Arkansas LegislativeArkansas LegislativeUpdate 2015Update 2015

Civics Review

Path of Legislation

Your Role During the Session• Educate your legislators!

– Refer to the Bill Number– Provide at least 3 good reasons to support

your position (and know what “the other side” thinks)

– Explain what the subject means to your organization

– Describe how the legislator’s constituents are affected

How do you do it?

Good stuff Bad stuff

• Be specific• Be brief• Be direct• Be honest• Be constructive• Be timely• Be complimentary

• Avoid form letters and “canned” material

• Don’t threaten• Don’t over-do it• Don’t assume they know

your issue

Your Role NOW

• Look for partners

• Form coalitions

• Educate the Public

• LISTEN! LISTEN! LISTEN!

• Be nimble

• Follow the regulatory process

• Do the right thing THE RIGHT WAY!

New Arkansas Laws YOU Should Know About

Health Care Reform Task Force

House Members Senate members

• Charlie Collins, Chair• Reginald Murdock, VC• Justin Boyd• Joe Farrer• Deborah Ferguson• Michelle Gray• Kim Hammer• David Meeks

• Jim Hendren, Chair• Cecile Bledsoe, VC• Linda Chesterfield• John Cooper• Keith Ingram• Jason Rapert• Terry Rice• David Sanders

Surgeon General Greg Bledsoe, ex officio

HCR Task Force Charge

• Established by SB 96 ( Sen. Jim Hendren)• “Recommend an alternative healthcare

coverage model and legislative framework to ensure the continued availability of healthcare services for vulnerable populations covered by the Health Care Independence Act…”

• “Explore and recommend options to modernize Medicaid programs serving the indigent, aged, and disabled”

HCR Task Force Charge (cont.)

• Identify resources and funding

• Identify populations and healthcare needs

• Allow maximum state flexibility for efficient management

• Serve healthier beneficiaries in private market

• Strengthen employer-sponsored health insurance market

• Increase employment for able-bodied recipients

HCR Task Force Charge MORE…

• Encourage healthier behaviors, increased accountability and personal responsibility for beneficiaries

• Encourage healthcare providers to serve patients

• Access healthcare services in rural areas of the state

• Continue payment innovation, delivery system reform, and market-driven improvement…

HCR Task Force Explicit Considerations

• “A block grant or global budget cap program in which the federal government provides the state with a defined annual lump sum, calculated on the basis of past and existing Medicaid funding levels, adjusted annually for healthcare inflation; and

• Innovative measures and options such as capitated payment models, including without limitation MANAGED CARE programs for specific high-need populations such as people with serious mental illness or elders with frailty.”

HCR Timeline

• First meeting held March 10, 2015, largely organizational

• Draft RFP discussed on Tuesday, March 17, 2015• Draft RFP presented on Monday, March 23, 2015• Another meeting held April 20, 2015

– Meetings shall occur at least one time every two months

• Final Report due on or prior to December 31, 2015• Expires December 31, 2016

And the Survey Says…

• AHA conducted survey Spring 2014– Number of self pay

patients reduced by 30%

• NEW ONE NOW – Final Report this month– Have 54 respondents,

but have key hospitals that have not submitted data YET

• HFMA/BKD – Fall 2014 (6 month comparison)– ER visits NOT

dramatically increased

– $69.2 million more collected

– Self pay admissions down 46.5%

– ER self pay encounters down 35.5%

– Self pay outpatient visits down 36.0%

There’s more …

For the Data Geeks

• 2105 Bills and Resolutions Filed– 1007 House– 1055 Senate– 27 House Joint Resolutions– 16 Senate Joint Resolutions

• 1288 Acts

• $133 million more than 2015 (RSA)

Important!

• Please do not rely on these slides as full explanations of the law. We hit the “high points” only, so we give you the act number to let you look at the law yourself.

• Read the full text of the law and seek the advice of a qualified attorney if you need legal advice or a legal opinion.

