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2008 Legislative Update


Stimulus through Medicaid. House and Senate each have economic stimulus bills that include Medicaid. ... Opposing the bill unless significantly amended. ... – PowerPoint PPT presentation

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Title: 2008 Legislative Update

2008 Legislative Update
  • 59th Annual AHCA/NCAL Convention
  • Tuesday, October 7, 2008
  • Nashville, TN

A busy year...
  • Medicare
  • Medicaid
  • Survey/Quality/Transparency
  • Workforce
  • Legal Reform
  • Disaster Response

FY2009 SNF Payment Rule
  • May 1st Proposed Rule
  • 3.1 Market Basket Update 710 million
  • 3.3 Forecast Error Adjustment (770 million)
  • Net Effect (60 million)

FY2009 SNF Payment Rule
  • Coordinated effort during May, June and July
  • Legislative, Research, Public Affairs, Grassroots
  • Significant Senate and House Support
  • 113 Representatives and 50 Senators weighed-in
    with HHS and White House through letters,
    meetings and phone calls.

FY2009 SNF Payment Rule
  • August 1st Final Rule
  • 3.4 Market Basket Update 780 million
  • NO Forecast Error adjustment
  • Net effect 780 million
  • May 1st to August 1st Net 840 million

Medicare Improvements for Patients and Providers
Act of 2008
  • Prevented a 10 reduction in payments to
    physicians participating in Medicare
  • Extended the Part B Therapy Cap exceptions
    process until December 31, 2009
  • Protected the SNF market basket update
  • Made SNFs eligible to be originating sites for
    telemedicine services
  • Repealed the competitive bidding demonstration
    project for clinical laboratory services
  • Delayed start of DMEPOS Competitive Acquisition
    Program to improve bidding process and better
    protect beneficiaries

Long Term Care Quality and Modernization Act
  • S. 1980 and H.R. 4082
  • Senators Gordon Smith (R-OR), Blanche Lincoln
    (D-AR), and Susan Collins (R-ME)
  • Representatives Earl Pomeroy (D-ND), Shelley
    Moore Capito (R-WV) and Tom Allen (D-ME)

Long Term Care Quality and Modernization Act
  • Modernizes Medicare payment policies regarding
    diabetes management, consolidated billing and the
    mandatory 3-day stay
  • Encourages collaboration between states and
    providers and would lessen burden on providers
    who lose their nurse aide training programs
  • Promotes LTC workforce initiatives by amending
    the Nurse Reinvestment Act
  • Amends the tax code to promote building
    renovation and the use of health information

Protecting the Medicaid Safety Net Act
  • Placed a one-year moratorium on CMS finalizing 6
    harmful regulations that would severely cut
    Medicaid funds for critical services
  • Public Provider Cost Limit
  • Provider Tax
  • Targeted Case Management
  • Rehabilitation Option
  • School Based Services
  • Graduate Medical Education

Stimulus through Medicaid
  • House and Senate each have economic stimulus
    bills that include Medicaid.
  • House Targets 14.4 billion in funds to all
    states in tiers on the basis of economic
    conditions. Passed on 9/26.
  • Senate Targets 19.6 billion through temporary
    increase of 4 in federal share to all states for
    15 months beginning 10/1.
  • House has passed Senate vote failed so
    resolution is unclear.

S. 2641 Nursing Home Transparency and
Improvement Act of 2008
  • Sponsored by Senators Chuck Grassley (R-IA) and
    Herb Kohl (D-WI)
  • House version introduced by Reps Stark (D-CA) and
    Schakowsky (D-IL)
  • Requires transparency of staffing data from
    payroll records
  • Requires extensive ownership disclosure
  • Requires posting on CMS Nursing Home Compare
    including 2567s and Plans of Correction

S. 2641 Nursing Home Transparency and
Improvement Act of 2008
  • Defines Accountable Corporate Entity
    Facilities under common ownership and which have
    revenues exceeding 50 million.  Requires annual
  • Significantly increases CMPs when deficiency
    results in death 100,000 CMP.
  • Must pay CMP before appeal is finished. 
  • Independent Monitor Program to oversee interstate
    and large intrastate chains.

S. 2641 Nursing Home Transparency and
Improvement Act of 2008
  • AHCA met several times with the authors staff to
    improve the bill.
  • Support transparency and disclosure that is
    meaningful and helpful to consumers and their
  • Opposing the bill unless significantly amended.
  • Using this as a platform to discuss flawed survey
    system and the need for a new system need to
    test new models and not increase fines and

S. 2641 Nursing Home Transparency and
Improvement Act of 2008
  • Some Provisions Could Support
  • Staffing data, 2567s and Plans of Correction
    posted on Nursing Home Compare
  • New facility closure requirements
  • Demonstration project on health information
    technology in nursing homes
  • Dementia and abuse training
  • Study on CNA training requirements

Medicare Part D
  • Issue Eliminate Medicare Part D Copayments for
    dual eligibles in Assisted Living residences
  • S. 1107-The Home and Community Services Copayment
    Equity Act of 2007 introduced by Senator Smith
    (R-OR) 20 cosponsors
  • H.R. 5604-The Medicare Part D Home and Community
    Services Copayment Equity Act of 2008 introduced
    by Doggett (D-TX) 28 cosponsors
  • Where do  we go from here? Next steps next

