IHA Daily Briefing: May 10

Friday, May 10, 2019
HFS Meetings Renew Integrated Health Home Planning
IHA Board Discusses Key State Issues
Trump Addresses Surprise Medical Bills
U.S. Rep. Schneider Introduces GME Bill
Briefly Noted

HFS Meetings Renew Integrated Health Home Planning
On May 9, the Illinois Department of Healthcare and Family Services (HFS) held two public meetings of the Medicaid Advisory Committee’s Waiver Advisory Subcommittee to discuss the future of Medicaid Integrated Health Homes (IHHs). HFS plans to gather stakeholder feedback to influence a new IHH application, which the agency would like to submit via two State Plan Amendments by Oct. 1, 2019, followed by a full IHH program rollout on Jan. 1, 2020. Plans for IHH application submission and provider training will be forthcoming.

HFS stated it will be seeking input as they revise the proposal and will be taking into consideration the numerous comments received.  HFS is proposing greater flexibility by allowing IHHs to serve either the adult or child population, shifting from a proposed requirement under the previous administration that mandated an IHH serve all age groups, noted on the state website for Integrated Health Homes. Kristine Herman, Chief, Bureau of Behavioral Health, HFS, noted that agency staff had looked to Oklahoma’s IHH model in approaching this new planning initiative in Illinois, which can be found here. Oklahoma does not have Medicaid managed care, so that variable will be different in the Illinois IHH model.

Details regarding the IHH relationship to Medicaid managed care organizations, algorithm criteria to place beneficiaries into specific Tiers, reimbursement rates, outcome measures and incentives, required staffing ratios, and process requirements have not yet been established. These details will be influenced by feedback from the Illinois Medicaid Advisory Committee’s Waiver Advisory Subcommittee and the Centers for Medicare & Medicaid Services.


IHA Board Discusses Key State Issues
With the General Assembly scheduled to adjourn just three weeks from today, the IHA Board of Trustees focused on several major state legislative issues of critical importance to the hospital community with an in-depth review and robust discussion at its meeting in Naperville today. Key issues included the state budget/Medicaid funding, Medicaid managed care organization (MCO) reforms, nurse staffing ratios, a hospital capital program and potential changes to the Certificate of Need Program.

In order to ensure full funding of the Medicaid program in the fiscal year 2020 state budget, IHA is supporting a $1-per-pack increase in the cigarette tax and tax increases on other tobacco products, as well as a tax on insurers/MCO assessment.  Without those revenues, state programs, including Medicaid, could face cuts of 4% to 6%.

IHA continues to aggressively push for needed Medicaid managed care reforms.  Priority issues for IHA include: payment for stays beyond medical necessity; uniform provider roster effective dates; standard medical necessity guidelines; third party arbitration; expedited payments; timely interest payment penalty; and payout/medical loss ratios.  The legislative Medicaid Work Group is now drafting a bill on potential reforms.

The IHA Board also received an update on the battle over mandatory nurse staffing ratios, with IHA members continuing to be actively engaged.  Members have sent legislators more than 5,800 emails and filed more than 1,600 witness slips opposing House Bill 2604.  IHA has offered a compromise proposal that would strengthen the state’s existing Nurse Staffing by Patient Acuity Act, but so far supporters of ratios have not agreed to it.

As part of its push for a $500 million Hospital Transformation Capital Program, IHA has joined the Build Up Illinois Coalition of healthcare, primary and higher education and trade unions in support of “vertical” construction (i.e., buildings). It is not clear yet whether the General Assembly will act on legislation for a state capital program by May 31 or if this work will carry over into the summer.

The Board learned that the issue of potential changes to the Certificate of Need Program – including revised requirements for closing a hospital or service line as well as changes of ownership – is up in the air, with several possible scenarios.

The IHA Board also had an extensive discussion on a looming federal issue – surprise medical bills – that President Trump focused on at a White House event Thursday (see story below), as well as an issue that is expected to resurface in Chicago when new Mayor Lori Lightfoot and the new City Council take office on May 20, namely a proposed restrictive scheduling ordinance strongly opposed by IHA.

Finally, the Board recognized Senior Vice President and General Counsel Mark Deaton, who is retiring at the end of this month. IHA Board Chair Mary Starmann-Harrison and IHA President and CEO A.J. Wilhelmi presented Mark with a proclamation and thanked him for his dedicated leadership, wise counsel, and service to the Association, staff and members during his 35-year career with the Association.


Trump Addresses Surprise Medical Bills
President Trump released a set of principles yesterday that he wants Congress to use to draft legislation to protect patients from receiving surprise medical bills.  
The principles include preventing providers from balance billing patients for care not covered (out-of-network) by their insurer in emergency situations; providing patients with a written estimate of their out-of-pocket cost prior to receiving non-emergency facility-based care and information regarding the network status of all providers; and preventing out-of-network physicians from separately billing patients for care provided in an in-network hospital by requiring a single hospital bill covering all providers regardless of whether physicians are out-of-network.
Congress continues to work on legislation to protect patients from surprise medical bills, and the American Hospital Association released a set of principles to help inform the ongoing federal policy debate.


U.S. Rep. Schneider Introduces GME Bill
U.S. Rep. Brad Schneider (IL-10) introduced the IHA-supported Opioid Workforce Treatment Act of 2018 (H.R. 2439), which seeks to help alleviate the shortage of substance use disorder (SUD) treatment providers by increasing the number of Medicare-supported graduate medical education (GME) positions in teaching hospitals with certain approved programs.

"Your legislation would help address this workforce shortage by adding 500 Medicare-supported GME slots in 2021, and a total of 500 additional slots over the next for four years to be allocated to teaching hospitals with approved programs in addiction medicine, addiction psychiatry or pain management," wrote IHA President and CEO A.J. Wilhelmi in a letter to Rep. Schneider.  

More than 6,000 medical residents and fellows train in Illinois' Academic Medical Centers and teaching hospitals, making Illinois among the leading states in training tomorrow's physician workforce. At the same time, the U.S. continues to face a critical shortage of physicians, especially in medically underserved areas and in high-need specialties, such as those with training to treat SUDs. Access to addiction treatment has reached a critical juncture: opioid-related overdose deaths have increased by more than 70% over a three-year period in Illinois.

In addition to H.R. 2439, IHA strongly supports the Resident Physician Shortage Reduction Act of 2019 (H.R. 1763/S. 348), of which Rep. Rodney Davis (IL-13) is an original cosponsor. The bill would increase the number of Medicare-supported physician residency positions by 15,000 over five years.
"A sufficient number of physicians is vital to our healthcare infrastructure and workforce, and if we do not address this impending workforce shortage, all patients, including pediatric and geriatric, will find it difficult to access the care they need," said Wilhelmi.


Briefly Noted
IHA has developed a video featuring nurses and quality leaders expressing their opposition to mandatory nurse staffing ratio legislation House Bill (HB) 2604. Members are encouraged to share this video as part of our joint work to educate legislators on the harmful consequences of HB 2604 (or any other legislative proposal calling for mandatory nurse staffing ratios) for patients and families.

Becker's Hospital Review recently released its list of 67 Critical Access Hospitals (CAH) to Know which include the following Illinois CAHs: Abraham Lincoln Memorial Hospital, Lincoln; Hammond-Henry Hospital, Geneseo; OSF HealthCare Holy Family Medical Center, Monmouth; OSF HealthCare Saint Paul Medical Center, Mendota; and Wabash General Hospital, Mount Carmel.