mrs KIMBERLY KRENIK

While Congress continued discussions and debate on how to address our nation's fiscal deadlines and avert a cut to doctor payments (Dec.13, Jan 1, and Jan 15), NJHA strongly urged lawmakers to reject arbitrary cuts to Medicare and Medicaid funding for providers. Since 2010, healthcare providers have been subjected to more than $250 billion in reductions and cannot sustain any additional cuts; NJHA advocated to lawmakers to avoid a 24 percent reduction in physician payments on January 1and to not finance that fix bycutting acute and post acute provider payments; Express concern on the site neutral payments proposal in President's budget and maintain the 75 rule (oppose to move to 60 percent), rebasing, and home health co-pays; Urge lawmakers to not cut GME funding, bad debt, additional across-the-board cuts to Medicare inpatient hospital rates through the use of coding adjustments; restrictions on Medicaid provider assessments; post acute payments; changes to the 340B program, as well as other important funding to providers. NJHA remains concerned and supports Congressional efforts to delay enforcement of the two midnight policy. CMS finalized its two-midnight policy whereby the agency will generally consider hospital admissions spanning two midnights as appropriate for payment under the inpatient prospective payment system (PPS). In contrast, hospital stays of less than two midnights will generally be considered outpatient cases, regardless of clinical severity. The policy took effect Oct. 1, but CMS has partially delayed its enforcement through March 31, 2014. NJHA continues to be deeply concerned that this policy to evaluate the medical necessity of hospital inpatient admissions will have significant financial and operational implications for hospitals and reduce protections and benefits for Medicare beneficiaries. NJHA Supports: H.R. 1920/S. 1555, the DSH Reduction Relief Act, which eliminates the first two years of planned cuts to Medicare and Medicaid disproportionate share hospital payments; H.R. 1250/S. 1012, the Medicare Audit Improvement Act, which reins in overly aggressive Medicare auditors; H.R. 3698, the Two Midnight Rule Delay Act of 2013, a bill to delay enforcement of CMS' two-midnight policy for one year; S. 1557, the Children's Hospital GME Support Reauthorization Act of 2013; H.R. 1180/S.577, the Resident Physician Shortage Reduction Act of 2013, which would create new residency positions to help alleviate physician shortages. NJHA strongly opposes: S.183/H.R.2053, bills to create a state-specific BNA for rural and imputed wage index floors. In addition, NJHA opposes any effort to include such language in any legislative vehicle.

NJHA strongly supports: S. 1012/H.R. 1250, the Medicare Audit Improvement Act of 2013, legislation that would make much-needed improvements to the Recovery Audit Contractor (RAC) program and other Medicare audit programs; H.R. 1920/S.1555, the DSH Reduction Relief Act, bills that would eliminate the first two years of the ACA's cuts to the Medicare and Medicaid disproportionate share hospital (DSH) programs to allow expansion of health coverage to become more fully realized;H.R. 1180/S. 577, the Resident Physician Shortage Reduction Act of 2013, which would create new residency positions to help alleviate physician shortages; S.1439, Care Planning Act of 2013. NJHA strongly opposes: S.183, the Hospital Payment Fairness Act of 2013 and H.R.2053, the Medicare Wage Index Equity Act of 2013, measures that would create a state specific bna for rural and imputed floors. Supported congressional efforts and letter to CMS expressing concerns regarding the Admission and Medical Review Criteria for Hospital Inpatient Services requirements that were finalized in the FY 2014 IPPS rule and to request a delay in the enforcement of the (two midnight policy) rule to enable the field to collaborate with CMS on the implementation process, including proper education and updating of electronic health record (EHR) systems; Supported a congressional letter to CMS regarding a proposal in their FY2014 IPPS proposed rule to include two stroke-related quality outcome measures in the hospital inpatient quality reporting (IQR) program; Supported a congressional letter to HHS urging the agency to reject the Presidents proposals to establish site neutral payments for IRFs and to reinstate the 75 percent compliance threshold; Supported a congressional letter regarding Physician Face-to-Face (F2F) requirements currently being implemented by CMS as part of the ACA; Supported congressional letter to CMS expressing concern on the implementation of the rebasing provision in Section 3131 of the ACA in proposed FY2014 Home Health Prospective Payment System (HHPPS) rule; Supported a letter to HHS calling for additional time for hospitals to meet the Medicare Electronic Health Records (EHR) Incentive Programs meaningful use Stage 2 requirements for one year. While Congress continued their discussions on how to handle our fiscal deadlines on October 1 (CR) and October 17 (debt ceiling), NJHA continued to urge NJ lawmakers to not make additional reductions to providers in the process. NJHA held a NJ congressional briefing that discussed the important issues facing are industry including wage index, oppose potential cuts to the provider industry, F2F, home health rebasing, site neutral payments, 60 percent rule, 25 percent rule, Medicare and Medicaid DSH, teaching hospital issues, SGR, RAC, and the two midnight policy.

Urged strong support for an extension of NJs imputed wage index floor in the FY2014 IPPS Rule. Urged support for keeping the budget neutrality for imputed and rural floors at a national practice. Strongly urged New Jerseys congressional delegation to prevent the automatic 2 percent cut to providers Medicare payments and advocate that Congress not impose arbitrary payment cuts to providers, but instead offer real solutions to our nation's fiscal problems.Urged Congress to prevent the 27 percent cut to doctor payments but not at the expense of providers. While Congress was deliberating how to address our fiscal woes, NJHA continued to oppose any reductions to Medicare and Medicaid payments as well as cuts to GME, IME, E/M services, bad debt, among other proposed reductions harmful to providers. Congress passed the American Taxpayer Relief Act (ATRA), that delayed the automatic spending reductions for two months and pushed off the 27 percent doctors payment cuts by 12 months as well as extended other expiring Medicare payment provisions. NJHA expressed dismay that Congress decided to pay for these provisions in part by implementing a documentation and coding offset and extending current Medicaid disproportionate share hospital reductions for an additional year. These reductions will have direct impact hospital payments. Urged support to reverse CMMI's decision to suspend the implementation of NJ's Bundled Payment Model 1 Gainsharing Demonstration Project. Support Congressional letter to CMS regarding proposed changes to Medicare payments for dementia and their negative implications for the Program of All-inclusive Care for the Elderly (PACE), which would eventually reduce Medicare payments to PACE organizations by an average of 10 percent. Support H.R. 297, to reauthorize the Childrens Hospitals Graduate Medical Education program, which provides funding to help freestanding children's hospitals train pediatric residents. Support H.R. 1390, the Urban Medicare-Dependent Hospitals (UMDH) Preservation Act, a measure to protect hospitals in New Jersey and other-urban areas that are facing unsustainable Medicare payment losses. Support H.R. 1250, the Medicare Audit Improvement Act of 2013. This legislation that would make much needed improvements to the Recovery Audit Contractor (RAC) program and other Medicare audit programs. Support S. 351, legislation to repeal the Independent Payment Advisory Board created by the PPACA. Strongly oppose S. 183, The Hospital Payment Fairness Act, a bill that would sunset the national budget neutrality for rural and imputed floors at the end of the fiscal year and replace it with a state-specific adjustment. Strongly opposed an amendment offered in the Senate Budget measure that proposed to reinstate a state budget neutrality for rural and imputed floors. NJHA supported an amendment that was offered in the Senate Budget measure that sought a larger review of the area wage index.

While Congress continued discussions and debate on how to address our nation's fiscal deadlines and avert a cut to doctor payments (Dec.13, Jan 1, and Jan 15), NJHA strongly urged lawmakers to reject arbitrary cuts to Medicare and Medicaid funding for providers. Since 2010, healthcare providers have been subjected to more than $250 billion in reductions and cannot sustain any additional cuts; NJHA advocated to lawmakers to avoid a 24 percent reduction in physician payments on January 1and to not finance that fix bycutting acute and post acute provider payments; Express concern on the site neutral payments proposal in President's budget and maintain the 75 rule (oppose to move to 60 percent), rebasing, and home health co-pays; Urge lawmakers to not cut GME funding, bad debt, additional across-the-board cuts to Medicare inpatient hospital rates through the use of coding adjustments; restrictions on Medicaid provider assessments; post acute payments; changes to the 340B program, as well as other important funding to providers. NJHA remains concerned and supports Congressional efforts to delay enforcement of the two midnight policy. CMS finalized its two-midnight policy whereby the agency will generally consider hospital admissions spanning two midnights as appropriate for payment under the inpatient prospective payment system (PPS). In contrast, hospital stays of less than two midnights will generally be considered outpatient cases, regardless of clinical severity. The policy took effect Oct. 1, but CMS has partially delayed its enforcement through March 31, 2014. NJHA continues to be deeply concerned that this policy to evaluate the medical necessity of hospital inpatient admissions will have significant financial and operational implications for hospitals and reduce protections and benefits for Medicare beneficiaries. NJHA Supports: H.R. 1920/S. 1555, the DSH Reduction Relief Act, which eliminates the first two years of planned cuts to Medicare and Medicaid disproportionate share hospital payments; H.R. 1250/S. 1012, the Medicare Audit Improvement Act, which reins in overly aggressive Medicare auditors; H.R. 3698, the Two Midnight Rule Delay Act of 2013, a bill to delay enforcement of CMS' two-midnight policy for one year; S. 1557, the Children's Hospital GME Support Reauthorization Act of 2013; H.R. 1180/S.577, the Resident Physician Shortage Reduction Act of 2013, which would create new residency positions to help alleviate physician shortages. NJHA strongly opposes: S.183/H.R.2053, bills to create a state-specific BNA for rural and imputed wage index floors. In addition, NJHA opposes any effort to include such language in any legislative vehicle.

NJHA strongly supports: S. 1012/H.R. 1250, the Medicare Audit Improvement Act of 2013, legislation that would make much-needed improvements to the Recovery Audit Contractor (RAC) program and other Medicare audit programs; H.R. 1920/S.1555, the DSH Reduction Relief Act, bills that would eliminate the first two years of the ACA's cuts to the Medicare and Medicaid disproportionate share hospital (DSH) programs to allow expansion of health coverage to become more fully realized;H.R. 1180/S. 577, the Resident Physician Shortage Reduction Act of 2013, which would create new residency positions to help alleviate physician shortages; S.1439, Care Planning Act of 2013. NJHA strongly opposes: S.183, the Hospital Payment Fairness Act of 2013 and H.R.2053, the Medicare Wage Index Equity Act of 2013, measures that would create a state specific bna for rural and imputed floors. Supported congressional efforts and letter to CMS expressing concerns regarding the Admission and Medical Review Criteria for Hospital Inpatient Services requirements that were finalized in the FY 2014 IPPS rule and to request a delay in the enforcement of the (two midnight policy) rule to enable the field to collaborate with CMS on the implementation process, including proper education and updating of electronic health record (EHR) systems; Supported a congressional letter to CMS regarding a proposal in their FY2014 IPPS proposed rule to include two stroke-related quality outcome measures in the hospital inpatient quality reporting (IQR) program; Supported a congressional letter to HHS urging the agency to reject the Presidents proposals to establish site neutral payments for IRFs and to reinstate the 75 percent compliance threshold; Supported a congressional letter regarding Physician Face-to-Face (F2F) requirements currently being implemented by CMS as part of the ACA; Supported congressional letter to CMS expressing concern on the implementation of the rebasing provision in Section 3131 of the ACA in proposed FY2014 Home Health Prospective Payment System (HHPPS) rule; Supported a letter to HHS calling for additional time for hospitals to meet the Medicare Electronic Health Records (EHR) Incentive Programs meaningful use Stage 2 requirements for one year. While Congress continued their discussions on how to handle our fiscal deadlines on October 1 (CR) and October 17 (debt ceiling), NJHA continued to urge NJ lawmakers to not make additional reductions to providers in the process. NJHA held a NJ congressional briefing that discussed the important issues facing are industry including wage index, oppose potential cuts to the provider industry, F2F, home health rebasing, site neutral payments, 60 percent rule, 25 percent rule, Medicare and Medicaid DSH, teaching hospital issues, SGR, RAC, and the two midnight policy.

Strongly advocate to extend NJs imputed wage index floor in the final FY2014 IPPS rule and for the continuation of national budget neutrality support for this vital provision; Wage index reform; Support delay of the Medicaid DSH cuts included in the ACA in light of lower than anticipated coverage expansion levels; Reject cuts to Medicare and Medicaid funding for provider services and support real solutions as Congress looks for ways to reduce the nations deficit; Improve the Recovery Audit Contractor (RAC) programand other Medicare audit programs; Mitigate the effects of the 2-percent sequester of Medicare payments; Mitigate the documentation and coding reductions to inpatient PPS hospitals; Reject the proposed reductions in Medicare funding to teaching hospitals for medical education; Create equity for urban Medicare-dependent hospitals; Support efforts to fix the physician payment formula in a manner that does not reduce the payments to other providers; Reject a site neutral payment policy between inpatient rehabilitation facilities (IRFs) and skilled nursing facilities because it fails to consider the clinical needs of patients and the substantive differences in outcomes for patient; Prevent the reinstatement of the 75 percent rule for IRFs; Eliminate implementation of the 25 percent rule for long term hospitals; Support regulatory and legislative efforts to create greater flexibility within the Program of All-Inclusive Care for the Elderly (PACE); Provide adequate funding for post-acute providers to assist in adopting interoperable electronic health records; and support the repeal of the Independent Payment Advisory Board (IPAB). NJHA supports S.1012/H.R.1250, the Medicare Audit Improvement Act of 2013, legislation that would make much-needed improvements to the Recovery Audit Contractor (RAC) program and other Medicare audit programs; Support H.R. 1920, the DSH Reduction Relief Act of 2013, a measure that would delay the Medicare and Medicaid disproportionate share hospital (DSH) cuts contained in the ACA for two years until FY2016. NJHA strongly opposes S. 183, the Hospital Payment Fairness Act of 2013 and H.R. 2053, the Medicare Wage Index Equity Act of 2013, measures that would create a state specific bna for rural and imputed floors.

