Government Relations Update – November 30, 2010

State Issues

Legislation

• H.B. 1482 (Act 110 of 2010): Health Care Worker Identification. On November 23, 2010, Governor Rendell signed a bill into law requiring health care workers to display photo identification in all patient settings. The new law requires home health workers to follow the same photo identification requirements as hospital employees. As previously reported, Representative Mann (D-Lehigh) served as prime sponsor for the bill, and Representatives Beyer (R-Lehigh, Northampton ), Brennan (D-Lehigh, Northampton ), Freeman (D-Northampton), Harhart (R-Lehigh, Northampton ) and Reichley (R-Berks, Lehigh) served as co-sponsors. HAP supported the bill because it is consistent with existing hospital regulations and because HAP believes that the bill protects patients receiving home treatments.
• H.B. 2521 (Act 121 of 2010): Anatomical Pathology Services. As reported previously, the House passed a bill on May 19, 2010 requiring health care providers who order but do not perform anatomic pathology services to disclose to each patient or payer the actual cost of the services. On October 12, 2010, the Senate amended the bill to exempt hospitals and only include pathology services ordered by a physician. On November 15, 2010, the House concurred with the Senate amendment. On November 23, 2010, Governor Rendell signed the bill into law. St. Luke’s Hospital & Health Network assisted HAP in amending the bill to exempt hospitals from these requirements. Representative Day (R-Berks, Lehigh) served as a co-sponsor of the bill.

Miscellaneous

• House Democratic Reorganization: On November 16, 2010, House Democrats reorganized and elected new members to leadership. Representative Frank Dermody (D-Allegheny) was elected to serve as the House Minority Leader. He replaces Representative Todd Eachus (D-Luzerne), who lost his reelection bid. Although Representative Jennifer Mann (D-Lehigh) originally sought the House Minority Whip position, she was elected instead to serve as the Minority Caucus Secretary. All positions will take effect on December 1, 2010, and all new and returning members will be sworn into office on January 4, 2011.
• Senate Reorganization: On November 17, 2010, Senate Republicans and Democrats elected new leaders for the 2011-2012 legislative session. Republican Senator Joe Scarnati (R-Jefferson) was elected to serve a second term as President Pro Tempore. All other Republican leadership positions remained the same, except that Senator Pat Browne (R-Lehigh, Monroe , Northampton ) was elected Majority Whip. The Majority Whip is considered the fourth-ranking leadership post in the Senate Republican caucus and is responsible for building support among party members on key issues. The position was previously held by Senator Jane Orie (R-Allegheny, Butler ), who resigned from the position on April 7, 2010 after being arrested on charges of using taxpayer money for political purposes. Senate Democrats elected Senator Jay Costa (D-Allegheny) as the Minority Leader. Senator Lisa Boscola (D-Lehigh, Monroe , Northampton ) was elected for the first time to a leadership position and will serve as the Minority Caucus Administrator. Senator Boscola replaces Senator Christine Tartaglione (D-Philadelphia), who was elected Caucus Secretary. As Minority Caucus Administrator, Senator Boscola will be responsible for caucus scheduling and policy negotiations.

Federal Issues

Advocacy

• 2011 Medicare Physician Fee Schedule: On November 18, 2010, the Senate unanimously passed a bill to avert for one month the 23% decrease in Medicare physician payments otherwise scheduled for December 1, 2010. Senate leaders assert that the delay will provide sufficient time to develop a year-long solution. On November 29, 2010, the House passed the bill, and the President is expected to sign the bill into law before the scheduled payment reductions take place. Without legislative action prior to January 1, 2011, St. Luke’s will experience an estimated annual payment reduction of $6.2 million.
• Patient Visitation Rights: On November 17, 2010, the Centers for Medicare & Medicaid Services (CMS) issued a final rule regarding patient visitation rights. The rule forbids hospitals from disallowing visitors on the basis of race, color, national origin, religion, sex, sexual orientation, gender identity or disability. The new patient visitation regulations allow patients to decide whom to allow as visitors, including a same-sex domestic partner. Hospitals will be required to have written policies and procedures that explain patients’ visitation rights, as well as the circumstances under which a facility can deny a visitor for clinical reasons. The rule is in response to President Obama’s directive that CMS-participating hospitals develop new visitation standards that respect the rights of all patients to choose their visitors. The rule becomes effective in 60 days. HAP is reviewing the rule and will provide additional guidance to members.
• Center for Medicare and Medicaid Innovation (CMMI): In accordance with regulations adopted pursuant to the Patient Protection and Affordable Care Act (PPACA), CMS established the CMS Innovation Center (CMMI) on November 17, 2010. Under the direction of Acting Director Dr. Richard Gilfillan, CMMI will be responsible for developing innovative health care delivery models intended to slow the growth of Medicare and Medicaid costs while improving quality. CMMI will review accountable care organizations and payment bundling, with the goal of finding models that reward physicians and hospitals for quality rather than volume. Dr. Gilfillan is a former family practice physician who previously served as President & Chief Executive Officer of the Geisinger Health Plan from 2005 to 2009. From 2001 to 2005, he served as Senior Vice President for National Network Management of Coventry Health Care. From 1989 to 2000, he held various positions at Independence Blue Cross. CMS has already announced several demonstration projects to be managed by CMMI, including the Multi-Payer Advanced Primary Care Practice Demonstration. Under this demonstration, CMS will participate in multi-payer reform initiatives that are currently being conducted by states to make advanced primary care practices more broadly available. The demonstration will evaluate whether these advanced primary care practices will reduce unjustified utilization and expenditures, improve the safety, effectiveness, timeliness and efficiency of health care, increase patient decision-making and increase the availability and delivery of care in underserved areas. In order to be chosen for the demonstration, states were required to validate that their reform initiatives reduced costs by increasing primary care resources. On November 20, 2010, Pennsylvania was selected as one of eight states to participate in the demonstration. The three-year demonstration project will expand Pennsylvania ’s Chronic Care Initiative (CCI), which assists more than 150 primary care practices and provides treatment for patients with chronic diseases such as diabetes, asthma and congestive heart failure. In the CCI, practices learn to use electronic disease registries to identify patients who have skipped appointments or are not improving and to monitor progress on key clinical outcome measures. Support staffs learn to work as a team to make sure patients receive lab tests, specialist care and referrals to community agencies while also helping patients learn how to better manage their own health. These steps are intended to result in fewer hospitalizations and emergency room visits. Pennsylvania ’s commercial health insurers and Medicaid have contributed $30 million since 2008 to compensate practices for the extra costs of adding care managers and gaining recognition as a Patient Centered Medical Home. Practices will have the opportunity to receive additional payments if their efforts result in overall health care savings. The demonstration through CMMI is scheduled to begin in 2011 and will be managed through the Governor’s Office of Health Care Reform. HAP will provide more details as they become available.
• Constitutional Challenges to PPACA: The United States Supreme Court has held that the commerce clause of the Constitution allows Congress to regulate “activities that substantially affect interstate commerce.” There are nearly two dozen legal challenges to PPACA, and Federal district judges are now being forced to decide whether the failure to obtain insurance can be defined as an “activity.” Only one ruling has been made on the merits, when a federal district judge in Michigan upheld the law last month. In a separate district, Judge Henry E. Hudson of the Federal District Court in Richmond , Virginia promised to rule by the end of the year. Judge Hudson has written preliminary opinions that seemingly accept key arguments made by state officials challenging the law. Most commentators expect the issue will eventually be decided by the United States Supreme Court, but that decision could take two years. In the meantime, it is unclear how, or if, hospitals, states and insurance companies will implement PPACA if district court judges rule against the law in various districts.