The document discusses the impacts of the Affordable Care Act (ACA) on rural America. It provides background on the National Rural Health Association and their role advocating for rural issues. It then summarizes the legal challenges to the ACA and the Supreme Court ruling in 2012 that upheld the individual mandate while limiting Medicaid expansion. The ruling determined Congress can use taxing powers to influence state programs but cannot take away all existing Medicaid funding from states that do not comply with the ACA's Medicaid provisions.
The document discusses the 2013 United States debt ceiling crisis. It provides background on the debt ceiling and defines it as the maximum amount of money the US can borrow. It describes the political debate between Republicans who wanted spending cuts in exchange for raising the ceiling, and Democrats who argued the ceiling should be raised without conditions. The crisis began in January 2013 and ended in October when a short term deal was passed, though the debate around spending and long term budget solutions continued.
MTBiz is for you if you are looking for contemporary information on business, economy and especially on banking industry of Bangladesh. You would also find periodical information on Global Economy and Commodity Markets.
Signature content of MTBiz is its Article of the Month (AoM), as depicted on Cover Page of each issue, with featured focus on different issues that fall into the wide definition of Market, Business, Organization and Leadership. The AoM also covers areas on Innovation, Central Banking, Monetary Policy, National Budget, Economic Depression or Growth and Capital Market. Scale of coverage of the AoM both, global and local subject to each issue.
MTBiz is a monthly Market Review produced and distributed by Group R&D, MTB since 2009.
Capital Thinking Update Special Edition - The Budget Control Act of 2011Patton Boggs LLP
The Budget Control Act establishes spending caps and a process for raising the debt ceiling. It creates a Joint Select Committee to find $1.2-$1.5 trillion in deficit reduction by November 23rd. If the committee fails, automatic across-the-board cuts will occur. The Act sets FY2012 discretionary spending at $1.043 trillion and caps overall growth at 2% through FY2021. It defines security and nonsecurity spending and prevents cuts to the former from impacting the latter in FY2012-2013. The Act's implementation could impact future appropriations bills and public agencies.
The political will for health care reform remains strong according to Speaker of the House Nancy Pelosi. President Obama also urges Congress to continue its work on reform. There are several options under consideration for passing reform, including having the House pass the Senate bill and agreeing to changes through reconciliation. Reconciliation could allow passage with a 51 vote majority in the Senate. Additionally, guidance on implementing the 2008 Mental Health Parity and Addiction Equity Act was released, applying to employer plans of 50 or more employees. The interim final rule provides details on compliance.
House Members return to their districts this week while the Senate will not convene until January 21 for Inaugural Ceremonies. Congress passed a fiscal cliff deal negotiated by Biden and McConnell, representing the second step in deficit reduction after the 2011 Budget Control Act. The deal focused on $600 billion in tax increases but Republicans want further entitlement reforms in exchange for raising the debt ceiling. The House and Senate will consider reauthorizing education, workforce, and higher education laws as top priorities for the new Congress.
Why the Balanced Budget Amendments are false ideas.
Done by premiere Constitutional lawyer. Read and understand the devious and or mis-understood reasons why attempts to amend the Constitution are dangerous to your health and treasure.
The document discusses the sources of federal revenue and expenditures in the United States. It notes that personal and corporate income taxes are the largest sources of revenue, along with social insurance taxes. Federal expenditures have grown over time due to the rise of national security and social programs. Most of the budget is spent on entitlement programs like Social Security and interest on the debt. Democratic politics also contributes to budget growth as politicians and interest groups advocate for more spending.
The document discusses the 2013 United States debt ceiling crisis. It provides background on the debt ceiling and defines it as the maximum amount of money the US can borrow. It describes the political debate between Republicans who wanted spending cuts in exchange for raising the ceiling, and Democrats who argued the ceiling should be raised without conditions. The crisis began in January 2013 and ended in October when a short term deal was passed, though the debate around spending and long term budget solutions continued.
MTBiz is for you if you are looking for contemporary information on business, economy and especially on banking industry of Bangladesh. You would also find periodical information on Global Economy and Commodity Markets.
Signature content of MTBiz is its Article of the Month (AoM), as depicted on Cover Page of each issue, with featured focus on different issues that fall into the wide definition of Market, Business, Organization and Leadership. The AoM also covers areas on Innovation, Central Banking, Monetary Policy, National Budget, Economic Depression or Growth and Capital Market. Scale of coverage of the AoM both, global and local subject to each issue.
MTBiz is a monthly Market Review produced and distributed by Group R&D, MTB since 2009.
Capital Thinking Update Special Edition - The Budget Control Act of 2011Patton Boggs LLP
The Budget Control Act establishes spending caps and a process for raising the debt ceiling. It creates a Joint Select Committee to find $1.2-$1.5 trillion in deficit reduction by November 23rd. If the committee fails, automatic across-the-board cuts will occur. The Act sets FY2012 discretionary spending at $1.043 trillion and caps overall growth at 2% through FY2021. It defines security and nonsecurity spending and prevents cuts to the former from impacting the latter in FY2012-2013. The Act's implementation could impact future appropriations bills and public agencies.
The political will for health care reform remains strong according to Speaker of the House Nancy Pelosi. President Obama also urges Congress to continue its work on reform. There are several options under consideration for passing reform, including having the House pass the Senate bill and agreeing to changes through reconciliation. Reconciliation could allow passage with a 51 vote majority in the Senate. Additionally, guidance on implementing the 2008 Mental Health Parity and Addiction Equity Act was released, applying to employer plans of 50 or more employees. The interim final rule provides details on compliance.
House Members return to their districts this week while the Senate will not convene until January 21 for Inaugural Ceremonies. Congress passed a fiscal cliff deal negotiated by Biden and McConnell, representing the second step in deficit reduction after the 2011 Budget Control Act. The deal focused on $600 billion in tax increases but Republicans want further entitlement reforms in exchange for raising the debt ceiling. The House and Senate will consider reauthorizing education, workforce, and higher education laws as top priorities for the new Congress.
Why the Balanced Budget Amendments are false ideas.
Done by premiere Constitutional lawyer. Read and understand the devious and or mis-understood reasons why attempts to amend the Constitution are dangerous to your health and treasure.
The document discusses the sources of federal revenue and expenditures in the United States. It notes that personal and corporate income taxes are the largest sources of revenue, along with social insurance taxes. Federal expenditures have grown over time due to the rise of national security and social programs. Most of the budget is spent on entitlement programs like Social Security and interest on the debt. Democratic politics also contributes to budget growth as politicians and interest groups advocate for more spending.
Unshackle Upstate sent a letter to Lawrence Schwartz, Chair of the Mandate Relief Redesign Team (MRRT) and senior advisor to Governor Cuomo, identifying nine recommendations that will help reduce the costly, unfunded mandates that the state imposes on local governments and school districts.