Strongly advocate to extend NJs imputed wage index floor in the final FY2014 IPPS rule and for the continuation of national budget neutrality support for this vital provision; Wage index reform; Support delay of the Medicaid DSH cuts included in the ACA in light of lower than anticipated coverage expansion levels; Reject cuts to Medicare and Medicaid funding for provider services and support real solutions as Congress looks for ways to reduce the nations deficit; Improve the Recovery Audit Contractor (RAC) programand other Medicare audit programs; Mitigate the effects of the 2-percent sequester of Medicare payments; Mitigate the documentation and coding reductions to inpatient PPS hospitals; Reject the proposed reductions in Medicare funding to teaching hospitals for medical education; Create equity for urban Medicare-dependent hospitals; Support efforts to fix the physician payment formula in a manner that does not reduce the payments to other providers; Reject a site neutral payment policy between inpatient rehabilitation facilities (IRFs) and skilled nursing facilities because it fails to consider the clinical needs of patients and the substantive differences in outcomes for patient; Prevent the reinstatement of the 75 percent rule for IRFs; Eliminate implementation of the 25 percent rule for long term hospitals; Support regulatory and legislative efforts to create greater flexibility within the Program of All-Inclusive Care for the Elderly (PACE); Provide adequate funding for post-acute providers to assist in adopting interoperable electronic health records; and support the repeal of the Independent Payment Advisory Board (IPAB). NJHA supports S.1012/H.R.1250, the Medicare Audit Improvement Act of 2013, legislation that would make much-needed improvements to the Recovery Audit Contractor (RAC) program and other Medicare audit programs; Support H.R. 1920, the DSH Reduction Relief Act of 2013, a measure that would delay the Medicare and Medicaid disproportionate share hospital (DSH) cuts contained in the ACA for two years until FY2016. NJHA strongly opposes S. 183, the Hospital Payment Fairness Act of 2013 and H.R. 2053, the Medicare Wage Index Equity Act of 2013, measures that would create a state specific bna for rural and imputed floors.

While Congress continued discussions and debate on how to address our nation's fiscal deadlines and avert a cut to doctor payments (Dec.13, Jan 1, and Jan 15), NJHA strongly urged lawmakers to reject arbitrary cuts to Medicare and Medicaid funding for providers. Since 2010, healthcare providers have been subjected to more than $250 billion in reductions and cannot sustain any additional cuts; NJHA advocated to lawmakers to avoid a 24 percent reduction in physician payments on January 1and to not finance that fix bycutting acute and post acute provider payments; Express concern on the site neutral payments proposal in President's budget and maintain the 75 rule (oppose to move to 60 percent), rebasing, and home health co-pays; Urge lawmakers to not cut GME funding, bad debt, additional across-the-board cuts to Medicare inpatient hospital rates through the use of coding adjustments; restrictions on Medicaid provider assessments; post acute payments; changes to the 340B program, as well as other important funding to providers. NJHA remains concerned and supports Congressional efforts to delay enforcement of the two midnight policy. CMS finalized its two-midnight policy whereby the agency will generally consider hospital admissions spanning two midnights as appropriate for payment under the inpatient prospective payment system (PPS). In contrast, hospital stays of less than two midnights will generally be considered outpatient cases, regardless of clinical severity. The policy took effect Oct. 1, but CMS has partially delayed its enforcement through March 31, 2014. NJHA continues to be deeply concerned that this policy to evaluate the medical necessity of hospital inpatient admissions will have significant financial and operational implications for hospitals and reduce protections and benefits for Medicare beneficiaries. NJHA Supports: H.R. 1920/S. 1555, the DSH Reduction Relief Act, which eliminates the first two years of planned cuts to Medicare and Medicaid disproportionate share hospital payments; H.R. 1250/S. 1012, the Medicare Audit Improvement Act, which reins in overly aggressive Medicare auditors; H.R. 3698, the Two Midnight Rule Delay Act of 2013, a bill to delay enforcement of CMS' two-midnight policy for one year; S. 1557, the Children's Hospital GME Support Reauthorization Act of 2013; H.R. 1180/S.577, the Resident Physician Shortage Reduction Act of 2013, which would create new residency positions to help alleviate physician shortages. NJHA strongly opposes: S.183/H.R.2053, bills to create a state-specific BNA for rural and imputed wage index floors. In addition, NJHA opposes any effort to include such language in any legislative vehicle.

NJHA strongly supports: S. 1012/H.R. 1250, the Medicare Audit Improvement Act of 2013, legislation that would make much-needed improvements to the Recovery Audit Contractor (RAC) program and other Medicare audit programs; H.R. 1920/S.1555, the DSH Reduction Relief Act, bills that would eliminate the first two years of the ACA's cuts to the Medicare and Medicaid disproportionate share hospital (DSH) programs to allow expansion of health coverage to become more fully realized;H.R. 1180/S. 577, the Resident Physician Shortage Reduction Act of 2013, which would create new residency positions to help alleviate physician shortages; S.1439, Care Planning Act of 2013. NJHA strongly opposes: S.183, the Hospital Payment Fairness Act of 2013 and H.R.2053, the Medicare Wage Index Equity Act of 2013, measures that would create a state specific bna for rural and imputed floors. Supported congressional efforts and letter to CMS expressing concerns regarding the Admission and Medical Review Criteria for Hospital Inpatient Services requirements that were finalized in the FY 2014 IPPS rule and to request a delay in the enforcement of the (two midnight policy) rule to enable the field to collaborate with CMS on the implementation process, including proper education and updating of electronic health record (EHR) systems; Supported a congressional letter to CMS regarding a proposal in their FY2014 IPPS proposed rule to include two stroke-related quality outcome measures in the hospital inpatient quality reporting (IQR) program; Supported a congressional letter to HHS urging the agency to reject the Presidents proposals to establish site neutral payments for IRFs and to reinstate the 75 percent compliance threshold; Supported a congressional letter regarding Physician Face-to-Face (F2F) requirements currently being implemented by CMS as part of the ACA; Supported congressional letter to CMS expressing concern on the implementation of the rebasing provision in Section 3131 of the ACA in proposed FY2014 Home Health Prospective Payment System (HHPPS) rule; Supported a letter to HHS calling for additional time for hospitals to meet the Medicare Electronic Health Records (EHR) Incentive Programs meaningful use Stage 2 requirements for one year. While Congress continued their discussions on how to handle our fiscal deadlines on October 1 (CR) and October 17 (debt ceiling), NJHA continued to urge NJ lawmakers to not make additional reductions to providers in the process. NJHA held a NJ congressional briefing that discussed the important issues facing are industry including wage index, oppose potential cuts to the provider industry, F2F, home health rebasing, site neutral payments, 60 percent rule, 25 percent rule, Medicare and Medicaid DSH, teaching hospital issues, SGR, RAC, and the two midnight policy.

Urged strong support for an extension of NJs imputed wage index floor in the FY2014 IPPS Rule. Urged support for keeping the budget neutrality for imputed and rural floors at a national practice. Strongly urged New Jerseys congressional delegation to prevent the automatic 2 percent cut to providers Medicare payments and advocate that Congress not impose arbitrary payment cuts to providers, but instead offer real solutions to our nation's fiscal problems.Urged Congress to prevent the 27 percent cut to doctor payments but not at the expense of providers. While Congress was deliberating how to address our fiscal woes, NJHA continued to oppose any reductions to Medicare and Medicaid payments as well as cuts to GME, IME, E/M services, bad debt, among other proposed reductions harmful to providers. Congress passed the American Taxpayer Relief Act (ATRA), that delayed the automatic spending reductions for two months and pushed off the 27 percent doctors payment cuts by 12 months as well as extended other expiring Medicare payment provisions. NJHA expressed dismay that Congress decided to pay for these provisions in part by implementing a documentation and coding offset and extending current Medicaid disproportionate share hospital reductions for an additional year. These reductions will have direct impact hospital payments. Urged support to reverse CMMI's decision to suspend the implementation of NJ's Bundled Payment Model 1 Gainsharing Demonstration Project. Support Congressional letter to CMS regarding proposed changes to Medicare payments for dementia and their negative implications for the Program of All-inclusive Care for the Elderly (PACE), which would eventually reduce Medicare payments to PACE organizations by an average of 10 percent. Support H.R. 297, to reauthorize the Childrens Hospitals Graduate Medical Education program, which provides funding to help freestanding children's hospitals train pediatric residents. Support H.R. 1390, the Urban Medicare-Dependent Hospitals (UMDH) Preservation Act, a measure to protect hospitals in New Jersey and other-urban areas that are facing unsustainable Medicare payment losses. Support H.R. 1250, the Medicare Audit Improvement Act of 2013. This legislation that would make much needed improvements to the Recovery Audit Contractor (RAC) program and other Medicare audit programs. Support S. 351, legislation to repeal the Independent Payment Advisory Board created by the PPACA. Strongly oppose S. 183, The Hospital Payment Fairness Act, a bill that would sunset the national budget neutrality for rural and imputed floors at the end of the fiscal year and replace it with a state-specific adjustment. Strongly opposed an amendment offered in the Senate Budget measure that proposed to reinstate a state budget neutrality for rural and imputed floors. NJHA supported an amendment that was offered in the Senate Budget measure that sought a larger review of the area wage index.

Urge Congress to act on a relief measure quickly to provide needed resources to our states providers for the recovery of Hurricane Sandy. Support H.R. 307, the Pandemic and All-Hazards Preparedness Reauthorization Act of 2013.

While Congress continued discussions and debate on how to address our nation's fiscal deadlines and avert a cut to doctor payments (Dec.13, Jan 1, and Jan 15), NJHA strongly urged lawmakers to reject arbitrary cuts to Medicare and Medicaid funding for providers. Since 2010, healthcare providers have been subjected to more than $250 billion in reductions and cannot sustain any additional cuts; NJHA advocated to lawmakers to avoid a 24 percent reduction in physician payments on January 1and to not finance that fix bycutting acute and post acute provider payments; Express concern on the site neutral payments proposal in President's budget and maintain the 75 rule (oppose to move to 60 percent), rebasing, and home health co-pays; Urge lawmakers to not cut GME funding, bad debt, additional across-the-board cuts to Medicare inpatient hospital rates through the use of coding adjustments; restrictions on Medicaid provider assessments; post acute payments; changes to the 340B program, as well as other important funding to providers. NJHA remains concerned and supports Congressional efforts to delay enforcement of the two midnight policy. CMS finalized its two-midnight policy whereby the agency will generally consider hospital admissions spanning two midnights as appropriate for payment under the inpatient prospective payment system (PPS). In contrast, hospital stays of less than two midnights will generally be considered outpatient cases, regardless of clinical severity. The policy took effect Oct. 1, but CMS has partially delayed its enforcement through March 31, 2014. NJHA continues to be deeply concerned that this policy to evaluate the medical necessity of hospital inpatient admissions will have significant financial and operational implications for hospitals and reduce protections and benefits for Medicare beneficiaries. NJHA Supports: H.R. 1920/S. 1555, the DSH Reduction Relief Act, which eliminates the first two years of planned cuts to Medicare and Medicaid disproportionate share hospital payments; H.R. 1250/S. 1012, the Medicare Audit Improvement Act, which reins in overly aggressive Medicare auditors; H.R. 3698, the Two Midnight Rule Delay Act of 2013, a bill to delay enforcement of CMS' two-midnight policy for one year; S. 1557, the Children's Hospital GME Support Reauthorization Act of 2013; H.R. 1180/S.577, the Resident Physician Shortage Reduction Act of 2013, which would create new residency positions to help alleviate physician shortages. NJHA strongly opposes: S.183/H.R.2053, bills to create a state-specific BNA for rural and imputed wage index floors. In addition, NJHA opposes any effort to include such language in any legislative vehicle.

Strongly advocate to extend NJs imputed wage index floor in the final FY2014 IPPS rule and for the continuation of national budget neutrality support for this vital provision; Wage index reform; Support delay of the Medicaid DSH cuts included in the ACA in light of lower than anticipated coverage expansion levels; Reject cuts to Medicare and Medicaid funding for provider services and support real solutions as Congress looks for ways to reduce the nations deficit; Improve the Recovery Audit Contractor (RAC) programand other Medicare audit programs; Mitigate the effects of the 2-percent sequester of Medicare payments; Mitigate the documentation and coding reductions to inpatient PPS hospitals; Reject the proposed reductions in Medicare funding to teaching hospitals for medical education; Create equity for urban Medicare-dependent hospitals; Support efforts to fix the physician payment formula in a manner that does not reduce the payments to other providers; Reject a site neutral payment policy between inpatient rehabilitation facilities (IRFs) and skilled nursing facilities because it fails to consider the clinical needs of patients and the substantive differences in outcomes for patient; Prevent the reinstatement of the 75 percent rule for IRFs; Eliminate implementation of the 25 percent rule for long term hospitals; Support regulatory and legislative efforts to create greater flexibility within the Program of All-Inclusive Care for the Elderly (PACE); Provide adequate funding for post-acute providers to assist in adopting interoperable electronic health records; and support the repeal of the Independent Payment Advisory Board (IPAB). NJHA supports S.1012/H.R.1250, the Medicare Audit Improvement Act of 2013, legislation that would make much-needed improvements to the Recovery Audit Contractor (RAC) program and other Medicare audit programs; Support H.R. 1920, the DSH Reduction Relief Act of 2013, a measure that would delay the Medicare and Medicaid disproportionate share hospital (DSH) cuts contained in the ACA for two years until FY2016. NJHA strongly opposes S. 183, the Hospital Payment Fairness Act of 2013 and H.R. 2053, the Medicare Wage Index Equity Act of 2013, measures that would create a state specific bna for rural and imputed floors.

