STATE POLICY UPDATE. MNACHC Annual Conference October 30,

Transcription

1 STATE MNACHC Annual Conference October 30, 2008 POLICY UPDATE 1

2 Goals & Objectives 1. Review 2008 Minnesota legislative session. 2. Health Care Reform 3. Preview 2009 session. 4. MNACHC 2009 Legislative Agenda 2

3 REVIEW OF Part One 2008 SESSION 3

4 Entering the 2008 Session Surplus to Deficit Chart 1: General Fund Surplus/Deficit $s in Millions $400 $200 $0 ($200) $294 $1.2 million budget swing in 9-month period technically a bonding year, yet major policy and budget decisions part of session. ($400) ($600) ($800) ($1,000) ($373) ($935) May-07 Nov-07 Feb-08 Session builds on 2007 momentum on Health Care Reform. Consider it a success if you don t get cut this year. 4

5 Big Ticket Items Entering the 2008 Session Bonding Bill 2008 House Elections 2008 Session Budget Deficit Health Care Reform Transportation Infrastructure 5

6 Eliminating the Deficit Chart 2: General Fund Spending Cuts, By Area Higher Ed., 6% State Govt., 9% Econ. Dev., 4% Transp., 5% Env/Energy, 12% Public Safety, 3% Agric., 1% HHS, 60% DEFICIT Table 1: Deficit Plan ($s in millions) Additional Spending Spending Reductions Transfers from Other Funds $935 -$137 $268 $117 ** Non Tax Revenue $51 Tax Revenue $141 Budget Reserve $500 SURPLUS $6 ** Includes $50 million transfer from Health Care Access Fund (HCAF) 6

7 Eliminating the Deficit Chart 3: Comparing General Fund Cuts vs. General Fund Spending 100% 90% 10% 80% 70% 60% 41% 50% 40% 30% 60% 20% 10% 0% % of GF Spending Cuts, 2008 Session 27% % of GF Spending, FY2007 HHS Env/Energy State Govt. Higher Ed Transp. Econ. Public Safety Agric. K-12 Property Tax 7

8 Major HHS Cuts to Eliminate Deficit $30 Chart 4: HHS Cuts in Budget Bill $25 $20 $8.0 Reduce inpatient rates. $15 $10 $5 $0 $10.0 inpatient $3.0 $10.0 Delay rebasing. Inpatient payment delay $14.0 Limit admin. Spending to 7% MHCP Withhold increase. $0.8 $2.4 Hospitals Managed Care DHS/MDH MDH & DHS grant reduction by 1.7% 8

9 MNACHC Agenda 2008 Table 2: MMACHC 2008 Agenda and Results Policy Item Result Increase CHC Appropriation $1 million increase (66%). Senator Berglin and Health Care Reform Conferees Change CHC Appropriation language to reflect most current year CHC data. Remove Medicare Cap from CHC Medicaid reimbursement Signed into law as Chapter 292 Senator Higgins and Rep. Loeffler No action $3.5 million annual cost. 9

10 CHC APPROPRIATION!!! $3,000,000 $2,000,000 $1,000,000 $0 Chart 5: CHC Appropriation, By Year and Fund $2,500,000 $2,500,000 $2,500,000 $1,824,000 $2,500,000 $2,500,000 $1,500,000 $676,000 FY2008 FY2009 FY2010 FY2011 General Fund HCAF 10

11 2008 Legislative Accomplishments Nearly $1 billion deficit eliminated Without raising STATE taxes (closed a loophole) Shifting/delaying funds, transferred from other funds. Property Tax cap (3.9% increase) for next three years. Capital projects including Central Corridor light rail and new state park. Begin of health care reform. +$6 billion for roads and bridges. +$26 million in E-12 education. 11

12 Health Care Part Two Reform 12

13 Why Reform the System? Rising health care costs. Uninsured rising, private insurance eroding. Quality low relative to amount spend and unevenly distributed across the population. $14 $12 $10 $8 $6 $4 $2 $0 Chart 6: Projected Savings by 2015 ($s in Billions) $7.8 $12.3 $6.9 Legislature Governor FINAL BILL 13

14 Rising Health Care Costs Nearly a 60% increase in spending from Growth in health care spending outpaces growth in: Worker s wages General inflation Per capita income Increasing portion of state budget. $35.0 $30.0 $25.0 $20.0 $15.0 $10.0 $5.0 $0.0 $19.2 Chart 7: Total MN Health Care Spending ($s in billions) $20.7 $22.9 $25.8 $27.0 $28.4 $ Source: MDH, Health Economics Program 14

15 Insurance Coverage in Minnesota Chart 8: Health Care Coverage, 2001 vs % 90% 80% 6.1% 7.2% 21.1% 25.2% 70% 60% 50% 40% 30% 4.8% 68.0% 5.1% 62.5% Uninsured Public Individual Group 20% 10% 0% Source: MDH, Health Access Surveys, 2001 &

