Federal Update NDHA Board of Trustees · 5/22/2015 · 5/22/2015 1 Federal Update NDHA Board of Trustees May 21, 2015 John w. Flink, Consultant, Federal Affairs, NDHA Agenda •

5/22/2015

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Federal UpdateNDHA Board of Trustees

May 21, 2015

John w. Flink, Consultant, Federal Affairs, NDHA

Agenda

• SGR Review

• King v. Burwell

• The Rest of the Year

5/22/2015

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March 2015 Deal: SGR Repeal & Replace• 0.5 percent update from 2015 through 2019

• 0 percent update from 2020 through 2025

• Transition physician pay away from volume-based system to one based on value

Consolidate three current quality programs into one that rewards providers who meet performance thresholds – i.e. value-based purchasing

• Establish process for improving payment accuracy for provider services

• Incentivize care coordination

• Incentives to move to alternative payment models

5 percent bonus to providers who receive significant revenue from an APM or PCMH

Participants need to receive 25 percent of Medicare revenue through an APM in 2018 – 2019

March 2015 Deal: Other Provisions… Medicare extensions

Delay enforcement of “two-midnight” policy (through September 30, 2015)

Extend rural ground ambulance add-on payments, including for “super rural” (through December 31, 2017)

Extend outpatient therapy caps exceptions process (through December 31, 2017)

Extend home health rural add-on payments (through December 31, 2017)

Extend Medicare rural low-volume adjustment (through September 30, 2017)

Extend Medicare dependent hospital program (through September 30, 2017)

Fund CHIP (through September 30, 2017)

Fund community health centers (through September 30, 2017)

Teaching Health Center Program funding (FY 2016 – 2017)

5/22/2015

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March 2015 Deal: Financing Estimated $210 billion cost

$70 billion offset with provider-beneficiary Medicare savings

$140 billion not paid for

Beneficiary cuts

Increase percentage higher-income beneficiaries pay toward Part B and D premiums

Limit first dollar coverage on Medigap plans

Provider provisions

PPS hospitals: Phase in over six years restoration of coding adjustment payback set for 2018

Prevent 0.55 percent coding adjustment on PPS hospitals

Sets post-acute update at 1 percent in 2018

Eliminates Medicaid DSH cuts in 2017, lowers 2018 – 2020 cuts, increases cuts in 2021 – 2024 and extends cuts into 2025

The Rest of the Year…

Trade Deal TAA paid for with extension of Medicare sequestration

21st Century Cures

• 340

• Interoperability

• Pay-fors

Physician-owned hospitals

King v. Burwell – the Congressional response?

5/22/2015

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More in 2015…

Budget

Budget resolution approved – sets spending, revenue targets

FY 2016 appropriations – October 1 deadlineCommittees are beginning to work on billsWill continue through summer and fall

Budget deal possible

Could include entitlement cuts

Venue Debt ceiling – September – November

End-of-Year sequester fix

NDHA’s Agenda for the Rest of the Year

Unfinished business Pass 96-hour, supervision fixes RAC reforms

Long-range policy initiatives Ongoing discussions about threats to access in rural and frontier

areas Medicare waiver AHA task force

Appropriations Adequate funding for workforce development, Flex and other rural

grant programs

Be vigilant Protect 340B program, CAH program Prevent additional payment cuts in a budget reconciliation, deal or

debt limit bill

Save the Date!Medicare Rural Hospital Flexibility Program (Flex) CAH Pre-conference June 2, 20158:00–11:15 am CST(prior to the Dakota Conference on Rural and Public Health)

Grand Hotel • Minot, North Dakota

Who should attend CEO, CFO, CNO, DON, EMS, & QI staffNursing CEUs and LTC Administrator contact hours available.

Registration fee: $15

To registerruralhealth.und.edu/dakota-conference/registration

5/22/2015

Bill No. Original Subject Matter Final Bill Outcome Sponsor(s) Committee Resolution

HB 1035

Provide for legislative management

studies of the state's health care

delivery system and a behavioral

health and addiction training initiative.

