Bulletin Daily Paper 06-08-13

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regon's sweeping changes to Medicaid don't stand a chance of succeeding if the Legislature doesn't stop bad bills such as House Bill 3309. Poison pill politics and health care reform do not mix. Gov. JohnKitzhaber'sMedicaid overhaul was designed to improve health and help hold down costs of Medicaid. It has hospitals, doctor groups and otherproviders working together to find solutions by forming what are called "coordinated care organizations," or CCOs. The state gives a CCO a fixed amount ofmoney to provide Medicaid care for a region of the state. CCOs figure out how to make it work to meet targets. When setting up a new system, there are going to be problems nobody expected. There was a process to settle disputes when a needed regional provider didn't want to participate in a CCO. But there's been a dispute in Salem that has highlighted that there may not be a good enough system in place to resolve disputes once a CCO is formed. Salem Health, the parent company of the Salem Hospital, is a participant in the CCO that operates in Marion and Polk counties. Salem Health sued over reimbursement rates. It has also been unhappy about the balance of power on the board of the CCO.

We don't know who is right or wrong in the dispute, but it could undermine the ability of the CCO to operate and provide care. Rep. Brian Clem, D-Salem, proposed House Bill 3309. It would enable CCOs inMarion and Polk counties to petition the state to throw a member of a CCO out after a two-thirds vote of the CCO board. A removed providerwould be forbidden from joining any CCO for five years and would only be able to receive severely lowered reimbursements — 58 percent of the Medicare reimbursement rate. That would be bad for the provider and could be very bad for patients, too. The bill also contains language suggesting this same method of resolving disputes should be considered for statewide expansion. It's poison pill politics — similar to the sequester on the federal level. We all know how well that worked. There's a hearing for the bill on Monday. In its current form, it doesn't deserve to get out of committee. You may want to read the related opinion piece below.

House lobbyingbill would clari reporting rules


hen a lobbyist lobbies a lobbyist, must he report the cost of their lunch? How about if each pays for his own food? And are the answers different if one "solicits" rather than just "lobbies" the other?

Such are the issues under discussion as the Oregon House Committee on Rules discusses House Bill 3528, which attempts to clarify some questions raised in a recent advisory statement from the Government Ethics Commission. The baffling complexity belies the simplicityof thepublic's interest, which is to know if decision-makers are being unduly influenced by moneyed interests. Here's just one of numerous examples from the ethics commission's March statement: "Question: Jill and Jack both are registered lobbyists. Jack and Jill go to lunch to discuss legislative measures of mutual interest. No legislators or legislative staff members are present. Jack and Jill each pay for their own lunch. Are Jack and Jill each required to report the amount each expended for food? "Answer: No, unless either lobbyist solicits the other to influence or attempt to influence legislative

action. In that case, the soliciting lobbyist must report his or her expenses." Soliciting is described as one component of lobbying: "Solicitation of executive officials or other persons to influence or attempt to influence legislative action." Even if we understood the distinction between lobbying that includes solicitation and lobbying that doesn't, we can't imagine the public's interest in the amount Jack and Jill paid for their own lunches. HB 3528 attempts to clarify by declaringthat expenses need not be reported for lobbyists meeting with lobbyists or with their own clients. The Associated Press reports an additional wrinkle, however, in that many public officials, including senior staff in the governor's office, are themselves registered lobbyists. HB 3528 may need some revision to fix that loophole. If that problem can be resolved, HB 3528 is a good move to eliminate some absurdity, and itdeserves support. Even better would be a much more thorough review and simplification that focuses on the public's actual interest and the original purpose of such expense reporting.


'Unwritten policy' backfires By Frank CerabIno

After (Florida Highway

Cox Newspapers

Patrol trooper Charles)

WEST PALM BEACH, Fla. ometimes it doesn't pay to be too creative. Just ask Charles Swindle, the Florida Highway Patrol trooper who lost his job over what might best be called creative generosity. Swindle was doing I-10 speed enforcement on the November day last year w hen state legislators were returning to Tallahassee for an organizational session. After Swindle pulled over a pair of carshe clocked at 87 mph — 17 mph above the speed limit — he discoveredthat the second car was being driven by a state legislator. H I had it on cruise control," state Rep. Charles McBurney, a Jacksonville lawyer, told the trooper, according to the recording of the traffic stop. "There's no way I was going 87. I had it on 75. T hen McBurney s howed t h e trooper his state legislator ID card, which caused Swindle to call up his supervisor and propose a deal. HI'm going to write (McBurney) a warning and benice,"the trooper said, "I'm going to stroke him 'cause I didn't see his insurance card. I'll give him that ticket and warn him for speed." Swindle had asked to see McBurney's license and registration, but not his insurance card. So the trooper reasoned that he w ould give a break to the state legislator by just issuing him a $10 non-moving violation for not having proof of insurance, but sparing McBurney from facing the moving violation of speeding, which could have resulted in points on his license and a $250 ticket. -


