IHA Daily Briefing: March 8

Governor Signs SB 1469: Healthcare Omnibus Bill
Step Up Opposition to Nurse Staffing Ratios
IHA Board Focuses on Short- & Long-Term Challenges
AHA Comments on Unified Payment System

Governor Signs SB 1469: Healthcare Omnibus Bill
Late this morning at Ferrell Hospital in Eldorado, Gov. J.B. Pritzker signed Senate Bill (SB)1469 (PA 100-1181) the healthcare omnibus legislation strongly backed by IHA.  The new law includes technical corrections to address an implementation issue on Critical Access Hospital rates in the redesigned Hospital Assessment Program; a clarification to maintain nonprofit hospital sales tax exemptions; an extension of the rule submission deadline for the Hospital Transformation Program; and an extension of requirements concerning DCFS Youth-in-Care beyond medical necessity.

“Today, we are taking a step to cement my commitment to ensure that families across Illinois have access to quality, affordable health care by strengthening critical access hospitals,” said Gov. Pritzker. “Health care is a right, not a privilege. Your income or your zip code should never dictate your access to that right. Critical access hospitals are on the frontlines of our work to provide quality health care in all of our communities.”

We greatly appreciate the Governor’s support of this critical legislation and the leadership of the bill’s sponsors, House Majority Leader Greg Harris and Senator Heather Steans, and key Republican legislators Senator Dave Syverson and Representative Tom Demmer, who worked together on this bi-partisan effort.  The Illinois General Assembly overwhelmingly passed the bill during the Veto Session last November (the Senate passed the bill 53-0; the House 107-0).

At the signing ceremony, Ferrell Hospital CEO Alisa Coleman and Pana Community Hospital President and CEO Trina Casner, who is also Chair of IHA’s Small and Rural Hospitals Constituency Section, thanked the Governor and legislators for their support of Critical Access Hospitals and rural healthcare in Illinois.

“Senate Bill 1469 includes a $55 million correction in payments to Critical Access Hospitals so they can continue to ensure access to healthcare for our local residents,” said Coleman. “In many communities across the state, Critical Access Hospitals are the only providers of health services in those areas. They are also critical to the economic health of our communities.”

“Critical Access Hospitals, and small and rural hospitals in general, face some unique challenges,” said Casner. “We care for a greater percentage of the state’s elderly citizens, and we are much more reliant on government. But every day, our hospitals, like Pana and Ferrell, meet these and many other challenges, and we do everything we can in rural areas across the state as vital healthcare providers and economic hubs of our communities.”

See IHA’s summary memo and the Governor’s statement. See photos of the signing here.

Step Up Opposition to Nurse Staffing Ratios
IHA appreciates the outstanding response of members to our advocacy alerts to oppose mandatory nurse staffing ratios legislation. So far, members have sent more than 1,300 emails to legislators and filed more than 700 electronic witness slips opposing one of the bills, House Bill 2604.  Thank you for your support.

But our fight is far from over.  National Nurses United, the powerful union that successfully pushed for nurse staffing ratios in California, is now backing House Bill 3585.  This union has been texting direct care nurses across the state, urging them to support the bill.  This bill is the most egregious and harmful of all the staffing ratio bills that have been introduced, with even more restrictive ratios than California's.

Both House Bills 3585 and 2064 will be heard in the Illinois House Labor & Commerce Committee on Wed., March 13. It is more critical than ever that we keep working to oppose these bills. We urge members to:

  1. Contact your state Representatives now and urge them to oppose House Bills 2604 and 3585. Also, engage your direct care nursing staff and urge them to contact their local state legislators to oppose these harmful bills. You and your staff can easily send emails to state representatives.
  2. Take a minute to submit electronic witness slips to the House Labor & Commerce Committee opposing HB 3585 and HB 2604.  Be sure to check the "Opponent" circle in the "Position" section and "Record of Appearance Only" in the "Testimony" section. Encourage your direct care nursing staff to fill out witness slips to oppose House Bills 3585 and 2604 and indicate in "Title" in the "Identification" section that they are a direct care nurse (or type in their actual nursing title). Opposition slips from direct care nurses will be especially impactful.
See IHA's Fact Sheet and Advocacy Alert.

IHA Board Focuses on Short- & Long-Term Challenges
The IHA Board of Trustees today engaged in a thorough review and discussion of several major issues and challenges facing the hospital community this spring and longer-term.

Regarding IHA's top legislative priorities this session, IHA President A.J. Wilhelmi characterized the Association playing “offense” on Medicaid managed care reform legislation and “defense” in opposing mandatory nurse staffing ratios. Wilhelmi and David Gross, Senior Vice President, Government Relations, noted that members have stepped up to contact their legislators, but they need to keep up the pressure because these issues will not be easily resolved.  (See above story for IHA’s latest call to action on the nurse staffing ratios issue; and an advocacy alert on IHA’s Medicaid managed care reform legislative package.)

The Board discussed possible approaches in the current state legislative session for seeking hospital funding from a major capital program, which would be the state’s first such program since 2009. The Board agreed that IHA should attempt to connect hospital capital funding to healthcare delivery transformation to address areas of greatest need and maximum impact.

Looking ahead, the Board had a wide ranging discussion about possible options for Phase 2 of the Hospital Assessment Program, which is scheduled to go into effect in July 2020.

On the federal level, the Board received a detailed update from Sarah Macchiarola, Vice President, Federal Relations on key hospital issues in Congress. They include price transparency, “surprise billing,” prescription drug prices, and “Medicare-for-All.”

The Board also received a “scorecard” on IHA's performance against our 2018 strategic priorities. Tim Nuding, Vice President, Member Services and Corporate Finance, said IHA accomplished the vast majority of its goals and barely missed on some others. Among the accomplishments were: the redesigned Hospital Assessment program; no Medicaid funding cuts; new telehealth reimbursements; the upholding of the constitutionality of the state’s nonprofit hospital tax-exemption law; a five-year extension of tax credits for Investor-Owned hospitals; setting the groundwork for addressing key Medicaid managed care challenges; the restructuring of the Association’s Chicago office that generated substantial savings; and exceeding budget and financial targets.

AHA Comments on Unified Payment System
Last month, AHA responded to questions related to the development of a unified post-acute care prospective payment system. The Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act) requires the development of a post-acute care payment model that would consolidate the four existing payment models—inpatient rehabilitation, inpatient skilled nursing, inpatient long-term acute care and home health—into one.

In its letter, AHA offers three recommendations for policymakers regarding this new payment model:

  • Prevent any additional changes that can threaten care for post-acute care patients;
  • Provide a stable environment to implement the complex regulations already in process; and
  • Allow evaluation of the impact of payment reform to guide future enhancements.

RTI International is developing this unified post-acute care prospective payment system model for the Centers for Medicare & Medicaid Services and scheduled to present it to Congress in 2022. The Medicare Payment Advisory Commission (MedPAC) in several of its previous meetings, has also recommended that a consolidated payment model for post-acute care services be implemented, and will present its model to Congress in 2023.