President’s ReportWashington UpdateND EMS Rendevous - April 13-14NDHA Education UpdateMedicaid Provider NewsletterPA of the Year Nominations SoughtIs it Legal to Play a Radio Station in the Public Area of a Place of Business100 Critical Access Top Hospitals 2018NDHA Convention Sponsors

Click on link to view attachments:https://www.ndha.org/resources/publications/

ND EMS RendevousMedicaid Provider Newsletter

Phone: 701-224-9732Fax: 701-224-9529Web Site: www.ndha.org

Jerry Jurena, PresidentTim Blasl, Vice PresidentCallen Cermak, Finance ManagerLori Schmautz, Executive AssistantPam Cook, Education DirectorMelissa Hauer, General Counsel

A portion of this publication is supported by The Center for Rural Health’s Medicare Rural Hospital Flexibility Program. Visit their site at http://rural-health.und.edu/projects/flex/.

The Informer

In This Edition:

Attachments:

NDHA Contacts

March 23, 2018

President’s Report ~ Jerry Jurena Regional Policy Board 6 meeting: Last week, AHA hosted the Regional Policy Board 6 (RPB6) meeting in Kansas City. Region 6 is made up of both Dakotas, Nebraska, Kansas, Missouri, Iowa and Minnesota. There were 40 people in attendance. The Committee chair for Region 6 is Dave Molmen of Altru in Grand Forks. The three day meeting focused on the changes occurring in health care. On Thursday, AHA pro-vided a political and legislative update, which was followed by a discussion on health care disruption for hospitals and health systems, focusing on the health care delivery process including the formation of new partnerships, rising consumerism, and the growing role of technology. In the afternoon, the discussion continued on the disrup-tion and future of health care. Attendees were asked to vote in order to give AHA a sense of the direction the members see themselves heading in the future, which lead to additional breakout sessions for further discussion. The afternoon concluded with discussion about the changes made to health care coverage in the past few years. On Friday, discussion was held on maximizing the effectiveness of alternative pay-ment models (APM), especially the Medicare Accountable Care Organization (ACO) program. The day ended with a discussion on population health and social determi-nants of health.

Legislative Committee Update: The NDHA legislative committee met on Thursday, March 22. The Chair of the committee is Reed Reyman from Dickinson. There are fourteen CEOs and six policy and upper management staff designees on the com-mittee, Courtney Koeble from NDMA, and Marcie Schulz of NDONE are non-voting attendees. The charge for the first meeting was to organize and discuss priorities for the upcoming legislative session. The committee will meet the fourth Thursday of each month through August. In September, the recommendations from the com-mittee will be given to the Board for final approval. The committee discussed the following issues:

• Medicaid o Continuation of Medicaid expansion o Continuation of commercial rates for Medicaid expansion o Continued development of IHS 100% FMAP reimbursement• Workforce o Continued work with the Governor’s task force on the nursing shortage o Support educational programs across the state • Behavioral health • Health Care Reform Review Committee• Telehealth• Medical Marijuana • Interstate Medical Licensure Compact .....continued

This edition of The Informer sponsored by:

2017-18 NDHA Associate Member

Page 2

The FY 2018 government funding odyssey may finally be over. Early Friday, the Senate approved a $1.3 trillion bill to fund the government through September 30. The House approved the bill Thursday afternoon. Notwithstanding a veto threat from the president, the White House says it will become law later today, just hours before the current funding resolution expires.Sens. Heitkamp and Hoeven voted for the measure. Rep. Cramer did not vote.

Based on the new budget caps enacted in February in the Bipartisan Budget Act of 2018, the bill substantially boosts fund-ing for a number of priority programs for NDHA. Overall, it includes $88.1 billion for the Department of Health and Human Services, a $10.1 billion increase from FY 2017.

Among other provisions, it appropriates $290.8 million for rural health programs, a $135 million increase over FY 2017 lev-els. It also boosts funding for a variety of workforce development programs; sets aside $3.6 billion to fight opioid abuse; and includes provisions to improve the nation’s broadband infrastructure, including $600 million for a Department of Agriculture pilot to expand broadband access in rural areas.

An effort to include funds for the cost-sharing reductions (CSR) authorized in the Affordable Care Act fell apart early Thursday when Democrats objected to Republican abortion provisions. As you recall, CSRs help offset out-of-pocket expenses for low-income enrollees in the ACA’s individual insurance marketplace.

The omnibus appropriations bill capped a busy week on the Hill. The House Energy and Commerce Committee, on which Rep. Cramer serves, held a two-day hearing on some 25 bills aimed at addressing the opioid crisis. Lawmakers hope to have a bipartisan package on the floor before Memorial Day.

