/ en Fri, 25 Apr 2025 16:12:14 -0500 Tue, 28 Jan 25 16:35:00 -0600 /fact-sheets/fact-sheet-340b-drug-pricing-program <div class="container"><div class="row"><div class="col-md-8"><h3><span>The Issue</span></h3><hr><p><span><strong>For more than 30 years, the 340B Drug Pricing Program has provided financial help to hospitals serving vulnerable communities to manage rising prescription drug costs</strong></span></p><p>Section 340B of the Public Health Service Act requires pharmaceutical manufacturers participating in Medicaid to sell outpatient drugs at discounted prices to health care organizations that care for many uninsured and low-income patients. These organizations include federal grantee organizations and several types of hospitals, including critical access hospitals (CAHs), sole community hospitals (SCHs), rural referral centers (RRCs), and public and nonprofit disproportionate share hospitals (DSH) that serve low-income and indigent populations.</p><p>The program allows 340B hospitals to stretch limited federal resources to reduce the price of outpatient pharmaceuticals for patients and expand health services to the patients and communities they serve. <strong>Hospitals use 340B savings to provide, for example, free care for uninsured patients, offer free vaccines, provide services in mental health clinics, and implement medication management and community health programs.</strong></p><p>Despite significant oversight from the Health Resources and Services Administration (HRSA) and the 340B program’s proven record of expanding access to vital patient care, program critics want to scale it back or drastically reduce the benefits that eligible hospitals and their patients receive from<br>the program.</p><h3><span>AHA Position</span></h3><hr><ul><li>Protect the 340B program for all providers and ensure the program continues to help stretch limited resources and provide more comprehensive services to more patients.</li><li>Thwart drug manufacturers’ efforts to unilaterally and unlawfully change the 340B program, which includes efforts to change the 340B program from an upfront discount to a back-end rebate model.</li><li>Support eliminating the orphan drug exclusion for certain 340B hospitals.</li><li>Oppose efforts to scale back, significantly reduce the benefits of, or expand the regulatory burden of the 340B program, including proposals to dramatically expand reporting requirements on certain 340B hospitals and impose a moratorium on new entrants into the program.</li><li>Support expanding the program to reach additional vulnerable communities, including investor owned hospitals that provide care for underserved populations.</li><li>Support program integrity efforts that hold accountable both providers and drug companies to<br>ensure adherence to the program’s rules and regulations.</li></ul><h3><span>Why?</span></h3><ul><li><span><strong>340B-eligible hospitals are the safety-net for their communities</strong>.</span> The 340B program allows eligible hospitals to further stretch their resources and provide additional benefits and services. These hospitals care for a significant share of the nation’s underserved populations including children, cancer patients living with cancer, and those living in rural communities.</li><li><span><strong>The 340B program generates valuable resources for eligible hospitals to maintain, improve and expand access to programs that improve the health and well-being of patients and communities.</strong></span><span> In 2020 alone, 340B hospitals provided nearly $85 billion in benefits to their communities which was a 25% increase from the prior year. Without the financial support from the 340B program, communities in need across the country could lose access to valuable, lifesaving care.</span></li><li><span><strong>The 340B program is a small program with big benefits.</strong></span> Though the 340B program has grown over time, it remains a small share of drug company revenues. In 2022, the discounts provided under the 340B program accounted for only 3% of drug companies’ global revenues. Moreover, growth of the program has been driven by decisions made by drug companies to increase drug prices and introduce new drugs into the market at record-high prices. In addition, broader changes in health care such as the increased reliance on specialty drugs, the shift away from inpatient care to outpatient care, and the substitution of complex and invasive surgeries in favor or drug therapies have all contributed to growing the program. Nevertheless, the program remains small relative to the benefits it provides to patients and communities across the country. </li><li><span><strong>The 340B Program is not a rebate program.</strong></span> <span><strong>The 340B Program is not a rebate program.</strong></span> In yet another attempt to diminish the program, several drug companies are attempting to convert the way covered entities access discounted 340B pricing from an upfront discount to a back-end rebate. This approach not only violates longstanding federal policy, but also jeopardizes patients’ access to drugs, complicates providers’ access to discounts, requires that financially-strapped organizations provide upfront financing and await reimbursement, and adds considerable burden and cost to the health care system. In addition, some rebate models have sought to usurp HRSA’s authority of overseeing the program by unilaterally imposing onerous standards around patient definition and other aspects of program integrity. AHA has urged HRSA to continue its efforts to block drug manufacturers and their third-party vendors from fundamentally changing the 340B program and harming patients and providers.</li><li><span><strong>Drug manufacturers are undermining the program</strong></span><strong>.</strong> Several of the largest drug manufacturers have unilaterally stopped providing discounts to 340B drugs dispensed through community and specialty pharmacies that contracted with 340B covered entities, violating the 340B statute. This illegal action threatens the integrity of the 340B program and the savings on which covered entities rely to provide care to millions of low-income Americans.</li><li><span><strong>The 340B program requires participating hospitals to meet numerous program integrity requirements</strong></span><strong>.</strong> Hospitals must recertify annually their eligibility to participate and attest to complying with all the program requirements; participate in audits conducted by HRSA and drug manufacturers; and maintain auditable records and inventories of all 340B and non-340B prescription drugs.  The AHA and its 340B hospital members support efforts that help covered entities comply with the program rules and requirements.</li><li><span><strong>340B hospitals are committed to improving transparency.</strong></span> The AHA actively works with its 340B member hospitals on efforts to strengthen the 340B program by increasing transparency in the program and helping 340B hospitals communicate publicly the value the program brings to patients and communities — such as through the AHA Good Stewardship Principles and case studies published on the AHA website..</li><li><span><strong>Additional transparency is needed from drug companies</strong></span><strong>.</strong> While HRSA conducts 200 covered entity audits every year, only five drug companies are audited annually. We urge HRSA to create more parity in oversight of the 340B program to ensure that drug companies are maintaining their compliance with all program rules and regulations. In addition, transparency is needed from drug companies as they continue to raise the prices of their drugs significantly and introduce new drugs at record-high prices.</li></ul><p><a href="/system/files/media/file/2019/03/fact-sheet-340b-drug-pricinig-program-0119.pdf" target="_blank" title="Fact Sheett PDF"><strong>View the Fact Sheet PDF.</strong></a><br><strong> </strong></p><hr><h4><strong>340B Podcast Playlist</strong></h4><div><strong></strong></div></div><div class="col-md-4"><a href="/system/files/media/file/2019/03/fact-sheet-340b-drug-pricinig-program-0119.pdf"><img src="/sites/default/files/inline-images/cover-fact-sheet-340b-drug-pricinig-program-01-28-2025.png" data-entity-uuid="61057745-8e8b-49df-b81e-7687d6318a32" data-entity-type="file" alt="Fact Sheet Cover" width="682" height="882"></a><p><strong> </strong></p><div><strong></strong></div></div></div></div> .resource-block-header .resource-block-title small { color: black; } Tue, 28 Jan 2025 16:35:00 -0600 AHA.org Advocacy Homepage Block /affordability-advocacy-agenda <div class="container"><div class="row"><div class="col-md-8"><h2><span>Advancing Affordability, Value, and Equity in Health Care Priorities for America’s Hospitals and Health Systems</span></h2><p>By all accounts 2020 was an unprecedented and historic year – one that tested our nation, our economy and our health care system like never before.</p><p>Hospitals, health systems and post-acute care providers – along with our doctors, nurses and other team members – have been on the front lines of the COVID-19 pandemic, working tirelessly to provide the best care for patients, families and communities. They have done this – and continue to do this – while facing daunting challenges. These challenges have persisted well into 2021, with continued surges of cases and hospitalizations.</p><p>At the same time, individuals, employers, and the government continue to seek greater value for their health care dollars. Concerns around the affordability of health care will only grow as overall health care spending continues to rise and, especially with respect to publicly-financed programs like Medicare and Medicaid, demographic trends mean that there are fewer workers to help finance this care. There is also a renewed focus on eliminating disparities in care, closing equity gaps, and enhancing quality and patient safety – all of which are integral to achieving greater value.</p><p>Our shared focus with Congress and Administration is on providing relief from the pandemic, ensuring a smooth recovery, and rebuilding a better health care system for the future. The ���������� Association continues to incorporate principles that promote improved affordability, value, and equity into our policy and advocacy activities. Below are some of our key priorities in these areas.</p><h3><span>Making Health Care More Affordable</span></h3><p>In recent years, health care spending growth has largely been driven by increased use and intensity of services. In other words, more people are getting care – and more care – and the care they are getting is more involved than in the past. Much of this is the result of substantial expansions in health care coverage, improved efforts to connect people to needed care, advances in medicine and technology, and growth in the prevalence of chronic disease. In some cases, prices have also risen, such as for prescription drugs. This can impact not only what individuals may pay at the pharmacy counter but also the cost of care provided by hospitals, physicians, and other providers that relies on critical drug therapies. Another substantial cost driver that has dramatically escalated in the past several years is the utilization management processes that health plans have erected and which require significant investments in technology and personnel to manage.</p><p>Hospital care requires a range of inputs such as wages for clinical and other personnel, prescription drugs, administrative software and other technology, food, medical devices, utilities and professional insurance. Steep increases in the prices for certain inputs, like drugs and administrative processes mandated by health plans, can undermine hospitals’ efforts to reduce the cost of care.</p><p>To address the underlying cost drivers in the health care system, we urge Congress and the Administration to:</p><ul><li>Rein in the rising cost of drugs, including by taking steps to increase competition among drug manufacturers; improve transparency in drug pricing; and advance value-based payment models for drugs.</li><li>In the same vein, protect the 340B drug savings program to ensure structurally marginalized communities have access to more affordable drug therapies by reversing harmful policies and holding drug manufacturers accountable to the rules of the program, especially as it relates to community pharmacy arrangements.