President's ReportWashington UpdateAHA Webinar Feb 15 on Safe Workplace CulturePhysician RecruitmentSpecial AHA Webcast Feb 6 on Ensuring AccessCMS Proposes MA, Part D Payment & Policy Changes for 2018340B Omnibus Guidance WithdrawnNDHA Education Update2017 National Rural EMS & Care Conference

Click on link to view attachments:https://www.ndha.org/resources/publications/

Phone: 701-224-9732Fax: 701-224-9529Web Site: www.ndha.org

Jerry Jurena, PresidentTim Blasl, Vice PresidentCallen Cermak, Finance ManagerLori Schmautz, Executive AssistantPam Cook, Education DirectorMelissa Hauer, General Counsel

A portion of this publication is supported by The Center for Rural Health’s Medicare Rural Hospital Flexibility Program. Visit their site at http://rural-health.und.edu/projects/flex/.

The InformerPresident’s Report ~ Jerry Jurena

In This Edition:

Attachments:

NDHA Contacts

February 3, 2017

Hospital Day: I want to say Thank you. From the comments I have received this week Hospital Day at the Capitol 2017 was huge success.

Wednesday through Friday as I walked the Capitol attending hearings or floor ses-sions I heard many comments such as: “my administrator came to talk to me or I had lunch with my CEO”. Many of the legislators said that they were supportive of Med-icaid Expansion; the only issue was coming up with the funds to pay for it. The next comment from many of the legislators was that they will work to find those funds. I also heard from many of you and there was 31 hospitals attending that you also heard that your legislators were supportive of Medicaid Expansion. Again thank you for coming and telling your story.

Not only did I hear about maintaining Medicaid Expansion but I heard comments on hiring a qualified workforce and the continuation of the loan program for health care professionals. Behavioral/mental health was discussed, as was the opioid crisis. From my perspective it was a very successful day. We need to keep that momentum moving forward. As a result of your discussions, I have been asked for additional in-formation. Some of the information requested is covered in the “Pulse” which was passed out to legislators on Monday.

I also want to thank Lori and Pam. A lot of work went into organizing and putting the day together. I received compliments on the lunch and the information that was laid out. It was a busy day with hearings and you made it a success. Thank you to Lori, Pam, Tim, Melissa and those that attended.

Direct Supervision: This past week Senators John Thune (R-SD) and Heidi Heitkamp (D-ND); and Representatives Lynn Jenkins (R-KS), Dave Loebsack (D-IA) and Adrian Smith (R-NE) introduced legislation to permanently extend the moratorium on “di-rect supervision”. S. 243 and H.R.741 will permanently extend the moratorium on outpatient therapeutic services for critical access hospitals and small, rural hospitals with 100 or fewer beds.

Please send a note to Senator Heitkamp thanking her for doing this.

IRS Phishing scheme: The Internal Revenue Service yesterday alerted payroll and human resources professionals to beware of a continuing phishing email scheme that alleges to be from company executives and requests W-2 forms and personal information on employees. “This is one of the most dangerous email phishing scams we’ve seen in a long time,” said IRS Commissioner John Koskinen. “It can result in the large-scale theft of sensitive data that criminals can use to commit various crimes, including filing fraudulent tax returns.” For more information on the phishing emails, see the news release.

Click logo to open Bill Tracking Update

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 The Trump whirlwind continued this week in Washington with a series of executive orders and tweets. Fortunately, the health care world was quieter.

Sen. Heitkamp and Sen. John Thune (R-SD) introduced legislation that would permanently suspend enforcement of supervision rules governing outpatient therapeutic services. Companion legislation has been introduced in the House of Representatives. We have already asked Sen. Hoeven and Rep. Cramer to co-sponsor these bills.

It’s especially difficult this year to identify a path for bills like the supervision moratorium. The ACA effort has sucked all the oxygen out of the halls of Congress, so how we move other pieces of our legislative agenda forward is unclear. But we will keep pressing ahead.

Meanwhile, the schedule for ACA action continues to slip, reflecting a significant shift in the tone and substance of the debate in Congress. A month ago, it seemed Congress was on a course to repeal the ACA immediately and replace it later. Members now are beginning to talk about repairing or rebuilding the health care system. All this means it looks like early April before the full House could vote on a package.