Act 685 – Community Paramedics

• Allows paramedics to perform and get paid for non-urgent services- Coordination of community services- Chronic disease monitoring and education- Health assessments- Hospital discharge follow-up care- Laboratory specimen collection- Medication compliance

• Provided to appropriate patients

Act 1168 – Sexual Assault Kits• Concern about possible backlog of

untested Sexual Assault Evidence Collection Kits – Stored at local law enforcement agencies– Not picked up from healthcare facilities

• State Crime Lab must audit untested sexual assault collection kits annually– Separate forms to be developed for law

enforcement and for healthcare providers

Act 411 – Diversion Reporting

• Must report healthcare providers to state licensing/certifying body if:– Terminate employment, contract or clinical

privileges (or allow resignation in lieu)– Because of drug diversion, misuse, or abuse

• Drug diversion by any other employee reported to law enforcement

• Applies to any entity that employs or contracts with healthcare professionals

Act 887 – Telemedicine

• Requires distant site provider to have “professional relationship,” which includes:– Cross-coverage/on-call arrangement– Referral by provider that has ongoing

relationship and has agreed to supervise care– Other circumstances approved by Med Board

• Requires many insurance plans to cover telemedicine

• Reimbursement protections for physicians

Act 895 – Criminal Justice Reform• Governor’s key initiative

– 41 page $64 criminal justice reform plan

• For medical service or treatment provided to local correctional facility for the benefit of an inmate, cannot charge more than:– “Prevailing cost paid by [Medicaid] for a

particular medical service or treatment established by the [Medicaid] fee schedules for a particular medical service, treatment, or medical code.”

Act 1208 – Combating Rx Drug Abuse• Hospitals must adopt guidelines for opioid

prescribing in the ED to address (at least):– Treatment of chronic nonmalignant pain and

acute pain– Limits on amounts or duration of opioid

prescriptions– Situations where opioid prescriptions should be

discouraged or prohibited

• Also contains various requirements for individual, licensed prescribers

Act 1233 – Transparency Initiative• Provides for establishment and

governance of all-payer claims database– Governed by AR Insurance Department (AID)– AID to be advised by oversight board– ACHI designated in statute as administrator

• Requires entities to submit claims data – Penalty up to $1,000 per day if fail to submit

• Certain data to be released for purposes set forth in the law, as authorized by AID

Act 535 – Human Tissue Disposal• Department of Health must adopt rules to

ensure that human tissue is disposed of by:– Releasing to the patient or authorized person;– Incineration;– Burial; or– Cremation.

• Licensed facilities must have policies to implement these requirements.

Act 1013 – Caregiver Act• Must allow each inpatient to designate a

caregiver before discharged to home– Have complied if patient says “no” or refuses to

allow disclosure of PHI to caregiver– [Note - May want to have written permission to

share PHI.]

• If caregiver designated, must notify of planned transfer or discharge.– If cannot contact caregiver, this will not delay or

stop medical care or discharge.

Caregiver Act, cont.

• If caregiver designated, must prepare caregiver to provide aftercare:– Have consultation and allow caregiver to ask

questions; and– Educate caregiver “consistent with current

accepted practices” and based on learning needs

• If cannot contact caregiver, this will not interfere with or delay discharge.

• Hospital not liable for caregiver’s acts or omissions.

Act 529 – Hydrocodone Rx• Nursing Board and Medical Board required

to enact rules allowing APNs and PAs to prescribe hydrocodone combination products reclassified from Schedule III to Schedule II last October– For APNs, must be expressly allowed by

collaborative practice agreement

• Rules must be consistent with Med Board rules for prescribing dangerous drugs and controlled substances

Just a few that did not pass…

• HB 1142 Surgical Technologists• HB 1160 APN Rx Authority w/o Supervision• HB 1346 General Revenue diversion to Highways• HB 1465 Stroke Designation• HB 1824 All Products Clause Prohibition• SB 150 Medical Records Fees• SB 725 Soda Pop Tax• SB 829 Medicaid Fairness• SB 830 False Claims• SB 959 COI Disclosure

Questions?