For more information, visit: www.unshackleupstate.com
The House will consider several bills under suspension of rules on Tuesday, July 17, including bills on levee construction, terrorist designations, foreign aid appropriations, US-Israel security cooperation, and insular areas. On Wednesday and the rest of the week, the House will consider bills on sequestration transparency and Department of Defense appropriations. The Senate will consider the nomination of a federal judge on Monday and is scheduled to discuss protecting the electric grid from cyberattacks on Tuesday.
The document provides an overview of state legislative activities in 2009 related to issues that affect the construction industry. Some key points:
- State budgets faced large deficits as revenues declined, which will dominate 2010 legislative sessions.
- 38 states considered legislation related to the proposed Employee Free Choice Act. Five states and two chambers passed measures opposing it.
- Only three states passed bills on hiring undocumented workers, with most states less active on immigration in 2009.
- 36 states examined independent contractor classifications and their tax implications. Several tightened requirements.
- Organized labor pushed to expand prevailing wage laws but were blocked in Iowa and Colorado. New Mexico tied rates to union contracts.
- 16 states debated project labor agreement issues, with
The Legislative Branch consists of Congress, which is made up of the House of Representatives and the Senate. The House has 435 members elected every two years who represent populations of their states. The Senate has 100 members with two from each state elected to six-year terms. Both bodies initiate and pass legislation through committees that examine bills and a process of votes. They work to balance the budget using major sources of revenue and spending on priorities like education, healthcare, and corrections.
This update is part of a Brown & Brown series summarizing the guidance issued in connection with the Patient Protection and Affordable Care Act. For this edition, we examine the recent resurgence and passage of the American Health Care Act (AHCA).
The House will meet today to consider legislation allowing the use of Capitol grounds for memorial events and postponing votes until 6:30pm. On Tuesday and the rest of the week, the House will consider the FY2014 budget and funding committee expenses. The Senate will continue considering the FY2013 continuing resolution to fund the government through September, aiming to send an amended bill back to the House this week before recess.
The document provides details on legislative activities scheduled for the House and Senate for the current week. It summarizes bills under consideration, including continuing appropriations legislation, and budget resolutions expected to be debated.
The document summarizes legislative activity in Congress during the week leading up to Christmas regarding the fiscal cliff negotiations and other issues. It notes that the House pulled a tax bill from consideration due to lack of Republican support. It also discusses upcoming Senate sessions and the President calling for a tax cut extension for those under $200k/$250k. Other topics covered include agriculture, appropriations, energy, and financial services.
1. Several attempts have been made recently to address reducing the debt and deficit through legislation like the Budget Control Act and the establishment of a bipartisan commission, but progress has been difficult.
2. President Obama recently announced a new budget proposal that includes $1.8 trillion in deficit reduction over 10 years through spending cuts and tax reforms, but it does not adequately address long-term reductions and includes some additional spending.
3. Finding agreement between the Democrat-supported and Republican-supported budget plans will be challenging as the two parties disagree on the need to raise taxes, but compromises may include further cuts to entitlement programs and military spending.
The Southwest California Legislative Council assigned each of the 17 ballot propositions to one of our Directors / subject matter experts. Each prepared a report noting the title of the proposition, official verbiage, entities in support or opposition to the measure, where the funding came from and what a YES or NO vote means on the ballot. The Council discussed these details and adopted a position based on our Strategic Initiatives and the impact of the proposition on our business community.
The document discusses recent legislative activity in Congress and regulatory actions by federal agencies. It covers topics such as the fiscal cliff negotiations, defense appropriations, agriculture issues including a potential one-year farm bill extension, education reforms, and energy policies including a natural gas export study. Upcoming hearings are also noted on various topics.
The presentation from the July 2 Rally for Freedom hosted by TCCRI in Plano, featuring Attorney General Greg Abbott and conservative state legislators. This presentation was delivered by TCCRI Executive Director John Colyandro.
The document provides information on legislative activities for the week of July 9, 2012. It summarizes bills scheduled for consideration in the House and Senate that week related to veterans, the farm bill, appropriations, cybersecurity, and education issues. It also outlines regulatory actions and hearings scheduled related to education issues like No Child Left Behind waivers and the gainful employment ruling.
A primer with answers to all your questions about a federal government shutdown. Such as, What services are affected in a shutdown and how?, How would federal employees be affected?, Does a government shutdown save money?, and more.
Health Care Legislative Roundup: February 2017ConnectYourCare
This presentation from ConnectYourCare spotlights recent legislative news and regulations impacting health benefits. This presentation covers:
- Legislation to Repeal HSA, FSA Restrictions on OTC Drug Purchases Introduced in Congress
- Confirmation of Rep. Tom Price (R-GA) as Secretary of Health and Human Services
- Republicans Targeting March or April to Advance Affordable Care Act (ACA) Replacement Measure
- ACA Repeal Bill Options
- President Trump and the Fiduciary Rule
- Executive Orders Impacting Regulations
Please Note: ConnectYourCare does not provide tax or legal advice. This information is not intended and should not be taken as tax or legal advice. Any tax or legal information in this notice is merely a summary of ConnectYourCare's understanding and interpretation of some of the current regulations and is not exhaustive. You should consult your tax advisor or legal counsel for advice and information concerning your particular situation before making any decisions.
The US government shutdown from October 1-16 due to Congress failing to pass a budget. Around 800,000 federal workers were furloughed and national parks and landmarks closed. The shutdown was caused by Republican efforts to defund the Affordable Care Act as part of budget negotiations. The shutdown had negative economic impacts, costing an estimated $24 billion. On October 16, Congress passed a bill to reopen the government and extend the debt ceiling.
The document discusses the 2013 United States debt ceiling crisis. It provides background on the debt ceiling and defines it as the maximum amount of money the US can borrow. It describes the political debate between Republicans who wanted spending cuts in exchange for raising the debt ceiling, and Democrats who argued the ceiling should be raised without conditions. The crisis began in January 2013 and was temporarily resolved in October 2013 when Congress passed a bill to raise the debt ceiling until February 2014.
Presentation by Mary Agnes Cary, from Reporting on Health's "From the White House to Community Clinics: What Happens Next for Healthcare Reform" webinar 11/8/2012.
The passage of the Affordable Care Act (ACA) involved extensive debate and compromise over several years. Key events included President Obama calling for healthcare reform in 2009, bipartisan Senate talks led by Max Baucus collapsing in 2009, and the House passing its version of the bill in late 2009. After further compromises to address Democratic opposition, the Senate passed its bill in December 2009. Attempts to reconcile the bills stalled until a special election in 2010 threatened the Senate's supermajority. In March 2010, the House passed the Senate bill and a reconciliation package was passed to implement some reforms immediately while phasing others in by 2014.