</li><li>Reduce administrative waste by streamlining prior authorization requirements and processes for hospitals and post-acute care providers, so that clinicians can spend more of their time and resources on direct patient care, not pushing paper and arguing with insurance companies over administrative delays and coverage denials.</li><li>Promote greater efficiency and safeguards against unnecessary burden in HIPAA administrative standards and other rules related to billing and ensure an achievable roadmap toward greater adoption of standard transactions.</li><li>Reduce unnecessary costs in the system by passing comprehensive medical liability reform, including caps on non-economic damages and allowing courts to limit attorneys’ contingency fees.</li></ul><h3><span>Improving the Affordability of Coverage</span></h3><p>In addition, we urge Congress and the Administration to take additional steps to make health care coverage more affordable and easier to use for patients. The entire point of insurance is to share large and unanticipated costs across a pool of people. Coverage is essential for making health care affordable for individuals and families in the same way car insurance enables individual drivers to weather the bad fortune of an unexpected crash. While we have made substantial gains in health coverage over the past decade, we are just beginning to fully understand the crisis of under-insurance that is primarily being driven by high deductible health plans.</p><p>The AHA supports bolstering our current public/private framework for coverage to close the remaining coverage gaps and taking immediate steps to ensure that patients do not face financial barriers to using their coverage. We encourage policymakers to preserve and build on the strong foundation of employer-sponsored coverage and further strengthen the individual market while ensuring that Medicare and Medicaid are available to those who rely on these programs. Specifically, we encourage Congress and the Administration to:</p><ul><li>Take additional steps to close coverage gaps, including by building on the existing incentives to encourage all states to expand Medicaid, making permanent the recent expansions in eligibility and the level of subsidies for coverage on the Health Insurance Marketplaces, and expanding existing outreach and enrollment efforts to ensure that every U.S. resident knows their options for coverage.</li><li>End the sale of products purporting to be health plans but that do not meet all of the consumer protections established in federal law, such as health sharing ministries and short-term limited duration coverage products which can leave patients with high and unexpected medical bills as a result of gaps in coverage.</li><li>Restrict the sale of high deductible health plans to consumers who can afford the associated cost-sharing obligations.</li><li>Ensure patients can rely on their coverage by disallowing health plans from inappropriately delaying and denying care, including by making mid-year coverage changes.</li><li>Protect patients from surprise medical bills and ensure that the implementing regulations do not unintentionally distort health care markets and reduce patient access to care.</li><li>Support price transparency efforts by ensuring patients have access to the information they seek when preparing for care, including cost estimates when appropriate, and creating alignment of federal price transparency requirements to avoid patient confusion and overly burdensome duplication of efforts.</li></ul><h2><span>Advancing Value through Health System Transformation and Enhancements in Quality</span></h2><h3><span>Health System Transformation</span></h3><p>In addition to making the health care system more affordable, hospitals and health systems are committed to ensuring that each dollar brings value. We will achieve this by continuously striving to deliver the highest quality care most efficiently, and that will require rethinking how and where we deliver care. We will also look for opportunities for providers to collaborate with payers and employers to ensure aligned incentives to achieve value, including identifying effective models of risk where appropriate.</p><p>The last decade brought significant changes in the health care landscape, but nothing has accelerated changes in the delivery of health care like the COVID-19 pandemic. During the public health emergency, hospitals and health systems were able to innovate at a pace and scale previously unseen as a result not only of the realities of containing a pandemic but also the regulatory flexibility provided by states and the federal government.</p><p>The AHA is eager to continue these advances and supports policies that:</p><ul><li>Expand use of telehealth, broadband and digital technologies by providing Medicare and Federal Communications Commission funding, coverage, and reimbursement for such services, technology and workforce training.</li><li>Implement policies to better integrate and coordinate behavioral health services with physical health services.</li><li>Build on the progress in modernizing the Stark Law and Anti-kickback Statute regulations that better protect arrangements that promote value-based care.</li><li>Allow providers to determine how best to utilize electronic health records (EHRs) and other technologies while promoting interoperability and access to health information for clinical care and patient engagement.</li><li>Provide robust support to ensure electronic communication between acute care hospitals and psychiatric hospitals and providers, and to encourage psychiatric hospitals and mental health providers to optimally use EHRs.</li><li>Advance use of innovative technologies and software (e.g., clinical decision support algorithms) without increasing regulatory burden by supporting policies that enable clinicians to have the data they need to treat patients and improve health outcomes.</li><li>Invest in health care infrastructure by expanding access to virtual care technologies and high-speed internet, strengthening the capacity and capability for emergency preparedness and response, assisting hospitals in “right-sizing” to meet the needs of their communities, and ensuring adequate financing mechanisms are in place for hospitals and health systems, including for training the workforce.</li><li>Address the impact that social determinants of health have on patient outcomes by improving care coordination and expanding the tools hospitals can use to meet these needs.</li><li>Advance rural health care alternatives to ensure sustainable care delivery and financing including: exploring rural pre-payment models; supporting additional inpatient/outpatient transformation strategies; promoting virtual care strategies; allowing innovative partnerships; and refining existing models that support hospitals serving historically marginalized communities.</li><li>Explore a new payment mechanism for metropolitan anchor institutions that treat a disproportionate number of government-funded or uninsured patients.</li></ul><h3><span>Enhancing Quality and Patient Safety</span></h3><p>America’s hospitals and health systems are world-renowned for the quality of care they provide and are always striving to do even better. Clinicians at U.S. hospitals set the global standard in COVID-19 care, such as by optimizing the use of ventilators for those patients who would most benefit from them. – knowledge that was then shared around the world.</p><p>There is no limit to hospitals’ and health systems’ commitment to quality. However, policy changes are needed to facilitate the identification and adoption of best clinical practices, including addressing challenges with public quality reporting and incentive programs. The AHA encourages policymakers to:</p><ul><li>Continue to streamline and coordinate quality measures in national programs to focus on the “measures that matter” most to improving health and outcomes while reducing burden on providers. These measures should be based on evidence that demonstrates meaningful improvements in patient outcomes are achievable by improving adherence to the measures.</li><li>Advocate for modernized conditions of participation, interpretative guidance and Joint Commission standards that hold hospitals accountable for taking actions that lead to higher-quality and safer care.</li><li>Enhance the effectiveness of the physician quality payment program by advocating for more accurate and meaningful cost measures and data-driven implementation of new program approaches.</li><li>Promote advanced illness management to better honor patients’ wishes at the end-of-life and remove barriers to expanding access to palliative care services.</li><li>Enhance care coordination and improve patient safety by implementing through rulemaking Sec. 3221 of the Coronavirus Aid, Relief, and Economic Security (CARES) Act, which revises and better aligns the outdated 42 CFR Part 2 regulations with HIPAA, allowing the responsible sharing of substance use disorder treatment records for the purposes of treatment, payment and health care operations.</li></ul><h3><span>Advancing Health Equity, Eliminating Health Care Disparities, and Increasing Diversity and Inclusion</span></h3><p>The COVID-19 outbreak in the U.S. has shown the country what all hospital and health systems leaders have known for years: serious gaps exist in access, cost and quality for patients based on race, ethnicity, gender and gender identity, age, sexual orientation or other demographic and socio-economic factors. Hospitals and health systems are committed to doing the work to address health equity issues. The AHA and its Institute for Diversity and Health Equity (IFDHE) are also committed to advancing health equity, eliminating health care disparities and increasing diversity and inclusion. The AHA supports policies that:</p><ul><li>Pursue strategies and support public policies aimed at improving maternal and child health outcomes with a particular focus on eliminating racial and ethnic disparities.</li><li>Promote health equity by encouraging cultural humility training in medical residency programs and in-service training for health care professionals.</li><li>Promote inclusion of adjustment for sociodemographic factors in quality measurement programs where appropriate to ensure performance measurement and payment adjustments support the efforts to make meaningful improvements.</li><li>Support coordinated collection of race and ethnicity data across federal agencies to elevate understanding of health care needs in Black and Latino Americans, Native Americans and other communities of color.</li><li>Increase funding for the health equity infrastructure in the Department of Health and Human Services, including the National Institute on Minority Health and Health Disparities, to better research and address the needs of communities of color.</li><li>Support efforts to increase diversity in the health care workforce, including through federal grants to minority-serving institutions for scholarships.</li><li>Repeal the June 2020 final rule that narrowed the scope of non-discrimination protections under Section 1557 of the Affordable Care Act.</li></ul></div><div class="col-md-4"><p><a href="/system/files/media/file/2019/09/report-affordability-agenda-0919.pdf" target="_blank" title="Click here to download the AHA Affordability Advocacy Agenda 2021 PDF."><img src="/sites/default/files/inline-images/Page-1-Affordability-Advocacy-Agenda-2021-10-15.jpg" data-entity-uuid="f0cf703c-d05d-4774-9ecd-c00015b522d3" data-entity-type="file" alt="Page one of the AHA Affordability Advocacy Agenda 2021." width="2550" height="3311"></a></p><div class="external-link spacer"><a class="btn btn-wide btn-primary" href="/system/files/media/file/2019/09/report-affordability-agenda-0919.pdf" target="_blank" title="Click here to download the AHA Affordability Advocacy Agenda 2021 PDF.">Download PDF</a></div><p><a href="/costsofcaring" target="_blank" title="Click here for more information."