Hospital Corporation of America Newsletter
For the Week Beginning May 26, 2014
NOTEWORTHY
     

 TX US District 4 Will Have a New Representative
Representative Ralph Hall (R-TX), the oldest-serving member of Congress and one of the last World War II veterans serving on Capitol Hill, became the first incumbent House lawmaker to lose a primary challenge this year.
 
Congressman Hall lost to John Ratcliffe, a former U.S. attorney and small-town mayor who spent more than $500,000 of his own fortune to defeat the 18-term incumbent.
 
Hall's defeat means that there will be no World War II veterans serving in Congress beginning next year. The only other remaining veteran of the war, Representative John D. Dingell (D-MI), is planning to retire.
 
With his win in the runoff, Ratcliffe, 48, is all but assured to represent the 4th Congressional District of Texas, a Republican stronghold that stretches from the far eastern suburbs of Dallas to the Louisiana border.
 
 

 Veterans Affairs
A preliminary internal investigation into allegations that patients in the Phoenix AZ VA facility waited longer than claimed by hospital officials to receive medical treatment has revealed that they waited on average 115 days for their first medical appointment. 

The VA Inspector General report also stated that another 1,700 patients were not placed on the official waiting lists and may never have received care. 
 
Veterans Affairs Secretary Eric Shinseki said that the Department will allow more veterans to seek care from non-VA treatment facilities amid allegations of delayed patient wait times at several veterans' health clinics nationwide.

Secretary Shinseki said more details about the move will be made available in the coming days but noted that the decision applies to an existing VA program that already allows some patients to seek private care.
 
Inside this issue
  FEDERAL  
  House Hearings Focus on RACs, Two-Midnight Policy  
  On May 20, the House Ways and Means Health Subcommittee held a hearing on hospitals' need for relief from the Centers for Medicare & Medicaid Services' (CMS's) two-midnight policy and Recovery Audit Contractor (RAC) program. Both of these issues are draining "time, resources and attention that need to be more effectively focused on patient-care," said Amy Deutschendorf, Senior Director of Utilization and Clinical Resource Management at the Johns Hopkins Health System in Baltimore. Ms. Deutschendorf told the House Ways and Means Health Subcommittee during testimony at a hearing on current hospital issues in the Medicare program, that the two-midnight policy has created "confusion and stress" for providers and patients, and has "taken away physicians' judgment in the determination of hospitalization as an inpatient." She also discussed the financial and administrative burden of complying with RAC audits as well as the significant number of erroneous RAC denials hospitals are experiencing.

The hospital industry generally supports the Medicare Audit Improvement Act (H.R. 1250/S. 1012), a comprehensive bill for reforming the RAC program, and the Two-Midnight Rule Coordination and Improvement Act (H.R. 3698/S. 2082), which directs CMS to further delay enforcement of the two-midnight rule and implement a new payment methodology for short inpatient stays. As of today, 219 representatives and 14 senators support H.R.1250/S.1012.
 

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  Suit Filed to Ensure Timely Hearings on RAC Appeals  
  The American Hospital Association (AHA) has filed suit against Health and Human Services (HHS) Secretary Kathleen Sebelius to ensure that Administrative Law Judges in her department hear appeals in a timely fashion in order that hospital appeals of Medicare payment claim denials are resolved and payment is made in an expeditious manner.
 
AHA says that an enormous backlog of appeals has built up because Recovery Audit Contractors (RACs) working for the government unfairly deny claims, and many decisions are subsequently overturned when they reach the stage of a hearing by an administrative law judge (ALJ).
 
According to Medicare law, an ALJ must decide an appeal within 90 calendar days of the date of a proper request for hearing. In December, despite the requirement, HHS announced a moratorium on assigning provider appeals to ALJs because of the three-year backlog. The suspension places hospitals in an untenable position; lodging new appeals may create wait times, potentially up to five years for a final decision, according to a statement from AHA. Approximately 460,000 ALJ reviews are already pending and that grows larger every day.
 

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  STATE  
  Idaho  
  On May 20, the state held their statewide and Congressional offices Primary elections with the following key results:

U.S. Senator
On the Republican side, incumbent Senator Jim Risch captured the majority of votes for his party and will face Democrat Nels Mitchell in the fall general election.

U.S. District 1
Incumbent Representative Raul Labrador defeated four other candidates in the GOP primary and will face Shirley Ringo who was victorious in the Democratic primary.

U. S. District 2
In the GOP primary, incumbent Mike Simpson defeated a challenge by Bryan Smith to return to Congress for another term. Democrat Richard Stallings will be on the ticket in November to oppose Congressman Simpson.

Governor
Incumbent Governor Butch Otter won an unprecedented third term as Governor in the GOP primary, and advances to the general election where he will be challenged by A.J. Balukoff, winner of the Democratic primary.

Lt. Governor
Incumbent Republican Lt. Governor Brad Little won the day and will go on once again to face his Democratic opponent Bert Marley in November.

Attorney General
The winner of the GOP primary was incumbent AG Lawrence Wasden who was victorious over his opponent Chris Troupis. AG Wasden's opponent in the fall general election will be Bruce Bistline, winner of the Democratic primary.
 

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  Louisiana  
  The House restored funding for ERs and post-acute care services in HB 1, the Appropriations Bill, on May 28. In an effort to get the Senate to go on record and have the same opportunity to support hospital ERs and post-acute care services, state Senator Sherri Smith Buffington (R-Keithville) offered an amendment on the Senate Floor that established language and legislative intent prohibiting the Department of Health and Hospitals from cutting critical ER and post-acute care services, which then passed.  

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  Texas  
  Dual Demo Program for Texas/CMS
The state is partnering with the Centers for Medicare and Medicaid Services (CMS) on a capitated three-year demonstration program intended to improve the health care experience of certain Texas residents who are eligible for both Medicare and Medicaid ("dual-eligibles"), according to a Memorandum of Understanding (MOU) between the state and CMS.
 
The "Duals Demo" will piggyback off the state's existing STAR+PLUS program, which currently provides "enhanced care coordination services" to Medicaid enrollees. Participation in the program will be limited to dual-eligibles over the age of 21 in the following six counties:  Bexar, Dallas, El Paso, Harris, Hildago, and Tarrant. According to a CMS Fact Sheet , it is anticipated that 168,000 individuals will be eligible to be enrolled in the program. Enrollment for the demo program is scheduled to start on March 1, 2015.
 
Key Primary Run-Off Results
Lt. Governor
State Senator Dan Patrick defeated three-term incumbent Lt. Governor David Dewhurst in the GOP nomination for Lt. Governor in a race that succumbed to personal attacks. Senator Patrick now faces the Democratic nominee and current state Senator Leticia Van de Putte. Ms Van de Putte served in the Texas House of Representatives prior to her service in the Texas Senate.
 
U.S. District 36
Republican Congressman Steve Stockman from the 36th District,  gave up his House seat to pursue an unsuccessful Senate bid against John Cornyn, leaving dentist Brian Babin and businessman Ben Streusand vying for his seat in the Republican runoff. Mr. Babin ended the night with 58 percent of the vote with Streusand trailing with 42 percent. Dr. Babin will face Michael Cole, the winner of the Democratic primary.
 

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