Unshackle Upstate sent a letter to Lawrence Schwartz, Chair of the Mandate Relief Redesign Team (MRRT) and senior advisor to Governor Cuomo, identifying nine recommendations that will help reduce the costly, unfunded mandates that the state imposes on local governments and school districts.
For more information, visit: www.unshackleupstate.com
The House will consider several bills under suspension of rules on Tuesday, July 17, including bills on levee construction, terrorist designations, foreign aid appropriations, US-Israel security cooperation, and insular areas. On Wednesday and the rest of the week, the House will consider bills on sequestration transparency and Department of Defense appropriations. The Senate will consider the nomination of a federal judge on Monday and is scheduled to discuss protecting the electric grid from cyberattacks on Tuesday.
The document provides an overview of state legislative activities in 2009 related to issues that affect the construction industry. Some key points:
- State budgets faced large deficits as revenues declined, which will dominate 2010 legislative sessions.
- 38 states considered legislation related to the proposed Employee Free Choice Act. Five states and two chambers passed measures opposing it.
- Only three states passed bills on hiring undocumented workers, with most states less active on immigration in 2009.
- 36 states examined independent contractor classifications and their tax implications. Several tightened requirements.
- Organized labor pushed to expand prevailing wage laws but were blocked in Iowa and Colorado. New Mexico tied rates to union contracts.
- 16 states debated project labor agreement issues, with
The Legislative Branch consists of Congress, which is made up of the House of Representatives and the Senate. The House has 435 members elected every two years who represent populations of their states. The Senate has 100 members with two from each state elected to six-year terms. Both bodies initiate and pass legislation through committees that examine bills and a process of votes. They work to balance the budget using major sources of revenue and spending on priorities like education, healthcare, and corrections.
This update is part of a Brown & Brown series summarizing the guidance issued in connection with the Patient Protection and Affordable Care Act. For this edition, we examine the recent resurgence and passage of the American Health Care Act (AHCA).
The House will meet today to consider legislation allowing the use of Capitol grounds for memorial events and postponing votes until 6:30pm. On Tuesday and the rest of the week, the House will consider the FY2014 budget and funding committee expenses. The Senate will continue considering the FY2013 continuing resolution to fund the government through September, aiming to send an amended bill back to the House this week before recess.
The document provides details on legislative activities scheduled for the House and Senate for the current week. It summarizes bills under consideration, including continuing appropriations legislation, and budget resolutions expected to be debated.
The document summarizes legislative activity in Congress during the week leading up to Christmas regarding the fiscal cliff negotiations and other issues. It notes that the House pulled a tax bill from consideration due to lack of Republican support. It also discusses upcoming Senate sessions and the President calling for a tax cut extension for those under $200k/$250k. Other topics covered include agriculture, appropriations, energy, and financial services.
1. Several attempts have been made recently to address reducing the debt and deficit through legislation like the Budget Control Act and the establishment of a bipartisan commission, but progress has been difficult.
2. President Obama recently announced a new budget proposal that includes $1.8 trillion in deficit reduction over 10 years through spending cuts and tax reforms, but it does not adequately address long-term reductions and includes some additional spending.
3. Finding agreement between the Democrat-supported and Republican-supported budget plans will be challenging as the two parties disagree on the need to raise taxes, but compromises may include further cuts to entitlement programs and military spending.
The Southwest California Legislative Council assigned each of the 17 ballot propositions to one of our Directors / subject matter experts. Each prepared a report noting the title of the proposition, official verbiage, entities in support or opposition to the measure, where the funding came from and what a YES or NO vote means on the ballot. The Council discussed these details and adopted a position based on our Strategic Initiatives and the impact of the proposition on our business community.
The document discusses recent legislative activity in Congress and regulatory actions by federal agencies. It covers topics such as the fiscal cliff negotiations, defense appropriations, agriculture issues including a potential one-year farm bill extension, education reforms, and energy policies including a natural gas export study. Upcoming hearings are also noted on various topics.
The presentation from the July 2 Rally for Freedom hosted by TCCRI in Plano, featuring Attorney General Greg Abbott and conservative state legislators. This presentation was delivered by TCCRI Executive Director John Colyandro.
The document provides information on legislative activities for the week of July 9, 2012. It summarizes bills scheduled for consideration in the House and Senate that week related to veterans, the farm bill, appropriations, cybersecurity, and education issues. It also outlines regulatory actions and hearings scheduled related to education issues like No Child Left Behind waivers and the gainful employment ruling.
A primer with answers to all your questions about a federal government shutdown. Such as, What services are affected in a shutdown and how?, How would federal employees be affected?, Does a government shutdown save money?, and more.
Health Care Legislative Roundup: February 2017ConnectYourCare
This presentation from ConnectYourCare spotlights recent legislative news and regulations impacting health benefits. This presentation covers:
- Legislation to Repeal HSA, FSA Restrictions on OTC Drug Purchases Introduced in Congress
- Confirmation of Rep. Tom Price (R-GA) as Secretary of Health and Human Services
- Republicans Targeting March or April to Advance Affordable Care Act (ACA) Replacement Measure
- ACA Repeal Bill Options
- President Trump and the Fiduciary Rule
- Executive Orders Impacting Regulations
Please Note: ConnectYourCare does not provide tax or legal advice. This information is not intended and should not be taken as tax or legal advice. Any tax or legal information in this notice is merely a summary of ConnectYourCare's understanding and interpretation of some of the current regulations and is not exhaustive. You should consult your tax advisor or legal counsel for advice and information concerning your particular situation before making any decisions.
The US government shutdown from October 1-16 due to Congress failing to pass a budget. Around 800,000 federal workers were furloughed and national parks and landmarks closed. The shutdown was caused by Republican efforts to defund the Affordable Care Act as part of budget negotiations. The shutdown had negative economic impacts, costing an estimated $24 billion. On October 16, Congress passed a bill to reopen the government and extend the debt ceiling.
The document discusses the 2013 United States debt ceiling crisis. It provides background on the debt ceiling and defines it as the maximum amount of money the US can borrow. It describes the political debate between Republicans who wanted spending cuts in exchange for raising the debt ceiling, and Democrats who argued the ceiling should be raised without conditions. The crisis began in January 2013 and was temporarily resolved in October 2013 when Congress passed a bill to raise the debt ceiling until February 2014.
Presentation by Mary Agnes Cary, from Reporting on Health's "From the White House to Community Clinics: What Happens Next for Healthcare Reform" webinar 11/8/2012.