Swindle pulled over a pair of cars he clocked at 87 mph — 17 mph above the speed limit — I7e discovered that the

second car was being driven by a state legislator. Now, what to do with the driver of the other car? It was being driven by Steve Caristi, 44, of Port St. John, a t r aveling printer repair technician. "Yeah, I was probably speeding," Caristi said Wednesday, remembering that day. HI get pulled over a lot. Sometimes you get a ticket, and sometimes you just get a warning and they tell you to slow down." The trooper told his supervisor that it was only fair to offer Caristi the same break he had giventhe legislator. "(McBurney) is no better than (Caristi), and (Caristi) is no better than (McBurney), so I'm going to do both the same," the trooper radioed to his supervisor. Caristi had no idea that he was being cut a break because he was lucky enough to be pulled over with a state legislator. He just thought this was one of those traffic stops when he gets a warning. He gladly paid the $10 ticket. "I'm always happy not to get a speeding ticket," he said. The state legislator, though, was peeved to get the $10 ticket, telling the trooper that he had his insur-


ance card with him, so he shouldn't be written up for having no proof of insurance. Swindle reminded the legislator that hischoice was a $250 speeding ticket or a $ 1 0 non-moving violation. "I'm cutting you a break on this one," he reminded the legislator. McBurney wasn't the only r eturning state legislator that Swindle stopped for speeding that day. The trooper later stopped state Rep. Michael Clelland, a retired f irefighter f ro m L o n gwood, f o r speeding. And Clelland got the $10 deal, too. Clelland paid it, later saying that he considered the break a matter of "professional courtesy" from the trooper. B ut McBurney wa s f a r f r o m grateful. The legislator wrote an official letter of complaint about the $10 ticket to the high command of the F l orida H i ghway Patrol, which sparked an investigation by the Inspector General's Office for the state Department of Highway Safety and Motor Vehicles. Swindle was fired for writing the $10 ticket under false pretenses. T oday, he i s w o r k in g a s a n emergency m e d ical t e c hnician in Perry and trying get his firing rescinded. "I don't think th e punishment fits the crime," Swindle said. "I'm just trying to clear my name." As for giving breaks to lawmakers stopped for violating the traffic laws'? "It was a n u n w r itten policy," he said. "But I'm sure it won't be

anymore." — Frank Cerabino writes for The Palm Beach Post.

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Legislature should follow health-care rule: Do no harm By TammyBaney and JIm DIegel regon has received national attention for its approach to health care reform. In a matter of months, all types of health care providers (physical, mental and dental) have come together to form 15 coordinated care organizations, which will manage the health care of more than 300,000 Oregonians who are covered through theOregon Health Plan, as well as thousands who will become covered in the next few years through the Affordable Care Act. The Central Oregon Health Council is proud to be a pioneer in this new model of care. However, there is a bill — HB 3309A — currently circulating through Salem that threatens to unravel the tremendous strides we have made in health care delivery. And, although it


is proposed as a pilot project for Marion and Polk counties, it gives everyone who participates in coordinated careorganizationsgreat pause. Establishing these CCOs was not an easy task. Each community experienced its own growing pains when shifting the way providers work together and provide services. One CCO in particular has had some trouble getting up and running, and there is a pending lawsuit between some of the CCO's parties about how to best deliverand pay forcare.In response, the Legislature has introduced a bill (HB 3309A) to try to provide a solution for this problem, misusing its power and undermining the flexibility of the health care system by usurping local control. A lso referred to as the HBad Actor" or "Agree or Leave" bill, HB 3309A

IN MY VIEW would allowfor the removal of a CCO's board member by a two-thirds vote (CCO boards are made up of representatives from the participating entities). This booted provider would not be allowed to contract with any CCO for five years, potentially limiting access to care for low-income Oregonians. The CCO can then pay this terminated entity a significantly reduced reimbursementrate— merely 58 percent of Medicarereimbursement rates. At its core, HB 3309A usurps local control and decision making, which is the foundation for CCO operation and success. CCOs were created under the mantra of "local solutions for local issues," and the Central Oregon Health Council has fully embraced this. Like us, each CCO has its own bylaws that

address how its board should resolve differences.These bylaws were created through a collaborative process with all members of the CCO and are unique to fit the needs of each community and the patients it serves. In anticipation of this bill, some key CCO participants, including St. Charles Health System, are beginning to consider leaving their CCO board in advance of the bill's enactment, rather than riskbeingvoted off at some future dateforan unforeseen reason.Central Oregon Health Council leadership is developing contingency plans in the event the bill passes. Who would want to put their own organization at risk? CCOs were created to integrate care from all the major health care providers in a local community and have those providers share in the financial risk and decision-making for the

Medicaid population. We and some 96 other health care, public policy and business organizations in the state believe HB 3309A only serves to disrupt the continuity of care for beneficiaries of the Oregon Health Plan. In the end, the Legislature hurts communities by misusing its power. The solution within HB 3309A for an isolated case could have a tremendous impact on all CCOs around the state for years to come. Our first rule in health care is to do no harm, and the Legislature should consider the same before it moves forward on HB 3309A. — Tammy Baneyis a Deschutes County commissionerand chair of the Central Oregon Health Council. Jim Diegeiis president and CEO o f St. Charles Health System and vice chair of the Central Oregon Health Council.

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