While Congress continued discussions and debate on how to address our nation's fiscal deadlines and avert a cut to doctor payments (Dec.13, Jan 1, and Jan 15), NJHA strongly urged lawmakers to reject arbitrary cuts to Medicare and Medicaid funding for providers. Since 2010, healthcare providers have been subjected to more than $250 billion in reductions and cannot sustain any additional cuts; NJHA advocated to lawmakers to avoid a 24 percent reduction in physician payments on January 1and to not finance that fix bycutting acute and post acute provider payments; Express concern on the site neutral payments proposal in President's budget and maintain the 75 rule (oppose to move to 60 percent), rebasing, and home health co-pays; Urge lawmakers to not cut GME funding, bad debt, additional across-the-board cuts to Medicare inpatient hospital rates through the use of coding adjustments; restrictions on Medicaid provider assessments; post acute payments; changes to the 340B program, as well as other important funding to providers. NJHA remains concerned and supports Congressional efforts to delay enforcement of the two midnight policy. CMS finalized its two-midnight policy whereby the agency will generally consider hospital admissions spanning two midnights as appropriate for payment under the inpatient prospective payment system (PPS). In contrast, hospital stays of less than two midnights will generally be considered outpatient cases, regardless of clinical severity. The policy took effect Oct. 1, but CMS has partially delayed its enforcement through March 31, 2014. NJHA continues to be deeply concerned that this policy to evaluate the medical necessity of hospital inpatient admissions will have significant financial and operational implications for hospitals and reduce protections and benefits for Medicare beneficiaries. NJHA Supports: H.R. 1920/S. 1555, the DSH Reduction Relief Act, which eliminates the first two years of planned cuts to Medicare and Medicaid disproportionate share hospital payments; H.R. 1250/S. 1012, the Medicare Audit Improvement Act, which reins in overly aggressive Medicare auditors; H.R. 3698, the Two Midnight Rule Delay Act of 2013, a bill to delay enforcement of CMS' two-midnight policy for one year; S. 1557, the Children's Hospital GME Support Reauthorization Act of 2013; H.R. 1180/S.577, the Resident Physician Shortage Reduction Act of 2013, which would create new residency positions to help alleviate physician shortages. NJHA strongly opposes: S.183/H.R.2053, bills to create a state-specific BNA for rural and imputed wage index floors. In addition, NJHA opposes any effort to include such language in any legislative vehicle.

NJHA strongly supports: S. 1012/H.R. 1250, the Medicare Audit Improvement Act of 2013, legislation that would make much-needed improvements to the Recovery Audit Contractor (RAC) program and other Medicare audit programs; H.R. 1920/S.1555, the DSH Reduction Relief Act, bills that would eliminate the first two years of the ACA's cuts to the Medicare and Medicaid disproportionate share hospital (DSH) programs to allow expansion of health coverage to become more fully realized;H.R. 1180/S. 577, the Resident Physician Shortage Reduction Act of 2013, which would create new residency positions to help alleviate physician shortages; S.1439, Care Planning Act of 2013. NJHA strongly opposes: S.183, the Hospital Payment Fairness Act of 2013 and H.R.2053, the Medicare Wage Index Equity Act of 2013, measures that would create a state specific bna for rural and imputed floors. Supported congressional efforts and letter to CMS expressing concerns regarding the Admission and Medical Review Criteria for Hospital Inpatient Services requirements that were finalized in the FY 2014 IPPS rule and to request a delay in the enforcement of the (two midnight policy) rule to enable the field to collaborate with CMS on the implementation process, including proper education and updating of electronic health record (EHR) systems; Supported a congressional letter to CMS regarding a proposal in their FY2014 IPPS proposed rule to include two stroke-related quality outcome measures in the hospital inpatient quality reporting (IQR) program; Supported a congressional letter to HHS urging the agency to reject the Presidents proposals to establish site neutral payments for IRFs and to reinstate the 75 percent compliance threshold; Supported a congressional letter regarding Physician Face-to-Face (F2F) requirements currently being implemented by CMS as part of the ACA; Supported congressional letter to CMS expressing concern on the implementation of the rebasing provision in Section 3131 of the ACA in proposed FY2014 Home Health Prospective Payment System (HHPPS) rule; Supported a letter to HHS calling for additional time for hospitals to meet the Medicare Electronic Health Records (EHR) Incentive Programs meaningful use Stage 2 requirements for one year. While Congress continued their discussions on how to handle our fiscal deadlines on October 1 (CR) and October 17 (debt ceiling), NJHA continued to urge NJ lawmakers to not make additional reductions to providers in the process. NJHA held a NJ congressional briefing that discussed the important issues facing are industry including wage index, oppose potential cuts to the provider industry, F2F, home health rebasing, site neutral payments, 60 percent rule, 25 percent rule, Medicare and Medicaid DSH, teaching hospital issues, SGR, RAC, and the two midnight policy.

NJHA strongly supports: S. 1012/H.R. 1250, the Medicare Audit Improvement Act of 2013, legislation that would make much-needed improvements to the Recovery Audit Contractor (RAC) program and other Medicare audit programs; H.R. 1920/S.1555, the DSH Reduction Relief Act, bills that would eliminate the first two years of the ACA's cuts to the Medicare and Medicaid disproportionate share hospital (DSH) programs to allow expansion of health coverage to become more fully realized;H.R. 1180/S. 577, the Resident Physician Shortage Reduction Act of 2013, which would create new residency positions to help alleviate physician shortages; S.1439, Care Planning Act of 2013. NJHA strongly opposes: S.183, the Hospital Payment Fairness Act of 2013 and H.R.2053, the Medicare Wage Index Equity Act of 2013, measures that would create a state specific bna for rural and imputed floors. Supported congressional efforts and letter to CMS expressing concerns regarding the Admission and Medical Review Criteria for Hospital Inpatient Services requirements that were finalized in the FY 2014 IPPS rule and to request a delay in the enforcement of the (two midnight policy) rule to enable the field to collaborate with CMS on the implementation process, including proper education and updating of electronic health record (EHR) systems; Supported a congressional letter to CMS regarding a proposal in their FY2014 IPPS proposed rule to include two stroke-related quality outcome measures in the hospital inpatient quality reporting (IQR) program; Supported a congressional letter to HHS urging the agency to reject the Presidents proposals to establish site neutral payments for IRFs and to reinstate the 75 percent compliance threshold; Supported a congressional letter regarding Physician Face-to-Face (F2F) requirements currently being implemented by CMS as part of the ACA; Supported congressional letter to CMS expressing concern on the implementation of the rebasing provision in Section 3131 of the ACA in proposed FY2014 Home Health Prospective Payment System (HHPPS) rule; Supported a letter to HHS calling for additional time for hospitals to meet the Medicare Electronic Health Records (EHR) Incentive Programs meaningful use Stage 2 requirements for one year. While Congress continued their discussions on how to handle our fiscal deadlines on October 1 (CR) and October 17 (debt ceiling), NJHA continued to urge NJ lawmakers to not make additional reductions to providers in the process. NJHA held a NJ congressional briefing that discussed the important issues facing are industry including wage index, oppose potential cuts to the provider industry, F2F, home health rebasing, site neutral payments, 60 percent rule, 25 percent rule, Medicare and Medicaid DSH, teaching hospital issues, SGR, RAC, and the two midnight policy.

While Congress continued discussions and debate on how to address our nation's fiscal deadlines and avert a cut to doctor payments (Dec.13, Jan 1, and Jan 15), NJHA strongly urged lawmakers to reject arbitrary cuts to Medicare and Medicaid funding for providers. Since 2010, healthcare providers have been subjected to more than $250 billion in reductions and cannot sustain any additional cuts; NJHA advocated to lawmakers to avoid a 24 percent reduction in physician payments on January 1and to not finance that fix bycutting acute and post acute provider payments; Express concern on the site neutral payments proposal in President's budget and maintain the 75 rule (oppose to move to 60 percent), rebasing, and home health co-pays; Urge lawmakers to not cut GME funding, bad debt, additional across-the-board cuts to Medicare inpatient hospital rates through the use of coding adjustments; restrictions on Medicaid provider assessments; post acute payments; changes to the 340B program, as well as other important funding to providers. NJHA remains concerned and supports Congressional efforts to delay enforcement of the two midnight policy. CMS finalized its two-midnight policy whereby the agency will generally consider hospital admissions spanning two midnights as appropriate for payment under the inpatient prospective payment system (PPS). In contrast, hospital stays of less than two midnights will generally be considered outpatient cases, regardless of clinical severity. The policy took effect Oct. 1, but CMS has partially delayed its enforcement through March 31, 2014. NJHA continues to be deeply concerned that this policy to evaluate the medical necessity of hospital inpatient admissions will have significant financial and operational implications for hospitals and reduce protections and benefits for Medicare beneficiaries. NJHA Supports: H.R. 1920/S. 1555, the DSH Reduction Relief Act, which eliminates the first two years of planned cuts to Medicare and Medicaid disproportionate share hospital payments; H.R. 1250/S. 1012, the Medicare Audit Improvement Act, which reins in overly aggressive Medicare auditors; H.R. 3698, the Two Midnight Rule Delay Act of 2013, a bill to delay enforcement of CMS' two-midnight policy for one year; S. 1557, the Children's Hospital GME Support Reauthorization Act of 2013; H.R. 1180/S.577, the Resident Physician Shortage Reduction Act of 2013, which would create new residency positions to help alleviate physician shortages. NJHA strongly opposes: S.183/H.R.2053, bills to create a state-specific BNA for rural and imputed wage index floors. In addition, NJHA opposes any effort to include such language in any legislative vehicle.

NJHA strongly supports: S. 1012/H.R. 1250, the Medicare Audit Improvement Act of 2013, legislation that would make much-needed improvements to the Recovery Audit Contractor (RAC) program and other Medicare audit programs; H.R. 1920/S.1555, the DSH Reduction Relief Act, bills that would eliminate the first two years of the ACA's cuts to the Medicare and Medicaid disproportionate share hospital (DSH) programs to allow expansion of health coverage to become more fully realized;H.R. 1180/S. 577, the Resident Physician Shortage Reduction Act of 2013, which would create new residency positions to help alleviate physician shortages; S.1439, Care Planning Act of 2013. NJHA strongly opposes: S.183, the Hospital Payment Fairness Act of 2013 and H.R.2053, the Medicare Wage Index Equity Act of 2013, measures that would create a state specific bna for rural and imputed floors. Supported congressional efforts and letter to CMS expressing concerns regarding the Admission and Medical Review Criteria for Hospital Inpatient Services requirements that were finalized in the FY 2014 IPPS rule and to request a delay in the enforcement of the (two midnight policy) rule to enable the field to collaborate with CMS on the implementation process, including proper education and updating of electronic health record (EHR) systems; Supported a congressional letter to CMS regarding a proposal in their FY2014 IPPS proposed rule to include two stroke-related quality outcome measures in the hospital inpatient quality reporting (IQR) program; Supported a congressional letter to HHS urging the agency to reject the Presidents proposals to establish site neutral payments for IRFs and to reinstate the 75 percent compliance threshold; Supported a congressional letter regarding Physician Face-to-Face (F2F) requirements currently being implemented by CMS as part of the ACA; Supported congressional letter to CMS expressing concern on the implementation of the rebasing provision in Section 3131 of the ACA in proposed FY2014 Home Health Prospective Payment System (HHPPS) rule; Supported a letter to HHS calling for additional time for hospitals to meet the Medicare Electronic Health Records (EHR) Incentive Programs meaningful use Stage 2 requirements for one year. While Congress continued their discussions on how to handle our fiscal deadlines on October 1 (CR) and October 17 (debt ceiling), NJHA continued to urge NJ lawmakers to not make additional reductions to providers in the process. NJHA held a NJ congressional briefing that discussed the important issues facing are industry including wage index, oppose potential cuts to the provider industry, F2F, home health rebasing, site neutral payments, 60 percent rule, 25 percent rule, Medicare and Medicaid DSH, teaching hospital issues, SGR, RAC, and the two midnight policy.

While Congress continued discussions and debate on how to address our nation's fiscal deadlines and avert a cut to doctor payments (Dec.13, Jan 1, and Jan 15), NJHA strongly urged lawmakers to reject arbitrary cuts to Medicare and Medicaid funding for providers. Since 2010, healthcare providers have been subjected to more than $250 billion in reductions and cannot sustain any additional cuts; NJHA advocated to lawmakers to avoid a 24 percent reduction in physician payments on January 1and to not finance that fix bycutting acute and post acute provider payments; Express concern on the site neutral payments proposal in President's budget and maintain the 75 rule (oppose to move to 60 percent), rebasing, and home health co-pays; Urge lawmakers to not cut GME funding, bad debt, additional across-the-board cuts to Medicare inpatient hospital rates through the use of coding adjustments; restrictions on Medicaid provider assessments; post acute payments; changes to the 340B program, as well as other important funding to providers. NJHA remains concerned and supports Congressional efforts to delay enforcement of the two midnight policy. CMS finalized its two-midnight policy whereby the agency will generally consider hospital admissions spanning two midnights as appropriate for payment under the inpatient prospective payment system (PPS). In contrast, hospital stays of less than two midnights will generally be considered outpatient cases, regardless of clinical severity. The policy took effect Oct. 1, but CMS has partially delayed its enforcement through March 31, 2014. NJHA continues to be deeply concerned that this policy to evaluate the medical necessity of hospital inpatient admissions will have significant financial and operational implications for hospitals and reduce protections and benefits for Medicare beneficiaries. NJHA Supports: H.R. 1920/S. 1555, the DSH Reduction Relief Act, which eliminates the first two years of planned cuts to Medicare and Medicaid disproportionate share hospital payments; H.R. 1250/S. 1012, the Medicare Audit Improvement Act, which reins in overly aggressive Medicare auditors; H.R. 3698, the Two Midnight Rule Delay Act of 2013, a bill to delay enforcement of CMS' two-midnight policy for one year; S. 1557, the Children's Hospital GME Support Reauthorization Act of 2013; H.R. 1180/S.577, the Resident Physician Shortage Reduction Act of 2013, which would create new residency positions to help alleviate physician shortages. NJHA strongly opposes: S.183/H.R.2053, bills to create a state-specific BNA for rural and imputed wage index floors. In addition, NJHA opposes any effort to include such language in any legislative vehicle.