><img src="/sites/default/files/2022-08/costs-of-caring-report-cover_Page_1.png" data-entity-uuid data-entity-type="file" alt="Costs of Caring 2022 Cover." width="1159" height="1500"></a></p><div class="external-link spacer"><a class="btn btn-primary btn-wide" href="/system/files/media/file/2022/04/2022-Hospital-Expenses-Increase-Report-Final-Final.pdf" target="_blank">Download PDF</a></div><div class="panel module-typeC"><div class="panel-heading"><h3 class="panel-title">Affordability Resources</h3></div><div class="panel-body group2"><p><a href="/issue-brief/2019-09-18-real-affordability-solutions-front-lines-caring" target="_blank" title="Click here to go to the Real Affordability Solutions from the Front Lines of Caring landing page.">Real Affordability Solutions from the Front Lines of Caring</a></p><p><a href="/costsofcaring" target="_blank" title="Click here to view the Cost of Caring report.">Cost of Caring</a></p><p><a href="/standardsguidelines/2021-10-08-partnerships-mergers-and-acquisitions-can-provide-benefits-certain" target="_blank">Partnerships, Mergers, and Acquisitions Can Provide Benefits to Certain Hospitals and Communities</a></p><p><a href="/guidesreports/2021-09-21-financial-effects-covid-19-hospital-outlook-remainder-2021" target="_blank">Financial Effects of COVID-19: Hospital Outlook for the Remainder of 2021</a></p><p><a href="/guidesreports/2021-09-09-results-2018-tax-exempt-hospitals-schedule-h-community-benefit-reports" target="_blank">Results from 2018 Tax-Exempt Hospitals’ Schedule H Community Benefit Reports</a></p><p><a href="/news/perspective/2021-10-08-perspective-confronting-commercial-insurers-practices-threaten-patient" target="_blank">Perspective: Confronting Commercial Insurers’ Practices that Threaten Patient Care</a></p><p><a href="/news/blog/2021-07-12-lown-institute-report-hospital-community-benefits-falls-short" target="_blank">Lown Institute Report on Hospital Community Benefits Falls Short</a></p><p><a href="/news/headline/2021-09-28-study-health-insurance-market-becoming-more-concentrated">Study: Health insurance market becoming more concentrated</a></p><p><a href="https://www.ama-assn.org/delivering-care/patient-support-advocacy/competition-health-insurance-research">Report: American Medical Association Report on Competition in the Health Insurance</a></p></div></div></div></div></div> Tue, 13 Aug 2024 10:00:00 -0500 AHA.org Advocacy Homepage Block <div class="container"><div class="row"><div class="col-md-8"><p>Rural hospitals and health systems are committed to ensuring local access to high-quality, affordable health care. However, these hospitals continue to experience ongoing challenges that jeopardize their ability to provide local access to care and essential services. These include severe underpayments by Medicare and Medicaid, which threaten the financial stability of the health care system; challenges imposed by commercial and Medicare Advantage plans; and a heavy regulatory burden.</p><div class="raw-html-embed"> <div class="col-md-12 cc_tabs"> /* reset */ .cc_tabs ul.a-container { margin: 0; padding: 0; list-style: none; } .cc_tabs input[type=checkbox] { display: none; } /* style */ .cc_tabs .a-container { width: 100%; margin: 20px auto; } .cc_tabs .a-container label { display: block; position: relative; cursor: pointer; font-size: 18px; font-weight: bold; padding: 10px 20px; color: #63666a; background-color: #eee; border-bottom: 1px solid #ddd; -webkit-transition: all .2s ease; -moz-transition: all .2s ease; -ms-transition: all .2s ease; -o-transition: all .2s ease; transition: all .2s ease; margin-bottom:15px } .cc_tabs .a-container label:after { content: ""; width: 0; height: 0; border-top: 8px solid #aaa; border-right: 6px solid transparent; border-bottom: 8px solid transparent; border-left: 6px solid transparent; position: absolute; right: 10px; top: 16px; } .cc_tabs .a-container input:checked + label, .cc_tabs .a-container label:hover { background-color: #003087; color: #fff; } .cc_tabs .a-container input:checked + label:after { border-top: 8px solid transparent; border-right: 6px solid transparent; border-bottom: 8px solid #fff; border-left: 6px solid transparent; top: 6px; } .cc_tabs .a-content { padding: 0 20px 20px; display: none; height:auto; max-height: 40vh; overflow: auto } .cc_tabs .a-container input:checked ~ .a-content { display: block; } /* Style the tab */ .cc_tabs .tab { background-color: #fff; width: auto; height: auto; overflow: auto; } /* Style the buttons inside the tab */ .cc_tabs .tab button { display: block; background-color: lightgray; color: #003087; padding: 10px 16px 10px 20px; width: calc(50% - 30px); border: solid 1px lightgray; outline: none; text-align: center; cursor: pointer; transition: 0.3s; font-size: 20px; float: left; overflow: auto; margin: 0px 15px; -webkit-border-top-left-radius: 15px; -webkit-border-top-right-radius: 15px; -moz-border-radius-topleft: 15px; -moz-border-radius-topright: 15px; border-top-left-radius: 15px; border-top-right-radius: 15px; font-weight: 700; } @media (max-width:452px){ .cc_tabs .tab button{ padding: 10px 5px 10px 5px; width: calc(50% - 4px); font-size: 17px; margin: 0px 2px; } } /* Change background color of buttons on hover */ .cc_tabs .tab button:hover { background-color: #003087; color:#fff } /* Create an active/current "tab button" class */ .cc_tabs .tab button.active { background-color: #003087; color: #ffffff } /* Style the tab content */ .cc_tabs .tab .tabcontent { float: left; padding: 15px 12px; border: 1px solid #ccc; width: 100%; height: auto; } .cc_tabs .tablinks:after { content: '\2610'; color: #777; font-weight: bold; float: right; margin-left: 5px; } .cc_tabs .tablinks.active:after { content: "\2611"; } Get CertifiedRecertify </div> --> <div class="tabcontent" id="General"> <a id="patienttools"> </a> <a id="patienttools"></a> <ul class="a-container"> <li class="a-items"> SUPPORT FLEXIBLE PAYMENT MODELS <div class="a-content"> <p> As the health care field continues to change at a rapid pace, flexible approaches and multiple options for reimbursing and delivering care are more critical than ever to sustain access to services in rural areas. </p> <p> <span><strong>Medicare-dependent Hospital (MDH) and Low-volume Adjustment (LVA).</strong></span> MDHs are small, rural hospitals where at least 60% of admissions or patient days are from Medicare patients. MDHs receive the inpatient prospective payment system (IPPS) rate plus 75% of the difference between the IPPS rate and their inflation-adjusted costs from one of three base years. <span><strong>AHA supports making the MDH program permanent and adding an additional base year that hospitals may choose for calculating payments.</strong></span> The LVA provides increased payments to isolated, rural hospitals with a low number of discharges. <span><strong>AHA also supports making the LVA permanent.</strong></span> The MDH designation and LVA protect the financial viability of these hospitals to ensure they can continue providing access to care. </p> <p> <span><strong>Necessary Provider Designation for Critical Access Hospitals (CAHs).</strong></span> The CAH designation allows small rural hospitals to receive cost-based Medicare reimbursement, which can help sustain services in the community. Hospitals must meet several criteria, including a mileage requirement, to be eligible.  A hospital can be exempt from the mileage requirement if the state certifies the hospital as a necessary provider, but only hospitals designated before Jan. 1, 2006 are eligible. <span><strong>AHA urges Congress to reopen the necessary provider CAH program to further support local access to care in rural areas.</strong></span> </p> <p> <span><strong>Rural Emergency Hospital (REH) Model.</strong></span> REHs are a Medicare provider type that small rural and critical access hospitals can convert to in order to provide emergency and outpatient services without needing to provide inpatient care. REHs are paid a monthly facility payment and the outpatient prospective payment system (OPPS) rate plus 5%. <span><strong>AHA continues to support strengthening and refining the REH model to ensure sustainable care delivery and financing.</strong></span> </p> <p> <span><strong>Rebasing for Sole Community Hospitals (SCHs).</strong></span><strong> </strong>SCHs must show they are the sole source of inpatient hospital services reasonably available in a certain geographic area to be eligible. They receive increased payments based on their cost per discharge in a base year. <span><strong>AHA supports adding an additional base year that SCHs may choose for calculating their payments.</strong></span> </p> </div> </li> <li class="a-items"> ENSURE FAIR REIMBURSEMENT, ACCESS TO CAPITAL & REGULATORY RELIEF <div class="a-content"> <p> Medicare and Medicaid pay only 82 cents for every dollar spent caring for patients, according to the latest AHA data. <strong>Given the challenges of providing care in rural areas, reimbursement rates across payers need to be updated to cover the cost of care.</strong> </p> <p> <span><strong>Telehealth.</strong></span><strong> </strong>Telehealth services are a crucial access point for many patients. AHA supports legislation to make permanent coverage of certain telehealth services made possible during the pandemic, including lifting geographic and originating site restrictions, allowing Rural Health Clinics and Federally Qualified Health Centers to serve as distant sites, expanding practitioners who can provide telehealth and allowing hospital outpatient billing for virtual services, among others. </p> <p> <span><strong>Infrastructure Financing for Rural Hospitals.</strong></span> Many rural hospitals were constructed following the passage of the Hill-Burton Act of 1947, which provided grants and loans for the construction and modernization of hospitals. Currently, many rural hospitals need to update their facilities and services to continue meeting the needs of their community. Yet, narrow financial margins limit rural hospitals’ ability to retain earnings and secure access to capital or qualify for U.S. Department of Agriculture or U.S. Department of Housing and Urban Development mortgage guarantees. Without those resources, rural hospitals are sometimes unable to update facilities. <span><strong>The AHA urges Congress to help ensure that vulnerable communities are able to preserve access to essential health care services by providing infrastructure funding for hospitals that restructure their facilities and services to meet community needs.</strong></span> </p> <p> <span><strong>Reverse Rural Health Clinic (RHC) Payment Cuts.</strong></span> RHCs provide access to primary care and other important services in rural, underserved areas.<strong> </strong><span><strong>AHA urges Congress to repeal payment caps on  provider-based RHCs</strong></span> that limit access to care. </p> <p> <span><strong>Maternal and Obstetric Care.</strong></span><strong> </strong>Maternal health is a top priority for AHA and its rural members. We urge Congress to continue to fund programs that improve or maintain access to maternal and obstetric care in rural areas, including supporting the maternal workforce, promoting best practices and educating health care professionals. </p> <p> <span><strong>Wage Index Floor.</strong></span> AHA supports legislation that would place a floor on the area wage index, effectively raising the area wage index for hospitals below that threshold with new money. </p> <p> <span><strong>96-hour Rule</strong></span>. <span><strong>We urge Congress to pass legislation to permanently remove the 96-hour physician certification requirement for CAHs.</strong></span><strong> </strong>These hospitals still would be required to satisfy the condition of participation requiring a 96-hour annual average length of stay, but removing the physician certification requirement would allow CAHs to serve patients needing critical medical services that have standard lengths of stay greater than 96 hours. </p> <p> <span><strong>Ambulance Add-on Payment.</strong></span> Rural ambulance service providers ensure timely access to emergency medical care but face higher costs than other areas due to lower patient volume. <span><strong>We support permanently extending the existing rural and “super rural” ambulance add-on payments to protect access to these essential services.</strong></span> </p> <p> <span><strong>Regulatory Burden</strong></span><strong>.</strong> Reduce regulatory burden by identifying and advocating for the repeal of unnecessary and duplicative Conditions of Participation that increase hospital inefficiency and reduce the time providers can spend caring for their patients. </p> </div> </li> <li class="a-items"> COMMERCIAL INSURER ACCOUNTABILITY <div class="a-content"> <p> Underpayment by commercial insurance plans and systematic and inappropriate payment delays for medically necessary care are putting patient access to care at risk.  </p> <p> <span><strong>Cost-based Reimbursement for Critical Access Hospitals (CAHs) from Medicare Advantage (MA) Plans</strong></span>. Congress created a special statutory payment designation for CAHs in recognition of the unique role they play in preserving access to health care services in rural areas. As certain MA plans in rural communities rapidly grow, there is an erosion of this important financial protection. A greater portion of a CAH’s revenue will be subject to negotiations with MA plans that often result in below-cost payment terms and involve onerous plan requirements that contribute to administrative burden, unnecessary delays and denials in approving and paying for patient care, and additional strains on the health care workforce.<span><strong> We support legislation to ensure CAHs receive cost-based reimbursement for MA patients. </strong></span> </p> <p> <span><strong>Prompt Pay</strong></span>. Ensure prompt payment from insurers for medically necessary, covered health care services delivered to patients. <span><strong>We support policies to increase oversight and accountability of health plans including establishing more stringent standards for timely payment</strong></span> to address certain insurer tactics to delay and deny payment to health care providers.  </p> <p> <span><strong>Prior Authorization</strong></span>. Hold commercial health insurers accountable for ensuring patients have timely access to care, including by reducing the excessive use of prior authorization, ensuring expeditious prior authorization decisions and eliminating inappropriate denials for services that should be covered. <span><strong>We support building on recent regulations and legislation that further streamline and improve prior authorization processes.</strong></span> </p> <div class="a-content"> <a> </a> <p class="MsoNormal"> <span></span> </p> <p> Underpayment by commercial insurance plans and systematic and inappropriate payment delays for<br> medically necessary care are putting patient access to care at risk. </p> <strong> <p> <span><strong>Cost-based Reimbursement for Critical Access Hospitals (CAHs) from Medicare Advantage (MA) Plans.</strong></span><strong> </strong>Congress created a special statutory payment designation for CAHs in recognition of the unique role they play in preserving access to health care services in rural areas. As certain MA plans in rural communities rapidly grow, there is an erosion of this important financial protection. A greater portion of a CAH’s revenue will be subject to negotiations with MA plans that often result in below-cost payment terms and involve onerous plan requirements that contribute to administrative burden, unnecessary delays and denials in approving and paying for patient care, and additional strains on the health care workforce.  <span><strong>We support legislation to ensure CAHs receive cost-based reimbursement for MA patients.</strong></span> </p> <p> <span><strong>Prompt Pay.</strong></span><strong> </strong>Ensure prompt payment from insurers for medically necessary, covered health care services delivered to patients. <span><strong>We support policies to increase oversight and accountability of health plans including establishing more stringent standards for timely payment </strong></span>to address certain insurer tactics to delay and deny payment to health care providers. </p> <p> <span><strong>Prior Authorization.</strong></span> Hold commercial health insurers accountable for ensuring patients have timely access to care, including by reducing the excessive use of prior authorization, ensuring expeditious prior authorization decisions and eliminating inappropriate denials for services that should be covered. <span><strong>We support building on recent regulations and legislation that further streamline and improve prior authorization processes.</strong></span> </p> </strong> </div> <strong> </strong> </div> </li> <li class="a-items"> BOLSTER THE WORKFORCE <div class="a-content"> <p> Recruitment and retention of health care professionals is an ongoing challenge and expense for rural hospitals. Nearly 70% of the primary care health professional shortage areas (HPSAs) are located in rural or partially rural areas. Targeted programs that help address workforce shortages in rural communities should be supported and expanded. Workforce policies and programs also should encourage nurses and other allied professionals to practice at the top of their license.  </p> <p> <span><strong>Graduate Medical Education</strong></span>. We urge Congress to enact legislation that would lift existing caps on the number of Medicare-funded residency slots, which would help alleviate physician shortages in rural and other underserved areas and improve patients’ access to care. We also support robust funding for rural residency track programs, which provide medical residents additional training opportunities in rural areas.  </p> <p> <span><strong>Conrad State 30 Program</strong></span>. We urge Congress to make permanent and expand the Conrad State 30 J-1 visa waiver program, which waives the requirement for physicians holding J-1 visas to return home for a period if they agree to stay in the U.S. for three years and practice in underserved areas.  </p> <p> <span><strong>Loan Repayment Programs</strong></span>. We urge Congress to pass legislation to provide incentives for clinicians to practice in rural HPSAs. We support expanding the National Health Service Corps and the National Nurse Corps, which incentivize health care graduates to provide health care services in underserved areas.  </p> <p> <span><strong>Visa Recapture</strong></span>. We urge Congress to pass legislation to recapture up to 40,000 unused employment visas for foreign-trained workers (25,000 for nurses and 15,000 for physicians). </p> </div> </li> <li class="a-items"> PROTECT THE 340B PROGRAM <div class="a-content"> <p> The 340B Drug Pricing Program helps CAHs, Sole Community Hospitals, Rural Referral Centers and other disproportionate share hospitals serving vulnerable populations stretch scarce resources. Section 340B of the Public Health Service Act requires pharmaceutical companies participating in Medicaid to sell outpatient drugs at discounted prices to organizations that care for many uninsured and low-income patients. </p> <p> Hospitals use 340B savings, for example, to provide free care for uninsured patients, offer free vaccines, provide services in mental health clinics and implement medication management and community health programs. The AHA opposes any efforts to undermine the 340B program and harm the patients and communities it serves, including drug company efforts to diminish the program by limiting contract pharmacy arrangements and attempting to change access to 340B pricing from an upfront discount to a back-end rebate. </p> </div> </li> </ul> </div> <strong> <div class="col-md-12 cc_tabs"> /* reset */ .cc_tabs ul.a-container { margin: 0; padding: 0; list-style: none; } .cc_tabs input[type=checkbox] { display: none; } /* style */ .cc_tabs .a-container { width: 100%; margin: 20px auto; } .cc_tabs .a-container label { display: block; position: relative; cursor: pointer; font-size: 18px; font-weight: bold; padding: 10px 20px; color: #63666a; background-color: #eee; border-bottom: 1px solid #ddd; -webkit-transition: all .2s ease; -moz-transition: all .2s ease; -ms-transition: all .2s ease; -o-transition: all .2s ease; transition: all .2s ease; margin-bottom:15px } .cc_tabs .a-container label:after { content: ""; 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} Get CertifiedRecertify </div> --> </div> </strong> </div> <strong> <p class="a-items"> <ul class="a-container"> item 1 <div class="a-content"> <p> ==== </p> </div> </li> </ul> <div> --> function openCity(evt, cityName) { var i, tabcontent, tablinks; tabcontent = document.getElementsByClassName("tabcontent"); for (i = 0; i < tabcontent.length; i++) { tabcontent[i].style.display = "none"; } tablinks = document.getElementsByClassName("tablinks"); for (i = 0; i < tablinks.length; i++) { tablinks[i].className = tablinks[i].className.replace(" active", ""); } document.getElementById(cityName).style.display = "block"; evt.currentTarget.className += " active"; } // Get the element with id="defaultOpen" and click on it document.getElementById("defaultOpen").click(); </p> </strong> </div><p> </p><p class="a-items"> Get CertifiedRecertify </div> --> <ul class="a-container"> item 1 <div class="a-content"> <p> ==== </p> </div> </li> </ul> <div> --> function openCity(evt, cityName) { var i, tabcontent, tablinks; tabcontent = document.getElementsByClassName("tabcontent"); for (i = 0; i < tabcontent.length; i++) { tabcontent[i].style.display = "none"; } tablinks = document.getElementsByClassName("tablinks"); for (i = 0; i < tablinks.length; i++) { tablinks[i].className = tablinks[i].className.replace(" active", ""); } document.getElementById(cityName).style.display = "block"; evt.currentTarget.className += " active"; } // Get the element with id="defaultOpen" and click on it document.getElementById("defaultOpen").click(); </p></div><div class="col-md-4"><p class="text-align-center"><a class="btn btn-primary" href="/system/files/media/file/2025/02/2025-Rural-Advocacy-Agenda.pdf">Download the Rural Advocacy Agenda</a><br> </p><p><a href="/system/files/media/file/2025/02/2025-Rural-Advocacy-Agenda.pdf"><img src="/sites/default/files/inline-images/cover-2025-Rural-Advocacy-Agenda_0.png" data-entity-uuid="43454eb5-2a7a-44ba-a764-b47efb669806" data-entity-type="file" width="655" height="847" alt="AHA 2025 Rural Advocacy Agenda page 1."></a></p><p> </p><p><a class="btn btn-wide btn-primary" href="/advocacy/2020-01-27-rural-advocacy-agenda-archives">View the Rural Advocacy Agenda Archives</a></p><p><a class="btn btn-wide btn-primary" href="/advocacy-agenda" title="2025 AHA Advocacy Agenda PDF">View the AHA 2025 Advocacy Agenda</a></p></div></div></div> Fri, 23 Feb 2024 23:01:00 -0600 AHA.org Advocacy Homepage Block /issue-brief/2019-09-18-real-affordability-solutions-front-lines-caring <div>.body { font-size: 16px } </div><div class="container"><div class="row"><div class="col-md-12"><div class="col-md-5"><p><a href="/costsofcaring" target="_blank" title="Download the Cost of Caring 2022 report."><img src="/sites/default/files/inline-images/Page-1-2022-Hospital-Expenses-Increase-Report-Final-Final.png" data-entity-uuid data-entity-type alt="Cost of Caring October 2022 page 1." width="1700" height="2200"></a></p></div><p>Consumers are seeking greater value for their health care dollars. Concerns around the affordability of health care will only grow as overall health care spending continues to rise to meet the needs of an aging America.</p><p>The women and men of America’s hospitals and health systems—physicians, nurses and other caregivers—understand and share consumer’s concerns, and are working hard to make care more affordable by transforming the way health care is delivered in our communities.</p><p>But we cannot do it alone. It will take a real effort by everyone involved—providers, the government, employers and individuals, device makers, drug manufacturers, insurers and others. With health insurance prices climbing and drug spending rising, insurers and drug companies can do more to address increased health care costs.