1. 2016 LEGISLATIVE REVIEW CAFP Annual Scientific Conference 2016 Lobbyist Report

2. PRIORITY LEGISLATIVE ISSUES 2016 Session

3. PRECEPTOR TAX CREDIT BILL HB16-1142  CAFP is part of the stakeholder group working on the Preceptor Tax Credit Legislation again, HB16- 1142  The Sponsors are Representatives Perry Buck & Ginal and Senators Crowder & Cooke  $1,000 personal tax income tax credit per year for preceptors in Pioneer (rural) health care shortage areas – as defined Federally  Currently we are stuck in the same place we were last year, House Appropriations, but we have a slightly better chance this year of getting passed this step

4. OTHER PRIORITY LEGISLATION  SB16-135 – Collaborative Pharmacy Practice Agreements  Support  Collaborative pharmacy practice agreements are voluntary agreements between a licensed pharmacist and a physician or advanced practice nurse that allow a pharmacist to provide evidence- based health care services to one or more patients pursuant to a specific treatment protocol delegated to a pharmacist by a physician or advanced practice nurse.  Collaborative pharmacy practice agreements also may include a statewide drug therapy protocol developed by the State Board of Pharmacy and the Department of Public Health and Environment for public health care services, including health care services for smoking cessation, travel health services, and self-administered hormonal contraception.  HB16 – 1212 – Temporary Tax Incentive for Unreimbursed Medicaid Costs  Support  This legislation takes a new and innovative approach to provider reimbursements for Medicaid patients. The bill would create an income tax credit for providers enrolled and serving Medicaid patients, for unreimbursed expenses. The eligible amount would be determined by calculating the difference between the state Medicaid rates versus Medicare (or equivalent Colorado specific rate, if no Medicare rate is available for comparison). The provider could apply 50% of the difference to their business taxes; however, the credit is nonrefundable and may not be carried forward to the next year if left unused. By evaluating methods besides fee-for-service reimbursement, the state could potentially save money, increase access for Medicaid patients and increase enrollment/ participation by healthcare providers who serve Medicaid.

5. 2016 STATE BUDGET ISSUES Primary Care Bump & Hospital Provider Fee Enterprise

6. PRIMARY CARE PARITY (BUMP) PROVIDER RATE REIMBURSEMENT – THE ISSUE  Starting January 1, 2013, Medicaid reimbursements to primary care providers were increased to the same level as Medicare, a benefit provided through the Affordable Care Act. Prior to the enhanced rates in 2013, Medicaid paid 74 cents on the dollar compared to Medicare, for the same service to be provided. Federal funding, through the ACA, covered the increase through 2014, but 15 states, including Colorado, made the decision to maintain the reimbursement rate parity.  When the State agreed to continue this rate parity for FY 2014-15 & FY 2015- 16, HCPF removed the primary care attestation and just increased the identified E&M codes to all providers; essentially tripling the pool of eligible providers  Unfortunately, the Governor’s Proposed Budget did not propose to continue this rate parity.  This decision was based on lack of support from HCPF, who has said they did not see an impact from those increased rates AND the fact that TABOR is forcing massive cuts across the board.  CAFP initiated a coalition in order to find a solution to this rate cliff. The coalition is composed on over 30 members including: Colorado Medical Society, Colorado Hospital Association, American Academy of Pediatrics, Colorado Rural Health Centers, ClinicNet, Kaiser, Mednex, and many others.

