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Advocacy update NEOONE Education Symposium Advocacy Update 6/14/2017
June 30, 2017 OHA Board of Trustees
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State budget update Executive Proposal Key Hospital Issues:
Maintains current Medicaid eligibility levels Replaces MCO sales tax with sustainable tax on all HMOs Assesses premium payments for adults above 100% FPL Eliminates price transparency law Creates a new high-Medicaid peer group and imposes new cut to hospitals outside peer group Imposes ICD-10 coding “inflation” cut Implements “non-contracting” language Advocacy Update NEOONE Education Symposium June 30, 2017
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Budget breakdown hospital payment growth
January 2017 Advocacy Update NEOONE Education Symposium June 30, 2017
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Budget breakdown hospital payment growth
April 2017 Advocacy Update NEOONE Education Symposium June 30, 2017
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Budget breakdown Where we started
Source: Ohio OBM, Office of Health Transformation Advocacy Update NEOONE Education Symposium June 30, 2017
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State budget update As Passed by the House Key Hospital Issues:
Eliminates hospital cuts Removes non-contracting language Freezes hospital rates and caps payments at $6.9B each year Adds Medicaid expansion eligibility requirements Requires Controlling Board approval every 6 months for Medicaid funds Reverts back to current price transparency law Eliminates the Comprehensive Primary Care program Restores proposed changes to BCMH Delays the behavioral health redesign and managed care carve-in Requires commercial insurers to cover telemedicine services the same as in-person Advocacy Update NEOONE Education Symposium June 30, 2017
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Ohio SFY 2018-19 Operating Budget │ OHA Finance Committee
6/8/2017 Revenue projections Dispatch tweet instead Advocacy Update NEOONE Education Symposium June 30, 2017
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State budget update Key Hospital Issues As Passed by the Senate
Rate Freeze Remains in the bill Expansion population enrollment cut in FY ’19 Adds Eligibility Requirements No longer requires Controlling Board every six months Continues current price transparency law Removes telemedicine changes Creates physician UPL program for County and University affiliated hospitals. Advocacy Update NEOONE Education Symposium June 30, 2017
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Ohio SFY 2018-19 Operating Budget │ OHA Finance Committee
6/8/2017 Legislative timeline June 20 Senate Finance Vote June 21 Senate Floor Vote June 22 - ? Conference Committee May 3 Bill introduced in Senate June 30 Gov. Signs Budget Advocacy Update NEOONE Education Symposium June 30, 2017
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Where are we now? Medicaid Expansion
Medicaid Expansion Enrollment Frozen in July 1, 2018 (Except for Mentally Ill and Drug Addicted) ODM Must Apply for Waiver on Medicaid Expansion Recipients Over 55 Medically Fragile Employed In Education/Workforce Training In Recovery Program Mentally Ill Drug Addicted Advocacy Update NEOONE Education Symposium June 30, 2017
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Where are they Now? Rate Freeze for Hospitals
Funding Rate Freeze for Hospitals Controlling Board Approval if Congress Changes Funding Agreement JMOC Review if Medicaid Wants to Raise Any Rates $6.9 Billion Cap on Hospital Payments Removed New Physician UPL for University Affiliated and County Hospitals Advocacy Update NEOONE Education Symposium June 30, 2017
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Other Major Hospital Provisions
Where are They Now? Other Major Hospital Provisions Managed Care Non-Contracting Language is out Current Law Remains Regarding Healthcare Price Transparency BCMH returned to the Dept. of Health Telemedicine Language Removed Advocacy Update NEOONE Education Symposium June 30, 2017
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Other Major Hospital Provisions
Where are they Now? Other Major Hospital Provisions State must Apply for a “Health Ohio Waiver” Hospital Data Reporting to ODH Removed Health Insuring Corporation Tax Increased to Help Local Governments Advocacy Update NEOONE Education Symposium June 30, 2017
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Ohio SFY 2018-19 Operating Budget │ OHA Finance Committee
6/8/2017 What they are saying News Media Freeze the freeze with a veto – ABJ Don’t Mess with Medicaid – Canton Rep GOP Hacks Away at Medicaid – Dispatch Gov. Kasich Must Veto Medicaid Freeze in Budget – Plain Dealer Advocacy Update NEOONE Education Symposium June 30, 2017
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What they are saying Ohio General Assembly
We're trying to help everybody we can and we've got to do it in a responsible way. As our costs go up in Medicaid, we have to balance the fact that there's a lot more things we still need to fund in this state," Chairman Rep. Ryan Smith Rep. Wes Goodman (R-Cardington) argued the latter point, saying that too much money is being spent on "able-bodied, childless adults," who are getting services while the "truly vulnerable" have to wait in line. Rep. Kyle Koehler (R-Springfield) There has to be a point where the state accepts it no longer has the resources to pay for expanded Medicaid costs Advocacy Update NEOONE Education Symposium June 30, 2017
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Governor Line Item Veto
Next Steps Governor Line Item Veto Possible Governor Line Item Veto’s Expansion Enrollment Freeze JMOC Authority Over Rate Increases Hospital Rate Freeze Controlling Board Authority on Expansion Payments HIC Tax Increase Others Advocacy Update NEOONE Education Symposium June 30, 2017
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Final Step Both Chambers Must Override a Veto Veto Override
3/5 majority in both chambers Does NOT happen very often Especially when the Gov and GA are of the same party Advocacy Update NEOONE Education Symposium June 30, 2017
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OHA Advocacy UpDate Board of Nursing AG Request S.B. 55
Certified Nurse Practitioners engagement in acute care practice OHA submitted comment letter on April 19 Expect opinion in August S.B. 55 Concept of nurse to patient ratio Sponsored by member of the minority OHA does not support Not anticipated to receive traction Palliative Care Legislation Creates Palliative Care & Quality of Life Council Creates Palliative Care information Requires healthcare facilities to identify patients that could benefit from palliative care Advocacy Update NEOONE Education Symposium June 30, 2017
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OHA Advocacy UpDate Reintroduction of CRNA Bill
House Bill 191, sponsored by Rep. Anne Gonzales (R- Westerville) Amends section of the Revised Code regarding the practice of certified registered nurse anesthetists OHA in the process of reviewing the bill and engaging members regarding impact Issue of Acute Care Certification Issue: “whether under Section , ORC a CNP not nationally certified in acute care may engage in acute care practice, based on clinical experience obtained post-graduate through the course of employment/workplace training”. OHA commented on April 19, 2017 to inform the AG’s analysis OHA submits that Ohio law permits CNPs who have acquired post-graduate clinical experience to engage in acute care practice OB Rules Maternal Newborn Advisory Committee met Proposed implementation of NRP standards for “complicated delivery” and issue of defining “complicated delivery” Removed NRP standards requirement Draft rules forthcoming Advocacy Update NEOONE Education Symposium June 30, 2017
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