Federal and State Advocacy: How are They Different? What are the Big Issues?

Cassie Sauer, Senior VP, Advocacy and Government AffairsChelene Whiteaker, Policy Director, Member Advocacy

• Increase your understanding of issues on the advocacy agenda at the state and federal level

• Get you more engaged in advocacy at the federal level, especially with our Senators

• Answer any questions you may have about our work

Goals

Washington State vs. Washington D.C.

Advocacy in Washington, D.C.

• Further away, less time in district – but more recesses

• Full-time job• Slower process with unclear beginnings,

middles, and ends• Larger geographic area to serve• Sometimes more issue specialization• Every vote counts

Washington D.C.

Important Partnerships

“A House Divided”

1982

1997

2012

U.S. Senators

U.S. Representatives: Democrats

U.S. Representatives: Republicans

• Problem: CMS decided only hospital stays that span over two midnights will be considered inpatient stays

• Legislation: Delays enforcement of “Two-Midnight” policy Tasks CMS with new payment policy

• Co-sponsors: Representatives DelBene, Larsen, Kilmer, McMorris Rodgers, Reichert

• Neither Senator has co-sponsored the bill

Two Midnight Rule: S. 2082 and H.R. 3698

• Problem: As part of the CMS conditions of payment, physicians at CAHs must certify that a Medicare beneficiary is reasonably expected to be at the hospital less than 96 hours. Patients would have to be transferred if they require more than 96 hours of care.

• Legislation: Repeals the 96-hour rule for payment purposes

• Cosponsors: Representatives McMorris Rodgers, Hastings, and Kilmer

• Neither Senator has co-sponsored the bill

96-Hour Rule: S. 2037 and H.R. 3991

Physician Supervision: S. 1143 H.R. 2801• Problem: CMS changed the physician supervision

requirement for therapeutic outpatient services to “direct” instead of “general”

• Legislation: Adopts a “general” supervision requirement for therapeutic outpatient services

• Cosponsors: Representatives McMorris Rodgers, Heck

• Neither Senator has co-sponsored the bill• Senate passed a delay for one year

• Program provides steep discounts to safety-net providers, including CAHs

• Problem: The pharmaceutical industry would like to see it scaled back

• A few hospitals may be abusing the program, making it vulnerable

• WSHA recently met with key Republicans about its importance

340B Drug Discount Program

Reducing Cost, Improving Quality: Early Elective Deliveries

Reducing Cost, Improving Quality: Central Line Bloodstream Infections

Reducing Cost, Improving Quality: Pressure Ulcers

Federal Advocacy Resources: WSHA Website

• Respond to requests for action• Consider a trip with us to D.C.• Let us know your interest in an in-district

meeting with your colleagues• Host a Congressional staff member• Deliver a PAC check

How You Can Get Involved

Montana Demonstration: Frontier Community Health Integration Demonstration Project

A new provider type and a new COP under which all services would be integrated

A single payment system Incentives to improve the quality of care such as pay-for-

performance and shared savings Increased use of telehealth and electronic medical records Increased emphasis on care transitions and care coordination Additional beds for long-term care services by raising the CAH

bed limit from 25 to 35 Incentives to increase community-based care by utilizing

visiting nurses and strengthening home health services

Montana Demonstration: What the Association Wanted

Cost-based payment of the originating CAH’s facility fee for telemedicine services

Medicare reimbursement to a CAH originating site and a distant site provider tor telehealth services furnished using asynchronous “store and forward” technology

Waiving the 35-mile rule for cost-base reimbursement of ambulance services furnished by a CAH

An increase in the bed limit for CAHs from 25 to 35 for SNF or NF-level services

Enhanced payment rates for home health providers to account for the costs of traveling extended distances to provide services

Montana Demonstration: What the Association Got

13 applicants in four states Washington not eligible Not as far as advocates hoped, but an

interesting start Took a lot of Congressional pressure

Montana Demonstration: Status

• Associations would need to bring member task force together

• Use our legislative leadership to shepherd it through

• Requires legislation and funding

• Might happen, might not

• Interest?

How Could We Move a Washington/Oregon Demonstration?

Advocacy in Olympia

• Closer, lots of time in district• Sometimes have another job• Speedy process with clear deadlines and

adjournment dates• Smaller geographic area to serve• Tend to want to know about more issues• Every vote counts

Olympia

• Long session• New leadership (4/5 of key players) has

more experience• Majority Coalition – interesting political

dynamics• Who wins the Senate?

Coming State Legislative Session

• Budget-writing session – House and Senate will likely differ on willingness to spend

• Revenue forecast likely better, but not great• Supreme Court mandates:– more education funding – threatening ruling

recently– more mental health funding?

• Smoke pot!

State Budget Overview

• Telemedicine

• Mental health investments and system improvements

• Increasing transparency

• Inmates and suspects

• Crisis standards of care

What We’ll Work On - Proactive

• Nurse staffing bills

• Clinic fees

• Partnerships and affiliations (particularly PHDs)

What We’ll Work On - Defensive

• Lawsuit over new Certificate of Need rule• Judge ruled in favor of WSHA• Revert to current Certificate of Need rule• Unclear if the case will be appealed• Do we want to reform CON?

WSHA v. DOH

• Respond to requests for action• Come to Olympia to testify or meet with your

legislators• Schedule an in-district meeting by yourself or

with your colleagues• Don’t forget to highlight care improvements

here too!• Deliver a PAC check

How You Can Get Involved

It is an honor to represent you.

Thank you for all your help in making our advocacy program successful!

Cassie SauerSenior Vice President, Advocacy & Government Affairs

cassies@wsha.org 206/216-2538

Chelene WhiteakerDirector, Member Policy

chelenew@wsha.org 206/216-2545