Public Policy Council Discusses Federal Rules Impacting Hospitals, Medicaid Opportunities

August 28, 2018

On August 23, WHA’s Public Policy Council (PPC) met with a full agenda as the federal government continues to propose regulations that will impact hospital finances and operations. In addition, the Council received a briefing on several items being discussed on WHA’s proposed agenda for the 2019-2020 state legislative session, particularly related to Medicaid payment, telemedicine, and behavioral health.
WHA’s Jon Hoelter, alongside WHA’s federal lobbying team at Health Policy Source, provided the Council with insight regarding recent regulations proposed at a federal level impacting hospital outpatient departments, the 340B drug discount program and recently enacted rules related to transparency. The presentation recapped WHA efforts to protect the 340B program from future harm and lessons going forward that can be applied to the upcoming fight against CMS’ proposed cuts to offsite hospital outpatient departments (site-neutral payments).
WHA has been working on scheduling roundtables with key members of Wisconsin’s Congressional delegation to educate them on the issue and is planning on hosting a fly-in to D.C. in late September. WHA will also submit a comment letter asking CMS to reverse the cuts which would amount to an estimated $30 million hit on Wisconsin hospitals in 2019.

Medicaid Workgroup Concludes Work, Reports out to PPC

In addition, the Council discussed recent recommendations from WHA’s Medicaid Policy Workgroup, which has now concluded its work in preparation for the next legislative session. The Council received a briefing from WHA Vice President, Public Policy Lisa Ellinger, who reminded the Council of Wisconsin’s poor payment in Medicaid resulting in underfunding hospital services by $1.2 billion in 2017 – particularly in our state’s high Medicaid payer-mix safety net and behavioral health hospitals, other hospitals that treat the sickest or highest acuity patients, and for hospital outpatient services where more care is increasingly delivered.

The Council also discussed WHA staff research regarding the differences between payment policies for telemedicine in Medicare and Medicaid.  For example, Medicare covers 55 more procedures codes than Medicaid, and Medicaid has created unnecessary regulation to pay for telemedicine services differently than when those services are provided in a non-telehealth setting.  Increasing utilization of telemedicine, rather than in-person visits, may reduce the costs Wisconsin Medicaid pays to transport some Medicaid beneficiaries, which currently amounts to $75 million per year.

Council member Maureen McNally, Froedtert Health, and WHA staff briefed the Council regarding a legislative study committee to examine what is referred to as “direct primary care (DPC).” The Legislature created this study committee following introduction of legislation that would create a regulatory structure for DPC practices and direct the Medicaid program to pursue a pilot offering DPC services to Medicaid enrollees.

For more information about this study committee or recent proposals on direct primary care, contact Jon Hoelter, WHA Director, Federal & State Relations, or Lisa Ellinger.

This story originally appeared in the August 28, 2018 edition of WHA Newsletter