1. www.nebraskahospitals.org 2015 Legislative Update AAHAM April 24, 2015 Bruce Rieker, J.D. Vice President, Advocacy

2. www.nebraskahospitals.org HHS Committee  Kathy Campbell, Chair – Lincoln  Sara Howard, Vice Chair – Omaha  Roy Baker – Lincoln  Tanya Cook – Omaha  Sue Crawford – Bellevue  Mark Kolterman – Seward  Merv Riepe – Ralston

3. www.nebraskahospitals.org Appropriations Committee  Heath Mello, Chair – Omaha  Bob Hilkemann, Vice Chair – Omaha  Kate Bolz – Lincoln  Ken Haar – Malcom  Bill Kintner – Papillion  John Kuehn – Heartwell  Jeremy Nordquist – Omaha  John Stinner – Gering  Dan Watermeier – Syracuse

4. www.nebraskahospitals.org 2015 Legislative Session  90 days  Tuesday is Day 70  Adjourns June 5  663 bills  Biennial budget  Transformation of health care  Health and Human Services  Executive leadership  Functionality  Medicaid Redesign

5. www.nebraskahospitals.org Principles of Transformation  Ensure all have access to coverage  Optimize public and private funding  Support effective models of delivery, financing and payments  Reduce per-patient cost through transparent pricing and payment linked to outcomes

6. www.nebraskahospitals.org Principles of Transformation  Transparency of quality and safety  Ensure consumer choice  Transition assessment of quality to outcomes- based measures  Statewide database for collection and analysis of health and delivery data, including all payers and patient outcomes

7. www.nebraskahospitals.org Principles of Transformation  Utilize interventions to influence outcomes of populations  Emphasize public health and prevention  Reduce burden of chronic disease  Promote personal responsibility  Improve health literacy  Incent personal health improvement

8. www.nebraskahospitals.org Principles of Transformation  Attract workers to underserved areas  Create new categories of health care teams  Enhance telemedicine and internet-capable care  Establish profile of care, quality goals and reduce disparities

9. www.nebraskahospitals.org Biennial Budget  Governor’s recommendations  $63.1 million for Medicaid related to participation in federal Medicaid program  $350,000/year for a seventh FQHC  $500,000/year reduction for NEHII  $360,000/year reduction for Medical Student Assistance Program

10. www.nebraskahospitals.org Governor’s Recommendations  $1,484,435 state/$4,453,304 federal in second year for Medicaid eligibility system  $1,296,515 state/$3,889,543 federal for Medicaid provider screening and enrollment  $171,370 state/$511,880 federal for real-time connectivity for Medicaid eligibility and claim status

11. www.nebraskahospitals.org Governor’s Recommendations  Twenty-Four Hour Care Facilities  $1,130,497 state/$328,043 federal for inflationary increases for food, prescription drugs, medical supplies and medical services  $849,592 state/$96,451 federal for rent, maintenance and depreciation

12. www.nebraskahospitals.org Governor’s Recommendations  Veterans’ Homes  $1,361,800 to convert twelve assisted living beds at the Western Nebraska Veterans’ Home to skilled nursing beds

13. www.nebraskahospitals.org Governor’s Recommendations  Norfolk Sex Offender Treatment Facility  $800,000 General Funds and $800,000 Personal Services Limitation funds over two years for sex offender treatment program for additional staffing and operating costs associated with increased census

14. www.nebraskahospitals.org Governor’s Recommendations  Provider Rates  2% annual increase  $20,113,655 state/$21,552,740 federal in year one, and $40,435,528 state/$43,730,591 federal in year two  Programs include Medicaid, Children’s Health Insurance Program, Public Assistance, Child Welfare Aid, Behavioral Health Aid, Developmental Disabilities Aid and Aging

15. www.nebraskahospitals.org Governor’s Recommendations  Federal Medical Assistance Percentage (FMAP)  53.27% to 51.16% reduction Oct. 1, 2015  Enhanced FMAP available for Children’s Health Insurance Program (CHIP), including 23% expanded FMAP from ACA for federal fiscal years 2016 through 2019  Increases from 67.29% to 88.81% effective Oct. 1