The passage of the Affordable Care Act (ACA) involved extensive debate and compromise over several years. Key events included President Obama calling for healthcare reform in 2009, bipartisan Senate talks led by Max Baucus collapsing in 2009, and the House passing its version of the bill in late 2009. After further compromises to address Democratic opposition, the Senate passed its bill in December 2009. Attempts to reconcile the bills stalled until a special election in 2010 threatened the Senate's supermajority. In March 2010, the House passed the Senate bill and a reconciliation package was passed to implement some reforms immediately while phasing others in by 2014.
The document discusses the legislative process and its relation to health policy in the United States. It covers the branches of government involved in legislation, including the House, Senate and President. It explains how a bill becomes law, from recognizing a problem through drafting, building support, committee reviews, votes, reconciling differences and presidential approval. It also covers the roles of federal, state and local governments in developing health policy and issues around access, cost and quality of care.
Week 2 DQPolicy and Legislation Examples.docxcelenarouzie
This document provides examples of federal policies and legislation to illustrate how federalism plays a role. It lists several major federal acts like the Controlled Substance Act, Gun Control Act, Every Student Succeeds Act, Civil Rights Act, Higher Education Act, Affordable Care Act, and Lilly Ledbetter Fair Pay Act. It notes the federal agency responsible for upholding or enforcing each one. It also provides context on federalism being covered in the textbook and guidance videos for the class. The document aims to help students select a policy or legislation for a discussion assignment and final paper that must address federalism.
The document summarizes the key political events and health policy issues in Washington D.C. for 2016. It outlines the election cycle including primary dates and the national conventions. It also discusses the agenda for the second session of the 114th Congress, focusing on appropriations and legislation around innovation, mental health, and chronic care. Top health care issues to watch include site neutral payments, MACRA implementation, health IT, and the opioid epidemic. Other policy issues include precision medicine, 340B, and the ACA. The document was presented by Julie Shroyer and Cybil Roehrenbeck of Polsinelli PC.
The document discusses government shutdowns in the United States. It provides details on several shutdowns between 1976-2013, including the causes such as disagreements over funding abortion and budget cuts. Shutdowns result when Congress and the President cannot agree on appropriations bills to fund government operations. During a shutdown, non-essential government services are suspended. The longest shutdowns lasted 18 days under President Carter in 1978 due to disagreements over Medicaid funding for abortions.
The political will for health care reform remains strong according to Speaker of the House Nancy Pelosi. President Obama also urges Congress to continue its work on reform. There are several options under consideration for passing reform, including having the House pass the Senate bill and agreeing to changes through reconciliation. Reconciliation could allow passage with a 51 vote majority in the Senate. Additionally, guidance on implementing the 2008 Mental Health Parity and Addiction Equity Act was released, applying to employer plans of 50 or more employees.
The document summarizes Georgians for a Healthy Future's policy priorities and advocacy opportunities for the 2016 Georgia legislative session. GHF's top priorities include closing Georgia's coverage gap by expanding Medicaid, setting and enforcing network adequacy standards for health plans, and ending surprise out-of-network medical bills. The document outlines the Georgia legislative process and opportunities for public advocacy, such as testifying at committee hearings or contacting legislators.
The document discusses the Comprehensive Addiction and Recovery Act (CARA), which aims to reform drug policy and the criminal justice system in the United States. It explains the seven parts of CARA, which include expanding prevention and education programs, increasing access to affordable treatment, helping those incarcerated reintegrate into society, and providing addiction recovery services for veterans and pregnant women. If signed into law, CARA will authorize $725 million in federal grants to fund these measures and improve responses to the addiction crisis.
The document discusses health care policy and the legislative process in New York State. It begins by outlining the three branches of government in NYS and how bills are formulated. It then describes key stages of the NYS budget process and how an idea becomes law, from bill drafting to gubernatorial approval. The document also discusses the New York Health Act, which would establish a single-payer health care system, and perspectives both for and against the Act. It concludes by noting criticisms of the dysfunctional NYS legislative process and questions around whether the Health Act should become law.
House Passes Permanent Bonus Depreciation ProvisionCBIZ, Inc.
On July 11, the U.S. House of Representatives passed a bill to restore and make permanent the 50 percent bonus depreciation provision. The vote was 258-160, largely along party lines, with only 34 Democrats voting for the bill and two Republicans voting against it.
Deficit-Financed Extension of Research Tax Credits Gets Nod from HouseCBIZ, Inc.
Several days of hotly contested debate over legislation that would make the Code Sec. 41 research tax credit permanent gave way to a bipartisan vote for House passage on May 9. House lawmakers approved the American Research and Competitiveness Bill of 2014 (HR 4438) over the objections of Democratic leaders, who faulted the bill because its 10-year cost of $155.5 billion will be added to the federal deficit.
This webinar presentation summarized the history and current state of health insurance regulation in the United States. It explained that while states originally had primary authority over insurance, federal programs and laws have increasingly shaped the system. Key federal programs discussed included Medicare, Medicaid, the Affordable Care Act, and laws governing ERISA, COBRA, EMTALA, Stark, and HIPAA. The presentation concluded that health care regulation now involves both state and federal oversight in a complex hybrid system.
Georgians for a Healthy Future's (GHF) 2015 policy agenda focused on closing Georgia's coverage gap, ensuring access to quality healthcare for Medicaid and PeachCare beneficiaries, maximizing enrollment and a positive consumer experience for private health insurance, increasing Georgia's tobacco tax, and reinvesting in public health. The presentation provided background on these issues, GHF's role in advocating for related policies, and resources for attendees to get involved in the legislative process through advocacy opportunities like meeting with their legislators.
The House will meet on February 4th to consider three bills under suspension of the rules. Votes will be postponed until 6:30pm. The Senate will meet to resume consideration of the Violence Against Women Act. The document also provides summaries of legislative activity regarding the debt ceiling, immigration reform, competitive foods regulations, the federal budget and sequestration, cybersecurity, and energy taxes and regulatory hearings.
The document discusses advocacy efforts for Medicaid expansion in South Carolina, including messaging around the importance of expanded access to care and treatment for people living with HIV, ongoing discussions in the state around essential health benefits and benchmark plans, and next steps advocates can take like meeting with stakeholders, elected officials, and participating in coalitions and sign-on letters.
The communications plan aims to educate the public and gain support for Congressman Austin Scott's American Health Care Reform Act (AHCRA) through social media growth targets, press interactions, and encouraging constituents to contact their representatives. If passed, the AHCRA would repeal the Affordable Care Act and introduce a conservative alternative focused on competition, choice, and limiting government overreach in healthcare. The plan outlines goals, key messaging, stakeholders, and a timeline of launch activities from developing materials to ongoing monitoring once the bill is introduced.
Abraham Baldwin Agricultural College is located in Tifton, Georgia. Tammy Carter and Troy Spicer are registered nurses who work at the college. Both Carter and Spicer have master's degrees in nursing and Spicer is also a family nurse practitioner.