Strongly advocate to extend NJs imputed wage index floor in the final FY2014 IPPS rule and for the continuation of national budget neutrality support for this vital provision; Wage index reform; Support delay of the Medicaid DSH cuts included in the ACA in light of lower than anticipated coverage expansion levels; Reject cuts to Medicare and Medicaid funding for provider services and support real solutions as Congress looks for ways to reduce the nations deficit; Improve the Recovery Audit Contractor (RAC) programand other Medicare audit programs; Mitigate the effects of the 2-percent sequester of Medicare payments; Mitigate the documentation and coding reductions to inpatient PPS hospitals; Reject the proposed reductions in Medicare funding to teaching hospitals for medical education; Create equity for urban Medicare-dependent hospitals; Support efforts to fix the physician payment formula in a manner that does not reduce the payments to other providers; Reject a site neutral payment policy between inpatient rehabilitation facilities (IRFs) and skilled nursing facilities because it fails to consider the clinical needs of patients and the substantive differences in outcomes for patient; Prevent the reinstatement of the 75 percent rule for IRFs; Eliminate implementation of the 25 percent rule for long term hospitals; Support regulatory and legislative efforts to create greater flexibility within the Program of All-Inclusive Care for the Elderly (PACE); Provide adequate funding for post-acute providers to assist in adopting interoperable electronic health records; and support the repeal of the Independent Payment Advisory Board (IPAB). NJHA supports S.1012/H.R.1250, the Medicare Audit Improvement Act of 2013, legislation that would make much-needed improvements to the Recovery Audit Contractor (RAC) program and other Medicare audit programs; Support H.R. 1920, the DSH Reduction Relief Act of 2013, a measure that would delay the Medicare and Medicaid disproportionate share hospital (DSH) cuts contained in the ACA for two years until FY2016. NJHA strongly opposes S. 183, the Hospital Payment Fairness Act of 2013 and H.R. 2053, the Medicare Wage Index Equity Act of 2013, measures that would create a state specific bna for rural and imputed floors.

Urged strong support for an extension of NJs imputed wage index floor in the FY2014 IPPS Rule. Urged support for keeping the budget neutrality for imputed and rural floors at a national practice. Strongly urged New Jerseys congressional delegation to prevent the automatic 2 percent cut to providers Medicare payments and advocate that Congress not impose arbitrary payment cuts to providers, but instead offer real solutions to our nation's fiscal problems.Urged Congress to prevent the 27 percent cut to doctor payments but not at the expense of providers. While Congress was deliberating how to address our fiscal woes, NJHA continued to oppose any reductions to Medicare and Medicaid payments as well as cuts to GME, IME, E/M services, bad debt, among other proposed reductions harmful to providers. Congress passed the American Taxpayer Relief Act (ATRA), that delayed the automatic spending reductions for two months and pushed off the 27 percent doctors payment cuts by 12 months as well as extended other expiring Medicare payment provisions. NJHA expressed dismay that Congress decided to pay for these provisions in part by implementing a documentation and coding offset and extending current Medicaid disproportionate share hospital reductions for an additional year. These reductions will have direct impact hospital payments. Urged support to reverse CMMI's decision to suspend the implementation of NJ's Bundled Payment Model 1 Gainsharing Demonstration Project. Support Congressional letter to CMS regarding proposed changes to Medicare payments for dementia and their negative implications for the Program of All-inclusive Care for the Elderly (PACE), which would eventually reduce Medicare payments to PACE organizations by an average of 10 percent. Support H.R. 297, to reauthorize the Childrens Hospitals Graduate Medical Education program, which provides funding to help freestanding children's hospitals train pediatric residents. Support H.R. 1390, the Urban Medicare-Dependent Hospitals (UMDH) Preservation Act, a measure to protect hospitals in New Jersey and other-urban areas that are facing unsustainable Medicare payment losses. Support H.R. 1250, the Medicare Audit Improvement Act of 2013. This legislation that would make much needed improvements to the Recovery Audit Contractor (RAC) program and other Medicare audit programs. Support S. 351, legislation to repeal the Independent Payment Advisory Board created by the PPACA. Strongly oppose S. 183, The Hospital Payment Fairness Act, a bill that would sunset the national budget neutrality for rural and imputed floors at the end of the fiscal year and replace it with a state-specific adjustment. Strongly opposed an amendment offered in the Senate Budget measure that proposed to reinstate a state budget neutrality for rural and imputed floors. NJHA supported an amendment that was offered in the Senate Budget measure that sought a larger review of the area wage index.

While Congress continued discussions and debate on how to address our nation's fiscal deadlines and avert a cut to doctor payments (Dec.13, Jan 1, and Jan 15), NJHA strongly urged lawmakers to reject arbitrary cuts to Medicare and Medicaid funding for providers. Since 2010, healthcare providers have been subjected to more than $250 billion in reductions and cannot sustain any additional cuts; NJHA advocated to lawmakers to avoid a 24 percent reduction in physician payments on January 1and to not finance that fix bycutting acute and post acute provider payments; Express concern on the site neutral payments proposal in President's budget and maintain the 75 rule (oppose to move to 60 percent), rebasing, and home health co-pays; Urge lawmakers to not cut GME funding, bad debt, additional across-the-board cuts to Medicare inpatient hospital rates through the use of coding adjustments; restrictions on Medicaid provider assessments; post acute payments; changes to the 340B program, as well as other important funding to providers. NJHA remains concerned and supports Congressional efforts to delay enforcement of the two midnight policy. CMS finalized its two-midnight policy whereby the agency will generally consider hospital admissions spanning two midnights as appropriate for payment under the inpatient prospective payment system (PPS). In contrast, hospital stays of less than two midnights will generally be considered outpatient cases, regardless of clinical severity. The policy took effect Oct. 1, but CMS has partially delayed its enforcement through March 31, 2014. NJHA continues to be deeply concerned that this policy to evaluate the medical necessity of hospital inpatient admissions will have significant financial and operational implications for hospitals and reduce protections and benefits for Medicare beneficiaries. NJHA Supports: H.R. 1920/S. 1555, the DSH Reduction Relief Act, which eliminates the first two years of planned cuts to Medicare and Medicaid disproportionate share hospital payments; H.R. 1250/S. 1012, the Medicare Audit Improvement Act, which reins in overly aggressive Medicare auditors; H.R. 3698, the Two Midnight Rule Delay Act of 2013, a bill to delay enforcement of CMS' two-midnight policy for one year; S. 1557, the Children's Hospital GME Support Reauthorization Act of 2013; H.R. 1180/S.577, the Resident Physician Shortage Reduction Act of 2013, which would create new residency positions to help alleviate physician shortages. NJHA strongly opposes: S.183/H.R.2053, bills to create a state-specific BNA for rural and imputed wage index floors. In addition, NJHA opposes any effort to include such language in any legislative vehicle.

NJHA strongly supports: S. 1012/H.R. 1250, the Medicare Audit Improvement Act of 2013, legislation that would make much-needed improvements to the Recovery Audit Contractor (RAC) program and other Medicare audit programs; H.R. 1920/S.1555, the DSH Reduction Relief Act, bills that would eliminate the first two years of the ACA's cuts to the Medicare and Medicaid disproportionate share hospital (DSH) programs to allow expansion of health coverage to become more fully realized;H.R. 1180/S. 577, the Resident Physician Shortage Reduction Act of 2013, which would create new residency positions to help alleviate physician shortages; S.1439, Care Planning Act of 2013. NJHA strongly opposes: S.183, the Hospital Payment Fairness Act of 2013 and H.R.2053, the Medicare Wage Index Equity Act of 2013, measures that would create a state specific bna for rural and imputed floors. Supported congressional efforts and letter to CMS expressing concerns regarding the Admission and Medical Review Criteria for Hospital Inpatient Services requirements that were finalized in the FY 2014 IPPS rule and to request a delay in the enforcement of the (two midnight policy) rule to enable the field to collaborate with CMS on the implementation process, including proper education and updating of electronic health record (EHR) systems; Supported a congressional letter to CMS regarding a proposal in their FY2014 IPPS proposed rule to include two stroke-related quality outcome measures in the hospital inpatient quality reporting (IQR) program; Supported a congressional letter to HHS urging the agency to reject the Presidents proposals to establish site neutral payments for IRFs and to reinstate the 75 percent compliance threshold; Supported a congressional letter regarding Physician Face-to-Face (F2F) requirements currently being implemented by CMS as part of the ACA; Supported congressional letter to CMS expressing concern on the implementation of the rebasing provision in Section 3131 of the ACA in proposed FY2014 Home Health Prospective Payment System (HHPPS) rule; Supported a letter to HHS calling for additional time for hospitals to meet the Medicare Electronic Health Records (EHR) Incentive Programs meaningful use Stage 2 requirements for one year. While Congress continued their discussions on how to handle our fiscal deadlines on October 1 (CR) and October 17 (debt ceiling), NJHA continued to urge NJ lawmakers to not make additional reductions to providers in the process. NJHA held a NJ congressional briefing that discussed the important issues facing are industry including wage index, oppose potential cuts to the provider industry, F2F, home health rebasing, site neutral payments, 60 percent rule, 25 percent rule, Medicare and Medicaid DSH, teaching hospital issues, SGR, RAC, and the two midnight policy.

Urged strong support for an extension of NJs imputed wage index floor in the FY2014 IPPS Rule. Urged support for keeping the budget neutrality for imputed and rural floors at a national practice. Strongly urged New Jerseys congressional delegation to prevent the automatic 2 percent cut to providers Medicare payments and advocate that Congress not impose arbitrary payment cuts to providers, but instead offer real solutions to our nation's fiscal problems.Urged Congress to prevent the 27 percent cut to doctor payments but not at the expense of providers. While Congress was deliberating how to address our fiscal woes, NJHA continued to oppose any reductions to Medicare and Medicaid payments as well as cuts to GME, IME, E/M services, bad debt, among other proposed reductions harmful to providers. Congress passed the American Taxpayer Relief Act (ATRA), that delayed the automatic spending reductions for two months and pushed off the 27 percent doctors payment cuts by 12 months as well as extended other expiring Medicare payment provisions. NJHA expressed dismay that Congress decided to pay for these provisions in part by implementing a documentation and coding offset and extending current Medicaid disproportionate share hospital reductions for an additional year. These reductions will have direct impact hospital payments. Urged support to reverse CMMI's decision to suspend the implementation of NJ's Bundled Payment Model 1 Gainsharing Demonstration Project. Support Congressional letter to CMS regarding proposed changes to Medicare payments for dementia and their negative implications for the Program of All-inclusive Care for the Elderly (PACE), which would eventually reduce Medicare payments to PACE organizations by an average of 10 percent. Support H.R. 297, to reauthorize the Childrens Hospitals Graduate Medical Education program, which provides funding to help freestanding children's hospitals train pediatric residents. Support H.R. 1390, the Urban Medicare-Dependent Hospitals (UMDH) Preservation Act, a measure to protect hospitals in New Jersey and other-urban areas that are facing unsustainable Medicare payment losses. Support H.R. 1250, the Medicare Audit Improvement Act of 2013. This legislation that would make much needed improvements to the Recovery Audit Contractor (RAC) program and other Medicare audit programs. Support S. 351, legislation to repeal the Independent Payment Advisory Board created by the PPACA. Strongly oppose S. 183, The Hospital Payment Fairness Act, a bill that would sunset the national budget neutrality for rural and imputed floors at the end of the fiscal year and replace it with a state-specific adjustment. Strongly opposed an amendment offered in the Senate Budget measure that proposed to reinstate a state budget neutrality for rural and imputed floors. NJHA supported an amendment that was offered in the Senate Budget measure that sought a larger review of the area wage index.

