H1N1 Cases Confirmed in Arkansas

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William Robinson
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1 May 11, 2009 Volume 16, Number 17 H1N1 Cases Confirmed in Arkansas State Health Officer and Director of the Arkansas Department of Health (ADH) Dr. Paul Halverson issued a statement last Friday verifying that the H1N1 flu virus has finally arrived in Arkansas. Communicable disease experts in the state have said since the worldwide outbreak began two weeks ago that it has been a matter of when the virus would show up in the state, not if it would happen. As of May 10, more than 2,500 cases of the H1N1 virus had been confirmed in 44 states across the U.S., with three related deaths. Including the United States, 29 countries have officially reported 4,379 H1N1 influenza cases. In a May 8 press conference, Halverson said that five cases of the H1N1 influenza A virus (swine flu) now have been confirmed in Arkansas four cases in Pulaski County and one in Lawrence County. The samples were tested and confirmed by the public health laboratory at ADH. The Camp Robinson illnesses occurred in active duty service members from other states who are training at the North Little Rock post. A school-aged child from Walnut Ridge Elementary School in Lawrence County (Northeast Arkansas) also tested positive for the virus. In addition to information made available to the general public, Health Department officials held audio/video conferences with hospitals and other groups across the state on Friday afternoon to provide guidance and monitor the number and location of suspected cases of illness. Halverson noted that H1N1 cases being seen in the U.S., for the most part, have been relatively mild and treatable with antiviral medications. Symptoms appear to be the same as those for seasonal flu: fever, body aches, coughing, sneezing, and sometimes nausea, diarrhea and vomiting. He said the Centers for Disease Control and Prevention guidance for what people should do has shifted to reflect a response that is similar to what folks need to do for seasonal flu: stay home and call your doctor for advice on how to treat your illness. For more information on new influenza A H1N1(swine flu), call (800) or click on: or Trauma System Policies, Application Readied During a special meeting May 7, the Arkansas Board of Health approved its policies for designating and funding of hospital trauma centers that will be a part of the state s trauma care network. The policies govern the manner in which the state will disburse to hospitals funds being made available through Act 180 of 2009, which levied an additional 56-cent per pack tax on cigarettes that is earmarked for trauma care. In a concurrent move, the Arkansas Department of Health on May 6 mailed each Arkansas hospital a copy of its Trauma Designation Intent Application. This application can also be found on the front page of the Arkansas Hospital Association (AHA) Web site ( Health Department officials have indicated that they also will forward to AHA any questions from hospitals relating to the application and the answers. Once received, the AHA will post those on its Web site for all to see. The deadline for interested hospitals to return their application is July 1. Once the applications have been received, Paul Cunningham, Editor Phil E. Matthews, President/CEO; 419 Natural Resources Drive; Little Rock, Arkansas 72205; ; facsimile