This document summarizes Georgia's telehealth initiative. It discusses plans to expand access to care through telehealth while not replacing the medical home. Telehealth is currently used across Georgia to deliver services like WIC and increase access to specialty care. The document outlines various telehealth projects across different departments, including high risk OB care, children's services, infectious disease care, and dentistry. It discusses partners, funding sources, goals of increasing access and capacity, and next steps like securing more funding and expanding available services.
The Hancock Healthcare Access Initiative aims to improve access to emergency and primary care in Hancock County through a partnership model. Hancock County ranks poorly in health factors, social economic factors, and physical environment. Approximately 68% of emergency room visits were for non-emergent issues and there is limited primary care access. The initiative would use emergency medical technicians trained in telemedicine to conduct in-home exams and diagnostics to treat non-emergency issues. This would decrease emergency room overuse and transportation costs while strengthening primary care. The goals are to enhance emergency care, decrease non-emergency transportation and emergency room use, provide 24/7 minor illness access, and ultimately decrease hospital readmissions by improving care transitions and prevention.
Telemedicine provides benefits to both physicians and patients. It allows physicians to expand their reach to serve more rural or underserved areas while improving patients' access to care and quality of life. However, telemedicine must be practiced according to the rules of state medical boards to ensure quality, safety, and compliance. The document outlines Georgia's rules for physicians, which require the establishment of a patient relationship, maintenance of proper records, credentialing of physician extenders, emergency contact information, and annual in-person examinations to practice telemedicine according to the highest standard of care.
The document discusses predictions for the future growth of telehealth. Sensors will continuously monitor vital signs and activities. Annual growth in telehealth is predicted to be 18.5% worldwide through 2018 and 56% annually in the US, reaching $1.9 billion by 2018. Consumer demand and government support will drive telehealth to become mainstream healthcare. Telehealth also enables greater international collaboration in business and healthcare missions.
The 2015 GPT Spring Conference focused on telehealth and the Southeastern TeleHealth Resource Center (SETRC) which provides technical assistance to advance telehealth in several southeastern states. SETRC's education arm, the National School of Applied TeleHealth (NSAT), offers online telehealth certification courses and has collaborated with various organizations across the U.S. and internationally to provide telehealth training. NSAT graduates come from 42 U.S. states and 16 foreign countries.
This document discusses how telehealth can help control healthcare costs, improve outcomes, avoid readmissions, and modify patient behavior. It provides examples of how telehealth is being used at UMMC and Mississippi to expand access to specialty care, support chronic disease management, improve care coordination, and enhance population health through tools like remote patient monitoring and data analytics. The goal is to improve quality, efficiency and safety through telehealth while empowering patients and preventing unnecessary hospitalizations and ER visits.
Mario gutierrez georgia trc 2015 mario finalSamantha Haas
The 6th Annual Georgia Partnership for TeleHealth Spring Conference will take place from March 25-27 in Savannah, Georgia. Telehealth uses digital technologies to enhance healthcare delivery and support. It can help redistribute healthcare expertise to where it is needed and create greater value. Common telehealth modalities include live video, store-and-forward, remote patient monitoring, and mobile health. Both federal and state policies will need to evolve to support greater use of telehealth as the healthcare system shifts from volume-based to value-based care.
We have a global presence to serve customers worldwide. With offices in North America, Europe, and Asia, we support over a million users across 150 countries. Our international teams help ensure customers have a consistent experience regardless of location.
The document discusses Berrien School-Based TeleCare Clinics. It appears to be written by Kayla Money, who is identified as the RN and nurse at Berrien Middle School. The document likely provides information about telehealth clinics operating within the Berrien school system.
This document summarizes the business case for remote patient monitoring. It outlines how remote monitoring has progressed from initial technologies to integrated virtual care solutions. It shows how new care delivery models incentivize providers to adopt remote monitoring to reduce costs and improve outcomes. Studies show remote monitoring can significantly reduce hospitalizations, ER visits, and costs for patients with chronic conditions. The document concludes by describing opportunities for hospitals, physicians, and post-acute providers to leverage remote monitoring.
This document discusses building a successful telehealth program. It begins by outlining the key components needed: a clinical business model that identifies needs and services, appropriate technology, and consideration of legal and reimbursement factors. The author describes three domains of telehealth - hospital/specialty care, integrated primary care, and transitions/monitoring. Different value propositions apply to each. Business models discussed include fee-for-service payments, travel reduction, remote hiring/retention, and remote monitoring. The document stresses adopting approaches aligned with the "Triple Aim" of improving patient experience, population health and reducing costs. It emphasizes having a team of champions, partners, and support from Telehealth Resource Centers.
This document provides information about Memorial University Medical Center (MUMC) and its telestroke program. MUMC is a 654-bed tertiary care hospital and regional referral center located in Georgia and South Carolina. It serves as the region's only level 1 trauma center and children's hospital. MUMC has been recognized as a primary stroke center and for its treatment of stroke patients according to national guidelines. The document outlines statistics on MUMC's stroke patients and telestroke program which allows neurologists to evaluate and treat acute stroke patients at regional spoke sites via telemedicine. The telestroke program has increased the number of patients receiving tPA and improved outcomes since its launch in 2011.
The document discusses the challenges facing healthcare systems due to an aging population and rising costs. It argues that new models of care delivery enabled by connected technologies can help address these issues. Specifically, it envisions a future where remote patient monitoring, clinical decision support, and analytics help manage chronic conditions and shift care settings to be more efficient and preventative. Realizing this vision will require overcoming historical barriers through incremental innovation and the development of an interoperable technology-enabled care ecosystem.
With A Successful Telehealth Program Comes An Unbeatable ROI
This document discusses the telehealth program and connections of Tift Regional Medical Center (TRMC) in Tifton, Georgia. It provides a list of the current telehealth connections TRMC has established, including with primary care physicians, neurology, nephrology, wound care, infectious disease, sleep lab follow-ups and more. It also lists potential future opportunities for telehealth connections including with dialysis, neurology, diabetic education, and continuing education. In summary, the document outlines the existing telehealth program partnerships and services of TRMC and possibilities to expand the program in the future.
The document lists different levels of exhibitors at an event, including Platinum Plus exhibitors at the top, followed by multiple Gold exhibitors, and then several Silver exhibitors listed afterwards in descending order.
Ellen bolch & max stachura advanced telehomecareSamantha Haas
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1. The ACA and Rural America
(and other workings of the
Federal Government)
David Lee
National Rural Health Association
2. NRHA Mission
The National Rural Health Association is a
national membership organization with more
than 21,000 members whose mission is to
provide leadership on rural issues
through advocacy, communications,
education and research.
3. Today
• The Federal Budget—Are we open or are we
closed? What about default?
