January 17, 2014
Volume 58, Issue 3

AHA Announces January 28 DC Fly-In on Two-Midnights Policy
CMS provides additional two midnights resources

The American Hospital Association (AHA) announced a Washington, DC fly-in January 28 to focus specifically on the "two-midnights" rule. During this fly-in AHA will brief individuals on current legislative activity, after which hospital leaders will head up to Capitol Hill to meet with their Members of Congress to discuss legislation called the Two Midnight Rule Delay Act (HR 3698).

Briefly, HR 3698 would:

The Wisconsin Hospital Association and several hospital leaders traveled to Washington, DC January 8 and discussed this issue with Wisconsin Congressional Members. To date, Rep. Ron Kind (D-3rd District) signed onto this legislation. WHA thanks Congressman Kind for this early support. If you plan to participate in the January 28 AHA fly-in, let WHAís Jenny Boese know at jboese@wha.org or 608-268-1816.

On a related note, on January 14 the CMS Medicare Learning Network held a webinar on the two-midnights policy, including several case scenarios. For those unable to participate in that webinar, you may access the MLN slides/audio resources at the following:

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Workerís Compensation Council Continues to Push Fee Schedule
Legislature has amended WCACís bill in the past

The Workerís Compensation Advisory Council (WCAC), with its five representatives of labor and five representatives of management, is close to finalizing its recommended changes to the Wisconsin Workerís Compensation system. The Council continues to recommend a new government-established fee schedule for reimbursing health care services provided to injured workers. The Councilís final vote on the proposed bill, which will direct the Department of Workforce Development to set reimbursement rates for hospitals, doctors, and other health care providers, is expected next week.

WHA, along with the Wisconsin Medical Society, Wisconsin Chiropractic Association, and the Wisconsin Physical Therapy Association, strongly objects to adding Workerís Compensation to Medicaid and Medicare as programs with government-imposed fee schedules. The health care provider community has emphasized to the Council and legislators that a fee schedule puts at risk the excellent outcomes produced by one of the best Workerís Compensation systems in the country.

"Workers in Wisconsin return to work faster than in any other state, have access to excellent care and are happy with that care. Those results are achieved for costs that are well below the national average," said WHA Executive Vice President Eric Borgerding. "The Council is going all in, putting at risk what has been a high-value system for a system that has not produced better results in other states. We are hopeful the Legislature stands firm, protecting injured workers and Wisconsinís stable business environment."

The Assembly and Senate labor committees will consider the Councilís recommendations. As with any bill voted on by the committees, the committees can approve, reject, or amend the bill. If the committees approve the Councilís bill, the full Assembly and Senate will have the opportunity to consider the dramatic policy changes proposed by the Council.

"Contrary to recent assumptions, the WCAC-approved bill has not always been rubber stamped by the Legislature," noted Borgerding. "In fact, the Legislature has exercised its role as elected policymakers by amending the WCAC-approved bill several times over the years, including amendments that were opposed by the WCAC."

A growing coalition of hospitals, providers and others in the health care community will ask their legislators over the next several weeks to protect Wisconsinís Workerís Compensation system by rejecting the Councilís proposal. Watch The Valued Voice for more information as this important issue continues to develop.

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Register Today for the WHA Wisconsin RAC Summit
March 26 at Glacier Canyon Lodge, Wisconsin Dells

"Early bird" discount available to those registering by February 21.

Register at http://events.SignUp4.com/14RACSummit.

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Senate Committee Recommends Passage of Mental Health Reforms
Legislation expected to be passed out of the Senate next week

The Senate Committee on Health and Human Services held a vote January 15 on two of WHAís legislative priorities for the 2013-2014 session.

AB 453, the Mental Health Care Coordination bill, received a 4-1 bipartisan vote recommending passage of the legislation to the full Senate. The bill would update Wisconsinís mental health medical records law to enable better coordinated, more holistic integrated health care for individuals with mental illness. AB 453 was a bipartisan recommendation of the Speakerís Mental Health Task Force and has 41 co-sponsors.