Continues the study of the health care delivery system in

North Dakota including Behavioral Health.

Health Care Reform

Interim Committee

House IBL Senate

Human Services

Committee

PASS(H)

85-1

PASS(S)

47-0

PASS(H)

88-4

HB 1036

An ACT to provide for the state

department of health to study health

professional assistance programs

and report to the legislative

management.

During the 2015-16 interim, the DOH shall evaluate the

state programs to assist health professionals, including

behavioral health professionals, with a focus on state

loan repayment programs for health professionals.

Health Care Reform

Interim Committee

Health Care Reform

Committee

PASS(H)

74-9

PASS(S)

45-1

Engrossed HB

1039

Relating to health insurance coverage

of substance abuse treatment; to

repeal 26. 1-36-08.1 of the ND

Century Code, relating to alternative

health insurance coverage of

substance abuse treatment and to

provide for application.

Issues was addressed without the necessity of the bill

FAILED TO PASSHealth Care Reform

Interim Committee

House

Human Services

Committee

Senate Human

Services Committee

PASS(H)

80-12

FAIL(S)

4-42

HB 1040

Expands the scope of practice for

Advanced Practice Registered

Nurses in involuntary commitment

proceedings

This bill authorizes additional medical professionals,

specifically nurse practitioners and physician assistants

with specialized mental health training to act in matters

of involuntary treatment.

Health Care Reform

Interim Committee

Senate

Judiciary Committee

PASS(H)

93-0

PASS(S)

46-0

PASS(H)

93-0

WRAP-UP64th Legislative Assembly - Behavioral Health Bills

Page 1

http://www.legis.nd.gov/assembly/64-2015/documents/15-0133-04000.pdf?20150410111408




5/22/2015


HB 1046

Relating to expanded traumatic brain

injury programming and to provide an

appropriation

Appropriation requested in the

original bill - $1,975,000

The amendments to this bill deleted sections one

through three relating to the traumatic brain injury

registry. The amendments provided $375,000 for

providing skill services as well as $50,000 for

coordinating services for individuals with TBI.

NOTE: There are also TBI services covered in HB 1256

and in the 3005, a study.

Human Services

Interim Committee

Human

Services Committee

PASS(H)

93-0

PASS(S)

47-0

PASS(H)

89-3

PASS(S)

47-0

HB 1048 Relating to uniform licensing

During the 2015-16 interim, the board of addiction

counseling examiners, board of counselor examiners,

North Dakota board of social work examiners, state

board of psychologist examiners, state board of medical

examiners and North Dakota marriage and family therapy

licensure board shall in collaboration with the other

boards, develop a plan for the administration and

implementation of licensing and reciprocity standards

for licensees.

(Duane Houdek form Board of Medicine will facilitate

discussions)

Human Services

Interim Committee

Senate

Human Services

Committee

PASS(H)

92-0

PASS(S)

47-0

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5/22/2015


HB 1049

Relating to loans and grants for

certain behavioral health

professionals.

Appropriations requested in original

bill - $1,380,000

This bill implements the following actions:

1) Requires Bank of North Dakota to develop and

implement an addiction counseling internship loan

program with a revolving fund.

2) As dedicated funds become available, the Center for

Rural Health at the UND School of Medicine & Health

Sciences (AHEC), has the infrastructure expertise

experience and established relationships to provide a

statewide assessment of viable internship sites for

addiction counselors and to implement and provide

oversight for such a program.

3) Appropriates $200,000 for purposes of the addiction

counselor internship loan program revolving fund.

Appropriations approved in final bill - $200,000

NOTE: It was suggested to the board that they

substitute "clinical experience" for "internships" to

enable students to qualify for student loans.

Human Services

Interim Committee

Senate

Appropriations

Committee

PASS(H)

85-8

PASS(S)

43-2

PASS(H)

81-88

PASS(S)

46-1

HB 1115

Relating to state behavioral health

professional loan repayment

program.