• What does it mean for the ACA?
• What does the ACA mean for rural?
• What is the future of the ACA?
4. Disclaimers:
• NRHA did NOT take a position on full
passage of the ACA
• NRHA actively sought for the inclusion of
rural-relevant funding and program
enhancements in the ACA
• Since passage, NRHA’s Rural Health
Congress has passed policy encouraging
states to expand Medicaid
5. Disclaimers
• NRHA is actively working to help
members take advantage of ACA
programs and grants, help State
Associations advocate for Medicaid
expansion, and enroll in the various
provider-side programs established in the
Act, including 340B, ACOs, and being
listed as Essential Community Providers
6. The Current Federal Budget
Situation
• Sept. 20: House approves legislation (a Continuing
Resolution or CR) denying money for much of
President Barack Obama's health care law while
keeping the government open through Dec. 15.
• Sept. 24-25: Sen. Ted Cruz, R-Texas, and other
conservatives speak on the Senate floor for more
than 21 consecutive hours against the health care
law in attempt to delay votes.
7. • Sept. 27: The Senate sends a bill keeping agencies open
through Nov. 15 back to the House, after removing Houseapproved provision defunding the health care law.
• Sept. 29: House shifts its demands for restricting the health
care law. It votes to delay implementation of the health care
overhaul by a year and to repeal the “medical device tax”.
Separately, the House votes to pay active duty troops, and
some Defense Department civilian workers and defense
contractors, in case of a shutdown. The next day, the
Senate approves the second bill and Obama signs it into
law.
8. • Sept. 30: Senate removes House provisions postponing the
health care law and erasing the medical device tax. The House
reworks its shutdown bill, delaying for a year the health care
law's requirement that individuals buy health insurance and
requiring members of Congress and their staff to pay the full
expense of health insurance, without the government paying
part of the costs. The Senate quickly kills the House health
care provisions.
• Oct. 1: The government's new fiscal year begins and the partial
federal shutdown starts. The House stands by its language
delaying required individual health coverage and blocking
federal health insurance subsidies for Congress, and requests
formal negotiations with the Senate. The Senate rejects the
House effort for a formal conference committee.
9. • Oct. 2: Embarking on a strategy of voting to restart
popular programs, the House passes smaller bills to
reopen national parks and the National Institutes of
Health and letting the District of Columbia municipal
government spend money. House Democrats mostly
vote "no" and Senate leaders ignore the measures,
saying the entire government must reopen.
• Oct. 3: House votes to pay members of the National
Guard and Reserves and finance veterans' programs.
10. • Oct. 4: House votes to finance federal disaster aid
programs and feeding programs for infants and pregnant
women. The shutdown fight is increasingly tied to the
need for Congress to renew federal borrowing authority
by Oct. 17 or risk an economy-rattling government
default. House leaders increasingly shift their conditions
for passage of the shutdown and debt limit bills to deficit
reduction.
• Oct. 5: House votes to pay furloughed federal workers
when the shutdown ends. DOD recalls 350,000
furloughed workers back to work immediately.
11. • Oct. 6: House Speaker John Boehner says House won't
pass bills ending shutdown or raising debt limit without
negotiations on GOP demands.
• Oct. 7: House votes to fund Food and Drug Administration
programs.
• Oct. 8: House votes to finance Head Start, pay civil
servants working during the shutdown and create a panel of
lawmakers to negotiate on deficit reduction. Obama and
Boehner suggest they might consider short-term bills ending
the shutdown and extending the debt limit to give them time
to negotiate. The Senate refuses to take up these
measures.
12. • Oct. 9: House votes to pay halted death benefits to families of
fallen troops and to finance the Federal Aviation
Administration.
• Oct. 10: Boehner proposes a six-week extension of the debt
limit, conditions it on Democrats bargaining over spending cuts
and reopening the government. Treasury Secretary Jack Lew
repeats warning that government borrowing authority expires
Oct. 17, threatening a damaging federal default. Senate
passes bill providing death benefits for slain troops and sends
to Obama, House votes to fund border security programs.
13. • Oct. 12: Boehner tells House Republicans that
negotiations with White House have stalled. Senate
Majority Leader Harry Reid, D-Nev., and Senate
Minority Leader Mitch McConnell, R-Ky., begin talks.
Senate rejects Democratic effort to debate debt limit
extension through 2014.
• Oct. 13: Senator Susan Collins (R-ME) proposes a
compromise to reopen the government and extend
the debt ceiling beyond CY 2013 while delaying the
medical device tax and establishing a joint
committee for long-term budgeting.
14. • Oct. 14-15: Senators Harry Reid (D-NV) and Mitch
McConnell (R-KY) modify the Collins proposal and
start receiving feedback from the House, the White
House, and their Caucuses.
• Oct. 15 a.m.: House announces it will move its own
debt ceiling legislation that will include a longer
medical device tax delay, install income verification
for ACA subsidies, and cancel health insurance
subsidies for members of Congress and the
presidential Cabinet.
15. • Oct 15 p.m.: Speaker Boehner pulls his proposal
from the House floor indicating that there is not
enough support to pass the bill. Aides indicate that
conservative members of his caucus joined with
Democrats to defeat his compromise solution
• October 16: Senator Harry Reid and Mitch
McConnell agree to a plan that would reopen the
Federal Government and lift the debt ceiling.
16. Final Compromise
• The plan passed by Congress LATE last night and
signed into law by the President will raise the debt
ceiling until Feb. 7, restore funding (a CR) for all
government operations until Jan. 15, and establish a
long term budget conference committee that must
report proposals by Dec. 13.
• It is unlikely that further efforts to derail the ACA will
succeed prior to Jan. 1, 2014 effective date.
17. Why do we care?
• This challenge was the last chance for Republicans
to gain concessions on the implementation of the
individual mandate prior to its statutory
implementation date.
• This saga has largely distracted the nation’s
attention from significant problems with the new
Health Insurance Exchanges (Marketplaces).
19. The Law
• The Patient Protection and Affordable Care Act was
signed into law on March 10, 2010.
• Amendments and full engrossment was
accomplished through the Education and Health
Care Reconciliation Act of 2010 signed on March
30, 2010
• It is divided into 9 titlesand contains provisions that
became effective immediately, 90 days after
enactment, and six months after enactment, as well
as provisions phased in at various points through to
2020
20. The Politics in 2009 and 2010
• VERY limited bipartisan support and
opposition. Fewer than five House
Democrats supported the legislation and
fewer than five House Republicans
supported
• Only one Senate Republican voted in favor
at ANY point during the process
• No Senate Democrats voted against at any
point
21. The Law
• The law is over 2,000 pages long and creates new
programs, modifies existing programs and payment
methodologies, authorizes pilot programs,
reauthorizes existing payments and pilot projects,
and establishes new rules for Medicaid and
insurance markets
• HHS, DOD, VA, IHS, and IRS have released tensof-thousands of pages of regulations implementing
the law
22. The Legal Challenge(s)
• Almost immediately, private individuals,
institutions, and states challenged various
provisions of the bill
• Challenges include the individual mandate,
employer mandate, Medicaid expansion,
mandatory contraceptive coverage, etc.
