Medicare DSH

Medicare DSH / en Sat, 26 Apr 2025 01:12:32 -0500 Mon, 09 Dec 24 16:09:29 -0600 Bipartisan letter calling for prevention of Medicaid DSH cuts gets signatures from 182 members of Congress /news/headline/2024-12-09-bipartisan-letter-calling-prevention-medicaid-dsh-cuts-gets-signatures-182-members-congress A House Dear Colleague letter calling on House leadership to address scheduled Medicaid Disproportionate Share Hospital payment cuts received <a href="/system/files/media/file/2024/12/final-medicaid-dsh-letter-12-9-2024.pdf" target="_blank">signatures from 182 bipartisan members of Congress</a>. The letter was circulated by Reps. Dan Crenshaw, R-Texas, Yvette Clarke, D-N.Y., Gus Bilirakis, R-Fla., and Diana DeGette, D-Colo. The cuts, scheduled to take effect Jan. 1, total $8 billion. The AHA has asked Congress to provide relief from the reductions. Mon, 09 Dec 2024 16:09:29 -0600 Medicare DSH AHA Comments to CMS on FY 2025 Wage Index Values /lettercomment/2024-11-26-aha-comments-cms-fy-2025-wage-index-values <div class="container"><div class="row"><div class="col-md-8">November 26, 2024The Honorable Chiquita Brooks-LaSure Administrator Centers for Medicare &amp; Medicaid Services Hubert H. Humphrey Building 200 Independence Avenue, S.W. Room 445-G Washington, DC 20201RE: CMS-1808-IFC, Changes to the Fiscal Year 2025 Hospital Inpatient Prospective Payment System (IPPS) Rates Due to Court Decision, (Vol. 89, No. 192), Oct. 3, 2024.Dear Administrator Brooks-LaSure:On behalf of our nearly 5,000 member hospitals, health systems and other health care organizations, our clinician partners — including more than 270,000 affiliated physicians, 2 million nurses and other caregivers — and the 43,000 health care leaders who belong to our professional membership groups, the �� Association (AHA) appreciates the opportunity to comment on the Centers for Medicare &amp; Medicaid Services’ (CMS) hospital inpatient prospective payment system (PPS) interim final action with comment period revising the Medicare wage index values for fiscal year (FY) 2025.In FY 2020, CMS implemented a policy to increase the wage indices for certain hospitals with low wage index values. This was done in a budget-neutral manner through an adjustment applied to the standardized amounts for all hospitals. Specifically, the agency increased the wage index for hospitals with a wage index value below the 25th percentile by half the difference between their otherwise applicable wage index value and the 25th percentile wage index value across all hospitals for that year. The agency stated at the time that it intended to implement the policy for at least four years. The agency subsequently extended this low wage index policy and its related budget neutrality adjustment through FY 2024 and 2025.However, when extending the policy in the FY 2025 final rule, CMS noted that the policy has been the subject of pending litigation. On July 23, 2024, the Court of Appeals for the D.C. Circuit held that the secretary lacked authority to adopt the policy for FY 2020 and that the policy and related budget neutrality adjustment must be vacated. As a result of this court decision, in this interim final action with comment period, the agency is removing the low wage index policy for FY 2025 and its related budget neutrality factor. However, the agency did not indicate if and how it would address the policy for FYs 2020-2024.The AHA has long stated that while we appreciated CMS’ recognition of the wage index’s shortcomings, the agency should not have implemented this policy by penalizing all hospitals, especially when Medicare already pays far less than the cost of providing care. As such, if CMS does address payments under this policy in FYs 2020-2024, it should not seek a clawback of funds that hospitals received because of the agency’s mistakes and have long since spent on patient care. These funds supported low-wage hospitals during the COVID-19 pandemic and increased payments by roughly $300 million for the first year of policy.1 This included helping nearly 800 rural hospitals when rural hospital closures hit an all-time high, with 19 hospitals closing in 2020 and two additional closures in 2021.2,3 To help ensure the financial viability of hospitals, including rural hospitals, the agency should not seek a clawback of these funds.At oral argument in the D.C. Circuit, the Department of Health and Human Services (HHS) counsel was asked whether there was a “scenario where the low budget hospitals that have gotten money would get to keep the money.” Counsel did not state that a clawback is legally required. Instead, counsel answered that the secretary had not yet determined that a clawback is required and that it is “not clear why the Secretary would need to go out” and make such a clawback. Based on its regulations, we presume that CMS will adhere to the position it stated in court. See 42 CFR § 412.64(l) (“If a judicial decision reverses a CMS denial of