There is also an emerging political divide between Senate Republican moderates who argue for a go-slow approach, and House conservatives want a vote now on repeal. Finding consensus on a proposal that bridges this divide has been elusive.

Several elements of a repeal plan are surfacing. They include:

• No individual, employer mandate; • Incentives to encourage coverage, including some sort of premium subsidy and potentially penalties for not getting coverage; • High deductible insurance plans coupled with health savings accounts and tax credits for investing in HSAs; • High risk pools for persons with pre-existing conditions and the sickest patients; • Elimination or reducing the ACA’s essential benefits requirements; • Transition Medicaid expansion to something else; • Converting Medicaid to a block grant or per capita cap program and giving states more flexibility in running their programs; and • Expanded insurance pooling allowing insurers to sell insurance across state lines.

However, the fundamental question remains: will these proposals ensure the same – or more – people are covered by health insurance and will they create a large enough insurance pool to support the ACA’s insurance reforms.

The House Energy and Commerce Health Subcommittee yesterday held the first meeting to discuss possible replacement bills, considering four insurance-related bills. They would like to move these through the process in the next few weeks so that they are in place when repeal legislation is passed.

The subcommittee action reflects the growing view that Republicans will not put forward one major ACA replacement bill, but will instead replace the law through a set of smaller measures.

The proposals would require patients to pre-verify their eligibility for special enrollment periods, allow states to reduce the grace period for subsidized coverage, revise the age-rating ratio and prohibit individual and group health plans from limiting or excluding benefits related to preexisting conditions if the ACA is repealed.

The hearing comes as lawmakers on both sides recognize the need to stabilize the insurance market. A Senate committee hearing this week considered the same topic and the Trump administration submitted a proposed rule aimed at stabilizing the ACA markets to the Office of Management and Budget. No details are publicly available about what’s in the CMS proposal.

Finally, Rep. Tom Price’s nomination for Secretary of Health and Human Services moved to the Senate floor this week. Democrats on the Finance Committee boycotted the panel’s vote on the nomination, forcing Republicans to alter the committee’s rules. The nomination could come up for a vote next week.

Washington Update ~ John Flink

AHA Webinar Feb. 15 on Promoting a Safe Workplace Culture The AHA’s Hospital Against Violence initiative and its American Society for Healthcare Risk Management will co-host a Feb. 15 webinar on practical strategies for promoting a safe workplace culture. For more information or to register for the 3 p.m. ET webinar, click here.

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Physician Recruitment ~ Kevin MaleeThe CV...What are we looking for?

The CV is our introduction to the candidate. Presentation is important and the CV should be easy to read and understand. However, outside of the candidate’s history; where they have been and what they have done, what else are we looking for in this document?

Where has the candidate trained and do we know any other providers who have trained in that program? Do we know the Program Director or any of the faculty currently or formerly at the program? Are there any gaps in the candidates training? Has our candidate moved several times in their career path? Is the candidate Board Certified, if not, why not? Look for leadership, character, community service, and professionalism, honors and awards or exemplary performance in their education and train-ing, for example; Chief Resident, presentations and publications and participation in professional Associations and Societies (i.e. AAFP or ACP) and finally what are their hobbies and interests. After reviewing a good CV, we should be excited to meet and visit with this candidate.

If I can assist you in your physician recruitment efforts, please contact me. I can be reached at northdakotarec@comcast.net or 701-320-2109

Special AHA Webcast Feb. 6 on Ensuring Access AHA President and CEO Rick Pollack will host a live webcast Monday, Feb. 6, from the Rural Health Care Leadership Conference in Phoenix. During the event, Pollack and members of the AHA’s Task Force on Ensuring Access in Vulnerable Communities will discuss the panel’s recent report on nine innovative strategies to preserve access to essential health services in vulnerable rural and urban communities and take questions from the audience and webcast participants. For more information and to participate at 11:45 a.m. ET, visit www.aha.org

