Federal Health Care Legislative Update

TO:
Trustee Leaders

President Obama’s Health Care Reform Summit last week did not yield bipartisan support to move the health care reform debate forward, and the President now says he believes a comprehensive reform bill deserves an “up or down” vote in the U.S. Senate. This leaves the door open for the Senate leadership to use the legislative process of budget reconciliation to pass reform legislation.

Reconciliation Process

Under reconciliation, the U.S. House of Representatives would likely approve the Senate-passed version of the health care reform bill and then approve a second bill containing “fixes.” The Senate, using reconciliation and therefore needing only a simple majority, would follow the House in approving the second piece of legislation. However, Democrats have yet to show the will to move comprehensive health care reform forward using reconciliation.

The road for reconciliation is very limited. Democrats have not yet started counting votes and have not finalized the details of what they plan to pass. Republicans claim that the Democrats do not have the votes in the House to do so.

Senate Passes “Jobs” Bill

Last week, the U.S. Senate passed a lean “jobs” bill; a second and more robust jobs bill is expected to be considered in the Senate this week.

The Senate’s second jobs bill contains important health care provider-related provisions, strongly supported by HTNYS and HANYS, including a six-month extension of the enhanced Federal Medical Assistance Percentage (FMAP) provided to states under the federal stimulus bill; the extension would be worth $3.2 billion in new federal funding to New York State. HTNYS joins HANYS in urging that any extension include requirements that states protect Medicaid programs and provider payments. The House has already passed an FMAP extension.

Other important provisions in the second Senate jobs bill include:

• extending the special “Section 508” Medicare wage index reclassifications for one year, until October 1, 2010;
• extending outpatient “hold harmless” payments for small rural and sole community hospitals through the end of 2010;
• allowing physicians practicing in hospital-based outpatient clinics to be eligible for the health information technology (HIT) incentive program; and
• pension obligation relief for employers with defined-benefit pension plans.

Any jobs bill approved by the Senate will have to be merged with the much larger jobs bill that was approved by the House late last year. HTNYS joins HANYS in working with Senator Charles Schumer (D-NY) to ensure the above provisions are included in any final jobs bill, along with an additional provision that would extend an American Recovery and Reinvestment Act (ARRA) provision that provided a temporary two-year increase to states’ Medicaid Disproportionate Share Hospital (DSH) cap allotments. Should the DSH cap increase not be extended, the loss of funding to New York State would jeopardize critical funding to safety net institutions.

Physician Payment Rates

This week, the Senate passed H.R. 4691, the “Temporary Extension Act of 2010,” which included provisions to extend 2009 Medicare physician payment rates through the end of the month. As a result, the 21% payment cut that took effect on March 1 has been postponed until April 1.

Health Information Technology

The Centers for Medicare and Medicaid Services (CMS) released an HIT “meaningful use” proposed rule that would implement HIT incentive payments for eligible hospitals and non hospital-based physicians established under ARRA. HTNYS joins HANYS in urging CMS to make its proposed definition of meaningful use more practical and flexible and is asking hospitals to send comments to CMS. HANYS provided hospital chief executives a draft comment letter to use as a guide for their own comments to CMS.

Please work with your chief executive officer to encourage fellow board members to contact your member of Congress to sign a letter drafted by U.S. Representatives Eliot Engel (R-NY), Zack Space (D-OH), Michael C. Burgess (R-TX), and Cliff Stearns (R-FL) urging CMS to make its proposed definition of meaningful use more practical and flexible.

In addition, contact New York Senators Charles Schumer (D) and Kirsten Gillibrand (D) and ask them to ensure a provision remains in the “jobs” bill to be considered in the U.S. Senate that would address CMS’ narrow definition of eligible providers and allow physicians practicing in hospital-based outpatient clinics to be eligible for the HIT incentive program.

To make your voice heard on federal issues, join us for our 2010 Federal Briefing and Congressional Advocacy Day, which will be held April 27 and 28 in Washington, D.C., in conjunction with the American Hospital Association’s Annual Membership Meeting. Please register online for this event. The registration page contains additional details.