OHA Advocacy Network

Advocacy Report • Friday, June 29, 2007

With the first six months of session complete, the legislature is in recess for the summer. Session will reconvene this fall, at which time legislation left pending which impacts the OHA membership may continue to be considered. In the coming weeks, OHA will provide a bulletin listing all of the hospital-related legislation under consideration this session. The following are highlights of some of the key issues that received attention this week.

Budget Wrap-Up

The House and Senate Wednesday adopted the conference committee report on House Bill 119, the state’s $52 billion biennium budget, which is now on its way to Gov. Ted Strickland, who has until June 30 to line item veto provisions before signing it into law.

The 2008-2009 state budget includes the following major hospital provisions:

Medicaid Update

Inpatient Update: All hospitals are provided with a 3.3 percent Medicaid inpatient update starting Jan. 1, 2008, and a 2.9 percent update Jan. 1, 2009.

Children’s Hospitals: For FYs 2008 and 2009, payments made by ODJFS for cost outlier claims less than the amount specified in code must be increased from an amount equal to 85% of the product of the hospital's allowable charges and the hospital's Medicaid inpatient cost-to-charge ratio to an amount equal to 100% of the product of the hospital's allowable charges and the hospital's Medicaid inpatient cost-to-charge ratio. The program will generate $30 million in state/ federal dollars for children’s hospitals.

Medicaid Expansions

Currently, children in families with incomes up to 200% of the federal poverty level are eligible for coverage under Medicaid. The budget creates several expansions in Medicaid coverage, including:

Children: Children with family incomes between 200% and 300% of the poverty level are covered under Medicaid, provided parents pay premiums to qualify.
Children with Medical Handicaps: Disabled children or children with pre-existing conditions or those that meet other strict criteria in families above 300% of poverty would be eligible for a similar “buy-in” option.
Pregnant Women: Pregnant women earning up to 200% of the federal poverty level are now eligible for Medicaid. OHA estimates 3,800 women will benefit from this provision.
Foster Children: Foster children between 18 and 21 are now eligible to maintain Medicaid benefits. Previously the benefits terminated upon 18.
Buy-in for Adults with Disabilities: ODJFS must seek federal approval for the program within 90 days. The Executive estimates that a new Medicaid Buy-In for Workers with Disabilities Program will serve 7,300 over the next two years.

OHA would like to thank all hospital executives and government relations personnel that contributed to OHA’s advocacy efforts related to the state budget by testifying, attending meetings, writing letters and making calls. OHA will prepare a budget bulletin on all provisions impacting hospitals. (Bridget Gargan, bridgetg@ohanet.org)

Vote on 24/7 ED Bill Postponed Until Fall

Before breaking for summer recess, the Senate Health, Human Services and Aging Committee held a hearing on Senate Bill 120 last Wednesday. Though OHA expected to see a committee vote on the legislation, which would require all hospitals to operate 24/7 EDs, last minute discussion of new opponent and proponent amendments complicated the issue and led to postponement of a vote until after summer recess. Responding on short notice, Jim Pancoast, president and CEO of Good Samaritan Hospital in Dayton, and LaMar Wyse, president and CEO of Galion Community Hospital, testified in support of the bill.

Responding to a question as to why rural hospitals, though not impacted by specialty hospital competition to the same extent as urban hospitals, still have a major stake in the issue, Wyse stated: “They have a destabilizing effect that trickles down to the whole industry. And as you destabilize the hospital, you destabilize the community."

After breaking for summer recess, the legislature will return to session in September. OHA will take that time to process the issue of limited-service hospitals with a number of OHA committees and task forces this summer. (Bridget Gargan, bridgetg@ohanet.org; Reed Fraley, reedf@ohanet.org)

Hospitals Weigh In on Physician Credentialing, Managed Care Contracting Bill

OHA testified last week in support of legislation to simplify the physician credentialing process used by health plans and provide relief from the burdensome and sometimes unfair contracting practices used by some insurers. Michele Napier, vice president of payor relations for The Health Alliance of Greater Cincinnati, noted that House Bill 125, sponsored by Rep. Matt Huffman (R-Lima), would go far in simplifying the cumbersome and overly complex credentialing and managed-care contracting process for physicians and physician practices.

Napier also spoke in support of amending the bill to prohibit health plans from using most favored nation clauses in their contracts with hospitals. At times, most favored nation clauses have been inserted into contracts at the insistence of a dominant health insurer, and they have been used to prohibit a provider from agreeing to a lower price with any other insurer without also giving a better or equal price to the dominant insurer. “MFN clauses are just as patently unfair, highly discriminatory and anti-competitive to hospitals as they are to physicians and physician practices. Hospitals would welcome the relief,” Napier said. View Napier’s complete testimony at http://www.ohanet.org/advocacy/state/issues/testimony/062007housebill125.pdf.

OHA also is working to include hospitals in other provisions, including requiring more rigorous time frames in which insurers must complete the credentialing process; prohibiting an insurer from selling, renting or giving its provider network information to any other person; and requiring an insurer to make available on the Internet eligibility and coverage information concerning enrollees.