a hospital’s wage data revision request, CMS pays the hospital by applying a revised wage index that reflects the revised wage data as if CMS's decision had been favorable rather than unfavorable.”); 42 CFR § 412.64(k) (“Except as provided in paragraph (k)(2)(ii) of this section, a midyear correction to the wage index is effective prospectively from the date the change is made to the wage index.”). After all, the inpatient PPS process is, as its name suggests, a “prospective” payment program, and nothing in the text of 42 U.S.C. § 1395ww(d)(3)(E) gives CMS the authority to claw back funds following an adverse judicial decision.4We appreciate your consideration of these issues. Please contact me if you have questions or feel free to have a member of your team contact Shannon Wu, AHA’s director for payment policy, at (202) 626-2963 or swu@aha.org.Sincerely,/s/Ashley B. Thompson Senior Vice President Public Policy Analysis and Development<hr><ol><li>FY 2020 Final Rule</li><li>FY 2020 Final Rule</li><li>https://www.shepscenter.unc.edu/programs-projects/rural-health/rural-hospital-closures/</li><li>See generally Georgetown Univ. Hosp. v. Bowen, 821 F.2d 750, 758 (D.C. Cir. 1987) (“In amending the statute, both Houses of Congress made it abundantly clear that this authority was to be exercised on a prospective basis only: ‘[The authority] to set limits on costs . . . would be exercised on a prospective, rather than retrospective, basis so that the provider would know in advance the limits to Government recognition of incurred costs and have the opportunity to act to avoid having costs that are not reimbursable.’ Senate Report at 188; House Report at 83”); Washington Hosp. Ctr. v. Bowen, 795 F.2d 139, 142 n.2 (D.C. Cir. 1986) (explaining that a prospective payment system is “not subject to retroactive adjustment”); Louisiana Dep’t of Health &amp; Hosps. v. U.S. Dep’t of Health &amp; Human Servs., 566 F. App’x 384, 387 (5th Cir. 2014) (discussing the differences between prospective and retrospective payment systems); Alexander County Hosp. v. Bowen, 692 F.Supp. 606, 609 (W.D.N.C. 1988) (“Thus, under both the APA and the Medicare Act, the Secretary’s authority for rulemaking is prospective, not retrospective. To hold otherwise would give the Secretary unfettered discretion in enacting regulations that give retroactive effect to any or every change that is made in formulas for determining reimbursable costs.”); cf. Paladin Community Mental Health Center v. Sebelius, 684 F.3d 527, 531 n.3 (5th Cir. 2012) (“[F]orcing the Secretary to retroactively alter payment rates for various covered services—e.g., payment rates that are adjusted annually and are required to remain budget neutral—would likely wreak havoc on the already complex administration of Medicare Part B's outpatient prospective payment system.”).</li></ol></div><div class="col-md-4"><div class="external-link spacer"><a class="btn btn-wide btn-primary" href="/system/files/media/file/2024/11/2024-11-25-FY2025-IPPS-Interim-Final-Rule-Wage-Index-f.pdf" target="_blank" title="Click here to download the AHA Comments to CMS on FY 2025 Wage Index Values letter PDF.">Download the Letter PDF</a></div><a href="/system/files/media/file/2024/11/2024-11-25-FY2025-IPPS-Interim-Final-Rule-Wage-Index-f.pdf" target="_blank" title="Click here to download the AHA Comments to CMS on FY 2025 Wage Index Valuesletter PDF."><img src="/sites/default/files/2024-11/AHA-Comments-to-CMS-on-FY-2025-Wage-Index-Values-Cover.png" data-entity-uuid data-entity-type="file" alt="AHA Comments to CMS on FY 2025 Wage Index Values letter page 1." width="604" height="783"></a></div></div></div> Tue, 26 Nov 2024 12:38:24 -0600 Medicare DSH AHA urges Congress to act on key priorities for hospitals before end of the year /news/headline/2024-11-12-aha-urges-congress-act-key-priorities-hospitals-end-year In <a href="/2024-11-12-aha-urges-congress-act-key-priorities-lame-duck-session" target="_blank">comments</a> Nov. 12 to majority and minority leaders of the House and Senate, the AHA requested that Congress act on key priorities for hospitals and health systems before the end of 2024. AHA urged Congress to continue providing relief from Medicaid Disproportionate Share Hospital Payment cuts; continue the Medicare-dependent Hospitals and Low-volume Adjustment programs that expire Dec. 31; reject site-neutral payment proposals; and pass the Improving Seniors’ Timely Access to Care Act (H.R. 8702/ S. 4532), legislation that would reduce the wide variation in prior authorization methods in the Medicare Advantage program.