1. State and Federal Review Delaware Healthcare Association Delaware Organization Of Nurse Executives Nov. 10, 2011

2. Delaware Legislation

3. Overview Revenues – January of 2011 = DOWN Revenues - June of 2011 = UP $350 Unexpected Money in Four Months Escheat Personal Income Tax Corporate Income Tax Bank Taxes Because of January DOWN: Governor Proposed Cutting Medicaid by $5 Million

4. Highlights Good: Proposed Medicaid Reduction of $5 million Turned Back DHIN Receives $2,996,900 Impediments to Blue Shield / Highmark Affiliation Removed Placed a DHA Appointee on Advisory Board to the Office of Public Guardian Bad: Reimbursements By Medicaid and Private Health Insurers for School Based Wellness Centers

5. Bradley Bills Continue Bradley Bills Continue Bradley Bills Continue Bradley Bills Continue Bradley Bills Continue

6. Professional licensure laws are amended to further define and clarify a health care license holder’s duty to report unprofessional conduct, child abuse and neglect; and providing for license revocation for felony sexual offenses.

7. SB 31 - Dentistry and Dental Hygiene SB 32 – Psychologists SB 33 - Physician Assistant SB 59 & HB 45 - Nursing HB 67 - Mental Health and Chemical Dependency Professionals HB 68 - Clinical Social Workers HB 165 - Physicians and Health Care Facilities

8. Other Legislation…. SB 13 – Needle Exchange Program Continuation SB 17 – Medical Marijuana Act SB 19 – Registered Lobbyists. Would prohibit lobbyists from serving on public bodies; commissions, task forces (Did not Pass) SB 45 – (Abortion Clinics). Licensure, monitoring and oversight HB 47 – DHSS Authority to Investigate and Inspect (Abortion Clinics) SB 90 – Accreditation for Medical Facilities Performing Invasive Procedures. (Abortion Clinics)

9. Other Legislation… HB 165 – Duty to Report Physician Privileges – Only adverse events HJR 7 – Study Group Child Mental Health Needs Downstate SB 137 – Health Insurance Charges for Different Classifications of Prescription Drugs – Health Care Commission to study the issue of specialty tier prescription drugs HB 95 – Motorcycle Helmets – Eliminates the requirement that those over age 19 must have a helmet on their bike HB 155 – Nursing Licensure – allows renewals up to 60 days past renewal period

10. Other Legislation SB 84 – Cardiovascular Disease and Stroke Prevention Program Established SB 108 – Prohibition on “Over-the-Line” Worker’s Compensation Facilities HB 3 – Limit on Trans Fatty Acids in School Meals

11. Worker’s Compensation Law Passed 2007  Difficult to Implement for Hospitals  HCAP Draft Solution  80% of Charge Reimbursement (Except Drugs/Supplies) Adjusted Annually…..  Blended Rate for All Hospitals  Compared to Medical CPI  Drugs and Supplies – Consistent Mark-up Methodology

12. Health Resources Board Health South Application Process Reverberates Governor, Members of General Assembly have Questioned Certificate of Public Review Process Is it Anti-Competitive and Drive Up Costs? Should Economic Development Be a Factor? HRB Places on Sun-Set Review

13. And Then There Is Medicaid…. Governor’s Plan -- $ 5 Million Cut by ($12 Million w/Fed $)  No Reimbursement for more than 3 Non-Urgent ED Visits  Non-Urgent ED Visits Reimbursed at 25% of Urgent Rate  Caps on Reimbursement for Outpatient  Caps on Reimbursement for Rehab

14. Medicaid…. Governor’s Plan -- $ 5 Million Cut by ($12 Million w/Fed $) Problems  Codes Not Properly Assigned  Urgency Determined on Diagnosis Not Presentation  Counter to Public Health Message to “Call 911 if Emergency”  We Don’t Have A Choice - EMTALA

15. Medicaid…. Governor’s Plan -- $ 5 Million Cut by ($12 Million w/Fed $)  Joint Finance Committee Turned Away Cut  We Advocated for a Task Force (Section 156 Task Force) to Work On Medicaid Savings  Senator Harris McDowell Legislated to Use Medical Care Advisory Committee to Explore “Health Care Savings and Reform”

16. Medicaid…. Governor’s Plan -- $ 5 Million Cut by ($12 Million w/Fed $) Section 156 Task Force  A Health Provider Presence  Report Due by December 1 st  Goal of $5 Million State Budget Savings  Looking at Alternatives  Christian’s “High Flyer” Pilot Expansion

17. Future of Nursing DHA – DNA Joined Campaign For Action Coalition  DHA Supports Nurse Advancement Opportunities  DHA Supports Practicum Opportunities  DHA Supports Nurses Being Included In Reform Discussions (Of Course Hospitals Haven’t Been Included In Reform Discussions, Either!)