7. COLORADO PRIMARY CARE ALLIANCE “PRIMARY CARE BUMP COALITION”

8. HB16 – 1408 THE SOLUTION  HB 16-1408, “Cash Fund Transfers for Health Care Programs,” provides two important provisions for the enhancement of primary care health care services in Colorado.  The bill establishes the PRIMARY CARE PROVIDER SUSTAINABILITY FUND and transfers $20 million in cash funds to this fund for continuation of rate enhancements in specific areas.  The bill authorizes the Department to begin work on enhanced reimbursement to physicians in the University of Colorado system through the Upper Payment Limit (UPL) funding mechanism. This proposal will increase access for both primary and specialty care across the state.  This achievement comes as the direct result of months of focused efforts by members of the Colorado Primary Care Alliance. This activity included grassroots advocacy, media efforts and direct lobbying. It is a hard fought victory and should be celebrated!  This said, we also must recognize that this achievement is only a partial success. With only $20 million to fill a $49 million hole, some code enhancements were removed from the formula, most notably care in emergency settings. Additionally, these funds are one-time and not built into the Medicaid rate base.  As such the work of the Alliance is just starting, we plan to continue to meet until we are able to identify a long term funding solution for these essential rates.

9. THE FINAL NUMBERS Option D: Increase by Uniform Percentage Using CHP+ Trust Funds Office Visits, Immunization Administration, Newborn, Neonatal & Pediatric Critical Care Visits, Counseling & Health Risk Assessment, and Preventative Medicine Visits Code GroupCodesTotal Impact General Fund Impact Cash Funds Impact Federal Funds Impact Percent of Medicare Counseling and Health Risk Assessments 99401-99414, 99417-99429$133,271$36,657$1,866$94,74887.30% Critical Care Visit99291-99292$0 - Critical Care Visit - Neonatal and Pediatric 99466-99476$807,040$397,664$1,649$407,72887.30% Emergency Department Visit99281-99288$0 - Home Visit99341-99350$0 - Immunization Administration90460-90461, 90471-90474$5,289,670$2,384,600$11,284$2,893,78587.30% Inpatient/facility Visit99217-99239, 99304-99337$0 - Newborn99460-99465, 99477-99486$856,575$412,578$954$443,04287.30% Office Visit99201-99205, 99211-99215$40,915,022$13,650,950$506,682$26,757,38987.30% Preventive Medicine visits99381-99397$7,692,659$3,117,550$34,424$4,540,68487.30% Prolonged visits99354-99359, 99415-99416$0 - Standby, Warfarin, Interdisciplinary conference 99360-99368$0 - Grand Total$55,694,236$20,000,000$556,859$35,137,37787.30% 1 Assumes that services incurred from July 1, 2016 through June 30, 2017 would receive increased payment if under a selected code group.

10. HOSPITAL PROVIDER FEE HOW IT WORKS

11. TABOR OBSTACLES & HOSPITAL PROVIDER FEE ENTERPRISE THE TABOR ISSUE WITH THE BUDGET & THE ENTERPRISE SOLUTION

12. HOSPITAL PROVIDER FEE LEGISLATION THE POTENTIAL SOLUTIONS:HB16-1420 & HB16-1421  HB16-­‐1420: Colorado Healthcare Affordability and Sustainability Enterprise (CHASE)  This bill which will create a new TABOR enterprise, repeal the Hospital Provider Fee, thus removing the revenue from the state’s Revenue. The funds would allow for dollars to go to transportation and would cap at $73M for the Hospital Provider Fee collected, impacting hospitals around the state but allowing for dollars to go to education and beyond. This would address SB228 because if this were to happen with the Hospital Provider Fee, there would be a kickback each year that would allow for the full SB228 transfer over the next several years. You can view the Fiscal Note here.  HB16-­‐1421  This bill will allow for additional spending for priorities identified in Colorado for the FY2016-­‐17, provided HB1420 passes. The revenue would be projected to come in after the beginning of the state Fiscal Year. This was done in the past for Capitol Construction. The first $50M would be applied to Transportation and taken out of SB228. It would also restore the $16M that was taken out of the Severance Tax in 2014. It would add to the Education Fund to further draw down the Negative Factor by $40M and all this funding could be made ongoing subject to the revenue cap. This would open up $63M but more potential would exist should HB1420 pass.

13. QUESTIONS?