2 AHA Notebook 2 May 11, 2009 the Health Department will convene a group to review them. Plans are for those reviews to be completed by this fall. The first round of start-up funds ought to be awarded shortly thereafter. The second half of the start-up grants will be awarded upon designation of the various trauma centers. The Health Department is encouraging all interested hospitals to apply. During a May 6 meeting of the Metro District hospitals at the AHA Headquarters, ADH officials acknowledged that it could be difficult for hospitals to show complete coverage for some specialties. However, the Board of Health may use discretion in waiving a requirement if all other qualifications are met and if applying hospitals have plans in place to treat patients when a specialist cannot be available. FY 2010 IPPS Proposed Rule The Centers for Medicare and Medicaid Services (CMS) released its proposed rule for Federal Fiscal Year (FY) 2010 covering the Medicare Inpatient Prospective Payment System (IPPS). The rule is effective for discharges on or after October 1, Comments on the proposed rules for IPPS and SNF PPS are due to CMS no later than 5 p.m. on June 30. The IPPS proposed rule will be published in the May 22, 2009 Federal Register. A display copy is available on the CMS Web site: There is also a fact sheet on the proposed rule at Although CMS is seeking a full market basket update of 2.1% for FY 2010, the standard rate actually would be reduced by 1.9% to account for changes due to documentation and coding, and further reduced for budget neutrality, resulting in a net reduction of 0.5% in the Medicare IPPS standard amount per discharge. Key highlights of the proposal include: Behavioral Offset: In FY 2007, CMS adopted the Medicare-Severity Diagnosis Related Groups (MS-DRGs) to better recognize severity of illness in Medicare payment rates under IPPS. In the final IPPS rule for FY 2008, CMS implemented a behavioral offset adjustment to the standard amount, to be phased-in over a three year period, to neutralize for the estimated case-mix increases due to changes in documentation and coding. Subsequent legislation reduced CMS behavioral offset adjustments to -0.6% in FY 2008 and -0.9% in FY 2009, but gave CMS the authority to retroactively correct for differences between the offsets applied during FYs 2008 and 2009 and the actual coding improvement impacts for those years. For FY 2010, CMS is proposing to apply a 1.9% reduction to the standard amount, based on its analysis of case-mix increases for claims paid in FY 2008, which showed that the increase in FY 2008 was 2.5% compared to the 0.6% behavioral offset adjustment that was applied for that year. CMS will evaluate FY 2009 claims paid and will propose a further reduction if deemed necessary in FY Quality Measures: Hospitals would be required to report data on 43 quality measures in order to receive a full market basket update in FY 2010 (one quality measure would be retired). CMS also is proposing for FY 2011 to add four new measures: two new chart-abstracted measures and two new structural measures. A 2.0 percentage point reduction will be applied for hospitals that do not submit quality data as required by the Deficit Reduction Act of 2005 (DRA). CMS did not include regulatory language regarding any of President Obama s proposals for value-based purchasing, readmissions, or payment bundling in this proposed rule. IME for Capital: CMS is proposing to eliminate the teaching adjustment for capital in FFY 2010.

3 AHA Notebook 3 May 11, 2009 Legal Note: Supreme Court Ruling Hurts Tort Reform On April 30, 2009, the Arkansas Supreme Court declared three important sections of the 2003 Arkansas tort reform law, the Civil Justice Reform Act, unconstitutional: 1) The section modifying joint and several liability, which says that each defendant is liable only for its share of the damages based upon its allocated percentage of fault; 2) The empty chair provision, which says that the fault of nonparties who contributed to the injury may be considered when allocating these percentages; and 3) The section that limits the damages for medical expenses to only those costs actually paid or required to be paid by or on behalf of the plaintiff, which prevents the plaintiff from collecting full medical charges even though he or she was only required to pay a discounted amount. The court ruled that when the legislature enacted these statutory sections, it invaded the powers granted to the judiciary by the Arkansas Constitution and violated the separation of powers doctrine. Johnson v. Rockwell Automation, Inc. (No ) (available online at: According to the Court s interpretation, the liability modification provision and the empty chair provision were procedural and not substantive in nature and that court procedure is for the judiciary branch to determine. It determined that the limitation on damages for medical expenses was a rule of evidence, which is also the exclusive province of the court. The Arkansas Hospital Association, along with numerous other businesses from around the state, had joined in an amicus curiae brief asking that the court uphold the tort reform law, but the court was not persuaded by arguments in support of the law. A case challenging the constitutionality of the punitive damages limitation in the Civil Justice Reform Act remains pending before the Arkansas Supreme Court. Suggested topics for the Legal Note may be submitted to elisawhite@arkhospitals.org. The Legal Note is provided solely for informational purpose and does not constitute legal advice. Readers are encouraged to consult with their own attorneys about any legal issues, including those discussed in this article. Medicaid Recoveries Being Pursued The Arkansas Hospital Association learned last week that the state Medicaid program is preparing to recover overpayments made to most Arkansas hospitals for claims dating back to Affected hospitals should receive a letter this week for claims identified for recoupment in March, April or December of Initial letters concerning the claims were distributed about a year ago, but the recoveries were never set up in the program s accounts receivable system for processing. Amounts to be recovered vary by hospital and range from around $100 to $10,000 or more. Notices of recoupment will be sent to the attention of hospitals Patient Accounts Offices. Hospitals needing additional time for payment, review, or to research the recipient overpayment detail for these specific claims should contact one of the following individuals. Name Phone Number Debra Holiman (501) Debra.Holiman@Arkansas.gov Debra Johnson (501) Debra.Johnson@Arkansas.gov Wanda Womack (501) Wanda.Womack@Arkansas.gov

