Arkansas Legislative Update

January 3, 2017

State Elections

Senate 35 members

Republicans = 26

Democrats = 9

Jonathan Dismang, pro tem

House 100 members

Republicans = 76

Democrats = 24

Jeremy Gillam, Speaker

General Revenue

2015 Medicaid Budget

Budget with and without APO

Hospitals are…

Redesigning care and embracing alternative payment models that promote better, more efficient, coordinated and seamless care for patients;

Improving quality and patient safety to reduce readmissions, complications, and health disparities;

Taking responsibility for the health outcomes of designated groups within communities;

Fostering innovation and adopting new technologies to improve care;

Implementing proven, evidence-based guidelines and protocols that reduce variation and ensure that patients get only the care that is most beneficial;

Promoting better strategies for managing advanced illnesses; and

MORE.

Brief History

March 23, 2010 – Patient Protection and Affordable Care Act became law

Prohibits insurance companies from denying coverage based on pre-existing conditions

Allows individuals up to age 26 to remain on a parent’s insurance plan

Requires insurance to cover preventive care

$2.5 billion in reimbursement cuts to hospitals over 10 years

June 28, 2012 – United State Supreme Court 5-4 decision

April 17, 2013 – Arkansas Health Care Independence Act (Arkansas Private Option)

2014, 2015…

April 7, 2016 – Arkansas Works

Arkansas Works

Arkansas Private Option (100% Federally funded) ends December 31, 2016) Cost aversion of $149 million in uncompensated care

Emergency Department uncompensated care decreased 38.8%

Inpatient uncompensated care decreased 48.7%

Outpatient uncompensated care decreased 45.7%

Uninsured rate dropped more than any state other than Kentucky – 22%

Arkansas Works (State share 5% in 2017; 6% in 2018; 7% in 2019; caps at 10% in 2020) Employer incentives for offering employee insurance

Work referral plans

Patient involvement in healthcare – premiums, cost sharing

Eligibility system enhancement

Elimination of 90-day retroactive-eligibility

Arkansas Works Waiver Arkansas Works will continue to use premium assistance to purchase Qualified Health

Plans (QHP) offered through the individual market in the Marketplace for those eligible for expanded coverage.

Beneficiaries who have access to cost-effective small group employer sponsored insurance (ESI) coverage will be required to enroll with their employers’ ESI if their small group employer has already enrolled with Arkansas Works. Arkansas Medicaid will ensure that the ESI plan complies with federal requirements for cost effectiveness and benefits and will wrap cost sharing to Medicaid allowable limits.

In 2017, a $13 monthly premium will be charged to the enrollees who have household incomes above 100% of the Federal Poverty Level (FPL) and are also in a QHP/ESI. In subsequent years, enrollees will be required to pay a monthly premium of up to 2% of their household income.

If an enrollee does not pay their premium, they will not lose eligibility but will accrue a debt to the state.

The premium payment will be paid to the QHP carrier or to their employer if they are in an ESI.

Beneficiaries who are determined to be below 100% FPL will not have a premium obligation.

The “RIGHT NOW” Issues

FEDERAL Affordable Care Act

Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)

Telemedicine

Outpatient Prospective Payment System Rule

Site neutral payments – off-campus HOPD

CAH Payment Policies

Socioeconomic strategies for Medicare readmissions

Flexibility in physician supervision

340b Drug Pricing (2% of $374 billion)

STATE Expanded Coverage

Payment Methodology Restructuring

Managed Care – Full Risk Capitation

Insurance Contracts

Regulations

State Board of Health

Department of Human Services

Environmental Quality

Employment – Labor – Work Force

Public Health

Regulatory Onslaught

Medicaid Rules

5,000

2,500

FY and CY Medicare Payment Rules

MA and Exchange Rules

Other Rules

Delivery and Payment Reform Rules

Program Integrity Rules CoP Rules

10,000

7,500

12,500

Num

ber o

f Pag

es

13,974 pages

Hospital Related Rules through Aug. 31

Average of one rule per week so

far in 2016

Government Auditors

• Novitas Solutions, Inc.  (MAC) 

•AdvanceMed           (CERT Auditor)

• CGS Nashville Regions (DME MAC) 

• Palmetto GBA (Home Health  & Hospice MAC) 

• Connolly (Recovery Audit Contractor) 

• AFMC (Quality of Care Auditor)

•AFMC (Beneficiary Complaints Auditor)

Medicare  Medicaid • Health Integrity (Audit MIC)

• AdvanceMed (Review MIC)

• A+ Government Solutions (PERM Review Auditor) 

• Arkansas Medicaid Fraud Control Unit

•Arkansas Medicaid Program Integrity ‐Field Audits

•HMS (Medicaid RAC) 

• AFMC (Utilization Review & Data Validation Auditor)

• AR Dept. of Health Surveys, Complaints & Quality of Care Audits

* Little Rock

• AdvanceMed (NCI) (ZPIC ‐ Zone 5) 

• OIG Audits

AHA 2017 Priorities Council on Government Relations met Friday, October 28, 2016

Recommendations adopted by the Board on November 11, 2016

Topics: Expanded coverage through Arkansas Works

Medicaid Reforms – Task Force Recommendations

Telemedicine

Payer Reimbursement

Scope of Practice Issues

Reasonable Tort Reform

Ballot Issue 6 - marijuana

DEFENSE! DEFENSE! DEFENSE!

Path of Legislation

Legislator•Drafted by Bureau of Legislative Research

House Committee

•Pass/Fail•Amend

Full House•Pass/Fail•Amend (then back to House

• Committee)

Senate Committee

•Pass/Fail•Amend

Full Senate•Pass/Fail•Amend (then back to Senate Committee)

Governor

•Sign into Law•Allow to become law without signing

•Veto (very weak veto power in Arkansas –simple majority override)

General Assembly Website

Contacting Legislators

Senate in Session – (501) 682-2902

House of Representatives in Session – (501) 682-6211

Be specific

Be Brief

Be Direct

Be Constructive

Be Timely

Be Complimentary

VoterVOICE

www.arkhospitals.org

Legislative/Regulatory/Legal

voterVOICE/Grassroots

REGISTER!

Questions?

Jodiane Tritt, JD

Arkansas Hospital Association

419 Natural Resources Drive

Little Rock, AR 72205

(501) 859-5805 Cell

jtritt@arkhospitals.org