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Legislative Issues. August 23, 2006. Federal Issues. CAH Relocation. FY06 inpatient hospital regulation set new rules for when a necessary provider CAH could relocate. Established the “75% rule” – CAH must serve 75% of same population, provide 75% of same services, employ 75% of same staff. - PowerPoint PPT Presentation
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Legislative Issues
August 23, 2006
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Federal Issues
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CAH Relocation
• FY06 inpatient hospital regulation set new rules for when a necessary provider CAH could relocate. Established the “75% rule” – CAH must serve 75% of same population, provide 75% of same services, employ 75% of same staff.
• CMS Interpretive Guidelines issued last fall were far more prescriptive…– 75% rule more prescriptive (e.g., mentions policies and
procedures, billing codes). Requirements for 75% test are more rigorous for necessary provider CAHs
– CMS has up to one year AFTER relocation to do final determination.
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Problems and Steps
• Problems– Too prescriptive and inflexible– More expensive to build on same site– Uncertainty – trouble securing financing since final
determination not made until after relocation• Steps
– Commented in FY07 inpatient rule– Congressional House Letter (Rep. Moran, Rep.
Ryun)– Congressional Senate Letter (Sen. Roberts, Sen.
Brownback)
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Medicare Advantage Rural Health Services Preservation Act
• H.R. 880: 101% of cost for inpatient and outpatient services at CAH and rural health clinics
• S. 2819: Choice of interim rate (101% of cost) and cost reconciliation OR 103% of interim rate for inpatient and outpatient services at CAHs and rural health clinics
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Extending MMA
• Rural Hospital and Provider Equity (R-HoPE) Act of 2006 (S. 3500)– Would create or increase Medicare payments to
rural hospitals and make changes to guidelines for CAHs (such as outpt lab, ambulance).
• Medicare Rural Health Provider Payment Extension Act (H.R. 5118)– Similar to R-HoPE and would address outpatient
laboratory and 5% rural add-on for home health services.
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Other Legislation
• CAH Outpatient Lab Reimbursement– Critical Access to Clinical Lab Services Act (S. 236/H.R.
1016)• Cost Based Reimbursement for Ambulance Services
– Rural Access to Emergency Services Act of 2005 (S. 1108/H.R. 2525)
• 340b Drug Discount– Safety Net Inpatient Drug Affordability Act (S. 1840/H.R.
3547)• Home Health Services
– Medicare Rural Home Health Payment Fairness Act (S. 300/H.R. 11)
• Expansion of Cost-Based Reimbursement– Rural Community Hospital Assistance Act of 2005 (S.
933/H.R. 2350)
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Other Legislation
• Rural Health Care Capital Access Act (H.R. 4912)– Provide a 5-year extension of the HUD 242 program
• The Comprehensive Immigration Reform Act (S. 2611)– Would extend permanently the State 30/J-1 visa program;
allow more qualified, internationally trained nurses to work in U.S.
• The Health Information Technology Promotion Act (H.R. 4157)– Accelerate the use of health information technology and
would establish national standards on privacy. Offers anti-kickback and physician self-referral exemptions for hospitals that share hardware, software, or information training and support to physicians.
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State Issues
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Looking Ahead…
• Transparency– Pricing, Quality, etc.
• Billings and Collections• Medicaid• Health Policy Authority• Uninsured• Concealed Weapons• Fire Mashal and State Surveys• Other legislative issues:
– Infection reporting; staff ratios; workforce
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The Time is Now..
• DO invest in a relationship with your legislators
• DO invite them to the hospital
• DO share with them any issues, concerns
• DO thank them for their support
• DO let us know if you have a personal relationship with your legislators
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Questions?