1. Kansas Hospital Association Legislative Issues August 23, 2006

2. Kansas Hospital Association Federal Issues

3. Kansas Hospital Association 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.

4. Kansas Hospital Association 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)

5. Kansas Hospital Association 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

6. Kansas Hospital Association 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.

7. Kansas Hospital Association 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)

8. Kansas Hospital Association 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.

9. Kansas Hospital Association State Issues

10. Kansas Hospital Association 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

11. Kansas Hospital Association 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

12. Kansas Hospital Association Questions?