While Congress continued discussions and debate on how to address our nation's fiscal deadlines and avert a cut to doctor payments (Dec.13, Jan 1, and Jan 15), NJHA strongly urged lawmakers to reject arbitrary cuts to Medicare and Medicaid funding for providers. Since 2010, healthcare providers have been subjected to more than $250 billion in reductions and cannot sustain any additional cuts; NJHA advocated to lawmakers to avoid a 24 percent reduction in physician payments on January 1and to not finance that fix bycutting acute and post acute provider payments; Express concern on the site neutral payments proposal in President's budget and maintain the 75 rule (oppose to move to 60 percent), rebasing, and home health co-pays; Urge lawmakers to not cut GME funding, bad debt, additional across-the-board cuts to Medicare inpatient hospital rates through the use of coding adjustments; restrictions on Medicaid provider assessments; post acute payments; changes to the 340B program, as well as other important funding to providers. NJHA remains concerned and supports Congressional efforts to delay enforcement of the two midnight policy. CMS finalized its two-midnight policy whereby the agency will generally consider hospital admissions spanning two midnights as appropriate for payment under the inpatient prospective payment system (PPS). In contrast, hospital stays of less than two midnights will generally be considered outpatient cases, regardless of clinical severity. The policy took effect Oct. 1, but CMS has partially delayed its enforcement through March 31, 2014. NJHA continues to be deeply concerned that this policy to evaluate the medical necessity of hospital inpatient admissions will have significant financial and operational implications for hospitals and reduce protections and benefits for Medicare beneficiaries. NJHA Supports: H.R. 1920/S. 1555, the DSH Reduction Relief Act, which eliminates the first two years of planned cuts to Medicare and Medicaid disproportionate share hospital payments; H.R. 1250/S. 1012, the Medicare Audit Improvement Act, which reins in overly aggressive Medicare auditors; H.R. 3698, the Two Midnight Rule Delay Act of 2013, a bill to delay enforcement of CMS' two-midnight policy for one year; S. 1557, the Children's Hospital GME Support Reauthorization Act of 2013; H.R. 1180/S.577, the Resident Physician Shortage Reduction Act of 2013, which would create new residency positions to help alleviate physician shortages. NJHA strongly opposes: S.183/H.R.2053, bills to create a state-specific BNA for rural and imputed wage index floors. In addition, NJHA opposes any effort to include such language in any legislative vehicle.

NJHA strongly supports: S. 1012/H.R. 1250, the Medicare Audit Improvement Act of 2013, legislation that would make much-needed improvements to the Recovery Audit Contractor (RAC) program and other Medicare audit programs; H.R. 1920/S.1555, the DSH Reduction Relief Act, bills that would eliminate the first two years of the ACA's cuts to the Medicare and Medicaid disproportionate share hospital (DSH) programs to allow expansion of health coverage to become more fully realized;H.R. 1180/S. 577, the Resident Physician Shortage Reduction Act of 2013, which would create new residency positions to help alleviate physician shortages; S.1439, Care Planning Act of 2013. NJHA strongly opposes: S.183, the Hospital Payment Fairness Act of 2013 and H.R.2053, the Medicare Wage Index Equity Act of 2013, measures that would create a state specific bna for rural and imputed floors. Supported congressional efforts and letter to CMS expressing concerns regarding the Admission and Medical Review Criteria for Hospital Inpatient Services requirements that were finalized in the FY 2014 IPPS rule and to request a delay in the enforcement of the (two midnight policy) rule to enable the field to collaborate with CMS on the implementation process, including proper education and updating of electronic health record (EHR) systems; Supported a congressional letter to CMS regarding a proposal in their FY2014 IPPS proposed rule to include two stroke-related quality outcome measures in the hospital inpatient quality reporting (IQR) program; Supported a congressional letter to HHS urging the agency to reject the Presidents proposals to establish site neutral payments for IRFs and to reinstate the 75 percent compliance threshold; Supported a congressional letter regarding Physician Face-to-Face (F2F) requirements currently being implemented by CMS as part of the ACA; Supported congressional letter to CMS expressing concern on the implementation of the rebasing provision in Section 3131 of the ACA in proposed FY2014 Home Health Prospective Payment System (HHPPS) rule; Supported a letter to HHS calling for additional time for hospitals to meet the Medicare Electronic Health Records (EHR) Incentive Programs meaningful use Stage 2 requirements for one year. While Congress continued their discussions on how to handle our fiscal deadlines on October 1 (CR) and October 17 (debt ceiling), NJHA continued to urge NJ lawmakers to not make additional reductions to providers in the process. NJHA held a NJ congressional briefing that discussed the important issues facing are industry including wage index, oppose potential cuts to the provider industry, F2F, home health rebasing, site neutral payments, 60 percent rule, 25 percent rule, Medicare and Medicaid DSH, teaching hospital issues, SGR, RAC, and the two midnight policy.

Medicare: Urged lawmakers to extend key hospital provisions and reject cuts to Medicare and Medicaid payments for provider services as part of any final agreement to extend the Social Security tax holiday, unemployment insurance benefits, and physician fix. Opposed reductions to Medicare bad debt for hospitals, nursing homes, clinical lab payments, and rebasing Medicaid DSH. Strong support for eliminating planned Medicare cuts to physicians and opposition to doing that by reducing payments to providers. Support for extension of other healthcare policies, including: MMA section 508 reclassifications, exceptions process for Medicare therapy caps, and outpatient hold harmless payments. Strongly oppose proposals included in the Administrations FY2013 budget blueprint that included $320 billion in reductions to Medicare and Medicaid as part of their $3.8 trillion budget plan. Specifically, oppose reductions to bad debt, IME, reductions to post acute providers, and strengthening the IPAB. As well as opposed proposed reductions to Medicaid provider taxes, Medicaid DSH, and changes to Medicaid payment formulas. Strongly oppose Medicare and Medicaid reductions included in the Houses FY2013 Budget Resolution, which proposed to cut more than $5.3 trillion in government spending over the next 10 years, approximately half of which would come from health care. The proposal called for a budget reconciliation process, directing six House committees, to produce legislation reducing the deficit by at least $18 billion in the first year and $261 billion over 10 years. The proposal called for eliminating the sequester cuts for defense and non-mandatory discretionary spending, Medicare sequester cuts, approximately $6 billion over 10 years, remain in place. Among other proposals, the budget plan would rescind the individual subsidies and Medicaid expansions included in the ACA, while keeping the $500 billion in Medicare cuts included in the law. The budget also would convert Medicaid into a block grant program, reducing federal Medicaid spending by $5 billion in 2013 and $810 billion over 10 years. Support efforts to urge HHS to extend current relief from full implementation of the 25% rule affecting long-term care hospitals (LTCHs) for an additional hospital cost reporting period and/or at least until the end of 2012 in order to give Congress an opportunity to resolve many of the issues affecting LTCHs. Urge support for application submitted to CMS to convene an expansive Medicare physician/hospital gainsharing pilot in New Jersey. The application was submitted in response to a request for applications (RFA) by CMMI for organizations interested in conducting a Bundled Payments for Care Improvement Initiative. Support adequate funding for freestanding childrens hospitals to train medical residents (CHGME); Support H.R. 5, Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011; Support H.R. 452, the Medicare Decisions Accountability Act, which repeals the Independent Payment Advisory Board, or IPAB; and Support S. 1855, the Pandemic and All-Hazards Preparedness Act Reauthorization of 2011.

Medicare: If Congress did not act, automatic 2% Medicare cuts contained in last years Budget Control Act would have proceeded on January 3.Congress was charged with making tough decisions that would have critically affected providers, including what to do with the Medicare physician payment fix, Medicare extenders, and other expiring tax provisions. NJHA advocated strongly to ensure that Congress did not impose arbitrary payment cuts to providers, but instead offers real solutions to our nations fiscal problems. NJHA remained concerned about, the SGR, the Medicare extenders, a framework to delay the sequester that could potentially impact Medicare and Medicaid, and the potential for reductions to payments for hospitals services to be used as an offset remain on the table for consideration. The current physician fix was set to expire December 31 as well as other expiring Medicare payment provisions of importance to hospitals. Unless Congress intervened, physicians would of seen their Medicare payments cut by 26 percent on January 1. NJHA supported fixing the physician payment formula to prevent this reduction; however, physician payment offsets should not come from other health care providers, including acute and post acute hospitals, who are themselves working to provide high-quality, innovative and efficient care to beneficiaries in their communities and experiencing negative margins under the Medicare program. NJHA opposed any reductions to Medicare and Medicaid payments Congress was considering to offset the fiscal cliff agreement, specifically, cuts to GME, IME, E/M services provided in hospital outpatient departments, bad debt, among other proposed reductions. NJHA supported efforts to avert the fiscal cliff and avoid the 2% reduction but not on the backs of providers. Strongly oppose any legislative efforts to eliminate NJ's imputed rural floor. Strongly urge Congress to protect and extend NJ's imputed floor that levels the playing with other states. Support legislation to reauthorize payments to childrens hospitals that operate graduate medical education programs (GME). The legislation reauthorized the children's hospital graduate medical education program and funds it at its original level of $330 million. The program has been operating with 30 percent less this year. While Congress continued to deliberate on how to address the fiscal cliff issue, NJHA continued to strongly urge the NJ Congressional delegation to act on important issues to NJ including extending NJs imputed rural floor, extension of Section 508 of the MMA, pass Urban Medicare Dependent Hospital legislation, SGR, extend and expand our gainsharing pilot, preserve payments to post acutes, and opposed any additional cuts to Medicare and Medicaid to NJs providers. CMMI unexpectedly suspended implementation of Bundled Payment Model 1 Gainsharing Demonstration Project. NJHA, on behalf of the 30 Medicare providers approved by CMMI to participate in this Demo, urged the NJ Congressional delegation to intercede to reverse CMMIs recent decision to suspend the gainsharing pilot. NJHA strongly urged CMS and CMMI to consider reinstating Model 1 for live implementation as originally planned. Support H.R. 6575, the Medicare Audit Improvement Act of 2012, legislation that would make much needed improvements to the Recovery Audit Contractor (RAC) program, and other Medicare audit programs.

Urge Congress to act quickly on a relief measure to provide needed resources to NJs providers to help recover from Hurricane Sandy. Support H.R. 6672, to reauthorize the Pandemic and All-Hazards Preparedness Act through 2012, which was set to expire in March.

Medicare:Continue to strongly urge CMS to extend or make permanent NJ's Medicare Imputed Wage Index Floor in the final FY2012 IPPS rule. Support Congresssional letters to CMS to extend floor and Congressional efforts; Continue to advocate for relief for NJ's DSH hospitals on the onerous retroactive recouping by CMS of DSH payments made to providers between 2005 and 2006; Continue to ask Congress for additional Medicare-supported physician-training positions and to maintain or increase funding for Graduate Medical Education (GME); support the simplification of the meaningful use requirements for electronic health records and payments for hospitals with multiple campuses; urge support for Urban Medicare-Dependent Hospital (UMDH) legislation; and passage of medical malpractice reform; Support Congressional letter to CMS expressing concerns on the final rule for section 6407 of the PPACA. This rule requires documentation of face-to-face encounters prior to certification for home health services and could negatively impact access to home health services for Medicare recipients; Support Congressional letter to CMS strongly urging the agency to make changes, reevaluate, and mitigate the reductions to the coding and documentation offset in the proposed FY2012 IPPS rule. The reduction was first included in last years final FY2011 IPPS rule. Support H.R. 1656, Urban, Medicare-Dependent Hospitals (UMDH) Preservation Act of 2011, a bill that would provide UMDHs with the same Medicare payment protection that is currently being afforded to rural Medicare-dependent hospitals; Support H. R. 1852, a measure that would reauthorize the Childrens Hospitals Graduate Medical Education program for five years to train the nations pediatric workforce; Support H.R.2500, legislation that clarifies that electronic health record incentive payments under Medicare and Medicaid should go to each campus of a multi-campus hospital system; Support H.R. 2267/S. 227, the Home Health Care Planning Improvement Act which would allow nurse practitioners (NPs), clinical nurse specialists (CNSs), certified nurse midwives (CNMs) and physician assistants (PAs) to order home health services under Medicare.

Medicare: Continue to strongly advocate for NJs Medicare Wage Index Floor to be made permanent or extended in final FY2012 IPPS rule; Support Senate and House Congressional letters to CMS urging the agency to make changes to the proposed coding offset in the FY2012 IPPS rule; Request Senate and House Appropriators to include stable funding for the Childrens Hospitals Graduate Medical Education (CHGME) program in the FY2012 appropriations bills; Support H.R. 1656, the Urban Medicare Dependent Preservation Act of 2011; Support relief from 25 percent rule, LTCH payment policies, and oppose reduction in skilled nursing facilities; Support H.R. 2500, the Equal Access and Parity for Multi-Campus Hospitals Act, which would ensure that multi-campus hospitals are treated fairly under the Medicare and Medicaid electronic health records incentive programs authorized in the ARRA. The bill clarifies that the EHR incentive payments should go to each campus of a multi-campus hospital system, as long as each campus meets the meaningful use requirements. Deficit Reduction/Joint Select Committee on Deficit Reduction: The bipartisan joint select committee on deficit reduction has begun its work to crafting a plan by Nov. 23 to reduce the national deficit by at least $1.2 trillion. If Congress fails to adopt the committee's recommendations by Dec. 23, or if the committee cannot find enough savings, automatic spending cuts totaling $1.2 trillion split between defense spending and non-defense programs will take effect. Under the trigger, reductions in Medicare payments to hospitals and other providers of up to 2 percent over nine years (2013 to 2021) would automatically take effect. Those cuts would reach an estimated $41 billion in hospital payments alone and $119 billion in Medicare overall. NJHA continues to strongly urge lawmakers to protect healthcare programs under Medicare and Medicaid as Congress continues to debate strategies and discuss the numerous Congressional proposals to rein in the national debt. Organized and participated in advocacy day on deficit reduction (July 13 and planning another one Oct 4th) to strongly urge lawmakers to oppose any additional cuts to provider payments while the debt limit discussions continue. Express concern and opposition to certain recommendations in the Administrations proposal to the Joint Select Committee on Deficit Reduction that includes cutting Medicare by $248 billion and Medicaid by $73 billion over 10 years. The healthcare recommendations included in the proposal include reducing bad debt payments; reducing indirect medical education payments; adjusting payment updates for certain post-acute care providers, including skilled nursing facilities, long-term care hospitals, inpatient rehabilitation facilities, a proposal to create a home health co-pay; and strengthening the IPAB which would jeopardize hospitals ability to care for patients and the training of our next generation of physicians. Any additional cuts to providers could result in threats to patient care could result in services eliminated; longer waits for care; ERs shut down; staffing reduced. Hospitals are doing more with less. There are other ways to reduce the deficit, but not on the backs of providers. In September, NJHA sent strong letters to the Joint Select Committee on Deficit Reduction Co-Chairs and the New Jersey Congressional Delegation urging them to reject any further reductions to healthcare providers. The letters requests that provider reductions stay off the table and asks that our N.J. Congressional Delegation express strong opposition with the Administration and the Joint Select Committee to healthcare provider reductions and to please ensure patients have the access to the hospital care they need and the continued economic benefits that hospitals bring to their communities. In New Jersey, hospitals provide nearly 145,000 jobs and about $19 billion in total contributions to the state economy.