Appropriation requested in original bill

- limits of $90,000 and $60,000 over

two years

FAILED TO PASSHuman Services

Committee

House Human

Services Committee

FAIL(H)

4-86

Engrossed HB

1272Relating to certification of medical

psychologists FAILED TO PASS Rep. Fehr

House

Human Services

Committee Senate

Human Services

Committee

PASS(H)

64-28

FAIL(S)

6-41

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5/22/2015


Engrossed HB

1273

An ACT to require the AG to develop

and implement a pilot grant program

to integrate the services of LSW's in

law enforcement agencies; to provide

for a report to legislative

management and to provide an

appropriation.


- $600,000

FAILED TO PASS Rep. FehrHouse Human

Services Committee

FAIL(H)

33-60

HB 1396Relating to student loan repayment

programs for health care

professionals.

The amendments to this bill clarified the requirements of

the loan program.

NOTE: The Health Council will administer newly

streamlined programs. HB 1396 also has a continuing

appropriation of nearly $700,000. In addition, additional

grants, gifts and federal dollars could increase total

dollars available.

Rep. Sukut,

Damschen, Fehr,

Hatlestad, Lefor, Rohr;

Senator Bekkedahl

Education

Committee

PASS(H)

78-13

PASS(S)

47-0

PASS(H)

77-15

PASS(S)

47-0

Page 4



5/22/2015


SB 2012DHS Budget Bill


- $3,646,706,208.

DHS Budget bill. Included in this bill:

1) behavioral health services quarterly reporting all

behavioral health services provided or supported by

DHS.

2) continues the Autism Spectrum Disorder Voucher

Program.

3) Funds $75,000 for parent-to-parent support group.

4) Funds $75,000 for family-to-family support in counties

with a population of less than 6,000.

5) Mental Health Hotline services - Legislative

Management shall consider studying the various

telephone contact numbers supported by state

appropriations to access services.

6) Legislative Management shall consider studying

services for children with autism.

Appropriations approved in final bill - $3,515,609,581

NOTE: Detail of behavioral health items added arelisted below.

Governor

Senate

Appropriations

Committee

PASS(S)

47-0

PASS(H)

72-20

PASS(H)

79-11

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5/22/2015


SB 2012 Outcome ContinuedSB 2012 also requires a new Behavioral Health Services quarterly report. "The department of human services shall publish a quarterly report of all behavioral

health services provided by or supported by the department. The report must include each type of behavioral health service, the number of clients served for

each service, and the amount of state and federal funds budgeted and spent for each service. Data must be identified for behavioral health services by human

service region and by mental health services provided to children, mental health services provided to adults, and substance abuse services".

The DHS budget also included $1.4 million in increase for Autism Spectrum Disorder services in the following areas:

1) Increased waiver slots to 25.

2) Increased voucher slots by 10.

3) Increased Autism Waiver from 7 years to thru 9 years. (12 slots)

Page 6

5/22/2015


Reengrossed

SB 2045

Provide voucher system for addiction

treatment services.


- $2,000,000

Appropriation of $750,000 was put in SB 2048

FAILED TO PASS

Human Services

Interim Committee

House

Human Services

Committee

PASS(S)

45-0

FAIL(H)

25-68

SB 2046

To increase access for adult and

youth behavioral health services


- $3,025,000

This bill requires DHS (effective 01/16) to allow licensed

marriage and family therapists to enroll and be eligible

for payment for behavioral health services provided to

recipients of medical assistance, subject to limitations

and exclusions DHS determines necessary.

An appropriation was not needed because LMFT's would

be eligible for reimbursement through regular Medicaid.

Human Services

Interim Committee

House

Appropriations

Committee

PASS(S)

45-0

PASS(H)

86-7

PASS(S)

46-0

Page 7



5/22/2015


SB 2047Relating to the definition of a qualified

mental health professional.

This bill included the following:

1) Under definitions, they deleted definitions of "qualified

mental health professional".