16. www.nebraskahospitals.org Governor’s Recommendations  Medicaid  $167,391,234 over two years for growth in utilization, a 2% increase for provider rates and a reduced FMAP  Increase of $6,509,050 over two years for prescription drugs, including new drugs for Hepatitis C  $17,832,696 over two years for payment of minimum wage, overtime and travel costs for workers providing home-based care

17. www.nebraskahospitals.org Governor’s Recommendations  Children’s Health Insurance Program (CHIP)  $15,157,370 and $21,035,087 reductions for years one and two, respectively, for CHIP  Reduced GFs of $15,786,958 in year one and $21,897,034 in year two from adding 23% enhanced FMAP as provided by ACA

18. www.nebraskahospitals.org Governor’s Recommendations  LB 593 - $250,000 to UNMC  Study current data systems  Make recommendations to increase efficiency and effectiveness of public’s health care dollars  NHA alternative to LB 593  Independent, third-party analysis  Utilize RFP process for consultant selection

19. www.nebraskahospitals.org Bills of Interest  Data Analytics Study  $250,000 for independent study of current health data systems in Nebraska  Facilitate transformation of health care through [open] access to actionable data analysis  Profiles patient populations  Maps utilization and spending patterns  Measures performance

20. www.nebraskahospitals.org Bills of Interest  Data Analytics Study  Review current:  Agency collection of health care information  Health reporting systems  Programming capabilities  Data warehouse usage

21. www.nebraskahospitals.org Bills of Interest  Data Analytics Recommendations  Access to timely data and transparent data  Medicaid eligibility and claims data  Linking existing data sources  Reporting system participants  Data portals allowing actionable data analysis  Privacy protections and quality assurance

22. www.nebraskahospitals.org Behavioral Health  Statewide Needs Assessment  Behavioral health conditions require comprehensive array of physical, behavioral and other support services  88 counties are federal- and state-designated shortage areas for psychiatric and mental health services  Nebraska would benefit from comprehensive delivery through integration of behavioral and physical care

23. www.nebraskahospitals.org Behavioral Health  Statewide Needs Assessment  Examination of data for population health  Infrastructure, reporting standards and data access  Provider rates, integration and coordination of behavioral and primary care services, and risk-based and no-risk models  Provider shortages and workforce needs  Institutional placement and community alternatives  Ratio of qualified facilities to state population

24. www.nebraskahospitals.org Medicaid Redesign  Components  Medicaid Redesign Task Force  Demonstration pilot project  Personal financial contribution  Value-based payments for PCMHs  Circuit breaker if federal funding falls below 90%  Health Care Access and Support Fund

25. www.nebraskahospitals.org Redesign Task Force  Comprehensive review  Cost savings and improved quality  Real-time, evidence-based approaches  Quality measurement to drive innovation  Interventions for super-utilizers and those with exceptional medical conditions  Effectiveness of managed care

26. www.nebraskahospitals.org Redesign Coverage  100%-133% FPL in premium assistance  50%-99% FPL in existing program  Medically frail, super-utilizers and individuals with exceptional health needs in health homes  No co-pays, except for inappropriate use of ER

27. www.nebraskahospitals.org Redesign and Responsibility  100%-133% of FPL contribute up to 2% of monthly income, except:  First year, and  Second year upon completion of program of required prevent care services and wellness activities during initial year

28. www.nebraskahospitals.org Redesign and PCMHs  Waiver will be demonstration pilot project  Patient-centered medical homes  Health homes for super-utilizers  Value-based payments  Per-member, per-month basis  Payment incentives for participation  Attainment of specific outcomes that promote wellness, prevention, chronic-disease management, immunizations, care management and EHR use

29. www.nebraskahospitals.org Redesign  Circuit breaker  If federal funding falls below 90%, coverage for individuals shall terminate  Health Care Access and Support Fund  Created to support Medicaid program