</p><h2>Specifically, America’s hospital and health systems are working to:</h2>.group div{ min-height: 275px; margin-bottom:25px } .group img{ border: solid 1px #D9D9D6 } .group p{ text-align: left ; font-size: 1.1em; font-family: univers, arial, sans-serif; line-height: 1.25em; font-weight:700 } .group p a{ color: #333; } <div class="row group"><div class="col-md-3 col-sm-4"><p><a href="/drug-prices/home"><img src="/sites/default/files/inline-images/Drug-prices.jpg" data-entity-uuid="dd6adb60-9627-4e03-8029-a6f1d55df241" data-entity-type="file" alt="Drug Prices stock" width="943" height="628"></a></p><p><a href="/drug-prices/home">Rein in Skyrocketing Drug Prices</a></p></div><div class="col-md-3 col-sm-4"><p><a href="/advocacy/access-and-health-coverage"><img src="/sites/default/files/inline-images/Transparency.jpg" data-entity-uuid="243aea5d-8f3f-4931-a626-011c4554f65f" data-entity-type="file" alt="Mark Information Available on Price and Quality" width="1055" height="702"></a></p><p><a href="/advocacy/access-and-health-coverage">Improve Access to Quality Health Coverage</a></p></div><div class="col-md-3 col-sm-4"><p><a href="/makingcareaffordable"><img src="/sites/default/files/inline-images/Social-determinants.jpg" data-entity-uuid="c698a352-b453-499d-a84f-918472e29998" data-entity-type="file" alt="Invest in Public Health to Improve Overall Health stock" width="943" height="628"></a></p><p><a href="/makingcareaffordable">Make Information Available on Price and Quality</a></p></div><div class="col-md-3 col-sm-4"><p><a href="/guidesreports/2019-05-15-social-determinants-health-and-value"><img src="/sites/default/files/inline-images/Coverage-access2_0.jpg" data-entity-uuid="8e07714e-fae7-44c0-b191-2fea8ea696e2" data-entity-type="file" alt="Access to Quality Health Coverage stock" width="1078" height="722"></a></p><p><a href="/guidesreports/2019-05-15-social-determinants-health-and-value">Invest in Public Health to Improve Overall Health and Well-being</a></p></div><div class="col-md-3 col-sm-4"><p><a href="/advocacy/access-and-health-coverage/access-behavioral-health"><img src="/sites/default/files/inline-images/Access-to-behavioral-health-care.jpg" data-entity-uuid="a8811c11-5d41-48d4-a5f3-118ea1727960" data-entity-type="file" alt="Increase Access to Behavioral Health Care stock" width="1009" height="673"></a></p><p><a href="/advocacy/access-and-health-coverage/access-behavioral-health">Treat the Whole Person—Increase Access to Behavioral Health Care</a></p></div><div class="col-md-3 col-sm-4"><p><a href="/regulatory-relief/regulatory"><img src="/sites/default/files/inline-images/Regulatory-relief.jpg" data-entity-uuid="26eec337-9235-419b-9855-2de2972e842d" data-entity-type="file" alt="Reduce Red Tape from Government Regulation stock" width="1431" height="954"></a></p><p><a href="/regulatory-relief/regulatory">Reduce Red Tape from Government Regulation</a></p></div><div class="col-md-3 col-sm-4"><p><a href="/bibliographylink-page/2018-04-20-value-hospital-mergers"><img src="/sites/default/files/2019-09/Hospital-realignment2b.jpg" data-entity-uuid data-entity-type alt="Remove Outdated Laws that Impede Communications and Collaboration stock" width="1055" height="702"></a></p><p><a href="/hospital-mergers" target="_blank">Remove Outdated Laws that Impede Communication and Collaboration between Hospitals and Other Providers</a></p></div><div class="col-md-3 col-sm-4"><p><a href="/topics/commercial-insurer-accountability"><img src="/sites/default/files/2021-10/commercial-insurer-accountability-520x350.jpg" data-entity-uuid data-entity-type alt="Commercial Insurer Accountability. A woman reviews her insurer's explanation of benefits." width="520" height="350"></a></p><p><a href="/topics/commercial-insurer-accountability">Hold Commercial Insurers Accountable</a></p></div></div>.group2 p{ font-family: univers, arial, sans-serif; font-weight:700 } .group2 p a{ color: #333; } <div class="col-md-6 col-md-offset-3"><div class="panel module-typeC"><div class="panel-heading"><h3 class="panel-title">Resources</h3></div><div class="panel-body group2"><p><a href="/affordability-advocacy-agenda" target="_blank" title="Click here to view the AHA Affordability Advocacy Agenda 2021.">Affordability Advocacy Agenda</a></p><p><a href="/costsofcaring">Fact Sheet: Cost of Caring</a></p><p><a href="/340b-drug-savings-program" target="_blank">The 340B Drug Savings Program</a></p><p><a href="/standardsguidelines/2021-10-08-partnerships-mergers-and-acquisitions-can-provide-benefits-certain" target="_blank">Partnerships, Mergers, and Acquisitions Can Provide Benefits to Certain Hospitals and Communities</a></p><p><a href="/guidesreports/2021-09-21-financial-effects-covid-19-hospital-outlook-remainder-2021" target="_blank">Financial Effects of COVID-19: Hospital Outlook for the Remainder of 2021</a></p><p><a href="/guidesreports/2021-09-09-results-2018-tax-exempt-hospitals-schedule-h-community-benefit-reports" target="_blank">Results from 2018 Tax-Exempt Hospitals’ Schedule H Community Benefit Reports</a></p><p><a href="/news/perspective/2021-10-08-perspective-confronting-commercial-insurers-practices-threaten-patient" target="_blank">Perspective: Confronting Commercial Insurers’ Practices that Threaten Patient Care</a></p><p><a href="/news/blog/2021-07-12-lown-institute-report-hospital-community-benefits-falls-short" target="_blank">Lown Institute Report on Hospital Community Benefits Falls Short</a></p><p><a href="/news/headline/2021-09-28-study-health-insurance-market-becoming-more-concentrated">Study: Health insurance market becoming more concentrated</a></p><p><a href="https://www.ama-assn.org/delivering-care/patient-support-advocacy/competition-health-insurance-research">Report: American Medical Association Report on Competition in the Health Insurance</a></p></div></div></div></div></div></div> Wed, 24 Aug 2022 14:32:40 -0500 AHA.org Advocacy Homepage Block .lead { font-size: 22px !important; } <p class="lead">Congress is currently fast-tracking legislation to advance with a simple majority in the U.S. Senate a $1.9 trillion COVID-19 relief package proposed by President Biden. In this relief package, it is imperative that Congress address the critical needs of hospitals and health systems—and their front-line caregivers—as we continue to navigate public health and financial challenges due to COVID-19.<br />  </p> <h2>TAKE ACTION:</h2> <p class="MsoNoSpacing"><strong><span><span><i>Send a letter to Congress</i></span></span></strong><br /> <span><span>AHA is making it easy to send a letter to your elected lawmakers in the Senate and House of Representatives using our VoterVoice tool.</span></span></p> <ul> <li class="MsoNoSpacing"><a href="https://www.votervoice.net/AHA/campaigns/80961/respond"><span><span><b>Urge Congress to Support Hospitals and Health Systems With COVID-19 Relief </b></span></span></a></li> </ul> <p class="MsoNoSpacing"><strong><span><span><i>Advocate via social media</i></span></span></strong><br /> <span><span>AHA crafted messages and graphics for you to use across your organization’s social media platforms. Remember to tag your members of Congress and @AHAadvocacy and use #SupportHospitals in all your messages.</span></span></p> <ul> <li class="MsoNoSpacing"><span><span><b><a href="/toolkitsmethodology/2021-02-22-aha-all-member-live-advocacy-event-february-23-2021-digital-toolkit">Digital Toolkit</a></b></span></span></li> </ul> <h2>Latest Action Alert</h2> <p class="MsoNoSpacing"><span><span><a href="/action-alert/2021-02-23-urge-your-lawmakers-support-hospitals-and-health-systems-congress-moves"><b>Urge Your Lawmakers to Support Hospitals as Congress Moves Forward on COVID-19 Relief Legislation</b></a></span></span></p> <h2>Advocacy Resources and Factsheets</h2> <ul> <li class="MsoNoSpacing"><span><span><em><span>What is reconciliation?</span></em><strong><span> Learn more about this process in the </span></strong><a href="/special-bulletin/2021-02-05-congress-begins-process-using-reconciliation-pass-covid-19-relief">Feb. 5 AHA Special Bulleti</a><a href="http://www.aha.org/special-bulletin/2021-02-05-congress-begins-process-using-reconciliation-pass-covid-19-relief">n</a><strong><span>.</span></strong></span></span></li> <li class="MsoNoSpacing"><span><span><strong>FACT SHEET:</strong> <a href="/fact-sheets/2021-02-08-fact-sheet-more-funding-needed-provider-relief-fund">More funding needed for the Provider Relief Fund allocations</a></span></span></li> <li class="MsoNoSpacing"><span><span><strong>FACT SHEET:</strong> <a href="/fact-sheets/2020-11-09-forgiveness-accelerated-payments-hospitals">Forgiveness for Medicare accelerated payments for hospitals</a></span></span></li> <li class="MsoNoSpacing"><span><span><strong>LETTER:</strong> <a href="/lettercomment/2021-02-01-aha-expresses-support-hr-315-medicare-sequester-covid-moratorium-act">Extending the moratorium on Medicare sequester cuts</a></span></span></li> <li class="MsoNoSpacing"><span><span><strong>FACT SHEET:</strong> <a href="/fact-sheets/2020-05-06-fact-sheet-support-health-care-heroes">Support Health Care Heroes</a></span></span></li> <li class="MsoNoSpacing"><span><span><strong>FACT SHEET:</strong> <a href="/fact-sheets/2020-05-06-fact-sheet-preserving-and-building-private-sector-health-care-coverage">Preserving and building on private sector health care coverag</a></span></span></li> <li class="MsoNoSpacing"><span><span><strong>RESOURCE:</strong> <a href="/resources/2020-05-01-additional-actions-needed-next-covid-19-relief-package-support-hospitals-and">Additional Actions Needed in the Next COVID-19 Relief Package to Support Hospitals and Health Systems</a> (<em><span>Updated Feb. 8, 2021</span></em>)</span></span></li> </ul> <h2>Press Releases</h2> <ul> <li class="MsoNoSpacing"><span><span><strong>PRESS RELEASE:</strong> <a href="/press-releases/2020-06-30-new-aha-report-losses-deepen-hospitals-health-systems">AHA report on hospitals’ and health systems’ deepening financial losses</a></span></span></li> </ul> <p class="MsoNoSpacing"> </p> Mon, 22 Feb 2021 16:14:33 -0600 AHA.org Advocacy Homepage Block /education-events/aha-virtual-advocacy-day-july-20-2020 <p>As Congress considers additional COVID-19 relief actions, we need to make sure hospital and health systems' priorities are at the top of the list. The focus is on the Senate, and it is critical that your lawmakers hear from you now on important issues that must be included in the legislative package.</p> <p><strong>Please join AHA President and CEO Rick Pollack and AHA Executive Vice President Tom Nickels June 30 at 2 p.m. ET for a special live presentation as part of an AHA Virtual Advocacy Day.</strong> They will give the latest updates on the next COVID-19 relief package and provide resources and ways you can engage with your lawmakers virtually.</p> Fri, 17 Jul 2020 11:28:29 -0500 AHA.org Advocacy Homepage Block .lead { font-size: 22px !important; } <p><img alt="AHA Virtual Advocacy Day logo. Support Hospitals. July 20, 2020." data-entity-type="file" data-entity-uuid="83e80046-0e2a-4d83-a869-40bdaa119324" src="/sites/default/files/inline-images/logo-aha-advocacy-day-July-2020.jpg" width="1197" height="455"></p> <div class="container"> <div class="row"> <div class="col-md-1"> </div> <div class="col-md-10"> <h2>AHA Virtual Advocacy Day July 20, 2020</h2> <p class="lead">As Congress considers additional COVID-19 relief actions, we need to make sure hospital and health systems' priorities are at the top of the list. The focus is on the Senate, and it is critical that your lawmakers hear from you now on important issues that need to be included in the legislative package.</p> <div class="row"> <div class="col-md-1 text-align-center"> </div> <div class="col-md-10"> <div class="external-link spacer text-align-center"><a class="btn btn-wide btn-primary" href="https://p2a.co/r1iSUh4" target="_blank"><span><strong>          Take Action and Contact Your Senators</strong></span><sup><i class="fa fa-external-link fa-fw"><span class="sr-only">this is an external link</span></i></sup>          </a></div> </div> <div class="col-md-1"> </div> </div> <p>It is imperative that Congress provides additional relief to hospitals and health systems as recent reports estimate total losses for the nation’s hospitals and health systems as at least $323.1 billion in 2020.</p> <p>The following broad provisions that cut across AHA membership should be included in the relief package:</p> <ul> <li>Additional dollars for the emergency relief fund;</li> <li>Additional support for health care heroes;</li> <li>Forgiveness for accelerated payments;</li> <li>Maintaining health benefits for individuals and families and increasing coverage options for those who are uninsured; and</li> <li>Appropriate liability protections to front-line medical providers and facilities</li> </ul> <h2>Latest Advocacy Alert</h2> <h3><a href="/action-alert/2020-07-22-contact-your-senators-and-urge-them-support-hospitals-and-health-systems">Contact Your Senators and Urge Them to Support Hospitals and Health Systems in the Next COVID-19 Relief Package</a></h3> <p>As Congress considers additional (and possibly its last for a while) COVID-19 relief actions, we need to mount a full court press to ensure that hospitals and health systems — and their front-line caregivers — receive additional federal support as we navigate the greatest public health and financial challenges our organizations have ever faced.