implementing hipaa state budgets, elections, and policy priorities national association of health...

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


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


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


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


“ “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


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


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


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


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


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


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.


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)


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


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


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: [email protected]@nga.org

implementing hipaa state budgets, elections, and policy priorities national association of health...

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