4 AHA Notebook 4 May 11, 2009 National ICD-10 Conference Call Healthcare providers may now register for CMS ICD-10-CM/PCS Implementation and General Equivalence Mappings (Crosswalks) National Provider Conference Call that will be conducted on May 19, 2009 from 12:00 p.m. 1:30 p.m. CENTRAL Daylight Time. This call will include a discussion of the following topics: An overview of the ICD-10 final rule, which requires the implementation of ICD-10- CM/PCS on October 1, 2013; The differences between ICD-9-CM and ICD-10-CM/PCS codes; The use of the General Equivalence Mappings that have been created to assist in converting policies, edits, and trend data from ICD-9-CM to ICD-10-CM/PCS; and The resources that are available to assist in planning for the transition from ICD-9-CM to ICD-10-CM/PCS. Conference call discussion materials and registration information can be accessed at Bill Extends Favorable LTCH Provisions The American Hospital Association has expressed its strong support for the Medicare Long- Term Care Hospital Improvement Act (H.R. 2124), which would extend for two years certain provisions of the 2007 Medicare, Medicaid and SCHIP Extension Act to allow more time to develop LTCH facility and patient criteria. Set to expire Dec. 29, 2010, the provisions delay full implementation of the so-called 25% Rule, which reduces payment for certain patients transferred to LTCHs from general acute-care hospitals. They also postpone payment reductions for very short-stay cases and place a moratorium on new LTCH facilities and beds, with certain exceptions. The AHA said in a letter to the bill s sponsors, Reps. Earl Pomeroy (D-ND), John Yarmuth (D- KY), Lloyd Doggett (D-TX) and Bill Pascrell (D-NJ), Extending these provisions would provide critical regulatory stability to the long-term care hospital community, and allow an essential segment of the post-acute healthcare delivery system to continue providing quality services to the patients who rely on them. See RepEarlPomeroy.pdf to read the full letter Sebelius Proposes FY 2010 HHS Budget Newly confirmed Health and Human Services (HHS) Secretary Kathleen Sebelius on May 5 released an $879 billion proposed budget for HHS programs in fiscal year 2010, a $63 billion increase from FY While the budget provides no new details on the president s health reform proposal, Sebelius called reform critical to protecting the nation s health and the budget reflects that opinion, calling for a $635 billion reserve fund to help pay for health reform over 10 years, partly through savings from the Medicare and Medicaid programs. The budget would raise funding for nursing education programs to $263 million, a $92 million increase, and provide $125 million for rural health programs and $310 million for Children s Hospital Graduate Medical Education. It also would increase funding for the Medicare Integrity Program s anti-fraud efforts, which the administration estimates will save $2.7 billion over five years.

5 AHA Notebook 5 May 11, 2009 House Amends Senate Fraud Bill The U.S. House of Representatives voted last week to pass the Fraud Enforcement and Recovery Act (S. 386), sending it back to the Senate with amendments to the False Claims Act section of the bill. The section retains a provision supported by the American Hospital Association clarifying that organizations receiving overpayments from federal programs are only liable for knowing and improper "retention" of those overpayments. It excludes the extensive FCA changes in H.R. 1788, an AHA-opposed bill passed by the Judiciary Committee earlier this month. TRICARE Outpatient Adjustment The Department of Defense will provide an additional payment adjustment to hospitals with at least $1.5 million in annual outpatient payments for active duty service members and their families under the new TRICARE Outpatient Prospective Payment System, according to a notice in the May 8 Federal Register. The adjustment will increase total TRICARE OPPS payments to eligible hospitals by 20% after the first year, and by 15%, 10% and 5% after the next three years, respectively, if the hospital continues to meet the $1.5 million threshold. In a paper describing the change, DoD said the additional payment adjustment does not require an amendment to the final rule. The American Hospital Association believes that the adjustment is an improvement, but only a temporary solution that is limited in application. Click on to see the notice. AHA Board Highlights During its regular monthly meeting on May 8 at the Red Apple Inn in Heber Springs, the Arkansas Hospital Association board of directors: Reviewed components of the recent Senate Finance Committee s recommendations about reforms in the delivery and financing of Medicare services. The committee has proposed establishing a Medicare value-based purchasing system, reducing payments to hospitals having high readmission rates and bundling payments for hospital and post-acute care. Reviewed the new Medicare Inpatient PPS proposed rule for FY 2010, which includes an annual update factor of -0.5%, after all adjustments are made. Learned that the Arkansas Department of Health has mailed each Arkansas hospital a Trauma Center Designation Application. The applications must be submitted by July 1. Heard that the AHA and its consultant have worked with state Medicaid officials to complete a State Medicaid Plan Amendment, which was submitted to CMS on May 8. The SPA would allow the state to disburse quarterly supplemental inpatient and outpatient hospital access payments to privately owned hospitals, effective July 1, Heard an update on the recent Arkansas Supreme Court decision to dismantle key parts of the state s tort reform law that was passed in Learned that the Arkansas Medicaid program is preparing to recover excess payments made to many Arkansas hospitals dating back to Medicaid officials sent lettersinforming hospitals about the overpayments more than a year ago, but the actual withholds to recover the money were never implemented.