16 Health Care Reform Final 2008 bill a mere shadow of the original bill introduced in January 08. Definition of health care home MN DHS and MDH discussion Components dropped along the way Universal coverage (98%). Measure of affordability (6%-300%FPL, 8%-400%) Passed House of Representatives Expansion of MHCP to 300% of poverty. Savings recapture mechanism. 16

17 Components of Health Care Reform Payment Reform Health Care Home Reform Administrative Efficiency Coverage & Affordability Public Health 17

18 Reform: Public Health Statewide health improvement program (SHIP). Modeled on the STEPS Program $47 million for FY2010 and FY2011. Requires 10% local match Reduce obesity and tobacco use. Grants to community health boards to implement evidence-based strategies. RFPs available March 2009 Funds available July

19 Reform: Health Care Homes Not a physical structure, rather an approach to delivering health care. Primary care providers, families and patients working in partnership to improve health outcomes and quality of life for individuals with chronic health conditions and disabilities. 19

20 Reform: Health Care Home HEALTH CARE HOMES.according to SF3780. Encourage the use of primary care. Deliver high-quality, efficient and effective health care. Encourage patient-centered care. Ongoing consistent personal clinician or team contact. Develop and maintain comprehensive care plan for those with chronic/complex conditions. Utilize wide range of health care professionals & top of license practice Measure quality, cost and patient satisfaction. Ensure use of HIT and systematic follow up. Use scientifically based health care. 20

21 Health Care Home Timeline Certification Personal clinician or primary care clinic For clinic, ALL clinicians must meet criteria Must offer health care home services to all patients with chronic/complex conditions who are interested in participating. Timeline Standards by July 2009 Payments beginning in July

22 Reform: Coverage/Affordability Public Coverage EXPANSION OF COVERAGE Private Coverage 7,000 additional MNCare enrollees 5,000 additional privately insured Adults without children expanded from 215% to 250% of poverty. MNCare maximum premium reduced from 9.8% to 7.2% of gross family income. 30-day grace period for processing re-enrollment. Application assistance bonus increased from $20 to $25. Tax incentives/grants for small employers to establish Section 125 plans. Employers with 11+ FTE employees who do not offer group health insurance must establish and maintain Section 125 Plan 22

23 Reform: Administrative Efficiency Requires all prescriptions be ordered electronically by Establish standard for electronic health records using nationally-certified criteria. 23

24 Reform: Payment Reform Single Quality-Based Incentive Payment System (QIPS) Statewide Pay for performance approach used by public and private health care purchasers and consumers. July 1, 2009 MDH specify quality measures and quality incentive payment system in QIPS. January 1, 2010 Providers submit quality measures. July 1, 2010 Public reporting of measures. Provide Peer Grouping Compare providers based on cost and quality adjusted for patient populations served. July 1, 2009 Health plans submit data June 1, 2010 MDH disseminates results of grouping to providers September 1, 2010 Public dissemination SUMMER 2009 PUBLIC INPUT Baskets of Care Bundle together health care services for a particular health care condition. July 1, 2009 establish seven baskets of care (workgroup input). January 1, 2010 Prices established by providers for baskets. July 1, 2010 Quality standards of baskets. 24

25 Reform: Other Items Health Care Workforce Shortages Study Recommend changes to health professional licensure requirements Study Group forward recommendations by 1/15/09 Uniform Claims Review Study By 1/1/10, recommend ways to reduce claims adjudication costs through more uniform payment methods. Health Care Affordability Study By 1/15/09, recommend ways to improve affordability for people with access to employer-subsidized coverage and family income below 300% FPL. 25

26 Oral Health Developments Oral Health Practitioner (OHP) Authorized to begin practicing on January 1, Qualifications Graduate of OHP education program Pass clinical examination Must practice in settings serving low-income, uninsured and underserved patients or in a dental HPSA. Workgroup provide further recommendations to 2009 legislature. Education/competencies, scope of practice, supervision, extractions, practice settings, licensure, 26

27 Oral Health Developments Foreign-trained dentists Granted a limited license for 3 years. Practice under supervision of MN-licensed dentist. Full licensure after that time. Carve out of Dental Services from PMAP Concept and study of concept both did not pass Session? 27

28 2009 Preview Part Three 28

29 Election 2008-Supermajority?? 2 seats up for election in Senate All seats up for election in House Chart 9: MN Senate Chart 10: MN House GOP, 22 GOP, 49 DFL, 45 DFL, SEATS FOR OVERRIDE 90 SEATS FOR OVERRIDE DFL Incumbent DFL Open R Open R Incumbent DFL Incumbent DFL Open R Open R Incumbent 29