Revisit User Fees
  • The CMS Revisit User Fee defeated in 2008
  • Proposed by the Administration in their Budget
    for FY 2009
  • Both the House and Senate have marked up their
    appropriations legislation
  • Current State Continuing Resolution has been
    passed by the House and Senate- funding until
    March of 2009
  • Where do we go from here? Next steps next Congress

Appropriations- Report language
  • Nursing Shortage and Long Term Care Facilities-
    The Committee is concerned that the current and
    projected shortage of nurses will have a
    significant impact on the ability of long-term
    care facilities to meet the needs of aging baby
    boomers.  Therefore, the Committee encourages CMS
    to study the reimbursement constraints impacting
    advance practice nursing in long- term care

Disaster Response
  • Appropriations- Report language
  • The Committee recognizes that in a pandemic
    situation, long-term care facilities may become
    surge sites for overrun hospitals and is
    concerned about the staffing of these
    facilities.  Therefore, as HHS moves forward in
    prioritizing populations for the pandemic
    influenza vaccine and antiviral medication, the
    Committee recommends that long-term care staff,
    part of our Nations critical infrastructure,
    should be appropriately placed in a top tier
    priority to ensure that they maintain adequate
    staffing and that our vulnerable residences
    remain safe in a time of national emergency.   

Disaster Response
Disaster Response
  • Stafford Act - continue to push hard for changes
    so for-profit LTC facilities may have the same
    access to disaster relief resources as
  • Legislation introduced by Jefferson (D-LA) and
    Paul (R-TX)
  • Extraordinary Evacuation/Sheltering in Place
  • Working for legislation/regulation so facilities
    can recoup at least part of the extraordinary
    costs (labor, transportation, etc.) incurred when
    evacuating or sheltering in place

  • Labor Relations
  • Employee Free Choice Act of 2007
  • RESPECT Act of 2007
  • Health Care Workforce Development
  • Caring for an Aging America Act of 2008
  • Troops to Nurse Teachers Act of 2007
  • AHCA Vacancy Turnover Study
  • Release scheduled for November 2008

H.R. 800, S. 1041 - The Employee Free Choice Act
  • a.k.a. the Card Check bill
  • Sponsored by Senator Edward Kennedy (D-MA) and
    Representatives George Miller (D-CA) and Peter
    King (R-NY)
  • Requires the National Labor Relations Board to
    certify a bargaining representative without a
    secret ballot election, if
  • a majority of the bargaining unit employees has
    designated a representative through a card check
    agreement and
  • no other individual or labor organization
    represents any of the employees in the unit

H.R. 800, S. 1041 - The Employee Free Choice Act
  • H.R. 800 passed the House by a vote of 241-185 on
    March 1, 2007
  • Then the bill died in the Senate on June 26, 2007
    since it failed, 51-48, to attain the necessary
    60 votes to end debate
  • The Administration had strongly indicated the
    Presidents opposition and had made a strong veto
    threat if passed by both chambers.

H.R. 1644, S. 969 -The RESPECTAct of 2007
  • Re-Empowerment of Skilled and Professional
    Employees and Construction Tradesworkers
    (RESPECT) Act of 2007
  • Sponsored by Senator Dodd (D-CT) and
    Representative Andrews (D-NJ)
  • changes the definition of supervisor under the
    National Labor Relations Act
  • would result in many RNs being allowed to be part
    of a collective bargaining unit
  • AHCA/NCAL opposes this legislation

Legal Reform
The Fairness in Nursing Home Arbitration Act
  • H.R. 6126 and S. 2838
  • Sponsored in House by Linda Sanchez (D-CA) and in
    the Senate by Herb Kohl (D-WI) and Mel Martinez
  • Essentially eliminates use of all pre-dispute
    arbitration agreements in long term care settings
  • Strongly opposed by AHCA/NCAL bill eventually
    died in both House and Senate after hearings and
    markups were held

Tax Issue 3 Withholding
  • In 2011 federal, state, and local governments
    will be required to withhold 3-percent from all
    payments for goods and services as a guard
    against possible business tax evasion
  • Medicare payments to SNFs will be affected
  • AHCA/NCAL working with multiple other industry
    organizations to repeal the tax levy prior to 2011

Outlook for 2009
  • Medicare
  • Market Basket, Therapy Caps, Part D Copays
  • RUG forecast error part two?
  • Medicaid
  • State Childrens Health Insurance Program (CHIP)
  • Medicaid regulation moratorium

Outlook for 2009
  • Survey/Quality Transparency
  • Ownership transparency issues still on the table
  • QIO Legislation may reduce assistance
  • Long Term Care Quality bill part three
  • Workforce
  • Labor Relations card check and RESPECT Act
  • Other Workforce development legislation pending
    (i.e. nurse reinvestment act reauthorization)

Outlook for 2009
  • Legal Reform
  • Arbitration limitations
  • False Claims Act
  • Other Issues
  • 3 tax withholding
  • Disaster relief

Outlook for 2009
  • Larger deficits due to financial markets bailout
    portend a budget fight from the start
  • Health care reform is it still possible? Will
    it include long term care?
  • Entitlement reform?
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