</p> <h2>Advocacy Resources</h2> <h3>Fact Sheets with Details on Provisions to Include in Next COVID-19 Relief Package</h3> <ul> <li><strong><a href="/fact-sheets/2020-05-06-fact-sheet-support-health-care-heroes" target="_blank">Federal Support for Health Care Heroes.</a></strong> Please urge Congress to: provide support for child care, housing, transportation and education benefits for hospital workers; provide bonus pay for hospital workers; and establish a compensation fund for COVID-19 health care workers and their families.</li> <li><strong><a href="/fact-sheets/2020-05-06-fact-sheet-forgiveness-accelerated-payments-hospitals" target="_blank">Accelerated Payment Forgiveness for Hospitals.</a></strong> Congress should provide for full forgiveness of Medicare accelerated payments for hospitals. Forgiving hospitals' accelerated payments will provide a necessary solution to recover and rebuild while delivering the care that patients and communities are depending on.</li> <li><strong><a href="/fact-sheets/2020-05-06-fact-sheet-preserving-and-building-private-sector-health-care-coverage" target="_blank">Increase Health Insurance Coverage.</a></strong> Congress should take action to maintain health benefits for individuals and families and increase coverage options for those who are already uninsured by: providing employer subsidies for preserving enrollment; covering COBRA costs; opening a Special Enrollment Period for Health Insurance Marketplaces; increasing eligibility for federal marketplace subsidies; expanding the period during which insurers cannot cancel coverage for non-payment of premiums; and providing charity care tax credits for hospitals.</li> <li><strong><a href="/fact-sheets/2020-05-06-fact-sheet-legislation-protect-health-care-providers-serving-front-lines" target="_blank">Federal Liability Protections.</a></strong> Congress should provide appropriate liability protections for facilities and front-line medical providers treating patients amid the COVID-19 crisis, for arranging for and providing health care services, including where treatment is provided, and how best to deploy personnel, equipment and facilities.</li> </ul> <h3>Fact Sheet on Provision NOT to Include in COVID-19 Relief Package</h3> <ul> <li><strong><a href="/system/files/media/file/2020/05/fact-sheet-covid-19-workers-first-protection-act-of-2020.pdf" target="_blank">The COVID-19 Workers First Protection Act of 2020.</a></strong> The House of Representatives approved the Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act (H.R. 6800) on May 15, 2020, which included the COVID-19 Every Worker First Protection Act of 2020. The bill would require that the Occupational Safety and Health Administration (OSHA) issue an Emergency Temporary Standard (ETS) within seven days requiring employers to develop and implement a comprehensive infectious disease exposure control plan. The ETS may not be less protective than the any OSHA state plan; meaning every state would need a standard at least as restrictive as California OSHA rules. The bill also would require a permanent standard be issued within two years. The version of the legislation (H.R. 6559, introduced April 21, 2020) included in the HEROES Act had been updated from previous bills by including a requirement for recording and reporting infections and deaths and an anti-retaliation provision.</li> </ul> <h3><a href="/resources/2020-05-01-additional-actions-needed-next-covid-19-relief-package-support-hospitals-and" target="_blank">Detailed List of AHA Advocacy Priorities for Next COVID-19 Relief Package</a></h3> <p>During the COVID-19 crisis, hospitals and health systems – and their dedicated caregivers and front-line teams – continue to work around-the-clock to provide the care that our communities and patients need. While the AHA greatly appreciates the passage of the Coronavirus Aid, Relief, and Economic Security (CARES) Act and Paycheck Protection Program and Health Care Enhancement Act and the valuable resources they provided, additional support is urgently needed. In order to make certain that hospitals are able to continue to provide treatments, front-line health care personnel are able to provide care and patients are able access health care services, Congress must act quickly to get additional needed resources into the health care system.</p> <h3><a href="/press-releases/2020-06-30-new-aha-report-losses-deepen-hospitals-health-systems" target="_blank">AHA Report: Financial Impact of COVID-19 on Hospitals and Health Systems Expected to Top $323 Billion in 2020</a></h3> <p>A new AHA report <a href="/press-releases/2020-06-30-new-aha-report-losses-deepen-hospitals-health-systems">released</a> June 30 finds that the immense financial strain facing hospitals and health systems due to COVID-19 will continue through at least 2020, with total losses estimated to be at least $323 billion by the end of the year.</p> <h3><a href="/system/files/media/file/2020/06/Advocacy_Day_Digital%20Toolkit.docx" target="_blank">AHA Digital Advocacy Toolkit</a></h3> <p>On July 20, we encourage you to get online to contact your senators and ask them to include a number of important provisions in the next COVID-19 relief package to support front-line health care personnel and providers — including hospitals, health systems, physicians and nurses.</p> <p>It is imperative that Congress provides additional relief to hospitals and health systems as recent reports estimate total losses for the nation’s hospitals and health systems as at least $323.1 billion in 2020.</p> <p>The following broad provisions that cut across AHA membership should be included in the relief package:</p> <ul> <li>Additional dollars for the emergency relief fund;</li> <li>Additional support for health care heroes;</li> <li>Forgiveness for accelerated payments;</li> <li>Maintaining health benefits for individuals and families and increasing coverage options for those who are uninsured; and</li> <li>Appropriate liability protections to front-line medical providers and facilities.</li> </ul> <p>To that end, we have crafted messages and accompanying graphics for you to use across your organization’s social media platforms. Remember to tag your members of Congress and @AHAadvocacy and use #SupportHospitals in all your messages.</p> <div class="row"> <div class="col-md-6 text-align-right"><a class="btn btn-primary" href="/system/files/media/file/2020/07/July20-Advocacy-Day_Digital-Toolkit_071020.pdf" target="_blank">Download Toolkit (PDF)</a></div> <div class="col-md-6"><a class="btn btn-primary" href="/system/files/media/file/2020/07/July20-Advocacy-Day_Digital-Toolkit_071020.docx" target="_blank">Download Toolkit (DOCX)</a></div> </div> <p> </p> </div> <div class="col-md-1"> <div class="advocacy-actionwidget" data-domain="p2a.co" data-shorturl="BLHOYE9"> </div> (function(d, s, id) { var js, fjs = d.getElementsByTagName(s)[0]; if (d.getElementById(id)) return; js = d.createElement(s); js.id = id; js.src = '//p2a.co/js/embed/widget/advocacywidget.min.js'; fjs.parentNode.insertBefore(js, fjs); }(document, 'script', 'advocacy-actionwidget-code')); </div> </div>--></div> </div> </div> Thu, 16 Jul 2020 12:50:28 -0500 AHA.org Advocacy Homepage Block <p><span><span><strong><span><span><span>The AHA has developed comments it will submit to the Centers for Medicare & Medicaid Services (CMS) regarding the agency's proposal to collect negotiated rate information on the Medicare cost report.</span></span></span></strong><span><span><span> These comments reiterate our concern that CMS does not have the authority to require hospitals to share negotiated rate information. Our comments will be incorporated into AHA's longer comment letter in response to CMS's fiscal year 2021 inpatient prospective payment system (IPPS) proposed rule. <a data-fontcolor="1" href="https://nam03.safelinks.protection.outlook.com/?url=http:%2F%2Fsend.aha.org%2Flink.cfm%3Fr%3D-AE84IntlHzsGTD1Z8Pnog~~%26pe%3DooO6VqWwiWsHjdTBcLLznu8wCyB7k2jm0VelUNYM3q1Z3gpz6aaEEEECOff5MCh1pgeRdSaIKJtCuqC7ZYHJSQ~~%26t%3Dkz3bQ-WSRqX8alnfj48c4A~~&data=02%7C01%7Cdsamuels%40aha.org%7C49a27638a13b4f61bf4b08d81eb32a8a%7Cb9119340beb74e5e84b23cc18f7b36a6%7C0%7C1%7C637293102148100785&sdata=DbipSriGc5B3YhzdRF1tDgZVBsypQXpYjEUcDKDlhKk%3D&reserved=0" originalsrc="http://send.aha.org/link.cfm?r=-AE84IntlHzsGTD1Z8Pnog~~&pe=ooO6VqWwiWsHjdTBcLLznu8wCyB7k2jm0VelUNYM3q1Z3gpz6aaEEEECOff5MCh1pgeRdSaIKJtCuqC7ZYHJSQ~~&t=kz3bQ-WSRqX8alnfj48c4A~~" shash="kyGy7iIgvZCqTD9Wy4eQS88xP3gNND8qOqa5wuygLuL2ED5JWLvMZTut5i0TCXC6ldSL3pzz0ooeYJJzuJ2Q6+qduP0aXHMDjCGVtmud5SgX3ZoH/H1r4QiP1mcDIJXAr34W0PMI0n8gYDZ7Bz8rxqSRI1HWHzLAbko6+a08Gf4=" target="_blank">Click here to download the comments</a>.</span></span></span></span></span></p> <p><span><span> </span></span><span><span><strong><span><span><span>We invite hospitals and health systems to include these comments in their organization's IPPS comment letter.</span></span></span></strong><span><span><span> All comments must be submitted before 5 p.m. ET on July 10, 2020. Please refer to file code CMS-1735-P when you submit your letter. You may submit electronic comments by following the instructions on this <a data-fontcolor="1" href="https://nam03.safelinks.protection.outlook.com/?url=http:%2F%2Fsend.aha.org%2Flink.cfm%3Fr%3D-AE84IntlHzsGTD1Z8Pnog~~%26pe%3DIMxcphrd6MqGlQDCwU5buSUduR7IGqyeVem0t9r8gAQQ1sHyP-6iaMGaDAh7WXB9JTbX_B4ln1D-K5gsiFwxiw~~%26t%3Dkz3bQ-WSRqX8alnfj48c4A~~&data=02%7C01%7Cdsamuels%40aha.org%7C49a27638a13b4f61bf4b08d81eb32a8a%7Cb9119340beb74e5e84b23cc18f7b36a6%7C0%7C1%7C637293102148100785&sdata=SR4q7XX6ZDs5puO5CZDCjfr%2F7F7fT%2B4sEgf%2FX33nqD0%3D&reserved=0" originalsrc="http://send.aha.org/link.cfm?r=-AE84IntlHzsGTD1Z8Pnog~~&pe=IMxcphrd6MqGlQDCwU5buSUduR7IGqyeVem0t9r8gAQQ1sHyP-6iaMGaDAh7WXB9JTbX_B4ln1D-K5gsiFwxiw~~&t=kz3bQ-WSRqX8alnfj48c4A~~" shash="pndzryCKLp677HUk8tJjdPUi9SOax+ajdtoG95vNgjk8V6eqT5xE9N6/u/LRv/oDq7eIJIMxYTwaQhRn4NTImidRc+5zVZ0DR1Vmx6gD775lD2BZOU9r+a9+3oFKbqzN6tdSj+QId0mWu1n+VCHfmRdM6sNe6XWaDYjCiBnAlqE=" target="_blank">webpage</a>.</span></span></span></span></span></p> <p><span><span> </span></span><span><span><span>For questions on these comments, please contact Ariel Levin, AHA senior associate director of policy, at <a data-fontcolor="1" href="mailto:alevin@aha.org?subject=Questions-collecting%20negotiated%20rate%20information" target="_blank">alevin@aha.org</a></span></span></span></p> Thu, 02 Jul 2020 11:44:51 -0500 AHA.org Advocacy Homepage Block <p><span><span><span><span><span>As Congress considers additional COVID-19 relief actions, we need to make sure hospital and health systems' priorities are at the top of its list. Additional support and resources are necessary, as an AHA study released <a data-fontcolor="1" href="https://nam03.safelinks.protection.outlook.com/?url=http:%2F%2Fsend.aha.org%2Flink.cfm%3Fr%3D-AE84IntlHzsGTD1Z8Pnog~~%26pe%3D1oWv8hoYW0qYLbXYRBOHDhdjNRcXkIfSytszSzmvF1KNwq7xn0YdtHwcFtmOOlVXVNS15v6e0Z1jaVAqerG2fw~~%26t%3DQE-e3s2T9aXj7ZIPhlkSRQ~~&data=02%7C01%7Cdsamuels%40aha.org%7Cc85a0a6d5a03426a17e208d81de1a1b1%7Cb9119340beb74e5e84b23cc18f7b36a6%7C0%7C0%7C637292202199229526&sdata=9DONe96DTkGVranZp7sfaEKq8gLsGFkJP3R%2FZpNrnbE%3D&reserved=0" originalsrc="http://send.aha.org/link.cfm?r=-AE84IntlHzsGTD1Z8Pnog~~&pe=1oWv8hoYW0qYLbXYRBOHDhdjNRcXkIfSytszSzmvF1KNwq7xn0YdtHwcFtmOOlVXVNS15v6e0Z1jaVAqerG2fw~~&t=QE-e3s2T9aXj7ZIPhlkSRQ~~" shash="dkatjdHPvJ8vF88oHEE9K7cDXZ5MXh5By9YAuX9sStrVgon5yjOMvrDTGcf2v0nPeF+6yTusB7xNyCqz2iWmfAOhSUEmYr73+N1TvsuUIn8MM8IEVApgcSlzbg4inkdN1FyH6u0kgFpQe2pu6Sd2LO0POWdppoGX3gSMsq5b0KM=" target="_blank">yesterday</a> estimates that hospitals' financial losses from COVID-19 are expected to top $323 billion in 2020.</span></span></span></span></span></p> <p><span><span><strong><span><span><span>We expect the next legislative package to come together this month, so please contact your senators while they are home for the July 4 district work period and ask them to include a number of important provisions in the next COVID-19 relief package.</span></span></span></strong></span></span></p> <p><span><span><span><span><span>Please urge your senators to include:</span></span></span></span></span></p> <ul> <li><span><span><span><span><span><span>additional support for front-line health care personnel;</span></span></span></span></span></span></li> <li><span><span><span><span><span><span>forgiveness for accelerated payments;</span></span></span></span></span></span></li> <li><span><span><span><span><span><span>maintaining health benefits for individuals and families and increasing coverage options for those who are uninsured;</span></span></span></span></span></span></li> <li><span><span><span><span><span><span>appropriate liability protections to front-line medical providers and facilities; and</span></span></span></span></span></span></li> <li><span><span><span><span><span><span>additional funding for hospitals and health systems.