• In July 2012, the Supreme Court issued its
ruling on the most divisive and prevalent
legal questions
23. The Ruling
• The individual mandate is a valid
exercise of Congress’s Taxing
Power.
• The mandate is not a valid exercise
of the Commerce Clause.
• Other major provisions, including
ALL rural provisions will be
implemented as outlined in the bill.
• One major exception: Medicaid.
24. The Ruling
• The federal government cannot rescind ALL
Medicaid funding if states don’t comply with
new requirements.
• The federal government can refuse NEW funds
if states don’t meet NEW Medicaid Rules.
25. The Ruling
• "Simply put, Congress may tax and
spend. This grant gives the federal
government considerable influence
even in areas where it cannot directly
regulate.
• “Congress may use this power to
establish cooperative state-federal
Spending Clause programs. The
legitimacy of Spending Clause
legislation, however, depends on
whether a State voluntarily and
knowingly accepts the terms of such
programs.”
26. The Ruling
• “The framers created a federal
government of limited powers and
assigned to this court the duty of
enforcing those limits. The court does
so today. But the court does not
express any opinion on the wisdom
of the Affordable Care Act. Under
the constitution, that judgment is
reserved to the people."
27. The Ruling
• Dissent: “The Act before us here exceeds
federal power both in mandating the purchase
of health insurance and in denying
nonconsenting states all Medicaid funding.
These parts of the Act are central to its design
and operation, and all the Act’s other
provisions would not have been enacted
without them. In our view it must follow that the
entire statute is inoperative.”
28. Major Provisions
• Major expansion of Medicaid:
• States may choose to expand Medicaid
eligibility up to 138% of the federal poverty
level.
• The federal government will pay 100% of
expansion for the first three years of
expansion and then phase down to 90%
of the costs of newly covered recipients by
2020.
29. Medicaid Expansion
• 25 states have agreed to expand their Medicaid
roles in accordance with the ACA
• Most of the expansion has taken place in
geographic pockets: New England, Upper Midwest,
and West Coast
• The Mountain West, Lower Midwest, and South
have mostly forgone expansion. Exceptions:
Colorado, New Mexico, Iowa, Arizona, Kentucky,
Arkansas
30. Medicaid Expansion
• States still have the option to expand Medicaid
whenever they see fit
• The three-year, 100% coverage by the Federal
government, is time limited
• By statute, the Federal government will only cover
all new costs for CYs 2014, 2015, and 2016
31. Major Provisions
• Establishment of Health Insurance Exchanges
•
States have the option of operating their own exchange or partnering with
the federal government to run an exchange. States choosing neither
option will default to a federally-facilitated exchange. All exchanges,
regardless of how they are administered, must be ready to begin enrolling
consumers into coverage on October 1, 2013 and must be fully
operational on January 1, 2014.
• Insurance Guarantee Issue and Renewability
• Essential Health Benefit Minimum
• Employer-based wellness programs
32. The Exchanges
• There have been significant challenges with the
exchanges, specifically the Federal Marketplace at
healthcare.gov, in the first two weeks of
administration
• Congress and the Administration have demanded
fixes and progress reports from the two main
contractors that designed the site
• State exchanges are having varying levels of
success. The more successful states usually are
those with less web traffic
33. The Exchanges
• Healthcare.gov was established to serve two
purposes:
• Clearing house for information related the Affordable Care
Act.
• Serve as the federal exchange for all those residing in
states that do not set up an independent marketplace.
• Federal government spent $400 million to set up
using contracts with health IT firms.
34. The Exchanges
• Members of both parties, from both chambers have
called the current federal exchange a “train wreck”.
• Due to poor design, software malfunctions, and
traffic to the site, very few people have been able to
create an account or enroll in a health plan.
• HHS stated earlier this week that parts of the site
may have to be rebuilt.
35. The Exchanges
• While over 9,000,000 distinct users have visited
Healthcare.gov, fewer than 100,000 have actually
enrolled in a health plan
• Web traffic to the federal exchange dropped 88%
between October 1 and October 13
• State exchanges have had some better results.
Utah and Massachusetts have had better results
since their exchanges were already established.
36. The Health IT in Exchanges
• The contracting process led to one contractor
building the user-interface inside of healthcare.gov
while another contractor built the “back-end,”
technical components.
• Early indications are that these two aren’t talking to
each other.
• The problem is similar to EHRs that won’t talk to
each other over health information exchanges in
MU.
37. The Exchanges
• In the hours since the passage of the Debt
Ceiling/CR compromise, a number of House
Committees have indicated that they intend to hold
hearings on the Federal exchange.
• In addition to the interoperability challenges, many
committees in both chambers have questioned the
fraud protections built into the cite.
38. Medicaid and the Exchanges in
states that do NOT expand
• Because the Supreme Court ruled that Medicaid
expansion was OPTIONAL, many states have not
expanded their eligibility requirements
• This has left a coverage gap or “donut hole” for
those ineligible for Medicaid but too poor to qualify
for coverage through the exchange
39. Medicaid “Donut Hole”
• Current Alabama statute offers Medicaid to adults with children
up to 16% of the federal poverty level. Alabama is not
expanding Medicaid
• In Alabama, 191,320 people are in this donut hole. This
represents 36% of all currently uninsured Alabama adults
(non-Medicare). It represents 88% of adults under 100% of the
federal poverty level
• More information:
http://kaiserfamilyfoundation.files.wordpress.com/2013/10/850
5-the-coverage-gap-uninsured-poor-adults1.pdf
40. Rural concerns with Exchange
products:
• As part of the rating system established under the
law, insurers must show that their products provide
access to local providers. The law calls these the
“essential community provider” lists.
• Because of a desire to increase the number of
products available in the exchange, insurers receive
a significant amount of deference.
41. ECPs in Rural
• Some of the insurers offering products in the
exchanges are new to rural. Others are offering
new products in the rural space.
• In order to establish an “easy” reference for who
would be an ECP, many insurers used pre-made
lists to define these providers.
• Most insurers defaulted to the 340B eligibility list for
rural determinations.
42. Concerns
• Some rural providers, like Rural Health Clinics, are
not 340B eligible and may not be included in a
insurers ECP list. This effectively makes visits to
these facilities “out of network”.
• While the list is what is commonly used, it is not
universal. If you have not talked to insurers offering
products in your state, CALL THEM NOW. Make
sure you are an ECP.