Another bill voted on in Committee was AB 488, which reforms Wisconsinís emergency detention law to better enable court review of requests to initiate an emergency detention using the existing three-party petition process. The legislation received a 4-1 bipartisan vote recommending passage of the bill.

WHA applauded the Senate Health Committee action in a press statement January 15. Read it here: www.wha.org/nr1-15-14mentalhealth.aspx

AB 453 and AB 488 have both been scheduled for a vote in the full Senate on January 22, 2014. WHA expects the legislation to pass the Senate and be sent to Governor Walkerís desk for his signature.

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Presidentís Column: Washington Sausage Factory in High Gear

The Washington D.C. "Sausage Factory" was in fine form last week when Congress narrowly rejected an extension in Unemployment Compensation benefits paid for with another round of future hospital and physician Medicare cuts.

The 52-48 vote (60 votes were needed) to invoke cloture staved off another Medicare payment hit that would have extended the current sequester (two percent annual Medicare cut) an extra year, through 2024.

The most disturbing aspect of this development was the apparent willingness of 52 U.S. Senators to pay for a one-year extension of unemployment benefits by once again cutting physician and hospital payments. A similar situation occurred just a few weeks ago with a bipartisan vote to pass a federal budget bill that included a temporary stop of the Medicare physician payment cut paid for with a one-year extension of the hospital payment sequester.

Wisconsin hospitals are already on the hook for $4 billion in cuts over the next decade to finance ACA coverage expansion (extremely disappointing results to date), three temporary physician payment "fixes" and deficit reduction. And a host of new headaches are on tap including:

WHA members have been extremely engaged in working with our Congressional Delegation to "say no" to new cuts. Our most recent D.C. meeting included eight members and WHA staff, with another trip planned in two weeks. And about 30 members from eight or nine hospitals will be meeting with Congressman Sean Duffy January 21 in Northwest Wisconsin (Osceola).

Stay tuned for new opportunities to get engaged. And please respond to HEAT calls for action over the next several months. WHAís Jenny Boese is leading federal relations and advocacy efforts on these issues, so please reach out to her at 608-268-1816 or jboese@wha.org with any questions.

Steve Brenton

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Reminder: WHA Physician Leadership Development Conference
The American Club, Kohler *** March 14-15, 2014

More information and online registration can be found at: http://events.SignUp4.com/14PLD

Need Hotel Reservations? Contact The American Club at 800-344-2838 before February 20.

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HHS Releases Latest Exchange Enrollment Figures
40,752 Wisconsinites selected a Qualified Health Plan by the end of December

By the end of December, 40,752 people in Wisconsin had selected a health plan through the exchange marketplace, according to the latest figures from the federal government. On December 13, the federal Department of Health and Human Services (HHS) released the data that shows the number of people applying for coverage through the health insurance exchange marketplaces, how many selected a qualified health plan, and how many were found eligible for Medicaid by state from October 1 through December 28, 2013. The full HHS report can be found on WHAís website at: www.wha.org/exchangemedicaidenrollment.aspx.

During a January 13 news conference, HHS officials were unable to provide information about how many enrollees had actually paid their premium, which is required for full enrollment into the health plan.

For the first time, HHS also provided data on the age of participants and the type of plan chosen. In Wisconsin, 45 percent of those who selected a plan were between the ages of 55 and 64, and 23 percent were under the age of 35. During the January 13 call, HHS said it plans to increase efforts to encourage young adults to enroll in exchange plans. The administration had been concerned that the pool would be overloaded with too many unhealthy people, which would mean rates for exchange plans may increase in 2015.

The figures released by HHS also indicate which type of plan enrollees have selected, with 69 percent in Wisconsin choosing a silver-level plan. This helps to alleviate some concerns that the majority of enrollees would choose the bronze plan which generally has the lowest premiums, but higher deductibles and copayments. Nevertheless, many silver level plans can still have high cost sharing and providers remain concerned about the risk for unpaid costs.