30 2009 is a Budget Year Chart 11 The Biennial Budget Process, FY July 2010 Fiscal Year 2011 Begins Odd-Year Session (January 2009) FY2010 & FY2011 Budgets Even-Year Session January 2010 Bonding Session Tweak FY2010 Budget July 2009 Fiscal Year 2010 Begins 30

31 Budget Blues Chart 12: Projected General Fund Budget Balance, FY10-11 $0 -$100,000,000 -$200,000,000 -$300,000,000 -$400,000,000 -$500,000,000 -$600,000,000 -$700,000,000 -$800,000,000 -$900,000,000 -$1,000,000,000 FY2010 ($720,064,000) FY2011 ($939,560,000) Tax revenue for 1 st quarter of FY2009 up 1.7% from estimates. Mostly due to higher income tax (withholding) Economic concerns for rest of 2008 and all of Department of Finance directs state agencies to cut 5% of budget. $125,000 to CHC appropriation. Balance 31

32 Healthy HCAF Chart 13: Projected Health Care Access Fund Budget Balance, FY09-11 $300,000,000 $250,000,000 $200,000,000 $150,000,000 $100,000,000 $50,000,000 $275,034,000 $255,092,000 $199,689,000 HCAF tapped for $56 million in FY2010 and $72 million in FY2011 for health care reform. CHC appropriation fully from HCAF by FY2010 $0 FY2009 FY2010 FY2011 Balance 32

33 Preview of 2009 Session White House & Congress Children s Health Expansion Continue Health Care Reform Budget Deficit Health Care Home Developed 2008 Session Hospitals Education Investment Fraud 33

34 Preview of 2009 Session Health Care Reform State issuing multiple RFPs for development of health care home and payment reform. Coverage Expansion Initiative to cover all children in Minnesota. MinnesotaCare waiver (SCHIP) 18,000 parents of MNCare children between % of poverty affected. $130 million over three years. Negotiations extended. 34

35 2009 MNACHC Part Four AGENDA 35

36 MNACHC 2009 Agenda MNACHC 2009 Legislative Agenda Increase CHC Appropriation by $17.5 million Remove the Medicare Cap on Medicaid reimbursement (+$6.0 million) CHC Fair Payment Act Expand Loan Forgiveness Program (MDH) Deem CHCs as Health Care Homes Establish Colorectal Screening Program Expand Minnesota Health Care Programs (MHCP) Clarify CHCs as Oral Health Practitioner practice settings 36

37 Proposed CHC Increase 2009 Chart 14: CHC Appropriation, $s in Millions (MNACHC Proposed FY ) $11.8 $12.0 $10.0 $8.0 $6.0 $4.0 $2.0 $0.0 $1.5 $10.7 $8.2 $9.3 $2.5 $2.5 $2.5 FY2008 FY2009 FY2010 FY2011 CHCs use subsidy for a variety of projects: Expanding services mental health, medical and dental services. Training staff on EMRs Adding provider staff CHC Appropriation Proposed Increase 37

38 Uninsured at MNACHC Chart 15: MNACHC Uninsured, ,000 64,940 58,606 60,000 52,774 50,000 48,396 42,378 43,145 40,000 36,385 30,000 20,000 10,000 Number of uninsured at CHCs in MN increased 11% in CY2007. Increased 78% since Average annual increase is 10% per year since Nearly 1 out of every 6 uninsured Minnesotan uses a CHC MNACHC Uninsured 38

39 Removing the Medicare Cap Calculation of Medicaid per encounter reimbursement is capped by Medicare cap. For every MA encounter, CHCs lose between $ By 2011, CHCs will collectively provide nearly 250,000 MA encounters. Invest $6 million into CHCs over the FY period. 39

40 CHC Fair Payment Act Improve the efficiency of the Medicaid reimbursement process: Look to other states for best practices Enhance Community Health Worker, pharmacist (medication therapy management) and dental hygienist reimbursement. Ensure timely payments to CHCs. 40

41 MNACHC Legislative Agenda LOAN FORGIVENESS Increase the slots and amounts of loan forgiveness. DEEM CHCs AS HEALTH CARE HOMES Use increased payment for care, not filling out forms. COLORECTAL SCREENING PROGRAM FOR UNINSURED 9,600 CHC patients between EXPANSION OF MNCARE PROGRAM Part of health care reform in 2009? CHCS AS ORAL HEALTH CARE PRACTITIONER SETTINGS Workgroup efforts to date are encouraging. 41

42 MNACHC Day on the Hill JANUARY 26-27, 2009 Visit with your state Senator and Representative. Hear from key Legislators about the 2009 session. Visit for more information 42

43 We Need More Advocates!!! Click Advocacy Legislative Alerts Monthly e-update Weekly Legislative Update (during session) 43

44 Jonathan Watson , ext 11 Contact Information Visit 44