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Legislative Update

Legislative Update. July 29, 2008. Medicare Legislation – HR 6331. Reimbursement for CAH Lab Payments Beginning 1/1/09 CAHs receive cost-based reimbursement for clinical lab services Physician Payment Fix Prevents a reduction and freezes 2008 fee schedule payment rates at current levels

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Legislative Update

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  1. Legislative Update July 29, 2008

  2. Medicare Legislation – HR 6331 • Reimbursement for CAH Lab Payments • Beginning 1/1/09 CAHs receive cost-based reimbursement for clinical lab services • Physician Payment Fix • Prevents a reduction and freezes 2008 fee schedule payment rates at current levels • Medicare Rural Hospital “FLEX” Program • Extends FLEX program through Sept 30, 2010. • Ambulance Services • For July 1, 2008 through 2009, reinstates add-on payment for ground ambulance services; 3% for rural and 2% for urban.

  3. HPSA/MUA Proposed Rule • Proposed rule in Feb. 28, 2008 Federal Register • Combines HPSA/MUP formula • Utilized “2 tier formula” • Based upon population to provider ratio of 3,000:1 • Several factors incorporated • Barrier Free Population • Definition of Provider • High Need Indicator • 2nd Tier excludes providers under certain programs • July 23, 2008 Federal Register withdraws proposed rule • New proposed rule to be developed

  4. RHC Proposed Rule • Proposed changes include: • Location Requirements: • Be located in “non-urbanized” area • Be located in a shortage area (HPSA; MUA; Governor’s designated shortage areas) • Provides exceptions to the location requirements • Staffing Requirements: • Eliminates the restrictions on the RHC contracting with non-physician providers • Payment Requirements: • Revises pymt methodology to be consistent with statutory requirements that set Medicare pymt at 80% of reasonable cost • Health, Safety, and Quality: • Requires RHCs to establish a QAPI program

  5. CAH Relocation Guidelines CMS’ Formal Guidance • 75% Rule • Same Service • Services available under similar terms/times • Same Population • Zip Code Analysis; hospitals may use different methodology • Same Employees • Medical staff, direct employees and FT contract staff count • J-1 visa; NHSC employees may be excluded • High turnover facilities may provide additional documentation • Necessary Provider Designation – must meet same criteria • CMS now provides preliminary determinations based on CAH letters of attestations and projections • Final approval only will be granted once the hospital has relocated and evidence confirming compliance is provided • Contact KHA if considering Relocation; Large Renovation

  6. Legislative Outlook - 2009 • Health Reform (Part II?) • Tobacco tax increase • Statewide smoking ban • Premium Assistance or SCHIP • “Medicaid Transformation” • Identified by KHPA • Subcommittee to discuss possibilities • Workforce Related Issues • Wichita Center for Graduate Medical Education • Nursing/Allied Health Shortages

  7. What Can You Do? • Meet with your Legislator • Invite to hospital • Need help, let KHA know • Find the connections • Trustees • Staff • Other community members

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