Deficit Reduction/Super Committee: While the bipartisan super committee was charged with crafting a plan to reduce the national deficit by at least $1.2 trillion by Nov. 23, NJHA urged Congress to oppose any further reductions to NJ's acute and post acute providers. These reductions would endanger access to care and jeopardize jobs in an already struggling economy. The committee's failure to reach an agreement means automatic spending cuts totaling $1.2 trillion effective January 2013, including a 2% reduction in Medicare payments to hospitals and other providers over nine years (2013 to 2021). For New Jersey, the automatic Medicare cuts would total $130 million in 2013 and nearly $1.3 billion by 2021, on top of $4.5 billion in cuts under the Affordable Care Act (ACA). Medicare: NJHA supported eliminating the scheduled reduction of 27.4 percent in Medicare payments to physicians set to begin on Jan. 1, but not by reducing payments to hospitals. Expressed opposition to efforts that cut payments to providers to pay for a patch to the sustainable growth rate (SGR) adjustment for physicians. Support Congressional letter to the Chairmen and Ranking Members of the House Committee on Ways & Means and the House Committee on Energy & Commerce asking them to reject proposals that would inappropriately reduce payments for rehabilitation hospitals and units. NJHA opposed provisions in H.R. 3630, the Middle Class Tax Relief and Job Creation Act of 2011 , which would of cut more than $17 billion in hospital funding as part of a year-end tax and unemployment package that included a two-year fix for physician payment under Medicare. NJHA supported efforts to extend the following provisions: Section 508 of MMA, exceptions process for Medicare therapy caps, physician fee schedule, outpatient hold harmless payments, mental health add-on payments; and Medicare work geographic adjustment floor, and temporary assistance for needy families program. Support introduction of S. 1900, The Urban, Medicare-Dependent Hospitals (UMDH) Preservation Act of 2011. Companion bill in the House is H.R. 1656. Support H.R. 2500/S. 3708, legislation that clarifies that electronic health records incentive payments under Medicare and Medicaid should go to each campus of a multi-campus hospital system.

Medicare:Continue to strongly urge CMS to extend or make permanent NJ's Medicare Imputed Wage Index Floor in the final FY2012 IPPS rule. Support Congresssional letters to CMS to extend floor and Congressional efforts; Continue to advocate for relief for NJ's DSH hospitals on the onerous retroactive recouping by CMS of DSH payments made to providers between 2005 and 2006; Continue to ask Congress for additional Medicare-supported physician-training positions and to maintain or increase funding for Graduate Medical Education (GME); support the simplification of the meaningful use requirements for electronic health records and payments for hospitals with multiple campuses; urge support for Urban Medicare-Dependent Hospital (UMDH) legislation; and passage of medical malpractice reform; Support Congressional letter to CMS expressing concerns on the final rule for section 6407 of the PPACA. This rule requires documentation of face-to-face encounters prior to certification for home health services and could negatively impact access to home health services for Medicare recipients; Support Congressional letter to CMS strongly urging the agency to make changes, reevaluate, and mitigate the reductions to the coding and documentation offset in the proposed FY2012 IPPS rule. The reduction was first included in last years final FY2011 IPPS rule. Support H.R. 1656, Urban, Medicare-Dependent Hospitals (UMDH) Preservation Act of 2011, a bill that would provide UMDHs with the same Medicare payment protection that is currently being afforded to rural Medicare-dependent hospitals; Support H. R. 1852, a measure that would reauthorize the Childrens Hospitals Graduate Medical Education program for five years to train the nations pediatric workforce; Support H.R.2500, legislation that clarifies that electronic health record incentive payments under Medicare and Medicaid should go to each campus of a multi-campus hospital system; Support H.R. 2267/S. 227, the Home Health Care Planning Improvement Act which would allow nurse practitioners (NPs), clinical nurse specialists (CNSs), certified nurse midwives (CNMs) and physician assistants (PAs) to order home health services under Medicare.

Medicare:Continue to strongly urge CMS to extend or make permanent NJ's Medicare Imputed Wage Index Floor in the final FY2012 IPPS rule. Support Congresssional letters to CMS to extend floor and Congressional efforts; Continue to advocate for relief for NJ's DSH hospitals on the onerous retroactive recouping by CMS of DSH payments made to providers between 2005 and 2006; Continue to ask Congress for additional Medicare-supported physician-training positions and to maintain or increase funding for Graduate Medical Education (GME); support the simplification of the meaningful use requirements for electronic health records and payments for hospitals with multiple campuses; urge support for Urban Medicare-Dependent Hospital (UMDH) legislation; and passage of medical malpractice reform; Support Congressional letter to CMS expressing concerns on the final rule for section 6407 of the PPACA. This rule requires documentation of face-to-face encounters prior to certification for home health services and could negatively impact access to home health services for Medicare recipients; Support Congressional letter to CMS strongly urging the agency to make changes, reevaluate, and mitigate the reductions to the coding and documentation offset in the proposed FY2012 IPPS rule. The reduction was first included in last years final FY2011 IPPS rule. Support H.R. 1656, Urban, Medicare-Dependent Hospitals (UMDH) Preservation Act of 2011, a bill that would provide UMDHs with the same Medicare payment protection that is currently being afforded to rural Medicare-dependent hospitals; Support H. R. 1852, a measure that would reauthorize the Childrens Hospitals Graduate Medical Education program for five years to train the nations pediatric workforce; Support H.R.2500, legislation that clarifies that electronic health record incentive payments under Medicare and Medicaid should go to each campus of a multi-campus hospital system; Support H.R. 2267/S. 227, the Home Health Care Planning Improvement Act which would allow nurse practitioners (NPs), clinical nurse specialists (CNSs), certified nurse midwives (CNMs) and physician assistants (PAs) to order home health services under Medicare.

Medicare: Continue to strongly advocate for NJs Medicare Wage Index Floor to be made permanent or extended in final FY2012 IPPS rule; Support Senate and House Congressional letters to CMS urging the agency to make changes to the proposed coding offset in the FY2012 IPPS rule; Request Senate and House Appropriators to include stable funding for the Childrens Hospitals Graduate Medical Education (CHGME) program in the FY2012 appropriations bills; Support H.R. 1656, the Urban Medicare Dependent Preservation Act of 2011; Support relief from 25 percent rule, LTCH payment policies, and oppose reduction in skilled nursing facilities; Support H.R. 2500, the Equal Access and Parity for Multi-Campus Hospitals Act, which would ensure that multi-campus hospitals are treated fairly under the Medicare and Medicaid electronic health records incentive programs authorized in the ARRA. The bill clarifies that the EHR incentive payments should go to each campus of a multi-campus hospital system, as long as each campus meets the meaningful use requirements. Deficit Reduction/Joint Select Committee on Deficit Reduction: The bipartisan joint select committee on deficit reduction has begun its work to crafting a plan by Nov. 23 to reduce the national deficit by at least $1.2 trillion. If Congress fails to adopt the committee's recommendations by Dec. 23, or if the committee cannot find enough savings, automatic spending cuts totaling $1.2 trillion split between defense spending and non-defense programs will take effect. Under the trigger, reductions in Medicare payments to hospitals and other providers of up to 2 percent over nine years (2013 to 2021) would automatically take effect. Those cuts would reach an estimated $41 billion in hospital payments alone and $119 billion in Medicare overall. NJHA continues to strongly urge lawmakers to protect healthcare programs under Medicare and Medicaid as Congress continues to debate strategies and discuss the numerous Congressional proposals to rein in the national debt. Organized and participated in advocacy day on deficit reduction (July 13 and planning another one Oct 4th) to strongly urge lawmakers to oppose any additional cuts to provider payments while the debt limit discussions continue. Express concern and opposition to certain recommendations in the Administrations proposal to the Joint Select Committee on Deficit Reduction that includes cutting Medicare by $248 billion and Medicaid by $73 billion over 10 years. The healthcare recommendations included in the proposal include reducing bad debt payments; reducing indirect medical education payments; adjusting payment updates for certain post-acute care providers, including skilled nursing facilities, long-term care hospitals, inpatient rehabilitation facilities, a proposal to create a home health co-pay; and strengthening the IPAB which would jeopardize hospitals ability to care for patients and the training of our next generation of physicians. Any additional cuts to providers could result in threats to patient care could result in services eliminated; longer waits for care; ERs shut down; staffing reduced. Hospitals are doing more with less. There are other ways to reduce the deficit, but not on the backs of providers. In September, NJHA sent strong letters to the Joint Select Committee on Deficit Reduction Co-Chairs and the New Jersey Congressional Delegation urging them to reject any further reductions to healthcare providers. The letters requests that provider reductions stay off the table and asks that our N.J. Congressional Delegation express strong opposition with the Administration and the Joint Select Committee to healthcare provider reductions and to please ensure patients have the access to the hospital care they need and the continued economic benefits that hospitals bring to their communities. In New Jersey, hospitals provide nearly 145,000 jobs and about $19 billion in total contributions to the state economy.

Medicare:Continue to strongly urge CMS to extend or make permanent NJ's Medicare Imputed Wage Index Floor in the final FY2012 IPPS rule. Support Congresssional letters to CMS to extend floor and Congressional efforts; Continue to advocate for relief for NJ's DSH hospitals on the onerous retroactive recouping by CMS of DSH payments made to providers between 2005 and 2006; Continue to ask Congress for additional Medicare-supported physician-training positions and to maintain or increase funding for Graduate Medical Education (GME); support the simplification of the meaningful use requirements for electronic health records and payments for hospitals with multiple campuses; urge support for Urban Medicare-Dependent Hospital (UMDH) legislation; and passage of medical malpractice reform; Support Congressional letter to CMS expressing concerns on the final rule for section 6407 of the PPACA. This rule requires documentation of face-to-face encounters prior to certification for home health services and could negatively impact access to home health services for Medicare recipients; Support Congressional letter to CMS strongly urging the agency to make changes, reevaluate, and mitigate the reductions to the coding and documentation offset in the proposed FY2012 IPPS rule. The reduction was first included in last years final FY2011 IPPS rule. Support H.R. 1656, Urban, Medicare-Dependent Hospitals (UMDH) Preservation Act of 2011, a bill that would provide UMDHs with the same Medicare payment protection that is currently being afforded to rural Medicare-dependent hospitals; Support H. R. 1852, a measure that would reauthorize the Childrens Hospitals Graduate Medical Education program for five years to train the nations pediatric workforce; Support H.R.2500, legislation that clarifies that electronic health record incentive payments under Medicare and Medicaid should go to each campus of a multi-campus hospital system; Support H.R. 2267/S. 227, the Home Health Care Planning Improvement Act which would allow nurse practitioners (NPs), clinical nurse specialists (CNSs), certified nurse midwives (CNMs) and physician assistants (PAs) to order home health services under Medicare.

Deficit Reduction/Super Committee: While the bipartisan super committee was charged with crafting a plan to reduce the national deficit by at least $1.2 trillion by Nov. 23, NJHA urged Congress to oppose any further reductions to NJ's acute and post acute providers. These reductions would endanger access to care and jeopardize jobs in an already struggling economy. The committee's failure to reach an agreement means automatic spending cuts totaling $1.2 trillion effective January 2013, including a 2% reduction in Medicare payments to hospitals and other providers over nine years (2013 to 2021). For New Jersey, the automatic Medicare cuts would total $130 million in 2013 and nearly $1.3 billion by 2021, on top of $4.5 billion in cuts under the Affordable Care Act (ACA). Medicare: NJHA supported eliminating the scheduled reduction of 27.4 percent in Medicare payments to physicians set to begin on Jan. 1, but not by reducing payments to hospitals. Expressed opposition to efforts that cut payments to providers to pay for a patch to the sustainable growth rate (SGR) adjustment for physicians. Support Congressional letter to the Chairmen and Ranking Members of the House Committee on Ways & Means and the House Committee on Energy & Commerce asking them to reject proposals that would inappropriately reduce payments for rehabilitation hospitals and units. NJHA opposed provisions in H.R. 3630, the Middle Class Tax Relief and Job Creation Act of 2011 , which would of cut more than $17 billion in hospital funding as part of a year-end tax and unemployment package that included a two-year fix for physician payment under Medicare. NJHA supported efforts to extend the following provisions: Section 508 of MMA, exceptions process for Medicare therapy caps, physician fee schedule, outpatient hold harmless payments, mental health add-on payments; and Medicare work geographic adjustment floor, and temporary assistance for needy families program. Support introduction of S. 1900, The Urban, Medicare-Dependent Hospitals (UMDH) Preservation Act of 2011. Companion bill in the House is H.R. 1656. Support H.R. 2500/S. 3708, legislation that clarifies that electronic health records incentive payments under Medicare and Medicaid should go to each campus of a multi-campus hospital system.