The House Ways and Means Committee held a lengthy hearing on implementation of MACRA, the new physician reimburse-ment model that replaced the sustainable growth rate formula. The Balanced Budget Act of 2018 included several changes to promote flexibility in the new system.

In other news, the Senate Indian Affairs Committee, chaired by Sen. Hoeven, last week held an oversight hearing on opioids. According to news reports, Hoeven was especially interested in whether the Indian Health Service is linked into PDMPs so it can upload relevant patient data directly into them.

IHS Chief Medical Officer Michael Toedt said the agency has partnered with 17 of the 18 states with federal IHS pharmacies to connect their PDMPs to electronic health records and also is encouraging tribes to help them connect the two databases. Toedt also said IHS is planning to partner with tribes to gather more data on how telemedicine is used for behavioral health.Meanwhile, CMS Administrator Seema Verma previewed the administration’s Medicare and Medicaid agenda with reporters this week. According to news reports today, she vowed that CMS will “double down” on price transparency, with the hope of helping enrollees understand their costs.

She also said the agency wants to reduce the burden on providers, partly by shrinking their reporting measures and changing the conditions of participation. She also said the agency is pursuing changes ;in the Stark laws, saying “We’ve heard that that’s a big barrier for providers when they’re trying to do value-based payment arrangements.”

Continued......

Washington Update ~ John Flink

President’s Report continued.......

• Coordination of ambulance services and regulations• 340B drug pricing program • Unnecessary rules and regulations • State licensure rules• Hospital construction requirements

The committee asked that NDHA organize the issues into: state and federal issues that we need to support or oppose, and is-sues that we need to monitor.

Chairman Reyman asked what went well last legislative session and communication was singled out as the most important pro-cess. The group asked for more information on Face Book and Twitter. The group also asked that more facility staff get involved in the legislative process and that information is provided as soon as possible so they can share with their legislators. They want to strive to have one message on each issue. The next meeting will be on April 26. If you would like to be part of the committee, let me know.

Page 3

NDHA Education Update Below is a listing of webinars that may be of interest to you. Registration fees for webinars are $175/NDHA member, and $300/non-member. This fee is “per facility” and you may have as many staff sit in on one connection as you’d like. All times listed below are central time.

Follow this link to register: https://www.ndha.org/education/education-events/

April 2018Best Practices for Workplace Sexual Harassment Internal InvestigationsDate: 04/5/2018 From: 10:00 AM to 11:30 AM

Finding the Perfect Fit: The Latest Behavioral Interviewing SecretsDate: 04/5/2018 From: 9:30 AM to 11:00 AM

April continued.....Texting & Email with Patients Under HIPAADate: 04/10/2018 From: 12:30 PM to 2:00 PM

Finding Lost Revenue - Why I Love the Two-Midnight RuleDate: 04/11/2018 From: Noon to 1:30 PM

The ND EMS Rendevous is scheduled for April 13-14 at the Bismarck Civic Center. For additional information and to regis-ter, follow this link: http://www.ndemsa.org/Rendezvous. The brochure is included in this week’s attachments.

The ND Board of Nursing has approved 21.58 contact hours for this conference. The following sessions are approved:Autism, Post Resuscitation, Suprise! What Do I Do with That, Every Breat You Take: The Most Common Respiratory Diagnosis, Pain Management, How Dirty Are You, One Pill One Kill: Deadly Pediatric Poisonings, All Shook Up: Seizures, Stroke Severity Triage Scales and Large Vessel Occlusions, The Incredible Hulk, Basic 12 Lead Interpretation, Waiting to Exhale: Capnography, Toxic Avenger: Sepsis, Recreational Pharmaceuticals, But We Have Always Done it This Way, Ventricular Assist Devices, CHF, The Magic Behind the Medicine, Here I Come Ready or Not, That’s a Shocker, Killer Bees: Anaphylaxis, Gimme Some Sugar.

ND EMS Rendevous - April 13-14

The March 2018 Medicaid Provider Newsletter is available online. A copy is included in this week’s attachments for your convenience.

Medicaid Provider Newsletter

Washington Update continued....... She noted that the agency will use the annual payment rules as the vehicle for proposing these changes.

Finally, members of Congress quickly left town after the omnibus vote to begin a two-week Easter recess. If you are expecting to meet with members of the congressional delegation, we’re here to provide briefing materials and talking points. We’d also welcome a de-briefing after your visit.

Each year, the North Dakota Academy of Physician Assistants (NDAPA) awards the distinction of North Dakota Physician Assistant of the Year. The NDAPA would like to provide you with the opportunity to nominate a PA who works in your prac-tice setting or community.

