A very busy Legislative session is underway

We are halfway through week five of the 2020 Legislative session, and activity has reached a fever pitch on a number of issues.

It won’t come as a surprise to any in the healthcare field that “surprise billing” is a key issue this session. The insurance companies have a plan to protect the patient from balance bills from out-of-network providers – which has our strong support. Their idea, however, is to go much further by getting the government involved in rate setting and intervening in private contracting between providers and payors. Their initial bill had a few fatal flaws, so 10 days later, they introduced a second version of their “No Surprises Act.”  It, too, is short on adequate definitions and clarity; as such, the House Health and Welfare Committee postponed the scheduled hearing based on issues raised by IHA. 

Another proposal – promoted by eastern Idaho billionaire Frank VanderSloot – was introduced in the House today. While he originally wanted to clamp down on predatory medical debt collectors and exorbitant attorneys’ fees, he also feels people end up in collections because providers delay notifying patients about their bills until many months have passed since they received care. His bill will require providers to submit claims to insurance in a more timely manner. If multiple providers will be billing a patient for services provided in one of our hospitals or clinics, we will have the responsibility to provide that patient with a summary of all providers who may bill them. Failure on our part to meet the timelines for these and other requirements could mean we forfeit the ability to pursue legal action on unpaid debt. Today, the bill was introduced in committee. IHA is reviewing the legislation, which has many of the changes we recommended, and will have a more detailed evaluation soon.

While both of these issues seem to be the focus of current healthcare discussions in the Capitol, we at IHA continue to work to ensure that if those bills progress, they indeed protect the best interests of patients with as minimal impact on cost and burden to hospitals and healthcare systems as possible.

Meanwhile, there have been positive developments on other issues important to IHA. The Governor’s request for $500,000 to implement a statewide advance care directive registry was very well received by the budget committee and has seen a groundswell of strong support among other legislators. Authorizing language to establish this registry in the Department of Health and Welfare will be introduced tomorrow.

IHA’s efforts to make sure hospitals have the tools necessary to recruit and retain quality leadership led to our co-sponsorship of Senate bill 1242 which unanimously passed the Senate this week and now heads to the House. This legislation will provide flexibility to hospitals with nursing home beds when hiring executives. “By opening the education qualifications for nursing home licensing to be more reflective of the current education and training of executives, we help assure those vital facilities remain available,” said IHA’s Vice President of Governmental Relations, Toni Lawson.

One final piece of good news to share is that the Governor’s office and the Department of Health and Welfare have intervened to ensure our hospitals can continue to offer health fairs in their communities without violating administrative rules regarding physician orders for laboratory work conducted as part of the health fair. They recognized the immense value to each of our communities when our hospitals offer prevention and screening opportunities to the public – and want those efforts to be able to continue. The Department of Health and Welfare is developing guidance which will be sent to our members as soon as it’s available. 

  ~Brian Whitlock, President/CEO

And we’re off ~ 2020 legislative session begins

Earlier today, the Governor shared his vision for the 2020 Idaho Legislative Session at the inaugral State of the State address. A key element of the speech was his plan for not only meeting today’s needs but also preparing for the future.
Part of those preparations include a “spending reset” which impacts the current fiscal budget as well as the next. The 2% “reset” will impact PPS hospitals as the Department of Health and Welfare looks to fund most of their savings via Medicaid reimbursement reductions to larger facilities and nursing homes. IHA continues to work with the department to minimize the impacts as they work to meet their budgetary targets.
While those cuts present significant challenges for many of our members, we are celebrating that over 53,000 Idahoans who were caught in the coverage gap can now get the healthcare and treatments they need to stay healthy. As anticipated, Governor Little’s funding recommendation for Medicaid Expansion had no net impact on the General Fund. Of the $41 million needed for the first full year of funding, the Governor has recommended redirecting savings in existing programs, utilizing the state’s tobacco settlement fund, and $8.5 million in funding from Idaho counties that will see a decrease in their indigent costs.
One of the Governor’s focal points is public education and we were interested in his funding proposal to help teachers with students struggling with mental health issues by creating opportunities for additional training and resources.
“Identifying and getting these young people help early and with adults they know and trust shows Governor Little’s commitment not only to effective schools but to Idaho’s students,” said IHA President/CEO Brian Whitlock. “Hospitals across the state work closely with their local schools to create better communities and we are pleased to see them getting this valuable help. These additional resources will help create better opportunities for mental health care locally and potentially avoid students being taken out of school or hospitalized away from home.”
Another success for hospitals and their communities was the Governor’s recommendation to continue the build-out of medical residency programs. When the “budget reset” was announced, many assumed that both existing and new funding for residencies would be reduced or eliminated. With an eye on helping assure Idahoans have quality healthcare close to home, the Governor’s budget kept existing funding in place along with new funding for 25 additional residency slots in Idaho.
Today’s State of the State address offered some very positive news; however, as we listen to the proposals in and around the Capitol, we know there will be challenges that can have long term negative impacts on healthcare. Sharing the realities of the work you each do in your hospitals and helping lawmakers understand the intricacies of healthcare will keep your IHA team busy throughout the session. We will keep you up to date on the latest and look forward to a successful 2020 Legislative Session.

