2013-2014 Federal and State Public Policy Priorities
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Health Care Reform Implementation
- Support public and private sector initiatives to expand coverage to the uninsured (e.g., Medicaid expansion), ensure greater access to coverage through insurance reforms, and focus additional resources on primary care, prevention and wellness.
- Support development of health insurance exchanges that are flexible enough to address local needs, encourage private insurers to participate, and balance the key objectives of pooling risk and managing public subsidies.
- Support meaningful refinement of the federal health care reform law, including modification of the Medicare hospital readmissions payment policy to limit reductions in payments to “avoidable” readmissions only.
Medicare and Medicaid
- Ensure stable Medicare and Medicaid reimbursement for hospital and physician services.
- Maximize federal matching funds for Medicaid and the Children’s Health Insurance Program (CHIP).
- Provide adequate, balanced funding among both public and private safety net hospitals in the Medicaid Disproportionate Share Hospital (DSH) and 1115 Waiver programs to help mitigate the state’s funding shortfalls.
- Support development of alternative Medicaid reimbursement models consistent with Medicare policy, including shared savings to Accountable Care Organizations (ACOs), bundled payments, and pay-for-performance.
- Support expansion of Medicare-funded medical residency training positions for community-based hospitals.
- Correct Medicare payment rates paid to long-term care hospitals and rehabilitation facilities.
- Support meaningful reform to Medicare contractor programs and audit processes to eliminate duplication, inappropriate denials, inaccurate data publication and the administrative burden for providers.
Quality and Patient Safety
- Support legislative and regulatory efforts that focus on enhancing quality and patient safety through:
- Defining a common set of evidence-based measures that are valid and reliable for public reporting;
- Sharing clinical quality and patient safety data with appropriate confidentiality and liability protections;
- Implementing meaningful pay-for-performance methodologies to improve quality and avoid unnecessary costs;
- Coordinating and aligning federal and state quality metric initiatives in order to reduce duplication, costs and administrative burden for providers; and,
- Encouraging utilization of a federally sponsored Patient Safety Organization to support confidential reporting of adverse events to an outside organization and benchmarking adverse event data to drive improvement (e.g., Leapfrog initiative).
- Support legislative and regulatory changes that enhance the alignment between physicians and hospitals, including:
- Revising the Stark rules to permit hospital-provided continuing medical education (CME) for physicians for the purpose of enhancing patient safety and quality improvements; and,
- Providing incentives to physicians to participate in patient safety programs that support team training and effective communication skills to reduce preventable errors.?
- Reduce the nursing, allied health and physician workforce shortages through enhanced funding for educational programs directed toward faculty salaries, student scholarships and financial aid with emphasis on prevention and wellness training.
- Support expansion of graduate medical residency slots, including positions for private, non-profit hospitals.
- Restore Medicaid graduate medical education (GME) funding.
- Support funding in the state budget for the Professional Nursing Shortage Reduction Fund to increase RN graduates.
- Support immigration policies to facilitate recruitment/retention of qualified nurses and allied health professionals.
- Oppose efforts to impose mandatory, arbitrary, one-size-fits all nurse-staffing ratios.
- Oppose proposals that allow establishment of a labor union without approval through a private ballot election.
- Provide the Texas Department of Insurance (TDI) with greater authority to regulate health insurance plans and enable more employers and insurance carriers to provide affordable health care coverage.
- Support licensure of Preferred Provider Organizations (PPOs) and increased regulatory requirements and oversight of the business practices of health plans and their subcontractors, including third-party administrators.
- Support efforts to require PPOs and Health Maintenance Organizations (HMOs) to develop and maintain adequate networks of physicians and other providers to reduce the exposure of patients to additional out-of-pocket costs.
- Strengthen prompt-pay requirements and impose them on the state Medicaid program and self-insured plans.
- Expand coverage to small businesses through adequate funding of the Healthy Texas reinsurance program.
- Improve coverage for persons with chronic or catastrophic conditions, e.g., expand the Texas High Risk Pool.
- Support state efforts for mental health parity and enforcement of the federal parity law.
Accountability and Transparency
- Support meaningful industry reforms that promote accountability and transparency in such areas as community benefit, charity care, charges to the uninsured and debt collection.
- Support industry efforts that provide meaningful information to consumers regarding the price and quality of selected health care services.
- Oppose statutory changes that would increase charity care requirements and/or negatively impact the tax liabilities of non-profit hospitals.
- Promote prevention and wellness programs that allow non-profit hospitals to satisfy community benefit obligations.
Trauma and Emergency Readiness
- Provide full appropriation of state funding for uncompensated trauma care services.
- Preserve and enhance the state’s Driver Responsibility Program.
- Provide partial use of the state’s trauma funds for Medicaid inpatient and DSH payments to designated facilities for trauma and emergency care programs.
Health Information Technology (HIT)
- Advance the adoption of HIT standardization, including “meaningful use” standards, by:
- Revising outdated Stark and anti-kickback rules;
- Ensuring adequate funding for eligible physicians and hospitals;
- Supporting HITECH initiatives to improve health care quality, safety and efficiency through the promotion of HIT, including electronic health records and private, secure electronic health information exchange (HIE); and,
- Enhancing focus and funding for state and regional efforts related to HIT connectivity and interoperability.
Medical Liability and Tort Reform
- Protect state tort/compensation laws that provide fairness, predictability and efficiency in the civil justice system.
- Protect existing peer review and credentialing confidentiality provisions.
- Support industry efforts to strengthen and clarify the state’s Advance Directives Act by improving communication processes between health care providers, patients and family members in end-of-life care situations.
- Oppose efforts to mandate “treat until transfer” indefinitely.