1. Federal Update June 2005

2. Update  Front Burner Legislative  Policy Issues—IPPS; Rehab  Other Issues on your mind

3. Antitrust and Business Practices –Retrospective reviews –Insurance industry consolidation –Group purchasing organizations BCC –Billing –Collections –Charges –Executive compensation –Class action litigation –Public Relations –Membership education and tools –Beyond current charges –Studies Coverage –HCCU –CTUW III –Association health plans –Comprehensive approach (UHPP) Delivery system reform –Limited service providers  Make moratorium permanent  Beyond specialty hospitals  Improving MD relations  Payment options (MEDPAC) –Chronic care management  Hospital participation in pilot projects  (UHPP) –Green Bay Packer model –Stark II/MD recruitment Emergency Readiness and Public Health –Federal appropriations –Flu vaccine legislation –HRSA readiness grant Fraud and Abuse –OIG pricing regulations Health Care Liability Reform –Federal MICRA legislation –Alternatives –State action center Information Technology –Interoperability standards –MD integration –Treatment of regional information networks –Federal funding Mental health –Medicare psychiatric PPS –Coverage parity Payment –Federal budget  Budget resolution  Reconciliation * M edicaid modernization –MD payment –Indirect medical education adjustment –Rural package –Regular PPS rule  Update factor/quality initiative  Area wage index  Outlier thresholds  Long-term care hospitals  Transfer Policy –Rehabilitation 75 percent rule –SNF rule (RUG refinement) –Pay for performance –Medicare advantage implementation –Health Care as Investmentf Quality and Patient Safety –Patient safety legislation –FCC medical telemetry –8 th Scope of Work –JCAHO legislation –COP revisions –Leadership Agenda  Improvement * Use of Evidenced-Based Medicine Practices * Best Practices Clearinghouse  Accountability * Hospital Quality Alliance * Governance Dashboard  Coordination * Organizational redesign/ clinical micro-systems * Chronic care coordination Racial and Ethnic Priorities –Health Gap/Equality Legislation –Data collection –Membership tools/leadership forum Regulatory Relief –HIPAA –Model practices –EMTALA –ICD-10 approval Tax (other) –Pensions –Community benefit Workforce –Federal appropriations –Foreign workers –Labor relations/organizing –MD supply –Best practices clearinghouse –Work design ISSUE MANAGEMENT

4. Payment –Medicaid –Medicare Public accountability –Quality and patient safety –BCC  Billing  Charges  Collections  Executive compensation  Tax-exempt status Liability reform Limited service providers Coverage Immediate Priorities Organizing Themes Protecting the safety net Increasing affordability and improving care Expanding coverage

5. Budget Conference Medicaid –$10 billion over five years  No cuts in first year –Commission (presidential appointment)  Short-term vs. long-term (15 voting; 15 non-voting; 8 MOCs– Ds may not play) Medicare –$1 billion over five years from House Ways and Means Committee Deadline: September 16 Outcome

6. Medicare exposure Medicaid…holding hospitals harmless –Rx reimbursement ($5-6 billion) Physician payment PaymentChallenges

9.  Competition Argument  House Leadership—other R (Barton/Coburn) Opposition  Terry Cloth Robe Factor (Patients like LSHs)  Payment refinements Limited Service HospitalsChallenges

10. “Special” Coverage Project Project Advisory Group –American Hospital Association –Association of Health Insurance Plans –U.S. Chamber of Commerce –Families USA –Federation of American Hospitals –Heritage Foundation –Health Leadership Council –Service Employees International Union “A Practical Plan for Expanding Health Care Coverage –As Many People As Possible…As Quickly As Possible AARP AAFP AFL-CIO AMA ANA APHA BCBSA CHA HR Association Johnson & Johnson Kaiser NGA NCSL Pfizer Project Hope