43. Health Reform? Or Health
Insurance Reform?
• “You’re a health care lobbyist? What do you think
about Obamacare?”
• There is MORE to the ACA
than Medicaid and the
Individual Mandate!!!!!
44. Rural ACA Provisions
•
•
•
•
•
•
•
Increase NHSC Funding/Slots
Residency reallocation
Expansion of 340B program (CAH/SCH)
Community Health Center funding/grants
Medicare Accountable Care Organizations
Increase AHEC funding authorization
Establishment of Rural Physician Training
Grants
45. Rural ACA Provisions
•
•
•
•
Establishment of CMMI
Pharmacy Reimbursement Increases
Primary Care Incentive Payments
1.0 Floor on the Hospital Wage Index for
Frontier States
• Community Transformation Grants
46. Rural ACA Provisions
• “Extenders”
• Establishment/Extension of Rural
Demonstration Projects
• Modification of the Low Volume Hospital
Adjustment
• Payment increases for Hospitals in
counties with the lowest Medicare
spending
47. LVH and MDH
• A straight extension of MDH was included in the
ACA. This extension was temporary, though, and
expired AGAIN on September 30.
• The LVH adjustment was dramatically expanded
from affecting only 3-4 hospitals per-year to over
600. This modification was temporary and has
expired again.
• Note on LVH: The FAH and other interested parties
are working on a lawsuit challenging the
implementation of the permanent adjustment.
48. Rural Provisions in Practice
• Accountable Care Organizations:
•
•
•
•
An ACO must meet the threshold of 5,000 Medicare beneficiaries who
receive a plurality of their services at a participating/qualifying provider
For purposes of rural they can include individual/group practices (must be
DO or MD), CAHs billing under method 2 and subsection D hospitals
including SCH and MDH
RHC, FQHC, CAHs billing under method 1 may all participate but
beneficiaries receiving a plurality of their services in these facilities are not
counted for the 5,000 threshold
ACOs are paid a standard FFS payment and then share in the savings
they produced based on:
o Amount of savings against prior, base year; and
o Number of beneficiaries in their ACO—more beneficiaries=more possible
sharing.
•
There are now 153 MSSP ACOs
49. Rural Provisions in Practice
“Pioneer” ACOs
• Program administered by the Center for Medicare and
Medicaid Innovation (CMMI) and, therefore, not subject to
the DO/MD requirements
• Intended for facilities and groups that have experience
doing this type of activity and are at a place to take more
risk and share in more savings
• Savings and loss caps applicable in the original MSSP are
not applicable here.
• There are now 32 Pioneer ACO
• Some of these ACOs have indicated they will terminate
their contract with CMMI because of an inability to produce
savings in sufficient quantities
50. Rural Provisions in Practice
Advance Payment Model
• Program administered by CMMI
• Intended to target groups that would like to participate but
are unable because of the high start up costs of ACOs.
Therefore only physician groups and rural facilities can
apply.
• Like Pioneer ACOs, they are exempt from SOME of the
strictest requirements for assignment and staffing.
• CMMI will loan the ACO funds to start the ACO and will
recoup the money later. This will be done either through
the ACO savings accrued or FFS payments withheld if no
savings accrue.
• As of July, there are 20 Advance Payment ACOs
51. Challenges to Rural
Participation in ACOs:
•
•
•
•
Beneficiary threshold
NPs, PAs ineligible for beneficiary assignment
Low sharing rate for low-beneficiary ACOs
Cost to establish with no guarantee of return on
investment
• Benchmarking savings against yourself
• Participation limited to one ACO leading to transfer
challenges
52. Affects of ACOs in the health
care marketplace
• The Medicare Payment Advisory Commission
(MedPAC) reports that consolidation, acquisitions,
and mergers are rising across the health care
market.
• The Rural Policy and Research Institute (RUPRI)
notes that this trend is increasing in rural areas as
well. The caution that the trend may be pre-existing
and unrelated to ACO development.
• Some argue that there are larger market trends and
ACOs are not to blame. Most cite ACOs as a
primary driver of this trend.
53. Rural Provisions in Practice
• Increase NHSC Funding/Slots
• Residency reallocation
• While these work workforce programs have been funded,
there has been some limited success in actual
implementation. Residency reallocation is behind schedule.
NHSC is shortage based, not rural based so all new slots not
automatically going to rural.
• Community Transformation Grants
• Despite language in the ACA that 20% of the funds had to go
to rural communities, the CDC definition of a “rural
community” was any place under 50,000 people. This
precluded a number of rural communities from successfully
receiving grants
54. Rural Provisions in Practice
• Establishment of Rural Physician Training Grants
• Increased funding authorization of Area Health
Education Centers
• Establish a National Health Care Workforce
Commission
• All three of these programs were “authorized” for significant
federal funding through the ACA. Unfortunately, Congress
has never “appropriated” money for these programs at the
same levels as contemplated in the ACA
• Again, another problem with failing to pass year-long
appropriation bills.
55. Rural Provisions in Practice
• Pharmacy Reimbursement Increases
• Starting in CY 2013, rural pharmacies will see a temporary
increase in payments; NRHA supports permanency of
change
• Primary Care Incentive Payments
• Starting in CY 2013, all Medicaid providers will get
increased payments meant to mirror Medicare rates; there
have been challenges in these payments being processed
by the feds.
• 1.0 Floor on the Wage Index for Frontier States
• All three of these payments have been targeted for repeal
as possible offsets for other spending, specifically SGR.
56. Direct rural provider concerns
• Modifications to DSH payments (2014)
• Bad Debt Reimbursement reduction* (2013)
• Failure to expand Medicaid
57. Rural provider concerns
• Lack of mandatory funding for rural health
appropriations
• Temporary extension of rural health programs
• Exclusion from ECP lists
58. What is the future of the ACA?
• Politically, it will be VERY hard to gain repeal at this
point. Assuming that Republicans win a majority in
the Senate AND the White House and maintain a
majority in the House through 2016, the ACA’s
provisions will already be pervasive throughout the
nation’s delivery systems.
59. What is the future of the ACA?
• Some tweaking will likely continue. There are a
number of concerns that members of both parties
continue to bring up:
•
•
•
•
Wage index change to benefit Massachusetts
Medical device tax
Technical components of grant and pilot programs
Technicalities of Medicaid and insurance products in the
exchanges
61. Thank You – Stay involved
NRHA doesn’t have a PAC
Website: ruralhealthweb.org
Depends solely on grassroots advocacy
Members have access to:
Periodic Washington Updates (webinars):
join-grassroots@lists.wisc.edu
Rural Health Blog
http://blog.ruralhealthweb.org
Join NRHA today at ruralhealthweb.org
David Lee
dlee@nrharural.org
(202) 639-0550