federal priorities 113 congress texas 83 legislative

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FEDERAL PRIORITIES 113TH CONGRESS As one of the top ten Catholic health systems in the United States, CHRISTUS Health is committed to delivering high-quality, accessible care to all its patients. Through innovations in care delivery, CHRISTUS is working proactively to improve quality, increase efficiency, and reduce costs through expansion of successful care coordination initiatives, which have significant potential to bend the Medicaid cost curve. CHRISTUS is a leading provider of uncompensated care among not-for-profit health care systems and operates in states with some of the highest rates of uninsured, including Texas, Louisiana, and New Mexico. Sequestration, combined with the loss of federal funds previously provided by the stimulus package and the reduction of Medicare bad debt payments included in The Middle Class Tax Relief and Job Creation Act of 2012, means that reimbursement levels will be inadequate to meet the health care needs of the vulnerable populations CHRISTUS serves. In addition, the prospect of further cuts in federal funding seriously threatens much-needed jobs in the health care sector at a time of continued economic uncertainty. CHRISTUS Health currently employs more than 30,000 individuals and treats more than three million patients annually through its almost 350 facilities, including more than 50 hospitals and long-term care facilities, 175 clinics and outpatient centers, and dozens of other health care ministries.

PRIORITIES

Support state flexibility for Medicaid expansion. Fix Medicare physician payments. Preserve Medicare Dependent, Sole Community & Low Volume Hospital programs.

CHRISTUS urges Congress to adopt a permanent solution to replace the fundamentally-flawed Medicare physician payment formula, and at a Stop sequestration and ensure minimum, to avert the impending Medicare physician payment cut scheduled sustainable health care funding. to go into effect on January 1, 2013. This much-needed reform or any shortterm payment “fix” should not be funded by cuts to hospitals, however, which Strengthen health information are already absorbing payment reductions enacted by the Affordable Care technology. Act and other recent legislation. As Congress considers the extension of expiring payment provisions, reauthorization of the rural hospital extenders that are essential to maintaining access to care for Medicare beneficiaries who reside in medically under-served rural areas.

As part of the health care safety net, CHRISTUS depends on sustainable Medicaid funding to serve those members of our communities who are uninsured, underinsured, or have inadequate access to health care. During the economic downturn, CHRISTUS Health has experienced a significant increase in demand for Medicaid services. At the same time, states have cut their Medicaid budgets significantly, and federal policy-makers are now considering additional proposals for deficit reduction and options to offset the cost of extending Medicare payment provisions. In the current economic climate, it is imperative to maintain current Medicaid funding for critical safety-net programs. CHRISTUS Health has invested heavily to strengthen and expand its health information infrastructure with federal support through incentive payments designed to ensure meaningful use of electronic health records.  CHRISTUS effectively leverages its technology to deliver care, enable the exchange of health information among patients and providers, support individuals with chronic diseases to help manage their conditions, enable frequent contact with care teams, and provide access to health services remotely.

TEXAS 83RD LEGISLATIVE PRIORITIES

CHRISTUS Health is the largest nonprofit system in the state of Texas. Given the major policy initiatives at both the federal and state level, there remains a tremendous amount of uncertainties for forecasting business operations, making it more important for safety net hospitals to rely on a variety of funding streams to maintain the health care safety net in our communities. In addition to our Catholic and mission related focus, we are a major employer in the state. CHRISTUS Health’s Texas hospitals have over 4500 licensed beds and provide more uncompensated care than any other nonprofit hospital system in Texas. 

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Texas Legislative Priorities PATIENT PROTECTION & AFFORDABLE CARE ACT OF 2010 CHRISTUS Health supports efforts to reduce the number of uninsured individuals in Texas.

CHRISTUS Health is committed to health care reform that will expand access to care to all citizens. While the state has currently chosen not to pursue expansion of Medicaid to additional populations under the terms and conditions outlined in the ACA, we urge the state to seriously consider alternative options for expanding health care and insurance coverage.

Medicaid remains a vital safety net and we are committed to reforming and strengthening the program to leverage every dollar invested by the State to provide quality health care to low-income individuals. Unfortunately, hospitals and other safety-net providers are already struggling to serve enrollees. Particularly because on average, acute care hospitals in Texas are paid only 51 cents for every dollar spent caring for Medicaid patients. Beginning in FY 2014, hospitals will face significant cuts in DSH payments to offset the cost of expanded coverage enacted in the health care reform law. Without increasing health insurance coverage, many Texans will remain uninsured and continue to seek care in the emergency room. This will increase the uncompensated care burden for health care providers while reimbursements for uncompensated care decline. In the end, costs will have to be shifted to those on private insurance in even greater amounts than today. 

1115 Waiver CHRISTUS Health supports a balanced approach that would level the playing field for both public and private providers under the waiver, either through rule making or legislation. This would ensure that the goal of greater access to care would allow for the money to follow the patient. The 82nd Texas Legislature approved the expansion of Medicaid managed care statewide. This change shifted hospital reimbursement from a fee-for-service to a capitated model. Due to the federal regulations prohibiting upper payment limit (UPL) payments under a capitated model, Texas requested and received approval for an 1115 waiver from the Centers for Medicare & Medicaid Services (CMS) that changes the way UPL payments are calculated, financed, and paid. The state’s waiver incentivizes transformation of the healthcare delivery system by utilizing these historical payments to reimburse uncompensated care costs and provide incentives for delivery system reform. However, additional sources of IGT funding are needed to leverage federal funds available under the waiver to cover uncompensated care costs and to provide DSRIP payments to qualified providers.

Medicaid Disproportionate Share Funding Disproportionate Share (DSH) payments supplement basic Medicaid payments to hospitals providing care to large numbers of Medicaid and uninsured patients. Private hospitals, such as CHRISTUS Health, provide almost half, or nearly $1.5 billion, of the uninsured care in the state; yet receive less than one percent of local taxes within the state. Additionally, private hospitals provide approximately 84% of Medicaid care in the state, while Medicaid payments cover only 51% of costs.

CHRISTUS Health asks the Legislature to support full-funding for the continuation of the DSH program to avoid leaving federal funds to be sent back to the federal government and redistributed to other states.

Data shows that most of the Medicaid and low income patients seek care at private hospitals, thereby providing the capacity for Texans to receive care that public systems cannot provide on their own. We believe it is equitable and makes financial sense for the public hospitals to help fund DSH. Under the 1115 waiver, public hospitals could re-direct those former DSH funds for their own use; contradicting guidance given to HHSC in SB 7 (82nd Regular). More importantly, this scenario would make DSH funding inequitable by favoring public care over privately provided care.

NeoNatal Intensive Care Units (NICU) Standards CHRISTUS Health advocates for healthy babies and healthy mothers, and urges caution in tying Medicaid reimbursement to NICU level.

Nov. 2012

During the previous Texas legislative session, lawmakers authorized the Texas Health and Human Services Commission to study and make recommendations regarding neonatal intensive care unit (NICU) operating standards. CHRISTUS Health will monitor any legislation arising from these recommendations and will evaluate any potential impact on the system’s seven NICUs across the state.

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