Committee Chairman Scott Oelslager (R-Canton) indicated the bill will not receive a committee vote before recess, as originally planned, but should be ready for a vote when the legislature returns in September. (Jeff Klingler, jeffk@ohanet.org)

Nursing Legislation Contains Prohibition on Overtime

Legislation receiving hearings in a House committee would help ease the nursing shortage, especially provisions aimed at increasing the number of nursing faculty. However, because the legislation, House Bill 185, sponsored by Rep. Joyce Beatty (D-Columbus), contains a prohibition on hospitals requiring nurses to work overtime, OHA opposes the legislation.

The bill has a number of positive provisions which address ways to ease the nursing shortage in Ohio, including:

provides an income tax credit for registered nurses who teach nursing at post-secondary educational institutions;
establishes the Nursing Education Reimbursement Program, which would reimburse registered nurses the annual actual costs of the nurse's pre-licensure nursing education program, or the statewide average of nursing education instructional costs for the year in which the nurse completed the pre-licensure nursing education program, whichever is less.

The bill also contains a provision prohibiting a hospital from requiring a nurse to work overtime and imposes severe penalties -- a $10,000 per violation penalty -- on hospitals not in compliance with the law.

In a letter to members of the House Ways and Means Committee, OHA indicated it opposes the bill because:

It would endanger the quality of and access to patient care. Hospital services are unpredictable, and as such hospitals must have flexibility in determining appropriate staffing to meet community needs.
Mandating nurses to work overtime is rarely used over more preferable options, such as seeking volunteers and offering financial incentives. However, hospitals must be able to quickly adjust staffing to meet community needs, especially during times of disasters, auto accidents, flu season and other local outbreaks. (Jeff Klingler, jeffk@ohanet.org)

Healthcare Access & Affordability Committee Hits the Road

The newly created House Healthcare Access & Affordability Committee will be traveling the state this summer, conducting field hearings outside the confines of the statehouse. The committee is scheduled to meet

July 30 in Cleveland

July 31 in Toledo

August 6 in Springfield

August 7 in Zanesville

August 8 in Sharonville

OHA will work with hospitals in the respective areas of the state to coordinate testimony for those hearings.

In related news, the Senate Health, Human Services & Aging Committee has begun hearing testimony similarly to the House Healthcare Access & Affordability Committee on top challenges facing Ohio’s hospitals and health care delivery system. Tom Urban, president and CEO of Mercy Health Partners in Cincinnati, testified this week before the committee, noting the positive impact of locally-designed public-private partnerships on the number of uninsured. He provided information on the Toledo/Lucas County CareNet program, which helps provide health care services to residents of Lucas County who are not eligible for public or private health care coverage. The program offers emergency and inpatient services at participating hospitals, primary and specialty care services and even transportation help. (Bridget Gargan, bridgetg@ohanet.org)

House and Senate Release Schedule for Remainder of 2007

The Ohio General Assembly this week outlined their calendar for the next six months. Committee hearings will resume the week of September 4, with House and Senate session resuming the week of September 11. The legislative schedule can be found at http://www.legislature.state.oh.us/today.cfm.

Federal

U.S. Senate Rejects Labor Union and Immigration Bills

The U.S. Senate this week rejected two bills with provisions opposed by hospitals and other interested parties. As introduced, an immigration reform bill, S. 1639, sponsored by Ted Kennedy (D-MA), would have made it more difficult for foreign nurses and physician residents to work in the U.S. Aimed at putting professionals and individuals with advanced degree on a fast track to U.S. citizenship, one of the bill’s apparently unintended consequences was to put nurses and other health care workers at a disadvantage in earning citizenship. Hospital advocates, working diligently this week to secure improvements for health care workers in the immigration bill, plan to continue educating legislators on the need to facilitate foreign worker recruitment in the face of continued shortages. S. 1639 failed to receive the necessary 60 votes for cloture of debate.

Another bill, the Employee Free Choice Act, also met with defeat. The labor-backed “card check” legislation would have amended the National Labor Relations Act to allow a union to be formed without a secret ballot vote by employees. OHA had concerns with the bill, which would have eliminated employees’ right to vote in a secret ballot election when union organizers collected cards supporting the union signed by a majority of employees. Also, the bill would have subjected employers and unions to mandatory arbitration of collective bargaining agreement terms, which critics argued would have created disincentives for parties in a labor dispute to reach a compromise agreement on their own.

Both chambers of Congress will recess next week to conduct district activities and observe Independence Day. Federal lawmakers are expected to take up S-CHIP reauthorization and Medicare physician payment improvements upon their return July 9. (Jonathan Archey, jonathana@ohanet.org)

OHA Advocacy “In the Know”

Updated information on executive branch legislative liaisons is now available at http://www.ohanet.org/advocacy/state/resources/agencylegislativeliaison.pdf

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The OHA Advocacy Network is a service of the Ohio Hospital Association, 155 E. Broad St., Columbus, OH 43215-3620, 614-221-7614, 614-221-4771 (fax)

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Direct questions on OHA’s advocacy agenda to:

Bridget Gargan, Vice President, State Policy & Advocacy (bridgetg@ohanet.org)

Jeff Klingler, Director, State Policy & Advocacy (jeffk@ohanet.org)

Jean Scholz, RN, Director, Health Policy (jeans@ohanet.org)

Rick Sites, General Counsel (ricks@ohanet.org)

Stacey Conrad, Specialist, State Policy & Advocacy (staceyc@ohanet.org)

Jonathan Archey, Manager, Federal Relations (jonathana@ohanet.org)

Laura Landis, Executive Assistant, State Policy & Advocacy (laural@ohanet.org)