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									                  The 2010
           State Legislative Session




Washington State Hospital Association
                           Presenters

             Cassie Sauer                        Claudia Sanders
             Vice President,                     Senior Vice President,
             Communications                      Policy Development




                                 Taya Briley
                                 General Legal
                                 Counsel




Washington State Hospital Association                                     2
                  Presentation Outline
• The state budget
• WSHA hospital safety net assessment
• Other WSHA budget priorities
• WSHA policy priorities
• Your advocacy
• Questions and comments


Washington State Hospital Association    3
                  The State Budget



Washington State Hospital Association
             How the 2009-2011
     $9 Billion Budget Hole Was Filled
                        Cut programs
                        $3.6 billion

                        Recovery Act Funds
                        $3 billion

                        Froze pay,
                        transferred funds
                         $2.1 billion
                        Rainy Day Fund
                        $0.4 billion


Washington State Hospital Association
               Impact of the Recession



                    $31 billion




Washington State Hospital Association
         Why We Are in This Situation
• More demand for state services in hard times
         PLUS
• Sharp decline in state revenues
• It’s the recession!                   2009




Washington State Hospital Association
        A Possible Balanced Approach




Washington State Hospital Association
                 Revenue Possibilities
• Closing loopholes and exemptions
• Increase sin taxes
• Create more sins (“non-essentials”)
• Sales tax on services
• Increase sales tax across the board
• No income taxes


Washington State Hospital Association
• Broad coalition
• Protect our economic future
• Prevent further erosion of the things that residents
  value so much about our state
• Adopt a balanced approach to closing the gap:
    close unfair tax loopholes
    identify new revenue sources
    stabilize short and long term funding
• We need your help!

Washington State Hospital Association
      The Governor’s Budget Proposal




Washington State Hospital Association
                              Timing
• First budget December 9, 2009
    All cuts
    Governor repudiated her own budget

• Second budget January 12, 2010
    More extensive and specific “buy-back” list
     totaling $779 million
    Tax loopholes identified for closure
    Hope for additional federal funds
    No other revenue sources specified

Washington State Hospital Association
        Health Care Cuts: First Budget
• More than 100,000 newly uninsured
  people
    Eliminates Basic Health
    Scales back Apple Health for Kids
    Eliminates General Assistance-Unemployable
      and ADATSA (drug/alcohol treatment)
• Eliminates optional Medicaid services
• Reduces funding for mental health


Washington State Hospital Association
           Governor’s First List
          of Programs to Protect
• Basic Health
• Apple Health for Kids
• General Assistance-Unemployable
• Levy equalization funds for public schools
• State financial aid
• Early childhood education and kindergarten
• Adult medical, dental, vision, and hospice
  programs
• Developmental disability services
• Long-term care
Washington State Hospital Association
                     WSHA Response

• Applaud her commitment and courage
• Committed to working with her on
  revenue
• Pleased most of our priority issues are on
  the list of programs to protect




Washington State Hospital Association
       Hospital Safety Net Assessment

• “Helping others help themselves”
  policy statement
• Clear support for the assessment
• Legislation will be “Governor request”
  legislation




Washington State Hospital Association
The Hospital Safety Net Assessment




 Washington State Hospital Association
                      Where We Are Now



September                                                      December
                    January/February
2009                                                           2010
                    2010

Technical work     Legislative approval/implementation   Federal approval
                                                         (retroactive)




    Washington State Hospital Association
       Hospital Safety Net Assessment
• New assessment on hospitals
• Used to obtain significant new federal
  Medicaid funds
• Money returned to hospitals through:
    Medicaid rate increases
    Disproportionate Share Hospital payments
    Access payments
• Stabilizes quality care for Medicaid and
  Apple Health enrollees

Washington State Hospital Association
                 Federal Requirements
• Federal requirements on approvable
  provider related tax
• If state does not meet requirements, federal
  government will not match Medicaid
  increases
• Tax needs to be redistributive and generally
  across-the-board
    Limits the number of hospitals excluded
    Limits tax differentials among hospitals

Washington State Hospital Association
   Forecast Medicaid Program Growth

• State is projecting annual program growth
  of 7% per year due to caseload and intensity
• Growth projections increase Medicaid
  hospital payments and assessments
• Assessments can be adjusted down or up if
  these growth rates are not accurate




Washington State Hospital Association
                 WSHA Requirements
• Sunset by June 30, 2013
• Create a dedicated account
• Return all dollars to hospitals
• Coincide timing of assessment and
  payments to protect cash flow
• Protect against changes
  in federal law



Washington State Hospital Association   22
             The Bottom Line

• Hospitals recoup their assessment and get
  significant payment improvements
    Hospitals gain about $200 million in the
      current biennium
    85% of the Medicaid budget cuts restored
    Significant new dollars next biennium




Washington State Hospital Association           23
                   Medicaid Increases
• Prospective payment hospitals:
    Inpatient rates by 4% + 12%
    Outpatient rates by 4% + 32%

• Certified public expenditure hospitals:
    Reduced increases for Harborview and
      University of Washington Medical Center
• Critical access hospitals:
    Protect program and small rural DSH at 120%
      or $50/day access payments

Washington State Hospital Association              24
                 Assessment Structure
• Based on non-Medicare inpatient days
    Historic data from Medicare cost reports
    Reduced rate for days above 60,000 per year

• Levied on all hospitals except:
    Shriners’ Hospital
    Long term acute care hospitals
    Certified Public Expenditure hospitals
    State-owned hospitals


Washington State Hospital Association              25
                  Assessment Amount
• PPS, psychiatric, rehabilitation hospitals:
    Varies by period
    Initially supports restoration of budget cuts
    Increases to support additional payment
     increases
    Varies by federal match rate
• Critical Access Hospitals
    Constant $10 rate