careLearning ~ affordable, trusted compliance education

logo for careLearning

Compliance education is a fundamental part of health care. A regulatory requirement, compliance education also contributes to safer working environments for employees, lowers organizational liabilities, and can greatly improve the patient experience.

Keeping compliance education timely, making it convenient for employees, and providing the ability to track completions with ease makes online training a go-to resource in today’s fast-paced environment.

Nearly 20 years ago, IHA, along with more than 40 other hospital associations, formed careLearning – a non-profit compliance education service. The goal is to provide member hospitals with a trusted entity they could depend on for excellent customer service, reliable content, and affordable pricing.

A Trusted Learning Management System

Today, careLearning’s economical learning management system package includes 29 compliance courses, 41 continuing education courses covering five disciplines, and the ability to track both live events and expirations of licensures and certifications. This package also offers organizations the freedom to create/customize courses at no extra cost, as well as access to a library of more than 7,000 courses written by other careLearning users.

careLearning removes the compliance education burden from staff by keeping all compliance and CE courses in the learning management system package timely and up to date; courses will always keep pace with all regulatory changes.

Current courses that reflect recent regulatory changes include:  emergency preparedness, the United Nations Globally Harmonized System of Classification and Labeling of Chemicals standard in terms of hazardous communication, safe injection practices, patient’s rights to visitation, reporting changes needed for using restraints, new Joint Commission requirements for medical radiation safety, CMS changes to health care compliance, and the encouragement of the use of non-opioid pharmaceuticals for pain management.

careLearning has not raised user rates since its inception. Features and offerings have grown over the years, but client costs remain static.

“Passport” for Rotations

careLearning also offers the “Passport” program to assist organizations in keeping clinical rotation students compliant. Students pay a flat $10 fee per year for this service, which allows them to report to any hospital accepting Passport as a part of its orientation program. This reduces their need to repeat the same course content at every location, and it verifies to each organization that orientation course work is complete. Passport is free for both hospitals and schools, and hospitals can upload additional content to supplement the curriculum, if desired. Thousands of students take advantage of this easy, inexpensive way to prepare for their rotations each year

Hospitals value the fact that students come to them properly prepared, and colleges say they appreciate the reduced coordination needed from facility to facility. careLearning maintains high customer service scores, with 97 percent of clients providing the highest rating on their annual surveys.

For more information about careLearning or Passport, contact support@carelearning.com or call 866.617.3904.

What’s ahead? A look at the 2020 Legislative Session

Image of year 2020

With 2020 just days away, the opening gavel of the Legislative Session will quickly be upon us. This year is shaping up to be incredibly pivotal for hospitals and healthcare in Idaho. In a preliminary review of potential and probable legislation, IHA staff identified over two dozen issues that may be addressed in the Legislature. Many could have significant negative impacts on hospitals and their ability to provide care.

Beginning with the Governor’s State of the State Address on January 6 (streaming will be available here), healthcare is expected to be highlighted when Governor Little offers up his budget plan for Medicaid Expansion. As of December 30, the Department of Health and Welfare reported just over 52,000 Idahoans have enrolled in Medicaid expansion and will receive coverage beginning January 1. This enrollment is significantly lower than the projected 91,000 Idahoans who would be eligible for coverage under expansion, however, Idahoans who qualify may still be enrolled when they show up for care. Savings in the State’s Catastrophic Healthcare Fund (CAT Fund), Health and Welfare programs, and the Deparment of Correction budget will likely comprise Governor Little’s expansion funding proposal, with earnings from the Millennium Fund making up the balance. This is in line with how the partial first year is funded.

The other key issue taking center stage is the budget reset the Governor called for in November. With revenues coming in lower than forecasted, he has asked all departments (with the exception of public education) to cut 1% from the current budget cycle and absorb a 2% base reduction in next year’s budgets. Health and Welfare is looking at hospital funding cuts to make up a majority of their cost containment goals. How this works out will be one of the most discussed issues of the Session.

