Minnesota Hospital Association


January 30, 2017

MHA Newsline: Jan. 30, 2017

In this issue 

Premium subsidy bill signed into law

Last week at the state Capitol, the bill to provide financial relief to Minnesotans in the individual insurance market was signed into law (Chapter 2). The bill uses $326 million from the budget reserve to fund a 25 percent premium rebate for Minnesotans who do not qualify for federal tax credits and purchased coverage through the individual market. The legislation also allows providers to appeal network adequacy decisions. The legislation includes new language related to surprise billing that holds the patient harmless while requiring a health plan and nonparticipating provider to negotiate payment. This legislation passed with strong bipartisan support; however, some DFL lawmakers objected to the provision allowing for-profit HMOs to operate in Minnesota.      

With questions, contact Mary Krinkie, vice president of government relations, MHA, 651-659-1465, or Kristin Loncorich, director of state government relations, MHA, 651-603-3526. 

Session bill tracker
For a complete list of 2017 legislative bills MHA is tracking, visit the MHA Member Center. For assistance accessing the Member Center, contact Emily Lowther, communications manager, MHA, 651-603-3495. return to top   

Governor’s budget proposal released

Last week, Gov. Dayton released his proposed 2018-19 budget for the state’s fiscal year beginning July 1, 2017. Much of the administration’s proposed new spending for health and human services, which is in addition to the spending growth that is part of the forecast, is paid for with Health Care Access Fund (HCAF) dollars.  

The budget proposes to “refinance” Medical Assistance with $358 million out of the HCAF in FY 2018 and another $358 million out of the HCAF in FY 2019. The governor is also proposing to expand MinnesotaCare to be a “public option” sold through MNsure as an additional option for the individual market. Purchasing this public option MinnesotaCare product would not be limited by an upper income threshold. Last year, MHA testified and lobbied against this idea due to low provider payment rates compared to payment rates from commercial products. The governor also proposed to continue the provider tax currently scheduled to end on Dec. 31, 2019.    

In alignment with MHA’s priorities, the governor is also recommending a 5 percent Medical Assistance rate increase for preventive medical care and outpatient mental health services. House and Senate committees will hold hearings this week on the governor’s proposed budget.   

A complete list of the governor’s budget proposals is available onlinereturn to top   

Congress continues focus on ACA repeal and replace

Republicans continued discussions on repeal and replacement of the Affordable Care Act (ACA) during their policy retreat in Philadelphia last week. There seems to be Republican support for considering ACA repeal and its replacement package simultaneously, and House Speaker Paul Ryan (R-WI) said the House aims to approve repeal and replace legislation in March or April.   

The House committees with jurisdiction began holding hearings related to ACA repeal. Rep. Michael Burgess (R-TX), who chairs the House Ways and Means Health Subcommittee and who will play a key role in ACA replacement, expressed support for a piecemeal approach to replacing the ACA, rather than one comprehensive bill.   

On Jan. 24, the Ways and Means Oversight Subcommittee held a hearing focused on the shortcomings of the individual insurance market and possible proposals to encourage healthy individuals to buy insurance and to prevent “gaming-the-system behaviors.” Among the discussed proposals were imposing penalties in the form of higher surcharges for each time that an individual fails to obtain or maintain qualified insurance coverage, tightening eligibility and enforcement for “special enrollment” periods, and enabling and incentivizing insurers to offer coverage that is less expensive and more attractive to uninsured individuals.

Next week, the Energy and Commerce Committee will begin a series of hearings on the Medicaid program, including ways to improve program oversight and legislation aimed at ensuring only the most vulnerable individuals are eligible for the program.   

MHA will continue to work with Senators Franken and Klobuchar and the House delegation, responding to information requests and impact analysis of ACA repeal and various replacement proposals.   

With questions, contact Briana Nord Parish, policy analyst, MHA, 651-603-3498, or Ben Peltier, vice president of legal and federal affairs, MHA, 651-603-3513. return to top   

Confirmation hearing held for HHS secretary nominee

On Jan. 24, the Senate Finance Committee held a confirmation hearing for Rep. Tom Price (R-GA), President Trump’s nominee for Department of Health and Human Services (HHS) secretary. Unlike the Senate Health, Education, Labor and Pensions (HELP) Committee, which held a courtesy confirmation hearing last week, the Finance Committee will vote to confirm Price’s nomination. The date of the committee vote has not yet been announced, but is expected in the few next weeks.    

