After two weeks town hall style meetings visiting with nearly 400 members from all over the state, GHCA wraps up the Spring Council Tour. The slides presented from the tour can be obtained on by clicking HERE.

On April 10, President Obama released his FY2014 budget proposal. In many ways, this budget is very similar to the President's past proposals and AHCA/NCAL has already publicly responded.

On the Medicaid side, the good news is that the president did not recommend any additional cuts.  It has been a major priority for AHCA/NCAL to get the President to take the reduction of the provider assessment to 3.5 percent out of his budget.  We succeeded.  This is important because supporters of provider tax cuts were using the President's support as justification to rely on provider tax cuts to pay for just about anything.  This was the justification for the use of provider tax cuts to pay for a lower student loan rate last year.

On the Medicare side, we will strongly oppose these arbitrary cuts proposed in this budget. We all know they are detrimental to our profession and we will actively work against them.

AHCA/NCAL will conduct a more detailed review and analysis of the President's budget proposal and keep you informed about our advocacy plans and any assistance we need reaching out to Members of Congress. It is important to note that introducing budgets such as this is largely a formality in the legislative process, but the President's budget does signal Administration priorities. Both the House and Senate have already passed budgets for FY2014 so they will not debate this budget in any formal manner.

Below is a short summary of the budget provisions in the President's FY2014 budget that have direct impact on the long term and post-acute care profession.

• Post-acute care market basket cuts
• The budget reduces the home health, SNF, IRF and LTCH market basket update by 1.1 percentage points in 2014 through 2023 with the floor set at a rate freeze.
• For example, if the update was supposed to be 0.5%, CMS would not apply the full 1.1% cut, and update would be 0%.  If the update was supposed to be 3%, the update would then be reduced to 1.9%. This is projected to save $79 billion from 2014-2023.

• Reduce Medicare coverage of bad debts
• The President proposes reducing bad debt payments from 65 percent generally to 25 percent for all eligible providers over three years beginning in 2014. This proposal will save approximately $25.5 billion over 10 years. 

• Hospital Readmissions
• The budget reduces SNF payments to reduce hospitalizations. Beginning in 2017, payments to SNFs with high preventable readmission rates would be cut by up to 3 percent. This is projected to save $2.2 billion in the next 10 years.

• Therapy multiple procedure payment reduction and therapy caps
• The President's budget notes the already-enacted reduction to Medicare payments to physicians when multiple therapies are provided to the same patient on the same day. The budget notes that reduction is estimated to save $1.8 billion over 10 years. 
• The budget also notes the already-enacted extension for the exceptions process for outpatient therapy caps. 
• While both items are noted, nothing new is proposed for either area.

• Equalize payment for certain conditions commonly treated in IRFs and SNFS
• The budget's proposals include adjusting payment updates for certain post-acute care providers and equalizing payments for certain conditions commonly treated in IRFs and SNFs, which is estimated to save $2 billion over 10 years.
• Specifically, the President's budget proposes to reduce payment disparities in the IRF and SNF settings for three conditions beginning in 2014:  hips and knees, pulmonary conditions, and other conditions as determined by the Secretary.
• It's unclear if IRF rates for these patients would be dropped to SNF rates, or if they would meet somewhere in the middle.

• Implement bundled post-acute care payment
• Beginning in 2018, at least half of the payments for LTCHs, IRFs, SNFs and home health services would be bundled. A permanent and total cumulative 2.85 percent cut would be applied by 2020. This is projected to save $8.2 billion from 2014-2023.

• Strengthen the Independent Payment Advisory Board
• The budget requires IPAB cuts to take effect when Medicare spending growth exceeds Gross Domestic Product (GDP) +.5%. Current law is GDP +1%. This is estimated to save $4.1 billion over 10 years.

• Medicaid
• The historical proposals to reduce or eliminate the provider assessment authority are omitted from the President's budget. 
• The budget proposes the expansion of Medicaid Fraud Control Units into Home and Community-Based Services settings. 
• The continued emphasis and expansion of Medicaid program integrity efforts is notable.

If you'd like to read more about the President's budget, you can view it online at www.whitehouse.gov/omb/budget.

The Ms. Georgia Nursing Home Pageant will be held on Saturday, May 18, 2013, at the Evergreen Resort at Stone Mountain, Georgia. Come & join us as we celebrate the lifetime achievements and drive for life of the lovely ladies participating in the 2013 Ms. Georgia Nursing Home pageant. This special event has been created to help promote a positive public image of nursing home residents and their potential for living fulfilling lives. Twenty-one contestants ranging from 59 to 98 years young are participating in this year's pageant. The pageant is free to enter just be sure to tell the gate entrance keepers that you are there to attend the pageant. We look forward to seeing you there!

It is hard to believe the 2013 legislative session has already come to a close. As you know, each Gold Dome Report has listed a short amount of bills and specific updates for that legislative week. We have included a final list of noteworthy bills we have been tracking HERE, including a brief summary and final status. Keep in mind, since this is the first year of a two year session, many bills are still alive for passage next year. Thank you for your continued support as we look out for your best interests at the state Capitol!

For questions, please do not hesitate to contact Jason Broce at This e-mail address is being protected from spambots. You need JavaScript enabled to view it or Sarah Ralston at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

This Thursday, March 28th, marked Sine Die, the last legislative day for 2013 session.  It was a very productive session and it would not have been possible without the leadership of the Governor’s office, House and Senate.

In the early morning hours on Thursday, a final deal was struck on the Fiscal Year 2014 budget.  The conference committee, comprised of three House and three Senate members, agreed to fully restore the proposed .74% Medicaid rate cut and also included the $300,000 for the SOURCE Quality Incentive Program.  While our top two priorities were funded, the $90,000 line item to increase the ventilator patient rates was removed from the final version.  We would like to thank the leadership and Appropriations chairs in both bodies for recognizing the value of what our membership does on a daily basis to care for this state’s most vulnerable population.

We would also like to thank all of you for staying so involved throughout this entire process and allowing us the opportunity to represent you at the State Capitol.