Announcement

President's Report
by: Rod Betit (February 09, 2007)

Summary: HB18, WWAMI, passed out of House Finance this week and is waiting to move to the House floor for a vote which should take place next Wednesday, February 14.

Full Story: PRESIDENT’S REPORT February 9, 2007 ________________________________________  HB18, WWAMI, passed out of House Finance this week and is waiting to move to the House floor for a vote which should take place next Wednesday, February 14. We feel there is strong support for this measure but we still need CEOs to contact your legislators to reinforce that you support ASHNHA’s stated position on this. The talking points were emailed several days ago so please put those in an email and get that off to you legislators if you have not already done so.  Workers Compensation has become a major concern. With Senator Seekins defeat in the general election the legislative arm of the WC Taskforce has stalled. This has produced a situation where we have a provider rate freeze expiring on August 1, 2007 with no provision to replace it. Workers Comp officials say they have no authority to fix this problem or to substitute a new rate methodology, leaving a ‘black hole’. ASHNHA is pressing the legislature and state officials to address this during the Session to head off a major problem in August.  ASHNHA has given Representative Kawasaki the ‘green light’ to start moving HB71 Licensing Rad Techs. The bill was being held as a courtesy to ASHNHA while we determined if tribal health officials had any remaining concerns with the compromise language. With the help of Frank Sutton at SEARHC we have been able to confirm that the tribal health concerns have been resolved.  While neither HB4 nor SB65 dealing with CON is moving in the legislature, there are important discussions going on around this issue, as well as developments around the State that have a bearing on the outcome of these discussions. If you want to know more about this dial into the Acute Care Committee meeting on February 20, 2007 at 11:30am. The conference # is 888 577-0004 pass code 17900#. ________________________________________ Dr. Jay Butler Dr. Butler has been appointed as Director of the Alaska Division of Public Health. Dr. Butler has been serving as Director on an interim basis. Commissioner Jackson appointed Dr. Butler given his extensive epidemiology, clinical and overall public health background. I share Commissioner Jackson’s respect for Dr. Butler’s abilities having had an opportunity to work with him these past few months on hospital preparedness, primary care and other issues. ________________________________________ ________________________________________ A highly anticipated independent report on Alaska's Medicaid program was presented Tuesday, February 6th by Pacific Health Policy Group to joint sessions in both the House and Senate. A complete copy of the 250 page report is available on the legislative website http://www.legis.state.ak.us/teldocs.asp . The report did not give any recommendations that would produce cost-savings on a ‘fast track’ that would help during this year’s FY2008 budget deliberations. I think that was a bit disappointing to Legislators. However, by not producing a ‘short list’ of immediate cost-savings it strengthens our position that requesting the Department to identify $80 million in state funds cost savings for the FY 2008 budget is not a realistic expectation. Here are the highlights of the report: General Findings:  Medicaid spending falls into five major categories:  Long Term Care (not just nursing home care) 27%  Hospital Services 24%  Behavioral Health 14%  Pharmacy 14%  Physician/Clinic 11%  Alaska is comparable to other states in what services Medicaid covers.  Alaska’s income eligibility limits fall somewhere in the middle of states.  Medicaid is the 2nd largest insurer in the State.  Alaska ranked in the top ten states both in terms of the percentage of the population with Medicaid coverage and the percentage uninsured.  Alaska’s elderly population is forecast to grow rapidly and the State needs to prepare for that in program redesign.  Not every program area shows the same potential for additional cost containment. “Physician and clinic fees, while high, appear to be supporting the broader ambulatory health care infrastructure”.  “Native Alaskans account for nearly four-in-ten Medicaid Beneficiaries. Hospital Services Findings:  Alaska’s hospital payments are made up of 2/3rds inpatient and 1/3rd outpatient.  Alaska’s hospital co-payments for Medicaid patients are the highest in the nation.  In 2004 Alaska had the lowest hospital admission rate and lowest hospital days per 1,000 population in the nation for all payor groups Alaska’s outpatient expenses per Medicaid enrollee were $450 in FY 2003, the second highest in the nation. However, this higher reimbursement methodology takes into account that “the state is reliant on hospitals in very rural areas to provide a portion of the routine care that in more urban states is available from physicians or free standing clinics”. ________________________________________ Hospital Services Recommendations:  Consider moving inpatient reimbursement methodology from the current cost-based per diem system to a DRG system.  Consider moving outpatient reimbursement methodology from the current percent of charges approach to a prospective payment methodology. Long Term Care Findings:  While LTC expenditures accounted for 1/4th of Medicaid expenditures, only 20% of that figure was for care in nursing homes.  The remainder was split evenly between Home & Community Based Waiver services and personal care services.  Alaska’s LTC costs are expected to triple between 2005 expenditures and 2015 expenditures (Lewin Group).  Only 1.4% of Alaska’s elderly reside in nursing homes compared to the national average of 3.8 percent.  Alaska’s Pioneer Homes increasingly serve a population that in other states would reside in the Alzheimer’s units of nursing homes or community settings.  Alaska’s high nursing home reimbursement (5th in the nation) is not only related to higher cost of living but “to the conscious decision to use nursing facility payments to subsidize institutions in rural communities that also serve as the sole inpatient provider for emergency acute care patients.”  