6 AHA Notebook 6 May 11, 2009 Welcomed Saline Memorial Hospital CEO Randy Fortner as the AHA representative to the Arkansas Foundation for Medical Care Board. Elected David Cicero (CEO/Ouachita County Medical Center) to serve as AHA Treasurer, replacing Luther Lewis, and Tim Johnsen (CEO/St. Joseph s Mercy Health Center) as the AHA board representative from the Southwest Hospital District, replacing Cicero. Recognized Russ Sword (CEO/Ashley County Medical Center) for his service on the AHA board during his tenure representing hospitals on the Arkansas Board of Health. NewsNotes About Arkansas Folks David Cicero, president of Ouachita County Medical Center in Camden, was elected Treasurer of the Arkansas Hospital Association s board of directors during its May 8 meeting. Cicero will fulfill the unexpired term of Luther Lewis, who resigned in February. Cicero has served as the Southwest District delegate to the AHA board since October The AHA board of directors also elected Tim Johnsen, president/ceo of St. Joseph s Mercy Health Center in Hot Springs, to serve the unexpired term of David Cicero as Southwest District delegate to the AHA board of directors. At its April meeting, the Arkansas Foundation for Medical Care s board of directors elected Randy Fortner, FACHE, CEO of Saline Memorial Hospital of Benton, to the board with a term expiring in the spring of By virtue of that appointment, Fortner will also serve on the Arkansas Hospital Association s board of directors representing the AFMC. Fortner also was elected last week to serve as president of the Metropolitan Hospital District. Also elected were Randy Cason, FACHE, administrator/ceo of St. Vincent Medical Center/North in Sherwood, president-elect; and Jennifer Nolan, CEO of The BridgeWay in North Little Rock, as secretary. The AHA Calendar May Mid-Management Leadership Series for Managers & Supervisors: The Legal Aspects of Management, AHA Classroom, Little Rock Society for Arkansas Healthcare Purchasing and Materials Management (SAHPMM) Annual Meeting and Trade Show, Inn of the Ozarks, Eureka Springs 14 National Incident Management System (NIMS) Training for Hospitals: ICS 100 and 200 for Healthcare, IS 700a, AHA Classroom, Little Rock and Tandberg videoconference 14 Joint Commission Requirements: How Do you Stay Continuously Survey Ready? Webinar #T Arkansas Social Workers in Health Care (ASWHC) 2009 Spring Conference, AHA Classroom, Little Rock 19 Arkansas Association of Hospital Trustees (AAHT) 2009 Regional Dinner Series Compliance is NOT a Four-Letter Word!, Embassy Suites Hotel and Spa, Hot Springs 19 The Revised 2009 Joint Commission Medication Management Standards: Ensuring Compliance Webinar #T2496

PROPOSED POLICY AND PAYMENT CHANGES FOR INPATIENT STAYS IN ACUTE-CARE HOSPITALS AND LONG-TERM CARE HOSPITALS IN FY 2014

PROPOSED POLICY AND PAYMENT CHANGES FOR INPATIENT STAYS IN ACUTE-CARE HOSPITALS AND LONG-TERM CARE HOSPITALS IN FY 2014 DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services Room 352-G 200 Independence Avenue, SW Washington, DC 20201 FACT SHEET FOR IMMEDIATE RELEASE Contact: CMS Media Relations