Implementing HIPAA State Budgets, Elections, and Policy Priorities

1
Implementing HIPAAState Budgets, Elections, and
Policy Priorities
Presented by Robert J. Burns NGA Center for Best
Practices

• National Association of Health Data Organizations
• 17th Annual Meeting
• Atlanta, GA December 2-3, 2002

2
State Budget Overview

• States closed 37.2 billion budget gap during
  FY2002
• 46 states reported budget deficits
• Revenues 1.2 percent less than expected
• Spending 1.8 percent more than expected
• States face 49.1 billion budget gap going into
  FY2003 (projections)
• 3.7 percent revenue growth (projected)
• 1.6 percent spending growth (projected)
• Year-end balance will decline 3.7 percent
  (projected)
• Source National Conference of State
  Legislatures, August 2002

3
Revenue Enhancements
4
Gubernatorial Elections 2002

• 36 governorships up for election
• 14 term limited
• 6 voluntary withdrawals
• 16 incumbent challenges
• 11 incumbents returning
• 24 new Governors assuming office
• Party changes in 20 states

5
Gubernatorial Changeovers(even years only)
Source National Governors Association, November
2002
6

• The chief executive of a state today holds
  more power and sway over the public purse and
  policyand likely presents more of a leadership
  profile in the state than any other office holder
  other than the President.
• Ray Sheppach
• Executive Director
• National Governors Association

7
Gubernatorial Powers(that do not require
legislative approval)

• Submit the state budget
• Establish policy priorities
• Set spending targets
• Veto components of legislative budget
• Appropriations
• Selected words
• Change meaning
• Line item
• Cut the budget
• Reorganize departments
• Spend unanticipated federal funds

8
Implications

• New priorities
• Energy, enthusiasm, personality
• Relationship with the public
• Relationship with legislature
• New appointees
• Commissioners, deputies, senior staffers
• Administer the Governors policies
• Advance the Governors issues

9
Top Campaign Priorities(Governors-Elect)

• Fostering economic recovery (balancing state
  budgets)
• Bolstering homeland security
• Maintaining education initiatives
• Containing health care costs

10
Top Health Priorities(Governors-Elect)

• Containing pharmaceutical costs
• Leveraging Medicaid and SCHIP
• Bolstering the health care workforce
• Financing long-term care

11
Why Still Emerging?

• Legally Complex
• Privacy
• New terms and interpretations
• Technically Complex
• Electronic transactions
• Electronic data interchange
• Poor Guidance
• Staggered rule making
• No arbitration process
• No validation

12
Regulation Status
13
The Ripple Effect(Covered Entities vs. Affected
Entities)

• Community-based providers (safety net)
• Public hospitals/clinics
• Mental health facilities
• Substance abuse treatment centers
• State/local health departments
• Academic medical/research centers
• Organ donation programs

• Law enforcement and corrections (coroners,
  medical examiners)
• TANF-funded programs
• MCH programs (Title V)
• School-based health programs (immunizations,
  dental)
• HIV/AIDS (Ryan White)
• State employee benefits
• Workers compensation
• State technology authorities
• Health policy offices

14
Prioritizing HIPAA

• What does a Governor really need to know about
• HIPAA implementation?
• Worsening the budget situation
• Impeding access to health care
• Affecting the quality of care
• Threatening provider solvency
• Impairing state-level program administration
• Hindering ability to make good policy decisions

15
Recommendations

• Get to know the new Governors staff
• Get to know the new Governors priorities
• Offer solutions
• Be practical (political, fiscal reality)
• Build consensus
• Identify resources
• Learn to speak the language

16
NGA Center for Best Practices(http//www.nga.org/
center)

• Robert J. Burns
• Policy Analyst
• Health Policy Studies Division
• National Governors Association
• Center for Best Practices
• Hall of States, Suite 267
• 444 North Capitol Street, NW
• Washington, DC 20001-1512
• [phone]
• fax [phone]
• email rburns_at_nga.org