2. Federal and State Advocacy: How are They Different? What are the Big Issues? Cassie Sauer, Senior VP, Advocacy and Government Affairs Chelene Whiteaker, Policy Director, Member Advocacy

3. Increase your understanding of issues on the advocacy agenda at the state and federal level Get you more engaged in advocacy at the federal level, especially with our Senators Answer any questions you may have about our work Goals

4. Washington State vs. Washington D.C.

5. Advocacy in Washington, D.C.

6. Further away, less time in district – but more recesses Full-time job Slower process with unclear beginnings, middles, and ends Larger geographic area to serve Sometimes more issue specialization Every vote counts Washington D.C.

7. Important Partnerships

8. “A House Divided” 1982 1997 2012

9. U.S. Senators

10. U.S. Representatives: Democrats

11. U.S. Representatives: Republicans

12. Problem: CMS decided only hospital stays that span over two midnights will be considered inpatient stays Legislation: Delays enforcement of “Two-Midnight” policy Tasks CMS with new payment policy Co-sponsors: Representatives DelBene, Larsen, Kilmer, McMorris Rodgers, Reichert Neither Senator has co-sponsored the bill Two Midnight Rule: S. 2082 and H.R. 3698

13. Problem: As part of the CMS conditions of payment, physicians at CAHs must certify that a Medicare beneficiary is reasonably expected to be at the hospital less than 96 hours. Patients would have to be transferred if they require more than 96 hours of care. Legislation: Repeals the 96-hour rule for payment purposes Cosponsors: Representatives McMorris Rodgers, Hastings, and Kilmer Neither Senator has co-sponsored the bill 96-Hour Rule: S. 2037 and H.R. 3991

14. Physician Supervision: S. 1143 H.R. 2801 Problem: CMS changed the physician supervision requirement for therapeutic outpatient services to “direct” instead of “general” Legislation: Adopts a “general” supervision requirement for therapeutic outpatient services Cosponsors: Representatives McMorris Rodgers, Heck Neither Senator has co-sponsored the bill Senate passed a delay for one year

15. Program provides steep discounts to safety-net providers, including CAHs Problem: The pharmaceutical industry would like to see it scaled back A few hospitals may be abusing the program, making it vulnerable WSHA recently met with key Republicans about its importance 340B Drug Discount Program

16. Reducing Cost, Improving Quality: Early Elective Deliveries

17. Reducing Cost, Improving Quality: Central Line Bloodstream Infections

18. Reducing Cost, Improving Quality: Pressure Ulcers

19. Federal Advocacy Resources: WSHA Website

20. Respond to requests for action Consider a trip with us to D.C. Let us know your interest in an in-district meeting with your colleagues Host a Congressional staff member Deliver a PAC check How You Can Get Involved

21. Montana Demonstration: Frontier Community Health Integration Demonstration Project

22.  A new provider type and a new COP under which all services would be integrated  A single payment system  Incentives to improve the quality of care such as pay-for- performance and shared savings  Increased use of telehealth and electronic medical records  Increased emphasis on care transitions and care coordination  Additional beds for long-term care services by raising the CAH bed limit from 25 to 35  Incentives to increase community-based care by utilizing visiting nurses and strengthening home health services Montana Demonstration: What the Association Wanted

23.  Cost-based payment of the originating CAH’s facility fee for telemedicine services  Medicare reimbursement to a CAH originating site and a distant site provider tor telehealth services furnished using asynchronous “store and forward” technology  Waiving the 35-mile rule for cost-base reimbursement of ambulance services furnished by a CAH  An increase in the bed limit for CAHs from 25 to 35 for SNF or NF-level services  Enhanced payment rates for home health providers to account for the costs of traveling extended distances to provide services Montana Demonstration: What the Association Got

24.  13 applicants in four states  Washington not eligible  Not as far as advocates hoped, but an interesting start  Took a lot of Congressional pressure Montana Demonstration: Status

25. Associations would need to bring member task force together Use our legislative leadership to shepherd it through Requires legislation and funding Might happen, might not Interest? How Could We Move a Washington/Oregon Demonstration?

26. Advocacy in Olympia

27. Closer, lots of time in district Sometimes have another job Speedy process with clear deadlines and adjournment dates Smaller geographic area to serve Tend to want to know about more issues Every vote counts Olympia

28. Long session New leadership (4/5 of key players) has more experience Majority Coalition – interesting political dynamics Who wins the Senate? Coming State Legislative Session

29. Budget-writing session – House and Senate will likely differ on willingness to spend Revenue forecast likely better, but not great Supreme Court mandates: – more education funding – threatening ruling recently – more mental health funding? Smoke pot! State Budget Overview

30. Telemedicine Mental health investments and system improvements Increasing transparency Inmates and suspects Crisis standards of care What We’ll Work On - Proactive

31. Nurse staffing bills Clinic fees Partnerships and affiliations (particularly PHDs) What We’ll Work On - Defensive

32. Lawsuit over new Certificate of Need rule Judge ruled in favor of WSHA Revert to current Certificate of Need rule Unclear if the case will be appealed Do we want to reform CON? WSHA v. DOH

33. Respond to requests for action Come to Olympia to testify or meet with your legislators Schedule an in-district meeting by yourself or with your colleagues Don’t forget to highlight care improvements here too! Deliver a PAC check How You Can Get Involved

35. It is an honor to represent you. Thank you for all your help in making our advocacy program successful!

36. Cassie Sauer Senior Vice President, Advocacy & Government Affairs cassies@wsha.org  206/216-2538 Chelene Whiteaker Director, Member Policy chelenew@wsha.org  206/216-2545