If you know a PA whom you would like to recommend as a candidate, please submit a letter of nomination that includes:

the nominee’s name address, city, state, zip telephone number (work or home) reasons for your nomination your name and contact information

Please email your nomination letter to Terri Lang, NDAPA Executive Secretary at terri.lang@med.und.edu. Deadline for nominations is Wednesday, April 18, 2018.

The nominations will be reviewed and voted upon by the NDAPA Board. The award will be presented at the NDAPA Spring Conference in Fargo, ND on Friday, May 4, 2018.

The Physician Assistant of the Year nominee must be a Physician Assistant who works or resides in North Dakota. You may feel this PA deserves recognition because he or she provides excellent patient care, is well respected by the medical commu-nity as well as patients, is considered to be an asset to your community and to the PA profession.

This might be someone who has been involved in medical education – in an academic setting, or by interactions with PA/NP students or colleagues. The Physician Assistant might be dedicated to improving public health by involvement in commu-nity education programs in addition to the every day patient education in the office. You might be aware of a Physician Assistant who is involved in humanitarian projects; one you feel is giving in service of others, above and beyond normal daily responsibility to local patients but also to the community, a third world community, or the profession.

PA of the Year Nominations Sought

Most music played on the radio or through music subscription services is protected by copyright law, which provides exclusive rights to copyright owners to perform or play their songs. If someone plays music without permission of the owner, it may infringe on the copyright. Copyright law allows the owner to recover damages ranging from $750 per violation, to $150,000 if the infringement was willful. Criminal penalties are also possible. With limited exceptions, having the legal right to listen to music for private enjoyment does not include the right to play that music for your customers.

Unless you fit into an exception, you have to pay music-rights organizations for the right to perform music publicly (which may include playing the radio in the public area of a business). One way to lawfully provide music in a commercial setting is to purchase a license to do so. One exception to the rule allows businesses of a certain size (establishments under 2,000 square feet, restaurants or bars under 3,750 square feet) to play music from a radio, television, or similar household device without a license, provided there are fewer than six speakers (with limits on the placement of speakers), and customers aren’t charged to listen. Investigate the exceptions to see if any apply before you make a decision to play a radio station or other music source in a public area of your facility. If you determine that a license is required, there are several music subscription services that offer a commercial version (i.e., Pandora For Business, Spotify Business, Sirius XM) that provide music as well as the license to play that music in a com-mercial setting. For example, Pandora For Business contracts with DMX, a leading provider of commercial music services, to offer special hardware that you can use to play your Pandora stations for the public at your business. Currently, this service costs $26.95 a month plus $99 for the hardware. As part of the package, DMX pays for the public performance licenses for you. Sirius XM and Spotify Business have a similar service. There are other commercial music subscription services out there that provide music and a license (i.e., ASCAP, BMI, SoundExchange, SESAC) and you could also contract with them directly for the right to play the songs in their music library in a commercial setting.

Copyright rules are very specific, and this summary does not cover all of the nuances, so be careful about playing a radio station or music service designed for personal use in your facility without carefully considering whether an exception ap-plies. Contact an attorney familiar with copyright law, as penalties can be steep for violations.

Is it Legal to Play a Radio Station in the Public Area of a Place of Business?

Page 4

Page 5

The Chartis Center for Rural Health named 10 North Dakota hospitals to its Top 100 Critical Access Hospitals in the United States.

Congratulations!

St. Andrew’s Health Center, Bottineau, NDhttp://www.standrewshealth.com/

Pembina County Memorial Hospital, Cavalier, ND http://www.cavalierhospital.com/

CHI Carrington Health Center, Carrington, NDhttps://www.chistalexiushealth.org/locations/carrington

CHI St. Alexius Health Devils Lake, Devils Lake, NDhttps://www.chistalexiushealth.org/devils-lake

CHI St. Alexius Health Dickinson, Dickinson, NDhttps://www.chistalexiushealth.org/locations/dickinson

West River Regional Medical Center, Hettinger, NDhttps://www.wrhs.com/

Jamestown Regional Medical Center, Jamestown, NDhttps://jrmcnd.com/

Linton Hospital, Linton, NDhttp://www.lintonhospital.org/

CHI Lisbon Health, Lison, NDhttp://www.lisbonhospital.com/

Sanford Mayville, Mayville, NDhttp://www.sanfordhealth.org/locations/sanford-mayville-medical-center

Page 6

NDHA Convention SponsorsThank you to the current sponsors of the 2018 NDHA Annual Convention & Trade Show!

Platinum Level Sponsor

NDHA’s annual convention and the HSI Solution | Intalere Update Conference will be held October 9-11, 2018 at the Double Tree by Hilton in West Fargo, ND. Each conference will have its own track and will again share keynote speakers. New this year will be one combined trade show! Watch for more information in April!

Lunch SponsorGold Level Sponsor