Running the Personal Care Attendant program outside of the Waiver program has “had the dual effect of driving up costs while impeding good care management.” Long Term Care Recommendations:  It would be in the State’s best interest, from both a financial and quality of service perspective, to actively participate in establishing greater capacity among tribal providers, particularly with respect to long term care”.  Move the Personal Care program under the Waiver and put additional controls in place.  Explore less costly alternatives for the growing Alzheimer’s/dementia group such as Adult Foster Care.  Consider imposing a 6% provider tax on nursing homes to generate approximately $2 million in additional federal funds annually (during testimony the Pacific Health Policy Group did point out that Medicaid nursing home rates would have to be increased somehow to offset this new expense!)  Pursue a demonstration program waiver from the federal government to gain greater flexibility for offering a broad range of long term care services - timeframe 18 to 24 months. ________________________________________ LEGISLATIVE SNAPSHOT (‘Ctrl + click’ on Bill # takes you to latest version of bill on Web) (Red font denotes change in status since last update) House Bills Bill # Sponsor Title/Description Position Status HB4 HES, L&C, & Finance Lynn An Act amending the CON requirements to apply only to health care facilities that are nursing homes or residential psychiatric treatment centers or that are located in a borough with a population of not more than 25,000, in the unorganized borough, or in a community with a critical access hospital. Oppose In HES No Hearing Scheduled CSHB18 HES & Finance Meyer An Act making WWHAMI amendments that change the functions and powers of the Alaska Commission on Postsecondary Education to give it authority to increase the number of medical students placed, and adds a requirement for payback of financial assistance if the student does not return to Alaska to practice medicine. Strongly Support House Floor Vote Expected on Feb 20 HB35 L&C, & Finance Kawasaki An Act extending the termination date for the Board of Certified Direct-Entry Midwives; and providing for an effective date. Neutral In L&C, No Hearing Scheduled HB55 HES & Finance Kelly An Act relating to Postsecondary Education that authorizes expansion of the WWHAMI program to 20 students. Strongly Support Provisions Merged by Sponsor into HB18 HB71 L&C & Finance Kawasaki An Act requiring licensure of occupations relating to radiologic technology, radiation therapy, and nuclear medicine technology Support In L&C, No Hearing Scheduled Senate Bills Bill # Sponsor Title/Description Position Status SB8 HES, JUD & Finance Davis Relating to a mental health patient’s right to choose the gender of the hospital staff providing intimate care to the mental health patient and to the duties of hospital staff in caring for patients receiving mental health treatment. Oppose In HES, No Hearing Scheduled SB27 HES & Finance Davis Relating to eligibility requirements for medical assistance for certain children, pregnant women and persons in medical or intermediate care facilities. Pending In HES, No Hearing Scheduled SB28 HES, L&C, & Finance Davis Relating to limitations on mandatory overtime for registered nurses and licensed practical nurses in health care. Oppose In HES No Hearing Scheduled SB29 HES, L&C, & Finance Dyson Requiring certain hospitals to make certain disclosures on patient billings. Pending Meeting with Sponsor In HES No Hearing Scheduled SB32 HES & Finance Wilken An Act relating to postsecondary educational services and programs for Alaska residents; relating to a student loan repayment program for medical doctors, and amending the duties of the State Medical Board that relate to the program; relating to a student loan repayment program for registered nurses, and amending the duties of the Board of Nursing that relate to the program Support In HES No Hearing Scheduled SB62 HES & Finance Stevens An Act establishing the Advisory Committee on Public Reporting of Health Care Associated Infections, relating to reporting and dissemination of data concerning health care associated infections, and providing for an effective date Pending Exec Committee Review In HES No Hearing Scheduled SB65 HES & Finance Huggins An Act amending the certificate of need requirements to apply only to health care facilities that are nursing homes or residential psychiatric treatment centers or that are located in a borough with a population of not more than 25,000, in the unorganized borough, or in a community with a critical access hospital. Oppose In HES No Hearing Scheduled SB73 SED, HES & Finance Ellis An Act amending the functions and powers of the Alaska Commission on Postsecondary Education; and relating to the repayment provisions for medical education and postsecondary degree program participants." Support In SED Hearing Feb 14 @ 8am ________________________________________ ----Loss Due to Reductions in the Market Basket Update---- Phase-out Medicare Estimated Inpatient Outpatient Home of Bad Advantage Five Year PPS PPS SNF Unit Health Rehab Debt IME Total Loss -11,735,059 -3,423,146 -460,316 -1,491,923 -886,613 -6,709,929 0 -24,706,985 These estimates from the American Hospital Association demonstrate the adverse impact of the Administration's proposed cuts to Medicare contained in the President’s 2008 budget. Alaska is slated to lose nearly $25 million over 5 years. Individual facility specific estimates have been sent to each facility by AHA. If you did not see yours please let me know and I will obtain it for you. AHA needs you to contact the Alaska Delegation to speak out against these cuts. ________________________________________ Upcoming Meetings of Interest: • ASHNHA 2007 Winter Meeting (Juneau) - NEW DATES March 29-30, 2007. A room block has been reserved at the Gold Belt Hotel for the nights of March 29 and 30. The phone numbers are - toll-free: 888-478-6909 or 907-586-6900. Meetings will be held at the Centennial Hall adjacent to the Hotel. The ASHNHA Board meeting will occur on March 30. • AHA Annual Meeting (D.C.) - May 6 through 9, 2007 in Washington, D.C. • National Rural Health Association Meeting (Anchorage) - May 14 through 17, 2007 in Anchorage, Alaska. • ASHNHA 2007 Annual Meeting (Petersburg) – to be held in conjunction with education sessions August 6 through August 9, 2007 in Petersburg. The ASHNHA meeting will take place on August 8 & 9.

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