The enrollment numbers also show 43,444 people have been deemed eligible for Medicaid in Wisconsin through the exchange marketplace. The Department of Health Services (DHS) should be receiving those official applications from the exchange through an account transfer process in the near future.

Also this week, both houses of the state Legislature approved technical changes to the previously-approved delay in the implementation of Medicaid program changes, and the Governor signed the bill December 16. As reported in The Valued Voice December 10, the technical bill continues to allow all current Medicaid recipients as well as parents and caretakers who apply for Medicaid before February 1, 2014 with income between 100 and 200 percent of the federal poverty level (FPL), to remain on the program until March 31. New parent and caretaker applicants who apply after February 1, 2014 would have eligibility determined under new modified adjusted gross income (MAGI) rules, and could be eligible for Medicaid only if income is below the poverty line.

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WHA Expresses Concerns to Congress Over Medicare Appeals "Freeze"

Recently the federal Office of Medicare Hearings & Appeals (OMHA) announced a temporary freeze in the assignment of new requests for hearings at the Administrative Law Judge (ALJ) level. The OMHA indicates this freeze in appeals could last up to 24 months. OMHA says the freeze is due to the rapid increase of claims being appealed in recent years and is necessary to allow the 357,000 current appeals in process to move forward.

The American Hospital Association (AHA) and Wisconsin Hospital Association (WHA) believe inappropriate Recovery Audit Contractor denials are a major contributor of the current appeals backlog. Both AHA and WHA are expressing strong concerns over the freeze and urging corrective action.

WHA has been in touch with Wisconsinís Congressional Delegation about this issue, and the AHA has asked the federal Centers for Medicare & Medicaid Services (CMS) to intervene. Read the AHA letter to CMS at: www.aha.org/advocacy-issues/letter/2014/140114-let-aljdelays.pdf.

Read the OMHA letter at: www.wha.org/pdf/OMHA_Appeal_freeze.pdf.

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Register Today for Statewide ICD-10 Summit, March 17-19 in WI Dells

Register today for the ICD-10 Summit: Ready. Set. Go Live! Conference, scheduled March 17-19 at the Kalahari Resort in Wisconsin Dells. Early registration discount expires January 17. Visit www.wha.org/icd-10summit.aspx for a full Summit agenda and access to online registration.

ICD-10 will affect all aspects of health care in 2014, and WHA, the Wisconsin Medical Society and the Wisconsin Medical Group Management Association have teamed up to make sure hospitals and clinics throughout Wisconsin are ready. Pass this information along to your coding and billing specialists, health information professionals, and other ICD-10 transition team members, and encourage them to attend.

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In Memoriam: Former WHA Chair Gordon Johnsen

Gordon N. Johnsen, 87, passed away December 29 in Middleton WI, following a long battle with Alzheimerís. Johnsen was active in the Wisconsin Hospital Association, serving as WHA Chair in 1969.

After graduating from high school in Britt, IA, he joined the U.S. Army Air Corps. He received his bachelorís degree from the University of Wisconsin in 1950. He received a Master of Science in Business Education from the UW in 1953 and a Master of Arts in Hospital Administration from the University of Minnesota in 1955.

Johnsen began his career in hospital administration at Iowa Methodist Hospital in Des Moines, IA. He joined Madison General Hospital in 1958 and served as administrator until 1975 at which time he was named president of Madison General Hospital, a post he held until 1984. Following his retirement, he served as a clinical professor in programs in Health Service Administration within the U.W Madison Medical School until 1997.

Johnsen was a founding member of the Board of Directors of VHA (Voluntary Hospitals of America) in 1977. He was a Fellow in ACHE and served as a trustee of the American Hospital Association.

"Gordon Johnsen was an influential health care leader at both the state and national level," said WHA President Steve Brenton. "Gordonís contributions, especially his WHA leadership during this organizationís formative years, helped create a strong trade association, effectively advocating for community hospitals."

A celebration of his life was held January 11 in Madison.

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