Your IHA team is also preparing for a host of other legislation on issues ranging from credentialing and IDAPA rules to telehealth and surprise billing. It promises to be a very busy session with Legislators anxious to take home wins leading up to the 2020 elections. Making sure those wins don’t impact your ability to provide quality care will continue to be our focus.

Looming state budget shortfalls will impact hospitals

Looming State Budget Shortfalls will Impact Hospitals

Charles Dickens begins A Tale of Two Cities with, “It was the best of times, it was the worst of times…”. 

For the Idaho State Budget, it also seems like the best of times as well as the worst of times. Despite a 5.2% growth in revenue this year – a growth rate that would be the envy of nearly every other state – the Governor has ordered a 1% budget holdback for the current year, and a 2% base reduction for the next fiscal year.

It’s all part of what the Governor is calling a “spending reset” because expenditures are growing at a faster rate than state revenues.

Reducing hospital’s Medicaid reimbursement rates by 5-10% is what the Dept. of Health & Welfare is considering to meet the Governor’s spending reset.

That spending reset will not affect education, which compounds the cuts necessary in other areas of the state budget – including Medicaid reimbursements to hospitals and nursing homes.

So, with healthy revenue growth, why is the state budget in “the worst of times”?  When the Legislature set the current year’s budget, they appropriated an overall increase in spending of about 7%. If revenues only grow at 5.2% (adjusted down from an original “best of times” and overly optimistic 8.2% projection) you can see the immediate problem. Just a maintenance budget that accounts for growth in student enrollment, Medicaid population, or the cost of housing prisoners is about a 5.5% year-over-year increase. To further complicate this, there are two supplemental funding requests that the Legislature will have to consider for the remainder of the year — $23 million from Department of Correction and $22 million from Department of Health and Welfare for Medicaid funding not related to Medicaid Expansion.

This year’s holdback and next year’s base reduction are designed to slow the growth of the overall state budget – but the Department of Health and Welfare has limited options on where they can “cut”. This year, the state’s total Medicaid budget grew by 6.7%. Hospital Medicaid payments are one of the largest portions of the Medicaid spend (about one-fourth of the total) and those reimbursements were up about 12%.

Hence, a “spending reset”.

From the Department’s perspective, the “best” way to come up with its holdback is to reduce the hospital 100% cost-reimbursement rate by as much as 5-10%. From a hospital’s perspective, it’s the “worst” way because you leave a significant federal match on the table. At this point, the intent is to limit the cuts to PPS hospitals – knowing that substantial reductions in Medicaid payments to CAH hospitals would threaten the viability of some community hospitals to keep their doors open.

Later in A Tale, Dickens offers hope in an otherwise dark time, “Nothing that we do, is done in vain.”  It is under this charge, that IHA is bringing alternatives to the Department, the Governor and Legislators to avoid “the worst of times” and assure that the unintended consequences of rate cuts and cost shifts don’t interrupt the “best of times” Idaho’s citizens are enjoying in our prospering economy.

Photo of Brian Whitlock, President / CEO Idaho Hospital Association
Brian Whitlock, President/CEO
Nov. 11, 2019

Proposition 2 arguments heard by Supreme Court

Proposition 2 arguments heard by Supreme Court

I attended the Supreme Court oral arguments today in Regan V. Denney, the challenge to the constitutionality of Proposition 2 -Idaho’s Medicaid expansion initiative. The Idaho Freedom Foundation argued that Proposition 2 cedes the State’s authority to the Federal government, primarily because Medicaid is tied to Federal Poverty Levels that are set by the Federal government and the 90/10 match rate could be changed by the federal government at some point in the future.

The State argued that the Freedom Foundation really didn’t have standing to bring this case before the Supreme Court, but the Justices seemed to want to move past that argument and get to a point where they could rule on the merits of this case. An attorney for the Idaho Medical Association also argued against the ceding of authority by highlighting the fact that the State currently has all types of federal-state programs and cooperative agreements, including our existing Medicaid program, none of which are considered to cede legislative authority to the federal government.

Both sides were asked thoughtful questions by the Court to bring greater clarity to the technical aspects of Medicaid and the implementation of the voter approved initiative.

The court recognizes that thousands of Idahoans are waiting for some determination in this case, and the legislature is also looking for some guidance from the court. They took today’s oral arguments under advisement, but it seemed like they would make their decisions and issue a ruling in fairly short order.