CMS Proposes MA, Part D Payment and Policy Changes for 2018 The Centers for Medicare & Medicaid Services yesterday announced proposed changes to the Medicare Advantage and Part D prescription drug programs for calendar year 2018, which would increase payment rates by a net 0.25%. When combined with expected growth in plan risk scores, CMS anticipates the MA plans and Part D sponsors will see an average revenue increase of 2.75%. CMS proposes to use the same proportion of Risk Adjustment Processing System and encounter data for purposes of cal-culating risk adjustment as was used in 2017 and apply the minimum coding intensity adjustment allowable under federal law. CMS also proposes several changes to the Medicare Advantage Star Ratings program, the service category cost-sharing require-ments, and the drug utilization review controls. CMS will accept comments on the 2018 Advance Notice and Draft Call Letter through March 3, and expects to publish a final rate announcement and call letter on April 3.

340B Omnibus Guidance Withdrawn The administration yesterday withdrew the Health Resources and Services Administration’s pending omnibus guidance for the 340B Drug Pricing Program. “We are pleased that the Administration chose not to finalize the Health Resources and Services Administration’s guidance, which, if enacted would have jeopardized hospitals’ ability to serve vulnerable populations, including low-income and uninsured individuals and patients receiving cancer treatments,” said AHA Executive Vice President Tom Nick-els. AHA previously expressed strong concerns regarding HRSA’s proposed policy changes, stating that re-defining 340B patient eligibility would have narrowed inappropriately the number of drugs that qualify for 340B pricing and threatened access to care for patients who need it the most. In addition, AHA objected to HRSA’s proposals regarding infusion services, and urged that pa-tients receiving infusion services provided at 340B hospitals or their outpatient sites be allowed to continue to qualify for 340B drug discount pricing.

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NDHA is hosting the following webinars. The web site will be updated as webinars are added. You can register online by follow-ing this link: https://www.ndha.org/education/education-events/

It Won’t Happen to Us...Active Shooter in the Health Care Setting Date: 02/07/2017 From: 10:00 AM to 11:30 AM

CMS Hospital Improvement Act Proposed Changes Date: 02/13/2017 From: 9:00 AM to 11:00 AM Leadership Challengs: Medical Errors, Protecting Speaking Up... Date: 02/14/2017 From: 1:00 PM to 2:00 PM

Telemedicine in ND Date: 02/24/2017 From: 10:30 AM to 12:00 PM

Infant & Pediatric Abductions: The Unthinkable Nightmare Date: 03/20/2017 From: 9:00 AM to 11:00 AM

Leadership - Challenging Standards Date: 03/21/2017 From: 10:00 AM to 11:30 AM

Understanding the Peer Review and Performance Improvement Process Date: 03/30/2017 From: 10:00 AM to 11:30 AM

NDHA Education Update

2017 National Rural EMS & Care Conference The National Rural EMS & Care Conference has a compelling agenda planned that you don’t want to miss! The conference will take place in Fargo, North Dakota on April 25-26, 2017.

Invited attendees include rural EMS directors, medical directors and officers, rural health care providers, state EMS officials, state rural health officials, hospital administrators, elected officials, federal agency officials, and other interested parties.

Attendees will learn about the future of rural EMS and hospital collaboration, making data useful, EMS providers’ role in rural population health, an active shooter program, how future technology will help rural EMS, national rural policy changes and their local impact, and more. Please view agenda here.

New this year: NOSORH is offering a 4-hour EMS Grant Writing 101 Workshop! Rural EMS agencies and other interested part-ners will learn how to write and submit a complete grant proposal, understand rural relevant data important to EMS and identify funding opportunities. This workshop will be held on Monday, April 24, 2017. Please view agenda here.

Also new this year is the National Rural EMS Poster Contest. Please click here for more information about the criteria, how to submit, voting procedures, and best of all, the cash prizes!

Registration for both the National Rural EMS Conference and NOSORH EMS Grant Writing 101 is open, click here.

The conference is being held at the Holiday Inn Fargo, 3803 13th Avenue South, Fargo, ND 58103. Call (877) 282-2700 and refer-ence National Rural EMS Conference. Book soon, the deadline for hotel reservations is March 21, 2017!

Vendors are welcome! Click here for more information.

For more information visit our website or contact: Matt Strycker Paige Law(888) 391-7258 x102 (888) 391-7258x101stryckerm@nosorh.org paigel@nosorh.org