Support H.R. 4, which repeals 1099 tax reporting requirements for small businesses that were included in the PPACA and other legislation.

Medicare:Continue to urge NJ delegations and CMS to make New Jerseys imputed wage index floor permanent; Eliminate Medicare DSH recoupments for cost reporting years 2004-2006, similar to prior years, that would unfairly hold NJ hospitals financially responsible calculation error and threaten the financial viability of many of our states safety-net providers; Reduce the size of the coding offset reduction in the FY2011 IPPS final rule; Support legislation to amend the meaningful use rule to reflect congressional intent to treat multi-campus hospitals equitably for the purposes of health IT incentive payments; Support the Medicare and Medicaid Extenders Act of 2010, which included a delay until January 2012 a 25% Medicare payment cut for physicians, extends Section 508 of the MMA; an exceptions process for Medicare therapy caps, an extension of the outpatient "hold harmless" payment provision, repeal of delay of RUG-IV, and restored to children's hospitals discounts for "orphan drugs" under the 340B drug discount program; Continue to urge recognition of the unique vulnerability of Medicare dependent urban hospitals in New Jersey through the Urban Medicare Dependent Hospital legislation and urge CMS to complete study on issue; Extend the timeframe to April 1, 2011 for implementation of the home health face-to-face encounter requirement; Support the Home Health Care Access Protection Act (S. 3315/H.R. 3803) that would reform the process of evaluating case mix changes in home health care; oppose reduction included in FY 2011 Physician Fee Schedule for outpatient physical therapy, occupational therapy, and speech-language pathology services, known as Multiple Procedure Payment Reduction for Therapy Services (MPPR). Shared concerns on the draft recommendations included in the National Commission on Fiscal Responsibility and Reform regarding accelerating DSH cuts, putting hospitals under the advisory board, reducing GME and IME funding and cutting bad debt payments to hospitals due to these These proposals would jeopardize provider services and have a direct impact our patients and communities.

Medicare:Continue to urge NJ delegations and CMS to make New Jerseys imputed wage index floor permanent; Eliminate Medicare DSH recoupments for cost reporting years 2004-2006, similar to prior years, that would unfairly hold NJ hospitals financially responsible calculation error and threaten the financial viability of many of our states safety-net providers; Reduce the size of the coding offset reduction in the FY2011 IPPS final rule; Support legislation to amend the meaningful use rule to reflect congressional intent to treat multi-campus hospitals equitably for the purposes of health IT incentive payments; Support the Medicare and Medicaid Extenders Act of 2010, which included a delay until January 2012 a 25% Medicare payment cut for physicians, extends Section 508 of the MMA; an exceptions process for Medicare therapy caps, an extension of the outpatient "hold harmless" payment provision, repeal of delay of RUG-IV, and restored to children's hospitals discounts for "orphan drugs" under the 340B drug discount program; Continue to urge recognition of the unique vulnerability of Medicare dependent urban hospitals in New Jersey through the Urban Medicare Dependent Hospital legislation and urge CMS to complete study on issue; Extend the timeframe to April 1, 2011 for implementation of the home health face-to-face encounter requirement; Support the Home Health Care Access Protection Act (S. 3315/H.R. 3803) that would reform the process of evaluating case mix changes in home health care; oppose reduction included in FY 2011 Physician Fee Schedule for outpatient physical therapy, occupational therapy, and speech-language pathology services, known as Multiple Procedure Payment Reduction for Therapy Services (MPPR). Shared concerns on the draft recommendations included in the National Commission on Fiscal Responsibility and Reform regarding accelerating DSH cuts, putting hospitals under the advisory board, reducing GME and IME funding and cutting bad debt payments to hospitals due to these These proposals would jeopardize provider services and have a direct impact our patients and communities.

Labor: Oppose HR1409/S560, the Employee Free Choice Act. Workforce: Support HR1946, the Health Workforce Investment Act of 2009, a bill to encourage national coordination of efforts to address the health worker shortage and would provide funding to develop the healthcare workforce of the future.

Labor: Oppose HR1409/S560, the Employee Free Choice Act. Workforce: Support HR1946, the Health Workforce Investment Act of 2009, a bill to encourage national coordination of efforts to address the health worker shortage and would provide funding to develop the healthcare workforce of the future.

Medicare: Urge CMS to withdraw the state-specific budget neutrality (BNA) policy when issuing the FY 2010 IPPS rule; support HR2525/S1108, the Safeguarding Our Hospitals Future, a bill that would repeal the state-specific budget neutrality policy and return to national budget neutrality for the rural and imputed rural floors; seek a hold harmless for NJ DSH hospitals due to inaccuracies associated with the states algorithm created for Medicare DSH payments to hospitals; support efforts to prohibit cuts to capital Indirect Medical Education (IME) in FY2010 IPPS rule scheduled to take effect October 1; support extension of Section 508 of the MMA; support HR2124/S935, to extend MMSEA protections to LTCHs.

Medicare: Urge CMS to withdraw the state-specific budget neutrality (BNA) policy when issuing the FY 2010 IPPS rule; support HR2525/S1108, the Safeguarding Our Hospitals Future, a bill that would repeal the state-specific budget neutrality policy and return to national budget neutrality for the rural and imputed rural floors; seek a hold harmless for NJ DSH hospitals due to inaccuracies associated with the states algorithm created for Medicare DSH payments to hospitals; support efforts to prohibit cuts to capital Indirect Medical Education (IME) in FY2010 IPPS rule scheduled to take effect October 1; support extension of Section 508 of the MMA; support HR2124/S935, to extend MMSEA protections to LTCHs.

Healthcare Reform: NJHA supports the expansion of healthcare coverage to all Americans while maintaining adequate financing for healthcare providers. NJHA expressed concern with H.R. 3200, the tri-committee bill that calls for $119 billion in market basket cuts over 10 years for inpatient, outpatient, long term care, inpatient rehabilitation facility, and inpatient psychiatric hospitals; the bill provides a public insurance option that pays hospitals at Medicare rates; $10 billion would be cut from the Medicare DSH program; Medicaid DSH also would be cut $10 billion; includes an aggressive readmission policy; as well as cuts to home health, skilled nursing facilities, and hospice facilities. NJHA also expressed concerns regarding efforts to include geographic variation language to alter geographic payment adjustment factors in Medicare spending and opposed any efforts to create a new federal entity with broad authority to cut Medicare spending by targeting provider payments. While the Senate crafted their respective healthcare reform proposals, NJHA advocated to reject any further cuts to Medicaid and Medicare programs for healthcare providers.

Medicare: Urge CMS to withdraw the state-specific budget neutrality (BNA) policy when issuing the FY 2010 IPPS rule; support HR2525/S1108, the Safeguarding Our Hospitals Future, a bill that would repeal the state-specific budget neutrality policy and return to national budget neutrality for the rural and imputed rural floors; seek a hold harmless for NJ DSH hospitals due to inaccuracies associated with the states algorithm created for Medicare DSH payments to hospitals; support efforts to prohibit cuts to capital Indirect Medical Education (IME) in FY2010 IPPS rule scheduled to take effect October 1; support extension of Section 508 of the MMA; support HR2124/S935, to extend MMSEA protections to LTCHs.

Labor: Oppose HR1409/S560, the Employee Free Choice Act. Workforce: Support HR1946, the Health Workforce Investment Act of 2009, a bill to encourage national coordination of efforts to address the health worker shortage and would provide funding to develop the healthcare workforce of the future.

Medicare: Urge CMS to withdraw the state-specific budget neutrality (BNA) policy when issuing the FY 2010 IPPS rule; support HR2525/S1108, the Safeguarding Our Hospitals Future, a bill that would repeal the state-specific budget neutrality policy and return to national budget neutrality for the rural and imputed rural floors; seek a hold harmless for NJ DSH hospitals due to inaccuracies associated with the states algorithm created for Medicare DSH payments to hospitals; support efforts to prohibit cuts to capital Indirect Medical Education (IME) in FY2010 IPPS rule scheduled to take effect October 1; support extension of Section 508 of the MMA; support HR2124/S935, to extend MMSEA protections to LTCHs.

Healthcare Reform: NJHA supports the expansion of healthcare coverage to all Americans while maintaining adequate financing for healthcare providers. In the House (H.R. 3962) and Senate (H.R.3590) healthcare measures, NJHA advocated for many issues of importance including: inclusion of language to repeal a CMS policy regarding the state-specific budget neutrality adjustment (BNA) for the rural and imputed floors; increase level of coverage, shared concern on hospital payment updates for inpatient and outpatient hospitals, inpatient psychiatric hospitals, inpatient rehabilitation facilities and long-term care hospitals; shared concerns on Medicare and Medicaid DSH cuts; opposed proposal to expand Medicare under the public option; shared concern on proposal to expand Medicaid; shared concerned on readmissions policy; shared concern on geographic variation proposal (problematic (2)IOM studies); opposed cuts to home health, skilled nursing facilities, and hospice; shared concerns on Medicare Commission/Independent Payment Advisory Board (IPAB); support adequate funding for GME/IME and support increase of residency slots; support extension of Medicaid FMAP; support extension of Section 508 of MMA for two years; support two year extension for LTCH protections and moratorium under MMSEA for two years; support inclusion of Urban Medicare Dependent Hospital (UMDH)language; support extension of NJ's gainsharing demonstration project; 340B program; bundling; value based purchasing. Physician Payment Fix. NJHA was supportive of efforts to avert a 21 percent cut in their Medicare fees on January 1.

Healthcare Reform: NJHA supports the expansion of healthcare coverage to all Americans while maintaining adequate financing for healthcare providers. In the House (H.R. 3962) and Senate (H.R.3590) healthcare measures, NJHA advocated for many issues of importance including: inclusion of language to repeal a CMS policy regarding the state-specific budget neutrality adjustment (BNA) for the rural and imputed floors; increase level of coverage, shared concern on hospital payment updates for inpatient and outpatient hospitals, inpatient psychiatric hospitals, inpatient rehabilitation facilities and long-term care hospitals; shared concerns on Medicare and Medicaid DSH cuts; opposed proposal to expand Medicare under the public option; shared concern on proposal to expand Medicaid; shared concerned on readmissions policy; shared concern on geographic variation proposal (problematic (2)IOM studies); opposed cuts to home health, skilled nursing facilities, and hospice; shared concerns on Medicare Commission/Independent Payment Advisory Board (IPAB); support adequate funding for GME/IME and support increase of residency slots; support extension of Medicaid FMAP; support extension of Section 508 of MMA for two years; support two year extension for LTCH protections and moratorium under MMSEA for two years; support inclusion of Urban Medicare Dependent Hospital (UMDH)language; support extension of NJ's gainsharing demonstration project; 340B program; bundling; value based purchasing. Physician Payment Fix. NJHA was supportive of efforts to avert a 21 percent cut in their Medicare fees on January 1.

Medicare: Make permanent/extend NJ's imputed wage index floor, set to expire September 30th; Extension of Section 508 of the MMA of 2003, set to expire September 30th. Support H.R. 5426, a bill that would increase the floor on Direct Graduate Medical Education (DGME) payment over three years to 100 percent of the national per resident amount (PRA). Medicaid: Support extension of moratorium on the Medicaid public provider and graduate medical education (GME) rules, set to expire in May 2008. Support H.R. 5613, the Protecting the Medicaid Safety Net Act. The bill would extend until March 31, 2009, moratorium on several Medicaid regulations that would strip an estimated $20 billion over five years from the program, including certified public expenditures (CPE), intergovernmental transfers (IGT) and graduate medical education (GME) as well regulations affecting coverage of hospital outpatient services; state provider tax laws; coverage of rehab services for people with disabilities; outreach and enrollment in schools and specialized medical transportation to school for children covered by Medicaid; and case management services that allow people with disabilities to remain in the community. Support H.R. 3533/S.2460 that proposes to extend a moratorium that expires May 25 on regulations issued by the Centers for Medicare & Medicaid Services (CMS) affecting CPEs, IGTs, and GME. Support H.R. 5268/S.2620, a bill that would temporarily increase the Medicaid FMAP by 2.95 percent from April 1, 2008 through June 30, 2009, but states would be required to maintain their Medicaid eligibility at current levels to receive the increase.

Medicare: Make permanent/extend NJ's imputed wage index floor, set to expire September 30th; Extension of Section 508 of the MMA of 2003, set to expire September 30th. Support H.R. 5426, a bill that would increase the floor on Direct Graduate Medical Education (DGME) payment over three years to 100 percent of the national per resident amount (PRA). Medicaid: Support extension of moratorium on the Medicaid public provider and graduate medical education (GME) rules, set to expire in May 2008. Support H.R. 5613, the Protecting the Medicaid Safety Net Act. The bill would extend until March 31, 2009, moratorium on several Medicaid regulations that would strip an estimated $20 billion over five years from the program, including certified public expenditures (CPE), intergovernmental transfers (IGT) and graduate medical education (GME) as well regulations affecting coverage of hospital outpatient services; state provider tax laws; coverage of rehab services for people with disabilities; outreach and enrollment in schools and specialized medical transportation to school for children covered by Medicaid; and case management services that allow people with disabilities to remain in the community. Support H.R. 3533/S.2460 that proposes to extend a moratorium that expires May 25 on regulations issued by the Centers for Medicare & Medicaid Services (CMS) affecting CPEs, IGTs, and GME. Support H.R. 5268/S.2620, a bill that would temporarily increase the Medicaid FMAP by 2.95 percent from April 1, 2008 through June 30, 2009, but states would be required to maintain their Medicaid eligibility at current levels to receive the increase.

