OHA Advocacy Network

Advocacy Report • Friday, May 23, 2008

As the Ohio General Assembly wraps up work before breaking for summer recess, a number of bills impacting hospitals saw action this week. The House and Senate will likely conclude session next week for the summer to allow legislators to return to their districts to begin campaigning for November’s election.

Action for next week…

Tuesday

SB 115 – Child Insurance: Senate Insurance, Commerce & Labor Committee, Finance Hearing Room at 9:30 am (All testimony, Possible vote)

HB 562 – Capital Appropriations/Budget Corrections: Senate Finance & Finance Institutions Committee, Finance Hearing Room at 2:30 pm (No testimony, Possible amendments & vote)

SB 278 – Colorectal Cancer: Senate Health, Human Services & Aging Committee, South Hearing Room at 2:30 pm (All testimony, Possible vote)

SB 339 – Anatomical Gifts: Senate Health, Human Services & Aging Committee, South Hearing Room at 2:30 pm (Proponent testimony)

Wednesday

SB 334 Worker’s Compensation: Senate Insurance, Commerce & Labor Committee, Hearing Room 109 at 9 am (All testimony)

Thursday

HB 456 – Health Care Reform: House Healthcare Access & Affordability Committee, Room 17 at 10 am (All testimony)

STATE

Hospitals Testify on Managed Care Provisions in Health Care Reform Bill
On May 20, House Health Care Access and Affordability Committee heard testimony on the bill’s Medicaid managed care provisions. Hospital representatives opposed a provision requiring hospitals to contract with all Medicaid Managed Care Plans (MCPs) in their region to be eligible for crucial Hospital Care Assurance Program (HCAP) reimbursement.

Brent Carson, vice president of managed care contracting for University Hospitals, also voiced concern about a provision requiring hospitals to provide non-emergent services to patients of non-contracted MCPs and accept 95 percent of the Medicaid fee-for-service rate. He noted it gives MCPs a disincentive to contract with hospitals and exposes hospitals to a financial risk related to payment because they have no contract with the MCP to enforce timely and accurate payment.

Charles Alderson, chief financial officer of Wadsworth-Rittman Hospital and Summa Barberton Hospital, spoke about the negative financial implications for hospitals of this provision coupled with the requirement that hospitals contract with the all local MCPs. Alderson explained the state would be requiring two independent parties to develop a financial relationship at the risk of one of the parties losing significant funding, while at the same time developing an incentive for the other party not to contract with the first.

President of the Ohio Children’s Hospital Association (OCHA) Nick Lashutka applauded provisions dealing with child nutrition and physical activity and requested that the organization be added to the Ohio Child Wellness Advisory Council created by the bill. Lashutka also supported to bill’s creation of a pediatric dental access pilot program.

Tim Robinson, executive vice president and chief financial officer of Nationwide Children’s Hospital also spoke on behalf of OCHA. Robinson noted that several managed care provisions in the HB 456 jeopardize programs created by his hospital to increase access to primary care for children in the Medicaid program as well as improve quality and lower costs.

Rep. Jim Raussen (R-Springdale) has released a substitute version of his health care reform bill (HB 456). OHA is analyzing the newly-introduced sub version of the bill, outlining provisions that impact the state’s hospitals, including health information technology requirements and Medicaid managed care mandates. OHA’s initial analysis of HB 456 and the Legislative Service Commission’s comparison document can be found on OHA’s Health Care Access & Affordability Web page. (Bridget Gargan, bridgetg@ohanet.org)

Legislators Question Providers’ Frozen Medicaid Reimbursement

The Ohio Medicaid Director John Corlett briefed the Ohio House Committee on Finance and Appropriations on the administration’s ongoing cost containment struggle in certain areas of the Medicaid program. Corlett noted that the Medicaid caseload has exceeded the budgeted estimate for 17 consecutive months. Enrollment among the lower income populations -- children and their parents with incomes up to 90 percent of the federal poverty level, continues to drive the unpredicted growth -- he said. The administration predicts a caseload increase of 66,000 by the end of the fiscal year 2008-2009 biennium.

Corlett noted that the administration fell short in several cost-cutting initiatives and Rep. Shannon Jones (R-Sprinboro) reiterated legislators’ concern about the lack of cost-containment and program expansions in other areas while reimbursement rates to hospitals and others remain frozen. “We can put everybody on Medicaid, but if you don’t have the providers to provide the services you aren’t getting anywhere,” she said. Asked whether hospitals would be first in line for future rate increases, Corlett said he would discuss the issue with interested parties.

Responding to this issue, language requested by OHA and the Ohio Children’s Hospital Association (OCHA) and supported by Rep. Jones was included in an amendment to the budget corrections bill unveiled Thursday. The language requires the Ohio Department of Job and Family Services (ODJFS) to report quarterly on the status of cost containment efforts such as electronic claims submission and payment systems and development of infrastructure policies for electronic health records and e-prescribing. Separate language in the amendment would supply just over half of the administration’s requested general revenue fund share to cover Medicaid overruns caused by increased caseload. The administration has the authority to tap the Budget Stabilization Fund for more money if needed due to failed cost containment strategies.

