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 online. return 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 article. return 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