</span></span></span></span></span></span></li> </ul> <p><span><span><span><span><span>More details and resources on these specific priorities and others are outlined below and available on our <a data-fontcolor="1" href="https://nam03.safelinks.protection.outlook.com/?url=http:%2F%2Fsend.aha.org%2Flink.cfm%3Fr%3D-AE84IntlHzsGTD1Z8Pnog~~%26pe%3DYJjVN2AhHOowyrcXYMjbJjKRvn6vmDfrvZuTJmFpplCz-aGfy3qfzBRFjQZEVPXRgVBPPigLxyQ9lIisrTdjGA~~%26t%3DQE-e3s2T9aXj7ZIPhlkSRQ~~&data=02%7C01%7Cdsamuels%40aha.org%7Cc85a0a6d5a03426a17e208d81de1a1b1%7Cb9119340beb74e5e84b23cc18f7b36a6%7C0%7C0%7C637292202199239524&sdata=QlGipevHO8Me%2FK8S4F43UJgU%2BZJxXHZqzoo3YuyVB78%3D&reserved=0" originalsrc="http://send.aha.org/link.cfm?r=-AE84IntlHzsGTD1Z8Pnog~~&pe=YJjVN2AhHOowyrcXYMjbJjKRvn6vmDfrvZuTJmFpplCz-aGfy3qfzBRFjQZEVPXRgVBPPigLxyQ9lIisrTdjGA~~&t=QE-e3s2T9aXj7ZIPhlkSRQ~~" shash="dpv6BX6SfVd3wB5IHBBAfaLhkMEFaGXZb5BDYYb0DbWapOpwrIOCqdHpLRPt/KXYCnivO3VQEo7pwdjNXwsQqNHVXcUs1u1e/KeX+in4eG8FNFDEnaYZd1mV0vM+IF8wSAHkxYssDg7MjDe4gdNR+ySsYtZvtMPRE556Joxl75w=" target="_blank">AHA Action Center webpage</a>.</span></span></span></span></span></p> <p><span><span><strong><span><span><span>We've also made it easy for you to send messages to your senators — via email, phone or Twitter — and have your community engage as well. You can <a data-fontcolor="1" href="https://nam03.safelinks.protection.outlook.com/?url=http:%2F%2Fsend.aha.org%2Flink.cfm%3Fr%3D-AE84IntlHzsGTD1Z8Pnog~~%26pe%3D0IELO_zk2DbLgFlnLM3N-of9ZuTalEEtKZ9KBmymb2cUn5zwgLmF5IyynvL_lgtV9jn2nFyeuK1oIfw8eIDQvw~~%26t%3DQE-e3s2T9aXj7ZIPhlkSRQ~~&data=02%7C01%7Cdsamuels%40aha.org%7Cc85a0a6d5a03426a17e208d81de1a1b1%7Cb9119340beb74e5e84b23cc18f7b36a6%7C0%7C0%7C637292202199239524&sdata=z35%2F8WcGPWP%2BUO2ZC318akJtOLmM%2BE48X2%2Fwjm7JJkc%3D&reserved=0" originalsrc="http://send.aha.org/link.cfm?r=-AE84IntlHzsGTD1Z8Pnog~~&pe=0IELO_zk2DbLgFlnLM3N-of9ZuTalEEtKZ9KBmymb2cUn5zwgLmF5IyynvL_lgtV9jn2nFyeuK1oIfw8eIDQvw~~&t=QE-e3s2T9aXj7ZIPhlkSRQ~~" shash="CuyizatmcUPCgBgTN6g59PnRC6bkJkb6FYEc3Qcp675GLD1XWuqp7HxJRCCzLFcw+1xLLj0pMxsKQlMXeXGzD2U8m+syvcXAveDdGn+SDKEcdTrXZe23FhVkpmcg3SgaNZ9RkB204X3WDu5+duWjvMEpeqwbCG1G8ShsBOr9qp4=" target="_blank">share this link</a> with your community and ask them to amplify our message as well.</span></span></span></strong></span></span></p> <p><span><span><strong><span><span><span>ADDITIONAL RESOURCES ON SPECIFIC PROVISIONS CONGRESS SHOULD INCLUDE IN THE NEXT COVID-19 RELIEF PACKAGE</span></span></span></strong></span></span></p> <ul> <li><span><span><span><span><strong><span><span>Federal Support for Health Care Heroes. </span></span></strong><span><span>Please urge Congress to: provide support for child care, housing, transportation and education benefits for hospital workers; provide bonus pay for hospital workers; and establish a compensation fund for COVID-19 health care workers and their families. <strong><span><a data-fontcolor="1" href="https://nam03.safelinks.protection.outlook.com/?url=http:%2F%2Fsend.aha.org%2Flink.cfm%3Fr%3D-AE84IntlHzsGTD1Z8Pnog~~%26pe%3Dg6AtTNuDEld7A0hR3IkfmBx8c173yjnVNoFH2lhbNw4f24FMLBFIJZBWnLId1hyGTVlSXkKEK-O0-Rw0RmBVlw~~%26t%3DQE-e3s2T9aXj7ZIPhlkSRQ~~&data=02%7C01%7Cdsamuels%40aha.org%7Cc85a0a6d5a03426a17e208d81de1a1b1%7Cb9119340beb74e5e84b23cc18f7b36a6%7C0%7C0%7C637292202199249513&sdata=gxzag2FPHYWxIk2xreIWkYBf%2FFfo1iZjj6mpgn2dBvo%3D&reserved=0" originalsrc="http://send.aha.org/link.cfm?r=-AE84IntlHzsGTD1Z8Pnog~~&pe=g6AtTNuDEld7A0hR3IkfmBx8c173yjnVNoFH2lhbNw4f24FMLBFIJZBWnLId1hyGTVlSXkKEK-O0-Rw0RmBVlw~~&t=QE-e3s2T9aXj7ZIPhlkSRQ~~" shash="t6dPTpiy2+2qd5ix6EfPB/rB5Ianuk/4MVs7XKMWlHO48WVrvQe3fdBS7TWnxKKIyqQE1/vqrmgpII68Xp4legkK4bZ5hhKFSAfK6CvTHqdnQeOw1kPDJ0p0ZdOgRz46sr+SXNjle7ElE5EJqlW2Dchv414enBHjxeyVupUZw2M=" target="_blank">View the AHA resource for more details</a>.</span></strong><br />  </span></span></span></span></span></span></li> <li><span><span><span><span><strong><span><span>Accelerated Payment Forgiveness for Hospitals.</span></span></strong><span><span> Congress should provide for full forgiveness of Medicare accelerated payments for hospitals. Forgiving hospitals' accelerated payments will provide a necessary solution to recover and rebuild while delivering the care that patients and communities are depending on. <strong><span><a data-fontcolor="1" href="https://nam03.safelinks.protection.outlook.com/?url=http:%2F%2Fsend.aha.org%2Flink.cfm%3Fr%3D-AE84IntlHzsGTD1Z8Pnog~~%26pe%3DY0ZKQ6QwJOjjPDLT1X614iYgdg_vXKp4AkPe7ydc4hUn_abKWNbtOXNoJQ0210aAD5N8aLDBNH9LlwmTyWwPkg~~%26t%3DQE-e3s2T9aXj7ZIPhlkSRQ~~&data=02%7C01%7Cdsamuels%40aha.org%7Cc85a0a6d5a03426a17e208d81de1a1b1%7Cb9119340beb74e5e84b23cc18f7b36a6%7C0%7C0%7C637292202199259516&sdata=A%2Bbzc8rxvyM2Mi8yucCqZKS%2BRFy4C7jAnBjOXeVQugQ%3D&reserved=0" originalsrc="http://send.aha.org/link.cfm?r=-AE84IntlHzsGTD1Z8Pnog~~&pe=Y0ZKQ6QwJOjjPDLT1X614iYgdg_vXKp4AkPe7ydc4hUn_abKWNbtOXNoJQ0210aAD5N8aLDBNH9LlwmTyWwPkg~~&t=QE-e3s2T9aXj7ZIPhlkSRQ~~" shash="z3pOgg3obT7mXubTCLdIGTr8zUfNLSA9fe8XImQonUGLVxezHb7aif3P7N9j+uDGpTDBHDfmvzsjG8OZSFU745C/ph6UPdd0z6xF3SnubnBgQ+TrwU72X41QM09CBKItISma35f8uY+UU8Aampt7Bry/FYVQacPt6joLgpmmarM=" target="_blank">View the AHA resource for more details</a>.</span></strong><br />  </span></span></span></span></span></span></li> <li><span><span><span><span><strong><span><span>Increase Health Insurance Coverage.</span></span></strong><span><span> Congress should take action to maintain health benefits for individuals and families and increase coverage options for those who are already uninsured by: providing employer subsidies for preserving enrollment; covering COBRA costs; opening a Special Enrollment Period for Health Insurance Marketplaces; increasing eligibility for federal marketplace subsidies; expanding the period during which insurers cannot cancel coverage for non-payment of premiums; and providing charity care tax credits for hospitals. <strong><span><a data-fontcolor="1" href="https://nam03.safelinks.protection.outlook.com/?url=http:%2F%2Fsend.aha.org%2Flink.cfm%3Fr%3D-AE84IntlHzsGTD1Z8Pnog~~%26pe%3DZbsabQfy89AQl41aMTvMHC3X0lWVMXUZS23vBR0mGl3yVPywwkjXyf_h4bRTd-8c7nNgQ5dBPlAyN6QWyKCrhg~~%26t%3DQE-e3s2T9aXj7ZIPhlkSRQ~~&data=02%7C01%7Cdsamuels%40aha.org%7Cc85a0a6d5a03426a17e208d81de1a1b1%7Cb9119340beb74e5e84b23cc18f7b36a6%7C0%7C0%7C637292202199259516&sdata=bOubdjoUNn9M0HrEkCZih6G988qMgSTZXzL8jHuHDec%3D&reserved=0" originalsrc="http://send.aha.org/link.cfm?r=-AE84IntlHzsGTD1Z8Pnog~~&pe=ZbsabQfy89AQl41aMTvMHC3X0lWVMXUZS23vBR0mGl3yVPywwkjXyf_h4bRTd-8c7nNgQ5dBPlAyN6QWyKCrhg~~&t=QE-e3s2T9aXj7ZIPhlkSRQ~~" shash="aja7EUsWFknThRw7vaLbdt9WicBsGefqCRF63a+xPx0ecPSeNSYV5FeeLxYS+p5qIbcosN6hEYBNSZIEh0rRgn3C8YyU+DtR4CV1Iy/1uo/YerlnUUndjmGktUz7DtvQRr8KQOmlxqRtN01MMVZ/KWBfXZZWQdoBXuToKgsXig8=" target="_blank">View the AHA resource for more details</a>.</span></strong><br />  </span></span></span></span></span></span></li> <li><span><span><span><span><strong><span><span>Federal Liability Protections.</span></span></strong><span><span> Congress should provide appropriate liability protections for facilities and front-line medical providers treating patients amid the COVID-19 crisis, for arranging for and providing health care services, including where treatment is provided, and how best to deploy personnel, equipment and facilities. <strong><span><a data-fontcolor="1" href="https://nam03.safelinks.protection.outlook.com/?url=http:%2F%2Fsend.aha.org%2Flink.cfm%3Fr%3D-AE84IntlHzsGTD1Z8Pnog~~%26pe%3Dt9c4YEPpkX3R1MAk99UZHqmhK7rBA3FF3XiH1FzulRRkAo2zyIs7OuNPE3-sJfS5atEzwz3xYtD4WUknOoPKfg~~%26t%3DQE-e3s2T9aXj7ZIPhlkSRQ~~&data=02%7C01%7Cdsamuels%40aha.org%7Cc85a0a6d5a03426a17e208d81de1a1b1%7Cb9119340beb74e5e84b23cc18f7b36a6%7C0%7C0%7C637292202199269508&sdata=GJOwiXBgpIyexJWL18f5MVts%2BpUBKUk7w4FYDPStqMU%3D&reserved=0" originalsrc="http://send.aha.org/link.cfm?r=-AE84IntlHzsGTD1Z8Pnog~~&pe=t9c4YEPpkX3R1MAk99UZHqmhK7rBA3FF3XiH1FzulRRkAo2zyIs7OuNPE3-sJfS5atEzwz3xYtD4WUknOoPKfg~~&t=QE-e3s2T9aXj7ZIPhlkSRQ~~" shash="kkvHfzgqRUEHADxzFniAXKk/Cj+QjiHCSuzvkMHS6u4ez1xii4ZA68PCqcGiKeDK2Wz0shE9CyJ+Ulf4Dh+DydeRe0Utje/lrIRb4g14A0OrHqRklqO2N1BC0k+JFgvu40H0wx64N40qH74/giRFHlFiTCjesgMSNjoq05lY0yg=" target="_blank">View the AHA resource for more details</a>.</span></strong><br />  </span></span></span></span></span></span></li> <li><span><span><span><span><strong><span><span>Funding for Hospitals and Health Systems.</span></span></strong><span><span> Congress should provide additional funding to support hospitals and health systems. Two recent AHA reports estimate that hospitals will lose more than $323 billion from March 2020 through December 2020 as a result of COVID-19. While Congress has provided some relief funds, additional support is needed to allow hospitals and health systems to preserve access to care in communities. <strong><span><a data-fontcolor="1" href="https://nam03.safelinks.protection.outlook.com/?url=http:%2F%2Fsend.aha.org%2Flink.cfm%3Fr%3D-AE84IntlHzsGTD1Z8Pnog~~%26pe%3DuEXTmUdR8D9qbHX5Ae8GqnjT7lvbWQM_nCo_DSuZoWQKC0mJHQGSyQxnYlUk9goJDnAA9Bh01BDqppv-yp9zlg~~%26t%3DQE-e3s2T9aXj7ZIPhlkSRQ~~&data=02%7C01%7Cdsamuels%40aha.org%7Cc85a0a6d5a03426a17e208d81de1a1b1%7Cb9119340beb74e5e84b23cc18f7b36a6%7C0%7C0%7C637292202199269508&sdata=q3ksBrIf9vPCIAW1CEYxFzPIbuD4taIg0HQv71DjSpg%3D&reserved=0" originalsrc="http://send.aha.org/link.cfm?r=-AE84IntlHzsGTD1Z8Pnog~~&pe=uEXTmUdR8D9qbHX5Ae8GqnjT7lvbWQM_nCo_DSuZoWQKC0mJHQGSyQxnYlUk9goJDnAA9Bh01BDqppv-yp9zlg~~&t=QE-e3s2T9aXj7ZIPhlkSRQ~~" shash="cyjGeFm6xb7cfC9dOEtN8jS07WxJRzb8QF7F2RQV8xMVcWORqzZyo4q9wslkZjZZfbeDDzB5TEtyH7czwEkKSgn4yOOwXWlgb+6+F7KxHo1rE8L5kbp42QuAMmcbGaPaQqXuk7bVgBld9Ot4gvKYBIscApZN5XV0hjlFzltUcJk=" target="_blank">View the AHA resource for more details</a>.</span></strong></span></span></span></span></span></span></li> </ul> <p><strong><span><span><span>Further Questions</span></span></span></strong><br /> <span><span><span>If you have questions, please contact AHA at 800-424-4301</span></span></span></p> Wed, 01 Jul 2020 13:04:48 -0500 AHA.org Advocacy Homepage Block <div class="container"> <div class="row"> <div class="col-md-8"> <p>The Centers for Medicare & Medicaid Services (CMS) May 11 issued its hospital inpatient prospective payment system (PPS) and long-term care hospital (LTCH) PPS <a href="https://s3.amazonaws.com/public-inspection.federalregister.gov/2020-10122.pdf" target="_blank">proposed rule</a> for fiscal year (FY) 2021. In addition to proposing a 3.1% increase in inpatient PPS payments for 2021, the rule would require disclosure of certain payer-negotiated rates and makes changes to Disproportionate Share Hospital (DSH) payments, Chimeric Antigen Receptor T-cell (CAR T) therapy payment and quality incentive programs. Highlights of the proposals related to the LTCH PPS are covered in a separate <a href="/special-bulletin/2020-05-12-special-bulletin-cms-releases-fy-2021-ltch-pps-proposed-rule" target="_blank">Special Bulletin</a>.</p> <h2>AHA Take</h2> <p>We are very disappointed that CMS continues down the unlawful path of requiring hospitals to disclose privately negotiated contract terms. The disclosure of privately negotiated rates will not further CMS's goal of paying market rates that reflect the cost of delivering care. These rates take into account any number of unique circumstances between a private payer and a hospital and simply are not relevant for fixing fee-for-service Medicare reimbursement.</p> <p>Highlights of the inpatient PPS rule follow.</p> <h2>Highlights of the Inpatient PPS Rule</h2> <h3>Inpatient PPS Payment Update</h3> <p>The proposed rule would increase inpatient PPS rates by a net of 3.1% in FY 2021, compared to FY 2020, after accounting for inflation and other adjustments required by law. Specifically, the update includes an initial market-basket update of 3.0%, less 0.4 percentage points for productivity required by the Affordable Care Act (ACA), and plus 0.5 percentage points to partially restore cuts made as a result of the American Taxpayer Relief Act (ATRA) of 2012. Table 1 below details the factors CMS includes in its estimate.