceptional medical conditions Effectiveness of managed care


Redesign Coverage 100%-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 ER


Redesign and Responsibility

100%-133% of FPL contribute up to 2% of monthly income, except: First year, and Second year upon completion of program of

required prevent care services and wellness activities during initial year


Redesign and PCMHs Waiver 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 use


Redesign Circuit breaker

If federal funding falls below 90%, coverage for individuals shall terminate

Health Care Access and Support Fund Created to support Medicaid program


Bills of Interest Medicaid Management Information System (MMIS)

Claims 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


Bills of Interest LB 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 Bill


Bills of Interest In Appropriations Committee

LB 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-research


Bills of Interest LB 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 Committee


Bills of Interest LB 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 Committee


Bills of Interest LB 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 Committee


Bills of Interest LB 264 - Issuance 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 - Certification of community paramedics Status: In HHS Committee

LB 548 - Adopt Surgical Assistant Practice Act Status: In HHS Committee


Bills of Interest LB 257 - Insurers 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 Committee


Bills of Interest LB 511 - Return-to-learn protocols for pediatric

cancer survivors Status: General File

LB 549 - Adopt Health Care Transformation Act Status: In HHS Committee

LB 573 - Create health enterprise zones to reduce disparities, costs, admissions and readmissions Status: In Revenue Committee


Bills of Interest LB 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

Committee


Questions?

Bruce RiekerVice President, Advocacy

(402) [email protected]

Www.nebraskahospitals.org 2015 Legislative Update AAHAM April 24, 2015 Bruce Rieker, J.D. Vice President, Advocacy.

Documents

advocacy slide

depreciation slide

status slide

federal medicaid program

public health

analysis of health

health literacy

personal health improvement