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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