</p> <h4>Table 1: Impacts of FY 2021 CMS Proposed Policies</h4> table, th, td { border: 1px solid black; } <table> <tbody> <tr> <th>Policy</th> <th>Average Impact on Payments</th> </tr> <tr> <td>Market-basket update</td> <td>+ 3.0%</td> </tr> <tr> <td>Productivity cut mandated by the ACA</td> <td>- 0.4%</td> </tr> <tr> <td>Partial restoration of documentation and coding cut mandated by ATRA</td> <td>+ 0.5%</td> </tr> <tr> <td><strong>Total</strong></td> <td><strong>+ 3.1%</strong></td> </tr> </tbody> </table> <p>The ACA and ATRA adjustments would be applied to all hospitals. Additionally, hospitals not submitting quality data would be subject to a one-quarter reduction of the initial market basket and, thus, would receive an update of 2.35%. Hospitals that were not meaningful users of electronic health records (EHRs) in FY 2019 would be subject to a three-quarter reduction of the initial market basket and, thus, would receive an update of 0.85%. Hospitals that fail to meet both of these requirements would be subject to a full reduction of the initial market-basket rate and receive an update of 0.10%.</p> <h3>Price Transparency: Market-based MS-DRG Data Collection and Weight Calculation</h3> <p>CMS proposes to require hospitals to report the median payer-specific negotiated rates for inpatient services, by MS-DRG, for Medicare Advantage organizations and third-party payers on the Medicare cost report. The agency notes that hospitals will be required to make this information public in accordance with the Hospital Price Transparency Final Rule.<sup><a href="#fn1">1</a></sup> CMS is considering incorporating this information into the methodology for calculating inpatient PPS MS-DRG relative weights, beginning FY 2024, and is seeking comment on this change.</p> <h3>Disproportionate Share Hospital (DSH) Payment Changes</h3> <p>Under the DSH program, hospitals receive 25% of the Medicare DSH funds they would have received under the former statutory formula (described as “empirically justified” DSH payments). The remaining 75% flows into a separate funding pool for DSH hospitals. This pool is updated as the percentage of uninsured individuals changes and is distributed based on the proportion of total uncompensated care each Medicare DSH hospital provides. For FY 2021, CMS estimates the 75% pool to be approximately $11.52 billion. After adjusting this pool for the percent of individuals without insurance, CMS estimates the uncompensated care amount to be approximately $7.82 billion, a decrease of roughly $530 million compared to FY 2020.</p> <p>The agency proposes again to use a single year of uncompensated care data from Worksheet S-10 to determine the distribution of DSH uncompensated care payments for FY 2021. Specifically, CMS proposes using S-10 data from the FY 2017 cost report, which the agency has recently audited. In addition, the agency proposes to use the most recent available single year of audited Worksheet S-10 data to distribute uncompensated care payments in all subsequent years for all eligible hospitals except Indian Health Service and Tribal hospitals.</p> <h3>New MS-DRG for CAR T Therapy</h3> <p>CAR T-cell therapy is a cell-based gene therapy. The CAR process genetically engineers a patient’s T-cells, resulting in the addition of a CAR that will bind to and attack a certain protein on the patient’s cancerous cells. CMS proposes creating a new MS-DRG 018 (Chimeric Antigen Receptor (CAR) T-cell Immunotherapy), which would have a proposed relative weight of 37.1412 that better reflects the high cost of the therapy. Because these cases would no longer group to MS-DRG 016, CMS is proposing to revise the title for MS-DRG 016 from “Autologous Bone Marrow Transplant with CC/MCC or T-cell Immunotherapy” to “Autologous Bone Marrow Transplant with CC/MCC.” As noted below, CMS proposes to discontinue new technology add-on payments for the two CAR T products currently available.</p> <h3>Comprehensive CC/MCC Analysis</h3> <p>In the FY 2018 inpatient PPS final rule, CMS provided public notice of its plans to conduct a comprehensive review of the Complications or Comorbidities (CC) and Major Complications or Comorbidities (MCC) lists for FY 2019. For FY 2020, CMS proposed but did not finalize a change in the severity level designation for 1,492 ICD-10-CM diagnosis codes.</p> <p>For FY 2021, CMS’s internal workgroup developed a set of guiding principles that, when applied, could assist in determining whether the presence of the specified secondary diagnosis would lead to increased hospital resource use in most instances. CMS plans to use a combination of mathematical analysis of claims data and the application of these guiding principles, to continue a comprehensive CC/MCC analysis and present the findings and proposals in future rulemaking. CMS is seeking public comment on the guiding principles as well as other possible ways the agency can incorporate meaningful indicators of expected resource use and clinical severity by a secondary diagnosis.</p> <h3>New Technology Add-on Payments (NTAPs)</h3> <p>The inpatient PPS provides additional payments, known as NTAPs, for cases with relatively high costs involving eligible new medical services or technologies. Twenty-four new applications for NTAPs are presented in the proposed rule, and CMS proposes to continue NTAPs in FY 2021 for 10 technologies already approved for the payments. Notably, the agency proposes to discontinue NTAPs for the two current CAR T products, KYMRIAH® and YESCARTA®, for FY 2021.</p> <p>As established in the FY 2020 final rule, technologies in the Food and Drug Administration (FDA) Breakthrough Devices Program and technologies with FDA Qualified Infectious Disease Product (QIDP) designation are considered new and not substantially similar to an existing technology. CMS proposes to extend this approach to NTAP eligibility to products approved through the FDA’s Limited Population Pathway for Antibacterial and Antifungal Drugs (“LPAD pathway”) beginning in FY 2022. The agency also proposes conditional NTAP approval for QIDPs and LPAD products that do not receive FDA marketing authorization or LPAD pathway approval by July 1, but otherwise meet the applicable NTAP criteria.</p> <h3>Area Wage Index</h3> <p>The area wage index adjusts payments to reflect differences in labor costs across geographic areas. CMS proposes to continue its low-wage-index hospital policy as established in the FY 2020 final rule. Specifically, for hospitals with a wage index value below the 25th percentile, the agency would continue to increase the hospital’s wage index by half the difference between the otherwise applicable wage index value for that hospital and the 25th percentile wage index value for all hospitals. As it has done previously, the agency would reduce the FY 2021 standardized amount for all hospitals to make this policy budget neutral.</p> <h3>Medicare Graduate Medical Education (GME) Residency Slots After Program or Hospital Closure</h3> <p>When a teaching hospital closes a residency program or the hospital closes entirely, Medicare regulations permit the hospital to temporarily transfer a portion of its hospital-specific direct GME and indirect medical education (IME) FTE resident caps to other hospitals that are willing to accept and train the displaced resident(s). The proposed rule states that CMS has previously defined “displaced resident” as one that is <em>physically present</em> at the hospital training <em>on the day prior to or the day of hospital or program closure.</em> CMS proposes to modify this definition to be based on the day that the closure was publicly announced. In addition, CMS proposes to consider as “displaced” those residents that were not physically present at the closing program/hospital, but had intended to train at – or return to training at – the closing program/hospital.</p> <h3>Promoting Interoperability Programs</h3> <p>CMS proposes to continue several policies including a continuous 90-day reporting period for CY 2022 and retaining the Query of Prescription Drug Monitoring Program measure as an optional measure worth five bonus points in CY 2021.</p> <h3>Hospital Quality Reporting and Value Programs</h3> <p>CMS proposes changes to the following programs:</p> <ul> <li><strong>Inpatient Quality Reporting (IQR).</strong> CMS retains the current IQR measure set, but proposes two significant changes to the program’s electronic clinical quality measure (eCQM) reporting requirements. First, CMS would increase the number of quarters required for data reporting to two self-selected quarters for CY 2021 reporting period (FY 2023 payment), three self-selected quarters for CY 2022 reporting/FY 2024 payment, and four quarters for CY 2023 reporting (FY 2025 payment). Second, CMS proposes to begin reporting eCQM measure results publicly in late 2022, starting with data from CY 2021. In addition, CMS proposes changes to the Promoting Interoperability Program’s eCQM requirements to align with the changes in the IQR. CMS also proposes changes to the IQR’s measure validation process that would be implemented gradually starting in 2021. This includes combining the validation process for chart-abstracted measures and eCQMs, requiring hospitals to submit records selected for validation using electronic-file submissions, and reducing the maximum number of hospitals selected for validation from 800 to 400.</li> <li><strong>Hospital Overall Star Ratings.</strong> Last year, CMS announced its intention to use the inpatient PPS proposed rule to propose changes to its star ratings methodology. However, CMS chose to defer proposals on star ratings to future rulemaking in light of the COVID-19 public health emergency. The agency does not indicate a timeframe for making future updates to the methodology.</li> <li><strong>Hospital Value Programs.</strong> CMS proposes minimal changes to the Hospital Readmission Reduction Program (HRRP), Hospital-Acquired Condition (HAC) Reduction Program, and Hospital Value-based Purchasing (VBP) Program. For the most part, CMS proposes to carry forward existing policies. For the HAC Reduction program, CMS proposes changes to the validation process to align with those in the IQR program. For VBP, CMS provides performance standards for measures through the FY 2026 program year.</li> </ul> <h2>Next Steps</h2> <p>CMS will accept comments on the proposed rule through July 10. While the final rule is typically published around Aug. 1, CMS has waived the typical timeline so that it may provide as few as 30 days between the publishing of the FY 2021 final rule and its effective date. Thus, the final rule could be published as late as Sept. 1. The policies and payment rates will still take effect Oct.1.</p> <p>If you have further questions, contact Erika Rogan, AHA senior associate director, policy, at <a href="tel:1-202-626-2963">(202) 626-2963</a> or <a href="mailto:erogan@aha.org?subject=Request for Information on CMS Hospital Inpatient PPS Proposed Rule for Fiscal Year 2021">erogan@aha.org</a>.</p> <hr /> <ol> <li id="fn1">The AHA, along with three other national organizations and member hospitals, sued the federal government over the Hospital Price Transparency Final Rule. Litigation is currently ongoing.</li> </ol> </div> <div class="col-md-4"> <div class="panel module-typeC"> <div class="panel-heading"> <h3 class="panel-title">Key Takeaways</h3> </div> <div class="panel-body"> <p>CMS proposes policies to:</p> <ul> <li>Increase inpatient PPS payments by 3.1% in FY 2021.</li> <li>Require hospitals to report the median payer-specific negotiated rates for inpatient services, by Medicare Severity-Diagnosis-related Group (MS-DRG), for Medicare Advantage organizations and third-party payers on the Medicare cost report.</li> <li>Use data from Worksheet S-10 in the FY 2017 cost report to determine the distribution of FY 2021 DSH uncompensated care payments.</li> <li>Create a new a MS-DRG for CAR T.</li> <li>Modify the definition of “displaced resident” for the purpose of transferring Medicare residency slots after a teaching hospital or residency program closes.</li> <li>Continue a reporting period of a minimum of any continuous 90 days for the calendar year (CY) 2021 reporting period for the Promoting Interoperability Programs.</li> <li>Increase the number of quarters of electronic clinical quality measure (eCQM) data and start publicly reporting eCQM data.</li> </ul> </div> </div> </div> </div> </div> Tue, 12 May 2020 14:03:56 -0500 AHA.org Advocacy Homepage Block