Washington State Hospital Association                26
                 Assessment Amounts
Dates                     PPS            Psych/   CAH
                                         Rehab
July 2009 to              $30            $6       $10
January 2010
February to               $130           $24      $10
December 2010
January to                $164           $30      $10
June 2011
July 2011 to              $174           $30      $10
June 2013

 Washington State Hospital Association                  27
 Hospital Safety Net Assessment Fund
• New dedicated state fund to support:
    Increased hospital payments
    State dollars needed to offset Governor’s
      proposed additional hospital payment cut
       • $32 million in state funds each biennium
    DSHS administrative expenses




Washington State Hospital Association
                  Hospital Protections
• If any significant part of the legislation
  is not enacted or key conditions are
  not met, law is not in force
• Managed care plans required to pay
  amounts calculated by DSHS for
  retroactive periods
• Assessments adjusted once a year
    State must give WSHA data to justify increases
    Any surpluses returned to hospitals

Washington State Hospital Association
              Impact on Your Hospital
• Data in state’s model:
    Days from 2007 and 2008 cost report
    Fee-for-service claims data from 2008
    Healthy Options data from Disproportionate
     Share Hospital reports
    Office of Financial Management estimates
     of program growth
• WSHA will mail out results this week


Washington State Hospital Association             30
WSHA’s Other Budget Priorities




Washington State Hospital Association
               Other Budget Priorities
• Access to Care
• Mental Health
• Health Work Force Shortages




Washington State Hospital Association
                Ensure Access to Care
• Preserve remaining Basic Health slots
    70,000 people
    $160 million state funds
• Continue Apple Health for Kids
    16,000 children could be cut
    $11.5 million state funds
    New federal bonus of $7.5 million
• Continue General Assistance-Unemployable
  or “Disability Lifeline”
    20,000 people
    $134 million state funds


Washington State Hospital Association
          Other 2010 Budget Priorities

• Prevent erosion of the mental health system
    Restore funding for Regional Support Networks
      ($7 million)
    Restore Program for Adaptive Living Skills
      ($3 million)

• Protect health care worker training funds



Washington State Hospital Association
             2010 Policy Priorities




Washington State Hospital Association
                      Policy Priorities
• Nurse Staffing
• Infection Rate Reporting
• Protect Patients from Influenza
• Access to Financing for Hospital Districts
• Adverse Event Reporting




Washington State Hospital Association
               Nurse Staffing – History

• Ongoing cycle of disagreement,
  negotiations, and compromise with nursing unions
• Ruckelshaus process
• Nurse staffing committees
• Current negotiations on pre-scheduled call and
  meal/rest breaks



 Washington State Hospital Association
    Nurse Staffing – Pre-Scheduled Call
• Agreed-upon issues:
     Not placing someone on call in order to
      extend a shift
     Schedule procedures carefully to ensure they do
      not run past the end of a shift – but balance this
      with patient needs
•   Nursing unions want more
•   Agreement to continue to negotiate
•   No legislation in 2010
Washington State Hospital Association
  Nurse Staffing – Meal and Rest Breaks
• Union position: Patient safety issue; want state law
  directing:
    Uninterrupted (block) breaks
    Scheduled breaks
    No ability to collectively bargain for flexibility

• Hospital position: Allow collective bargaining or
  nurse staffing committees to deal with the issue in
  order to provide flexibility
• Unions will pursue legislation this session;
  WSHA will oppose
 Washington State Hospital Association
      Do Your Staff Nurses Support
     Meal and Rest Break Legislation?
• Nursing unions say their members want it
• The details may be problematic to staff:
    Block break – no interruptions
    Pre-scheduled break
    No flexibility
    No role for professional
      judgment of the nurse
• We need your direct care
  staff to testify
Washington State Hospital Association
       Infection Rate Reporting

• Goal: Create a workable system for reporting
  surgical site infections
• Hospitals are currently required to report
  central line, ventilator associated pneumonia,
  and now surgical site infections to CDC
• Change reporting to WSHA’s Quality
  Benchmarking System or some other system
  until CDC is ready
• Continue to comply fully with existing law
Washington State Hospital Association
      Protect Patients from Influenza
• Goal: Require hospital workers to have an annual
  flu vaccination or follow infection control
  guidelines
• WSHA’s survey shows only 69 percent of health
  care workers were vaccinated this season for
  seasonal flu
• Requirements can boost immunization rates to
  more than 99 percent
• Our patients and the public expect health care
  workers to be vaccinated
   Washington State Hospital Association
                  Access to Financing
• Goal: Increase hospital district access to
  financing
• Narrow statutory change
• Authority to mortgage their property and grant a
  security interest
• Obtain insurance through the
  Federal Housing Administration




Washington State Hospital Association
             Adverse Event Reporting
• Goal: Ensure accurate reporting of
  adverse events
• Concern: Some hospitals are not reporting
  correctly or fully
• Senate Bill 6247 (Keiser)
    Fines for non-reporting
    $1,000 per incident per day

• WSHA is researching other solutions

Washington State Hospital Association
                      Your Advocacy



Washington State Hospital Association
                  We Need Your Help!
• Stay in contact with your legislators
• Answer calls for action promptly in
  Inside Olympia
• Support your staff in testifying if
  we need them
• Talk to leaders in your community
  about hospitals and health care


 Washington State Hospital Association
           Questions and Comments
         cassies@wsha.org, 206/216-2538
        claudias@wsha.org, 206/216-2508
           tayab@wsha.org, 206/216-2554


Washington State Hospital Association     47

								
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