Maine Hospital Association Testimony on Maine’s Proposed Section 1115 Demonstration Waiver

Maine Hospital Association Testimony on Maine’s Proposed Section 1115 Demonstration Waiver
May 18, 2017
Good morning, my name is David Winslow and I am the Vice President of Financial Policy at the Maine Hospital Association.  Thank you for accepting these comments today regarding the Maine’s Proposed Section 1115 Demonstration Waiver.
The Maine Hospital Association represents all 36 community- governed hospitals in the state including 33 general acute care hospitals, 2 private psychiatric hospitals, and 1 acute rehabilitation hospital.  In addition to the acute hospital facilities, our hospitals represent 11 home health agencies, 18 skilled nursing facilities, 19 nursing facilities, 12 residential care facilities, and more than 300 physician practices employing thousands of medical professionals.
This proposed waiver would impose new work requirements, monthly premiums, and asset tests for MaineCare recipients.  It is unclear how recipients would respond to these new requirements, but it seems safe to say that they are created and designed to further reduce the number of people receiving MaineCare coverage.  By our latest count, there are approximately 76,000 fewer people receiving MaineCare today then there were five years ago.  Certainly, some of these people are receiving employer-sponsored health insurance coverage which is a positive development.  Unfortunately though, most of them are uninsured.  Maine hospitals are still providing excellent care for these patients just as they did in 2010.  The only difference is instead of receiving a MaineCare payment of 72% of the cost of this care, hospitals are receiving no payment at all.  This is shown rather dramatically in that Maine hospital’s uncompensated care grew by $124 million during the past 6 years.  We ask that the Department reconsider any of these steps that would most certainly result in more people becoming uninsured.       
These new requirements would also likely delay the processing of new MaineCare applications resulting in fewer member days being covered.  The processing of MaineCare applications is already quite lengthy, and we ask the Department to avoid taking steps that would further lengthen that process. 
In this waiver, the Department is proposing to reclassify emergency department visits that do not result in an inpatient admission as “non-emergency.”  The Department will then bill the patient $20 for each emergency department visit that does not result in an inpatient admission.  This would be an unprecedented step for any government or private payer, so it is unclear what the result would be on patient care.  This step may cause some patients to seek care in a different setting but it will also result in many patients not seeking needed care at all.  This likely wouldn’t be good for the patient, and depending on how this policy is implemented, may result in potential EMTALA issues for hospitals.  
We appreciate that the proposal states that these co-payments “will not result in a decrease to provider payments.”  It is unclear, however, what will happen if the patient cannot or does not pay their bill.  Would the patient be removed from MaineCare for nonpayment resulting in even further uncompensated care provided by hospitals?  For all of these reasons, we ask that the Department not move forward with the proposal to reclassify emergency department visits.
The proposed waiver allows MaineCare providers to bill patients for missed appointments.  This billing would need to be consistent with office policy meaning that the office would need to have a policy in place that bills all patients for missed appointments, not just MaineCare patients. Missed visits by any patient are certainly a problem in our practices, but we don’t believe that billing MaineCare patients for missed appointments is necessarily the answer to that problem. The primary reason for this is we already have an extremely difficult time collecting the existing modest co-payments from patients, so it is difficult to see how significantly higher payments for missed visits would be collected.
The proposal eliminates retroactive eligibility for members and replaces it with a policy that “MaineCare coverage for an individual will begin on the first day of the month that an application for assistance if filed.”  Although this proposed change would continue to allow for many new patient hospital visits to be covered, it is clearly designed to disallow payment for services delivered prior to an application being filed, resulting in a new financial burden on hospitals.  We believe that the current MaineCare retroactive eligibility policy works well so we would encourage the Department to not move forward with this change. 
Thank you again for the opportunity to comment this morning and please feel free to contact me with any questions about this testimony.