implementing hipaa state budgets, elections, and policy priorities national association of health...
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Implementing HIPAAImplementing HIPAAState Budgets, Elections, and Policy PrioritiesState Budgets, Elections, and Policy Priorities
Implementing HIPAAImplementing HIPAAState Budgets, Elections, and Policy PrioritiesState Budgets, Elections, and Policy Priorities
National Association of Health Data OrganizationsNational Association of Health Data Organizations1717thth Annual Meeting Annual Meeting
Atlanta, GA Atlanta, GA • December 2-3• December 2-3, 2002 , 2002
Presented byPresented by
Robert J. BurnsRobert J. BurnsNGA Center for Best PracticesNGA Center for Best Practices
© 2002 National Governors Association© 2002 National Governors Association
State Budget OverviewState Budget Overview
States closed $37.2 billion budget gap during States closed $37.2 billion budget gap during FY2002FY2002– 46 states reported budget deficits46 states reported budget deficits– Revenues 1.2 percent less than expectedRevenues 1.2 percent less than expected– Spending 1.8 percent more than expectedSpending 1.8 percent more than expected
States face $49.1 billion budget gap going into States face $49.1 billion budget gap going into FY2003 (projections)FY2003 (projections)– 3.7 percent revenue growth (projected)3.7 percent revenue growth (projected)– 1.6 percent spending growth (projected)1.6 percent spending growth (projected)– Year-end balance will decline 3.7 percent (projected)Year-end balance will decline 3.7 percent (projected)
Source: National Conference of State Legislatures, August 2002
© 2002 National Governors Association© 2002 National Governors Association
Revenue EnhancementsRevenue Enhancements
During During FY2002FY2002
IntoInto
FY2003FY2003
Budget cutsBudget cuts 29 states29 states 26 states26 states
Other state reservesOther state reserves 20 states20 states 23 states23 states
Tobacco settlement fundsTobacco settlement funds 12 states12 states 16 states16 states
TaxesTaxes 16 states16 states 16 states16 states
Rainy day fundsRainy day funds 19 states19 states 12 states12 states
Other feesOther fees 13 states13 states 10 states10 statesSource: National Conference of State Legislatures, August 2002
© 2002 National Governors Association© 2002 National Governors Association
Gubernatorial Elections 2002Gubernatorial Elections 2002
36 governorships up for election36 governorships up for election– 14 term limited14 term limited– 6 voluntary withdrawals6 voluntary withdrawals– 16 incumbent challenges16 incumbent challenges
11 incumbents returning11 incumbents returning
24 new Governors assuming office24 new Governors assuming office– Party changes in 20 statesParty changes in 20 states
© 2002 National Governors Association© 2002 National Governors Association
Gubernatorial ChangeoversGubernatorial Changeovers(even years only)(even years only)
20022002 2525
20002000 77
19981998 1414
19961996 55
19941994 2121
19921992 1111
19901990 1818
19881988 66
19861986 2222
19841984 1111
19821982 1818
Source: National Governors Association, November 2002
© 2002 National Governors Association© 2002 National Governors Association
“ “The chief executive of a state today holds The chief executive of a state today holds more power and sway over the public more power and sway over the public purse and policy—and likely presents purse and policy—and likely presents more of a leadership profile in the state more of a leadership profile in the state than any other office holder other than the than any other office holder other than the President.”President.”
Ray SheppachRay SheppachExecutive DirectorExecutive Director
National Governors AssociationNational Governors Association
© 2002 National Governors Association© 2002 National Governors Association
Gubernatorial PowersGubernatorial Powers(that do not require legislative approval)(that do not require legislative approval)
Submit the state budgetSubmit the state budget– Establish policy prioritiesEstablish policy priorities– Set spending targetsSet spending targets
Veto components of legislative budgetVeto components of legislative budget– AppropriationsAppropriations– Selected wordsSelected words– Change meaningChange meaning– Line itemLine item
Cut the budgetCut the budget
Reorganize departmentsReorganize departments
Spend unanticipated federal fundsSpend unanticipated federal funds
© 2002 National Governors Association© 2002 National Governors Association
ImplicationsImplications
New prioritiesNew priorities
Energy, enthusiasm, personalityEnergy, enthusiasm, personality– Relationship with the publicRelationship with the public– Relationship with legislatureRelationship with legislature
New appointeesNew appointees– Commissioners, deputies, senior staffersCommissioners, deputies, senior staffers– Administer the Governor’s policiesAdminister the Governor’s policies– Advance the Governor’s issuesAdvance the Governor’s issues
© 2002 National Governors Association© 2002 National Governors Association
Top Campaign PrioritiesTop Campaign Priorities(Governors-Elect)(Governors-Elect)
Fostering economic Fostering economic recovery (balancing recovery (balancing state budgets)state budgets)
Bolstering homeland Bolstering homeland securitysecurity
Maintaining education Maintaining education initiativesinitiatives
Containing health Containing health care costscare costs
© 2002 National Governors Association© 2002 National Governors Association
Top Health PrioritiesTop Health Priorities(Governors-Elect)(Governors-Elect)
Containing pharmaceutical costsContaining pharmaceutical costs
Leveraging Medicaid and SCHIPLeveraging Medicaid and SCHIP
Bolstering the health care Bolstering the health care workforceworkforce
Financing long-term careFinancing long-term care
© 2002 National Governors Association© 2002 National Governors Association
Why Still “Emerging?”Why Still “Emerging?”