2) Amended the method of providing service by deleting

"full time or part time employment of all contracts with

qualified mental health professionals" and replaced it

with " as set forth by department rules".

3) Requires DHS to adopt rules defining which

professional may provide clinical supervision, review,

and may develop, update and sign on individual

treatment plans within a psychiatric residential treatment

facility for children.

NOTE: DHS will adopt rules concerning which

professions will provide treatments based on their

scopes of practice as defined in current state statutes.

Human Services

Interim Committee

House Human

Services Committee

PASS(S)

46-0

PASS(H)

84-1

Page 8


5/22/2015


SB 2048

This bill requires/allows for:

1) Requires school boards ensure a candidate for

teacher licensure demonstrates competencies in youth

mental health. The bill lists several specific

competencies.

2) Requires each school district to provide a minimum of

8 hours of training on youth mental health to elementary,

middle and high school teachers and administrators

once every two years.

3) Requires superintendent of public instruction to

collaborate with regional education association to

disseminate information.

4) Requires Department of Public Instruction to compile

information on mental health training provided by school

districts and provide a report to the legislative

management.

5) Out-of-state teachers applying for ND licenses can be

issued a 2-year provisional license during which time

they are required to take 8 hours of continuing education

in youth mental health.

6) DPI will compile information on mental health training

provided by school districts and report to legislative

management. 7)

Provides $150,000 to DHS for 1FTE and for the purpose

of facilitating the behavioral health planning protocols

for discharge or release of individuals with behavioral

health issues. Planning protocols must involve law

enforcement, health care providers and other related

organizations and must include outcome measure.

8) Provides $750,000 to DHS for the purpose of

establishing and administering a voucher system to

address underserved area and gaps in the state's

substance abuse treatment system and to assist in the

payment of addiction treatment services provided by

private licensed substance abuse treatment programs to

start 7/01/2016.

NOTE: Appropriation approved in final bill - $150,000.

Human Services

Interim Committee

House

Appropriations

Committee

PASS(S)

45-0

PASS(H)

82-7

PASS(S)

46-0

PASS(H)

73-16

Enhance behavioral health services

by establishing a consistent and

common methodology of

assessing/diagnosing those in need.

It also addressing the need for crisis

intervention in our rural communities

by providing training to the Critical

Access Hospitals.


- $6,225,000

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5/22/2015


SB 2162

Relating to loan repayment programs

for social workers and addiction

counselors; and to provide an

appropriation.


- $360,000

NOTE: $200,000 in HB 1049

FAILED TO PASS

Senator LarsenSenate Human

Services Committee

FAIL(S)

4-41

SCR 4021

Directing the Legislative Management

to study how the institution for mental

disease Medicaid reimbursement

exclusion impacts this state, including

the impact on Medicaid enrollees and

on private and public sector

providers.

Directing the Legislative Management to study how the

institution for mental disease Medicaid reimbursement

exclusion impacts this state, including the impact on

Medicaid enrollees and on private and public sector

providers.

NOTE: Current IMD exclusion limits ability of facilities to

expand cost effectively, because of limit to 16 beds or

fewer.

Sen. Mathern, J.Lee

Rep. Silbernagel,

Hogan, Hofstad

House

Human Services

Committee

ADOPTED

ADOPTED

PASS(S)

47-0

PASS(H)

86-1

SB 2049Behavioral Health professional role

clarification.

During 2015-16 interim, DHS in consultation with DOH

and other stakeholders shall study references to mental

health professionals to determine whether changes in

law may help to more fully utilize there professionals

within their scope of practices. DHS shall report

recommended changes in alignment with the most

current professional standard or with the most current

diagnostic and statistical manual.

Human Services

Interim Committee

House

Human Services

Committee

Page 10




Documents

Federal Update NDHA Board of Trustees · 5/22/2015 · 5/22/2015 1 Federal Update NDHA Board of Trustees May 21, 2015 John w. Flink, Consultant, Federal Affairs, NDHA Agenda •