As the legislature moves forward the budget corrections bill, OHA and OCHA will continue working with key legislators and the Strickland administration to press ODJFS on lifting the freeze on inpatient Medicaid reimbursement rates for hospitals. (Bridget Gargan, bridgetg@ohanet.org)

Ohio Senate Unanimously Approves OHA-Backed Nurse Staffing Bill
The Ohio Senate Thursday unanimously passed House Bill 346, which requires hospitals to establish nurse staffing plans with input from direct care nurses.

The legislation, sponsored by Rep. Jim Hughes (R-Columbus), would require hospitals to create a nursing care committee to include nurses representing all types of nursing services offered by the hospital. The committee will develop recommendations for a nurse staffing plan that is consistent with current governmental or private accreditation standards. Hospitals would be required to significantly consider the recommendations when establishing staffing plans, and provide the nursing staff with a copy of the staffing plan, free of charge, and offer it to others who request it for a nominal fee.

Debi Jones, vice president of patient care and chief nursing officer for the EMH Regional Healthcare System, testified Wednesday before the Senate Health, Human Services and Aging Committee in support of the bill on behalf of OHA and the Ohio Organization for Nurse Executives. Jones said the bill ensures nurses have a voice in staffing decisions made in every Ohio hospital, provides hospitals with flexibility in meeting patient needs, and furthers hospitals’ efforts towards transparency in health care.

Before the committee vote, State Senator Sue Morano (D-Lorain), a practicing registered nurse and a member of the Senate Health Committee, amended the bill with the following changes:

The nursing care committees created by hospitals must be comprised of at least 50 percent staff nurses;
Hospitals must post a notice informing the public of the plan’s availability and specifying directions on how to obtain a copy.

Morano discussed the amendments last week with the Board of Directors of the Ohio Organization of Nurse Executives (OONE), an OHA-affiliated society representing nurse leaders throughout the state. OONE is supportive of the changes. The bill now heads back to the House, which must agree on Senate changes, and then to the governor for his signature. (Jeff Klingler, jeffk@ohanet.org; Jean Scholz, jeans@ohanet.org)

OONE to Receive the OHA Leadership Through Advocacy Award

Congratulations to the Ohio Organization of Nurse Executives (OONE) whose advocacy efforts on nurse staffing legislation garnered them the 2008 OHA Leadership Through Advocacy Award. OONE members processed HB 346 in their committee meetings, wrote letters to their state legislators, sponsored regional meetings with key lawmakers and testified in health committee to help ensure passage of nurse staffing plans that is supported by OHA, the Ohio Nurses Association and OONE.

The award will be accepted by Grace Wakulchik, OONE president and vice president, patient services/CNO, Children’s Hospital Medical Center, Akron, at OHA’s Recognition Dinner on June 9, as part of the OHA Annual Meeting. (Jeff Klingler, jeffk@ohanet.org)

Maternity Licensure Bill Heads to Governor
Legislation that will reduce regulatory burden, lower costs and enhance maternal and newborn care in Ohio is now on its way to the governor, after receiving final House approval. House Bill 331, sponsored by Sen. Mark Wagoner (R-Toledo), combines the two current sets of maternity licensure requirements, moves from annual maternity inspections to three-year licenses and tri-annual inspections, and creates a maternity advisory council to assist the Ohio Department of Health (ODH) in promulgating rules that are evidence-based and reflect best practices. The bill is the result of collaboration between the Ohio Maternity Licensure Task Force and ODH, and reflects the needs of large and urban hospitals as well as small and rural facilities. (Bridget Gargan, bridgetg@ohanet.org)

County Hospitals Included in County Contracting Bill

Through the leadership of MetroHealth Medical Center and with the support of OHA, the House Local and Municipal Government and Urban Revitalization Committee adopted an amendment to include county hospitals in SB 268 which permits counties to use competitive sealed proposals for the purchase of goods and services after providing public notice of the business opportunity to interested vendors. One of the provisions in the legislation, sponsored by Sen. Bill Seitz (R-Cincinnati), requires vendor responses to an RFP remain confidential until after the award of a final contract. The bill will be sent to the governor before the legislature recesses for the summer.

Click here to read more about the county contracting bill. (Bridget Gargan, bridgetg@ohanet.org)

FEDERAL

U.S. Senate Approves Medicaid Moratorium, Self-Referral Ban
Secretary of the U.S. Department of Health and Human Services (HHS) Mike Leavitt this week announced an extension until Aug. 1 of the moratorium on two new Medicaid rules that would cut billions from the program – directly impacting hospitals and the many residents they train. The current moratorium was set to expire May 25.

On the heels of this announcement, the U.S. Senate approved by a veto-proof margin an amendment to the Iraq appropriations bill that extends the moratorium on seven Medicaid regulations through March 2009 and bans self-referral to new physician-owned hospitals. The bill now moves to the House and will reach the president in early June, though he has threatened to veto the legislation. A presidential veto would spark a redraft, with OHA and other hospital advocates working to retain crucial provisions before the bill is re-submitted to the president. In addition, an American Hospital Association lawsuit against regarding the Medicaid regulations is expected to receive a decision today.

OHA thanks the hospital representatives who advocated for this important Medicaid moratorium and encourages them to continue contact with the Ohio delegation on this issue. (Jonathan Archey, jonathana@ohanet.org)

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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, Manager, State Policy & Advocacy (staceyc@ohanet.org)

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

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