Legally ComplexLegally Complex– PrivacyPrivacy– New terms and New terms and
interpretationsinterpretations
Technically ComplexTechnically Complex– Electronic transactionsElectronic transactions– Electronic data interchangeElectronic data interchange
Poor GuidancePoor Guidance– Staggered rule makingStaggered rule making– No arbitration processNo arbitration process– No validationNo validation
© 2002 National Governors Association© 2002 National Governors Association
Regulation StatusRegulation StatusProposedProposed
RuleRule
FinalFinal
RuleRule
Compliance Compliance DeadlineDeadline††
PrivacyPrivacy 11/9911/99 8/028/02‡‡ 4/034/03
SecuritySecurity 8/988/98 —— ——
Transactions and CodesTransactions and Codes 5/985/98 10/0010/00 10/0210/02**
National Provider IdentifierNational Provider Identifier 5/985/98 —— ——
Health Plan IdentifierHealth Plan Identifier —— —— ——
Employer IdentifierEmployer Identifier 6/986/98 7/027/02 7/047/04
EnforcementEnforcement —— —— ——†† Small health plans have one additional year following this date to be compliant.Small health plans have one additional year following this date to be compliant.‡‡ HHS proposed modifications to the privacy rule on March 27, 2002. The modifications were finalized on August 14, 2002. HHS proposed modifications to the privacy rule on March 27, 2002. The modifications were finalized on August 14, 2002. The compliance deadline will not change. The compliance deadline will not change.** The compliance deadline may be extended by one year if a compliance plan is submitted to HHS before October 16, The compliance deadline may be extended by one year if a compliance plan is submitted to HHS before October 16, 2002. Small health plans are not eligible for the conditional extension.2002. Small health plans are not eligible for the conditional extension.
© 2002 National Governors Association© 2002 National Governors Association
Community-based providers Community-based providers (“safety net”)(“safety net”)
Public hospitals/clinicsPublic hospitals/clinics
Mental health facilitiesMental health facilities
Substance abuse treatment Substance abuse treatment centerscenters
State/local health State/local health departmentsdepartments
Academic medical/research Academic medical/research centerscenters
Organ donation programsOrgan donation programs
Law enforcement and corrections Law enforcement and corrections (coroners, medical examiners)(coroners, medical examiners)
TANF-funded programsTANF-funded programs
MCH programs (Title V)MCH programs (Title V)
School-based health programs School-based health programs (immunizations, dental)(immunizations, dental)
HIV/AIDS (“Ryan White”)HIV/AIDS (“Ryan White”)
State employee benefitsState employee benefits
Worker’s compensationWorker’s compensation
State technology authoritiesState technology authorities
Health policy officesHealth policy offices
The Ripple EffectThe Ripple Effect(Covered Entities vs. Affected Entities)(Covered Entities vs. Affected Entities)
© 2002 National Governors Association© 2002 National Governors Association
Prioritizing HIPAAPrioritizing HIPAA
What does a Governor really need to know aboutWhat does a Governor really need to know aboutHIPAA implementation?HIPAA implementation?
Worsening the budget situationWorsening the budget situation
Impeding access to health careImpeding access to health care
Affecting the quality of careAffecting the quality of care
Threatening provider solvencyThreatening provider solvency
Impairing state-level program administrationImpairing state-level program administration
Hindering ability to make good policy decisionsHindering ability to make good policy decisions
© 2002 National Governors Association© 2002 National Governors Association
RecommendationsRecommendations
Get to know the new Governor’s staffGet to know the new Governor’s staff
Get to know the new Governor’s prioritiesGet to know the new Governor’s priorities
Offer solutionsOffer solutions– Be practical (political, fiscal reality)Be practical (political, fiscal reality)– Build consensusBuild consensus– Identify resourcesIdentify resources
Learn to speak the languageLearn to speak the language
© 2002 National Governors Association© 2002 National Governors Association
NGA Center for Best PracticesNGA Center for Best Practices((http://www.nga.org/centerhttp://www.nga.org/center))
Robert J. BurnsRobert J. BurnsPolicy AnalystPolicy AnalystHealth Policy Studies DivisionHealth Policy Studies Division
National Governors AssociationNational Governors AssociationCenter for Best PracticesCenter for Best Practices
Hall of States, Suite 267Hall of States, Suite 267444 North Capitol Street, NW444 North Capitol Street, NWWashington, DC 20001-1512Washington, DC 20001-1512
(202) 624-7729(202) 624-7729fax: (202) 624-5313fax: (202) 624-5313email: email: rburns@nga.orgrburns@nga.org
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