During his confirmation hearing, Price said his first order of business if confirmed as HHS secretary would be to examine how Trump’s executive order designed to "ease the burden" of the Affordable Care Act (ACA) would be implemented. Price also said he believed that a reform or replacement plan should be “instituted simultaneously” with ACA repeal. Price told the committee that “nobody ought to be priced out of the market for having a preexisting condition” and expressed support for extending the Children’s Health Insurance Program.   

Sen. John Thune (R-SD) pressed Price on whether he would support permanently extending the enforcement moratorium on direct supervision requirements for outpatient therapeutic services provided in critical access hospitals and rural prospective payment system hospitals with 100 or fewer beds; Price responded, “I look forward to working with you on it” and expressed support for telemedicine and other technologies, especially in rural areas. He added the Obama administration's regulations, including meaningful use, are "choking" rural providers.   

Price reiterated his support for the Center for Medicare and Medicaid Innovation (CMMI) and its incentives for innovation, but said he “hopes that we can move CMMI in a direction that actually makes sense for patients," and not mandatory demonstration programs. In the HELP Committee hearing, Price said he is a "strong proponent" of CMMI, and that it holds "great possibility and great promise."

With questions, contact Briana Nord Parish, policy analyst, MHA, 651-603-3498, or Ben Peltier, vice president of legal and federal affairs, MHA, 651-603-3513. return to top   

CMS issues guidance on implementing Medical Outpatient Observation Notice

Beginning March 8, 2017, hospitals and critical access hospitals (CAHs) must provide Medicare beneficiaries receiving observation services for more than 24 hours with the standard federal Medicare Outpatient Observation Notice (MOON). In preparation for the March 8 enforcement date, the Centers for Medicare and Medicaid Services (CMS) updated its Medicare claims processing manual to include guidance on MOON implementation.   

Under the Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act, hospitals must provide oral and written notice to beneficiaries within 36 hours after observation services are initiated, or sooner if the individual is transferred, discharged or admitted as an inpatient. Under Minnesota requirements, notice of outpatient observational status must be given to a patient within 24 hours after being placed under such status. The MOON requires notice after 24 hours, but before 36 hours or earlier if the patient is discharged. According to CMS, there is no prohibition on providing the notice before 24 hours, so there is no impact on existing state requirements.   

The MOON informs beneficiaries of their outpatient status receiving observation services, and the associated implications for cost-sharing and eligibility for Medicare coverage of skilled nursing facility services. The guidance addresses the scope of the requirements, including how hospitals must deliver the notice and delivery timeframes, steps to take if a beneficiary refuses to sign the MOON or if the notice must be delivered to a beneficiary’s representative, ensuring beneficiary comprehension, what may be provided in the “additional information” field of the MOON, retention requirements for the MOON and the intersection with state laws on observation notices. The guidance reiterates that state notice requirements may be incorporated into the MOON as “additional information” to satisfy both federal and state mandates.   

The guidance is posted online. For more information, read the related Medlearn Matters articlereturn to top

Healthcare Leadership Institute approved for 11 Long Term Care Administrator Hours

The MHA Healthcare Leadership Institute, themed “Leadership, Change and Vision — Connecting the Dots,” will be held March 8-10 at the Crowne Plaza Minneapolis West in Plymouth. For more information or to register, download the conference brochure or visit the MHA website. Reserve accommodations online.   

The Healthcare Leadership Institute features 11 general sessions on current health care issues and leadership. Highlights include sessions from Maryjane Wurth, American Hospital Association chief strategy and relationship officer and Health Forum president and CEO; and Thomas Atchison, founder and president of health care consulting firm Atchison Consulting. 

Wurth will open the conference with her presentation, “Future of Health Care in the New Administration.” She will share details on the latest key public policy issues being discussed at the federal level in the legislative and regulatory arena and the potential effects they might have on the nation’s health care delivery systems. She will also look at other key priorities and decision points that Congress has addressed or will address in the coming months.   

Atchison will present an extended, interactive session, “Leading and Managing in Changing Times.” During the session, Atchison will: 

  • Provide strategies for talent management as change processes are implemented and managed; 
  • Examine where change leadership initiatives most often fall short; 
  • Discuss how to avoid common pitfalls; and 
  • Provide the coaching skills needed to drive performance through daily problem solving and continuous staff development. 

Continuing Education
The Minnesota Board of Examiners for Nursing Home Administrators (MN BENHA) has approved the content of this institute for 11 clock hours. return to top