Medicare: Make permanent/extend NJ's imputed wage index floor, set to expire September 30th; Extension of Section 508 of the MMA of 2003, set to expire September 30th. Support H.R. 5426, a bill that would increase the floor on Direct Graduate Medical Education (DGME) payment over three years to 100 percent of the national per resident amount (PRA). Medicaid: Support extension of moratorium on the Medicaid public provider and graduate medical education (GME) rules, set to expire in May 2008. Support H.R. 5613, the Protecting the Medicaid Safety Net Act. The bill would extend until March 31, 2009, moratorium on several Medicaid regulations that would strip an estimated $20 billion over five years from the program, including certified public expenditures (CPE), intergovernmental transfers (IGT) and graduate medical education (GME) as well regulations affecting coverage of hospital outpatient services; state provider tax laws; coverage of rehab services for people with disabilities; outreach and enrollment in schools and specialized medical transportation to school for children covered by Medicaid; and case management services that allow people with disabilities to remain in the community. Support H.R. 3533/S.2460 that proposes to extend a moratorium that expires May 25 on regulations issued by the Centers for Medicare & Medicaid Services (CMS) affecting CPEs, IGTs, and GME. Support H.R. 5268/S.2620, a bill that would temporarily increase the Medicaid FMAP by 2.95 percent from April 1, 2008 through June 30, 2009, but states would be required to maintain their Medicaid eligibility at current levels to receive the increase.

Medicare: Make permanent/extend NJ's imputed wage index floor, set to expire September 30th; Extension of Section 508 of the MMA of 2003, set to expire September 30th. Support H.R. 5426, a bill that would increase the floor on Direct Graduate Medical Education (DGME) payment over three years to 100 percent of the national per resident amount (PRA). Medicaid: Support extension of moratorium on the Medicaid public provider and graduate medical education (GME) rules, set to expire in May 2008. Support H.R. 5613, the Protecting the Medicaid Safety Net Act. The bill would extend until March 31, 2009, moratorium on several Medicaid regulations that would strip an estimated $20 billion over five years from the program, including certified public expenditures (CPE), intergovernmental transfers (IGT) and graduate medical education (GME) as well regulations affecting coverage of hospital outpatient services; state provider tax laws; coverage of rehab services for people with disabilities; outreach and enrollment in schools and specialized medical transportation to school for children covered by Medicaid; and case management services that allow people with disabilities to remain in the community. Support H.R. 3533/S.2460 that proposes to extend a moratorium that expires May 25 on regulations issued by the Centers for Medicare & Medicaid Services (CMS) affecting CPEs, IGTs, and GME. Support H.R. 5268/S.2620, a bill that would temporarily increase the Medicaid FMAP by 2.95 percent from April 1, 2008 through June 30, 2009, but states would be required to maintain their Medicaid eligibility at current levels to receive the increase.

Medicare: Advocated to make permanent NJs imputed wage index floor policy which has provided equity and consistency in the Medicare reimbursement process for hospitals in New Jersey; Advocate for an extension of Section 508 of the Medicare Modernization Act of 2003; Prevent a 10.6% physician payment cut scheduled for July 1. Strongly oppose language included in the FY 2009 Inpatient PPS Proposed Rule that would alter the longstanding practice of applying a national budget neutrality adjustment to the rural floor of the wage index and replace it with a state-specific budget neutrality adjustment. Support technical correction amendments (MMSEA Section 114) to provisions regarding the 25 percent threshold and the moratorium on new LTCHs; Support extension of Section 1011 of the Medicare program, which helps reimburse hospitals for emergency services provided to undocumented immigrants. Medicaid: Advocate for extension of moratorium that prevents harmful Medicaid regulations regarding certified public expenditures, intergovernmental transfers and graduate medical education, coverage of hospital outpatient services; state provider tax laws; coverage of rehab services for people with disabilities; outreach and enrollment in schools and specialized medical transportation to school for children covered by Medicaid; and case management services that allow people with disabilities to remain in the community from being implemented by CMS that were set to expire in May 2008. Support H.R. 5613, the Protecting the Medicaid Safety Net Act of 2007, to delay implementation of the regulations until April 1, 2009.

Support H.R. 677, the Nursing School Capacity Act 2007, which would provide for a study by the Institute of Medicine of the National Academy of Sciences to identify constraints encountered by schools of nursing in admitting and graduating the number of nurses sufficient to meet the healthcare needs of the nation.

Medicare: Make correction in DSH payments made to NJ's hospitals and seek a hold harmless treatment already used by CMS; Strongly opposed CMS proposal in FY09 IPPS rule to implement state-specific budget neutrality for rural and imputed rural floors; Urged CMS to rescind proposal to eliminate the IME adjustment for teaching hospitals in the Medicare capital payment system and opposed proposal to revise the average hourly wage comparison criteria required for hospitals to qualify for wage index geographic reclassification in the FY09 IPPS rule; Prevent physician payment cut; Advocate for an extension of Section 508 of the MMA of 2003; Support extension of Section 1011 of the Medicare program; Support S.3582/H.R.6966 to keep the budget neutrality for rural and imputed floors at a national practice; Support for H.R. 6873, the Medicare Hospice Protection Act of 2008 that would delay Oct. 1 implementation of the reduction of the hospice budget neutrality adjustment factor for one year; Seek technical correction amendments (MMSEA Section 114) to provisions regarding the 25 percent threshold and the moratorium on new LTCHs. Medicaid: Advocate to increase the amount of Medicaid monies the state receives from the Federal government (FMAP increase)

Medicare: Make correction in DSH payments made to NJ's hospitals and seek a hold harmless treatment already used by CMS; Strongly opposed CMS proposal in FY09 IPPS rule to implement state-specific budget neutrality for rural and imputed rural floors; Urged CMS to rescind proposal to eliminate the IME adjustment for teaching hospitals in the Medicare capital payment system and opposed proposal to revise the average hourly wage comparison criteria required for hospitals to qualify for wage index geographic reclassification in the FY09 IPPS rule; Prevent physician payment cut; Advocate for an extension of Section 508 of the MMA of 2003; Support extension of Section 1011 of the Medicare program; Support S.3582/H.R.6966 to keep the budget neutrality for rural and imputed floors at a national practice; Support for H.R. 6873, the Medicare Hospice Protection Act of 2008 that would delay Oct. 1 implementation of the reduction of the hospice budget neutrality adjustment factor for one year; Seek technical correction amendments (MMSEA Section 114) to provisions regarding the 25 percent threshold and the moratorium on new LTCHs. Medicaid: Advocate to increase the amount of Medicaid monies the state receives from the Federal government (FMAP increase)

Medicare: Make permanent/extend NJ's imputed wage index floor, set to expire September 30th; Extension of Section 508 of the MMA of 2003, set to expire September 30th. Support H.R. 5426, a bill that would increase the floor on Direct Graduate Medical Education (DGME) payment over three years to 100 percent of the national per resident amount (PRA). Medicaid: Support extension of moratorium on the Medicaid public provider and graduate medical education (GME) rules, set to expire in May 2008. Support H.R. 5613, the Protecting the Medicaid Safety Net Act. The bill would extend until March 31, 2009, moratorium on several Medicaid regulations that would strip an estimated $20 billion over five years from the program, including certified public expenditures (CPE), intergovernmental transfers (IGT) and graduate medical education (GME) as well regulations affecting coverage of hospital outpatient services; state provider tax laws; coverage of rehab services for people with disabilities; outreach and enrollment in schools and specialized medical transportation to school for children covered by Medicaid; and case management services that allow people with disabilities to remain in the community. Support H.R. 3533/S.2460 that proposes to extend a moratorium that expires May 25 on regulations issued by the Centers for Medicare & Medicaid Services (CMS) affecting CPEs, IGTs, and GME. Support H.R. 5268/S.2620, a bill that would temporarily increase the Medicaid FMAP by 2.95 percent from April 1, 2008 through June 30, 2009, but states would be required to maintain their Medicaid eligibility at current levels to receive the increase.

Medicare: Make permanent/extend NJ's imputed wage index floor, set to expire September 30th; Extension of Section 508 of the MMA of 2003, set to expire September 30th. Support H.R. 5426, a bill that would increase the floor on Direct Graduate Medical Education (DGME) payment over three years to 100 percent of the national per resident amount (PRA). Medicaid: Support extension of moratorium on the Medicaid public provider and graduate medical education (GME) rules, set to expire in May 2008. Support H.R. 5613, the Protecting the Medicaid Safety Net Act. The bill would extend until March 31, 2009, moratorium on several Medicaid regulations that would strip an estimated $20 billion over five years from the program, including certified public expenditures (CPE), intergovernmental transfers (IGT) and graduate medical education (GME) as well regulations affecting coverage of hospital outpatient services; state provider tax laws; coverage of rehab services for people with disabilities; outreach and enrollment in schools and specialized medical transportation to school for children covered by Medicaid; and case management services that allow people with disabilities to remain in the community. Support H.R. 3533/S.2460 that proposes to extend a moratorium that expires May 25 on regulations issued by the Centers for Medicare & Medicaid Services (CMS) affecting CPEs, IGTs, and GME. Support H.R. 5268/S.2620, a bill that would temporarily increase the Medicaid FMAP by 2.95 percent from April 1, 2008 through June 30, 2009, but states would be required to maintain their Medicaid eligibility at current levels to receive the increase.

Medicare: Make correction in DSH payments made to NJ's hospitals and seek a hold harmless treatment already used by CMS; Strongly opposed CMS proposal in FY09 IPPS rule to implement state-specific budget neutrality for rural and imputed rural floors; Urged CMS to rescind proposal to eliminate the IME adjustment for teaching hospitals in the Medicare capital payment system and opposed proposal to revise the average hourly wage comparison criteria required for hospitals to qualify for wage index geographic reclassification in the FY09 IPPS rule; Prevent physician payment cut; Advocate for an extension of Section 508 of the MMA of 2003; Support extension of Section 1011 of the Medicare program; Support S.3582/H.R.6966 to keep the budget neutrality for rural and imputed floors at a national practice; Support for H.R. 6873, the Medicare Hospice Protection Act of 2008 that would delay Oct. 1 implementation of the reduction of the hospice budget neutrality adjustment factor for one year; Seek technical correction amendments (MMSEA Section 114) to provisions regarding the 25 percent threshold and the moratorium on new LTCHs. Medicaid: Advocate to increase the amount of Medicaid monies the state receives from the Federal government (FMAP increase)

help patients across the nation have access to the rehabilitative care they need by holding the current 60% threshold for compliance and ensure that appropriate medical necessity standards are utilized when evaluating the need for inpatient rehabilitation care; reverse reduction in Medicare physician reimbursements. Medicaid:DSH re-coupment issue, impacts New Jersey hospitals that were contacted by Medicare’s fiscal intermediary to repay past years of disproportionate share hospital payments; Advocated to stop CMS from pursuing its January 18th proposed rule, which would reduce Medicaid funding by what the Administration estimates is $3.8 billion over five years and urge for a moratorium on CMS from moving forward with the Medicaid rule on intergovernmental transfers (IGTs) and certified public expenditures (CPEs); prevent CMS from working on any rules related to eliminating payments for graduate medical education (GME) under the Medicaid program. Medicare: Make permanent a policy for computing and applying an imputed rural wage index floor for each all-urban States; Extend Section 508 of the MMA that allows for geographic reclass; Oppose proposed cuts to Medicare and Medicaid spending by more than $100 billion over five years in the FY08 Budget; Opposing provisions in the 2008 Medicare inpatient prospective payment system proposed rule (IPPS) that would cut payments to hospitals by $25 billion over five years; Support S.543/H.R.1459, bill to

NJHA opposed H.R. 1644, the Re-empowerment of Skilled and Professional Employees and Construction and Trade workers Act, legislation that would include nurse supervisors as part of a hospital's collective bargaining unit.

Oppose Employee Free Choice Act (S. 1041/ H.R. 800), or commonly known as the card check bill.

help patients across the nation have access to the rehabilitative care they need by holding the current 60% threshold for compliance and ensure that appropriate medical necessity standards are utilized when evaluating the need for inpatient rehabilitation care; reverse reduction in Medicare physician reimbursements. Medicaid:DSH re-coupment issue, impacts New Jersey hospitals that were contacted by Medicare’s fiscal intermediary to repay past years of disproportionate share hospital payments; Advocated to stop CMS from pursuing its January 18th proposed rule, which would reduce Medicaid funding by what the Administration estimates is $3.8 billion over five years and urge for a moratorium on CMS from moving forward with the Medicaid rule on intergovernmental transfers (IGTs) and certified public expenditures (CPEs); prevent CMS from working on any rules related to eliminating payments for graduate medical education (GME) under the Medicaid program. Medicare: Make permanent a policy for computing and applying an imputed rural wage index floor for each all-urban States; Extend Section 508 of the MMA that allows for geographic reclass; Oppose proposed cuts to Medicare and Medicaid spending by more than $100 billion over five years in the FY08 Budget; Opposing provisions in the 2008 Medicare inpatient prospective payment system proposed rule (IPPS) that would cut payments to hospitals by $25 billion over five years; Support S.543/H.R.1459, bill to

Oppose Employee Free Choice Act (S. 1041/ H.R. 800), or commonly known as the card check bill.

Advocated for S. 3678, the Pandemic and All-Hazards Preparedness Act, a bill to reauthorize the Department of Health and Human Services' Hospital Preparedness Program through 2011 and improve U.S. preparedness for biological threats and disease outbreaks.

Advocated for S. 3678, the Pandemic and All-Hazards Preparedness Act, a bill to reauthorize the Department of Health and Human Services' Hospital Preparedness Program through 2011 and improve U.S. preparedness for biological threats and disease outbreaks.