Photo of Brian Whitlock, President / CEO Idaho Hospital Association
Brian Whitlock, President/CEO
January 29, 2019

Budget Recap – Medicaid Expansion, GME

Budget Recap - Medicaid Expansion, GME

In addition to the inaugural events and the State of the State address, we were able to get a first look at the Executive Budget Recommendations from the Governor to the Legislature. We thought we would highlight for you some of the key budget items affecting Medicaid expansion, Graduate Medical Education as well as overall Medicaid funding.

The total cost of the state match for Medicaid expansion is $19,655,500. That 10% match will bring in a projected $176.9 million in Federal funds. The total Medicaid expansion spend in the final six-months of FY2020 is projected to be $196,555,600.

The Governor is recommending a “net zero” impact to the state’s General Fund to come up with the required state match. He is recommending that $9,267,000 be redirected from existing programs that serve individuals who will become eligible for enrollment in the Medicaid expansion population:

$1,422,900 – Hospitalization per diem reduction (Dept. of Correction budget)
$1,444,100 – Community based Substance Use Disorder Treatment (Dept. of Correction budget)
$1,000,000 – Community Hospitalization (H&W budget)
$4,200,000 – Adult Mental Health (H&W budget)
$1,200,000 – Substance Use Disorder Treatment (H&W budget)

Again, this funding represents six-months’ worth of spend in the last half of FY2020. When the Legislature sets the funding level for FY2021 next year, they would be able to redirect the full years’ worth of those program dollars to Medicaid expansion – $18,534,000.

For the remaining balance of the FY2020 10% match, the Governor recommends the use of $10,388,600 in one-time money from interest on the state’s Master Tobacco Settlement Agreement Fund – or Millennium Fund.

As the Legislature considers the Governor’s funding recommendations, it will be done against the backdrop of more upward pressure on the existing Medicaid budget.

For instance, because of the way our state’s economy is performing, and the fact that our FMAP rate is based on per-capita income, the FY2020 blended rate of our Medicaid Federal match will drop from 71.14% to 70.53%. That may not seem like a significant decrease, but given the size of the Medicaid spend, that means the state will have to shift $13.2 million from Federal funds to the State General Fund.

Additionally, Health and Welfare is asking for a $31,878,000 for the current fiscal year to address increased utilization in the enhanced Medicaid program. And, looking ahead to the next fiscal year, they are projecting a need for an additional $32.5 million because of increased utilization, and an additional $40.2 million to bring the Department current with their hospital cost-settlement adjustments.

Also, the Catastrophic Healthcare Fund requested a doubling of their budget to meet projected demands in FY2020. They asked for $20 million and the Governor recommended $15 million. If actual costs exceed the appropriation, they would need to come back to the Legislature for a supplemental appropriation.

The Governor’s recommendation for Graduate Medical Education was a compromise reached by the State Board of Education’s GME Committee. It increases the current per resident amount from $35,000 to $40,000 for existing programs, and for any buildout or new residencies, it funds them at a $60,000 level.

This will be a benefit to the 18 residents at the Kootenai FMR program ($90,000), the 10 existing and 10 new residents at EIRMC ($650,000), and the existing and one new resident at Bingham Internal Medicine ($120,000).

The Governor’s budget recommendation did not include funding for the Honoring Choices initiative. The creation of a statewide advance care directive registry was not requested by the Department of Health and Welfare, and while the Governor was aware of the initiative, he also did not include it in his budget recommendation. However, we have been in contact with all 20 members of the Joint Finance and Appropriations Committee (JFAC), and are hopeful that when the Department presents to JFAC, there will be questions about the cost-benefit of this $860,000 potential line-item. The positive feedback we’ve received from committee members may be reflected in their final Health and Welfare budget.

Most legislators are concerned about a timing issue on General Fund revenues. Because of last year’s Federal and State tax cuts, and no resulting change in the withholding tables, individual income tax receipts are coming in well short of projections. The Tax Commission expects more people will be writing checks to the IRS and the State in April – but they also enjoyed more money in the paychecks throughout 2018. The timing of when that money comes in has the Legislature cautious about spending money that’s not in the bank – and you will probably see a very conservative approach to setting next year’s budget while the withholding issue settles itself out. In fact, the Legislative committee that sets revenue projections reduced the Governor’s FY2020 revenue forecast by $93 million dollars.

We hope this gives you a good sense of the Governor’s budget recommendations as they relate to hospitals and healthcare, and also a feel for the cautious approach that the budget committees will probably take as they begin their work. Please reach out to us if you have any questions.

Photo of Brian Whitlock, President / CEO Idaho Hospital Association
Brian Whitlock, President/CEO
January 11, 2019