30. www.nebraskahospitals.org Bills of Interest  Medicaid Management Information System (MMIS)  Claims processing system should maximize information retrieval for monitoring and analysis  Benefit coordination, management and utilization analysis  Modernization will reduce waste and inefficiencies  DHHS in planning phase of replacement  NHA supports continued funding

31. www.nebraskahospitals.org Bills of Interest  LB 98 - $7 million/year for smoking cessation  Status: In Appropriations Committee  LB 196 - Change Rural Health Systems and Professional Incentive Act to establish loan repayment program that will incent residents to practice in designated shortage area - $40,000/year, not exceed $120,000  Status: On General File and a Speaker Priority Bill

32. www.nebraskahospitals.org Bills of Interest  In Appropriations Committee  LB 110 - $500,000/year for pediatric cancer specialists  LB 233 - $100,000/year for UNMC for Perinatal Quality Improvement Collaborative  LB 417 - $1,800,000/year for pediatric cancer research  LB 436 - $425,000 to UNMC to establish pilot program and expand pediatric dental residents from 8 to 10  LB 418 - $2,000,000/year in HCCF for bio-research

33. www.nebraskahospitals.org Bills of Interest  LB 21 - Rate increases for BH providers  Status: General File  LB 37 - Adopt Prescription Drug Safety Act  Status: Signed into law  LB 46 - Change Statewide Trauma System Act  Status: Signed into law  LB 125 - Funds for FQHCs and HHs for underserved – 25% of tobacco settlement funds  Status: In Appropriations Committee

34. www.nebraskahospitals.org Bills of Interest  LB 148 - Medicaid for youth formerly in foster care  Status: In HHS Committee  LB 471 - PDMP to prohibit patients from opting out; require all prescriptions entered; allow all prescribers or dispensers free access; and include all payers  Status: In HHS Committee  LB 625 - Interstate Placement for Involuntarily Admitted Patients  Status: In Judiciary Committee

35. www.nebraskahospitals.org Bills of Interest  LB 107 - Eliminate Integrated Practice Agreements and create Transition to Practice Agreements for NPs  Status: Signed into law  LB 108 - $250,000 /year for 12 one-year BH master's level internships in rural and underserved areas  Status: In Appropriations Committee  LB 258 - Adopt Interstate Medical Licensure Compact  Status: In HHS Committee

36. www.nebraskahospitals.org Bills of Interest  LB 264 - Issuance of credentials under UCA based on military education, training or experience  Status: General File  LB 353 - Credentialing for nursing home administrators  Status: In HHS Committee  LB 543 - Certification of community paramedics  Status: In HHS Committee  LB 548 - Adopt Surgical Assistant Practice Act  Status: In HHS Committee

37. www.nebraskahospitals.org Bills of Interest  LB 257 - Insurers must provide descriptions for telehealth  Status: General File  LB 315 - Medicaid recovery audit contractors  Status: General File and Speaker Priority Bill  LB 332 - $600,000 for prescription drug disposal  Status: In Appropriations Committee  LB 333 - Create Program of Health Care Transformation administered by Division of Public Health  Status: In HHS Committee

38. www.nebraskahospitals.org Bills of Interest  LB 511 - Return-to-learn protocols for pediatric cancer survivors  Status: General File  LB 549 - Adopt Health Care Transformation Act  Status: In HHS Committee  LB 573 - Create health enterprise zones to reduce disparities, costs, admissions and readmissions  Status: In Revenue Committee

39. www.nebraskahospitals.org Bills of Interest  LB 584 - $16.2 million for dental clinic and oral health training facility  Status: In Appropriations Committee  LB 652 - Establishes 911 Emergency Services Communications Act to ensure all have comparable accessibility  Status: In Transportation and Telecommunications Committee

40. www.nebraskahospitals.org Questions? Bruce Rieker Vice President, Advocacy (402) 742-8146 brieker@nebraskahospitals.org