&nbsp; &nbsp; "Hospitals and health systems are experiencing significant financial pressures that challenge their ability to provide 24/7 care for the patients and communities they serve," said AHA President and CEO Rick Pollack. "Increased expenses for drugs and supplies, inflation and the mounting burden due to certain commercial health insurer denial and delay practices continue to strain hospitals and health systems. At the same time, underpayments in reimbursements from Medicare and Medicaid do not keep pace with these mounting costs and exacerbate the problems hospitals are having." &nbsp; &nbsp; AHA also urged Congress to extend the hospital-at-home waiver for five years through 2029; mitigate scheduled physician reimbursement cuts for 2025; and pass the Safety from Violence for Healthcare Employees Act (H.R. 2584/S. 2768), legislation that would provide federal protections from workplace violence for hospital workers, similar to protections for airport and airline workers. Tue, 12 Nov 2024 15:48:16 -0600 Medicare DSH AHA Amicus Brief in Supreme Court Urging Correction of HHS Undercounting of SSI-eligible Recipients in DSH Formula /amicus-brief/2024-08-14-aha-amicus-brief-supreme-court-urging-correction-hhs-undercounting-ssi-eligible-recipients-dsh-formula No. 23-715 In the Supreme Court of the United States &nbsp;ADVOCATE CHRIST MEDICAL CENTER, et al., v. XAVIER BECERRA, SECRETARY OF HEALTH AND HUMAN SERVICES __________ON WRIT OF CERTIORARI&nbsp; TO THE UNITED STATES COURT OF APPEALS&nbsp; FOR THE DISTRICT OF COLUMBIA CIRCUIT &nbsp;BRIEF FOR AMERICAN HOSPITAL ASSOCIATION, ASSOCIATION OF AMERICAN MEDICAL COLLEGES, AMERICA’S ESSENTIAL HOSPITALS, CATHOLIC HEALTH ASSOCIATION, FEDERATION OF AMERICAN HOSPITALS, AND NATIONAL RURAL HEALTH ASSOCIATION AS AMICI CURIAE SUPPORTING PETITIONERS &nbsp;<table><tbody><tr><td>MORGAN L. RATNER Counsel of Record DANIEL J. RICHARDSON SULLIVAN &amp; CROMWELL LLP 1700 New York Avenue, N.W. Suite 700 Washington, DC 20006 (202) 956-7522 ratnerm@sullcrom.com</td></tr></tbody></table>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;View the detailed brief below. Wed, 14 Aug 2024 14:52:05 -0500 Medicare DSH AHA files brief in Supreme Court urging correction of HHS undercounting of SSI-eligible recipients in DSH formula /news/headline/2024-08-14-aha-files-brief-supreme-court-urging-correction-hhs-undercounting-ssi-eligible-recipients-dsh-formula The AHA, joined by five other national hospital associations, Aug. 14 filed an <a href="/amicus-brief/2024-08-14-aha-amicus-brief-supreme-court-urging-correction-hhs-undercounting-ssi-eligible-recipients-dsh-formula">amicus brief</a> urging the Supreme Court to correct the Department of Health and Human Services’ misinterpretation of the formula set by Congress to calculate Disproportionate Share Hospital (DSH) payments, which includes a Medicare fraction that counts supplemental security income-eligible Medicare beneficiaries in the numerator and the total Medicare-eligible population in the denominator. The AHA said that HHS is undercounting the number of SSI-eligible Medicare beneficiaries by claiming patients are "entitled to" SSI benefits only if they actually receive SSI benefits, which lowers the numerator in the formula, resulting in smaller payments. &nbsp; &nbsp; HHS’ interpretation undermines the DSH program, AHA said, and is inconsistent with a previous Supreme Court ruling in Becerra v. Empire Health Foundation in which HHS successfully argued that a patient is “entitled to” Medicare under the DSH formula if they are qualified for Medicare, regardless of whether Medicare paid for the hospital stay. "But despite that victory, HHS has refused to apply the same logic to determine whether a patient is 'entitled to' SSI benefits — even though Congress used the same words in the same sentence," the brief notes. "That approach is textually indefensible, and it significantly undercounts the needy patients served by America’s hospitals." If this misinterpretation stands uncorrected, hospitals are estimated to lose more than a billion dollars annually in DSH payments, according to the brief. “What’s more, a hospital’s eligibility for DSH payments affects its entitlement to other federal benefits designed to help hospitals ‘provide a wide range of medical services’ to vulnerable populations," the brief added.&nbsp; &nbsp; The Association of American Medical Colleges, America's Essential Hospitals, the Catholic Health Association, the Federation of ��s and the National Rural Health Association joined AHA in the filing. The AHA and fellow amici filed an amicus brief at the cert petition stage in February advocating for the Supreme Court to take up the issue for <a href="/news/headline/2024-02-02-aha-others-urge-supreme-court-review-challenge-hhs-interpretation-dsh-formula">review</a>. Wed, 14 Aug 2024 14:24:09 -0500 Medicare DSH AHA Comments on Potential DSH Cuts in IPPS Final Rule for FY 2025 /lettercomment/2024-07-25-aha-comments-potential-dsh-cuts-ipps-final-rule-fy-2025 <div class="container"><div class="row"><div class="col-md-8">July 25, 2024The Honorable Chiquita Brooks-LaSure Administrator Centers for Medicare &amp; Medicaid Services Hubert H. Humphrey Building 200 Independence Avenue, S.W. Room 445-G Washington, DC 20201Re: FY 2025 Inpatient Prospective Payment Systems for Acute Care Hospitals; Disproportionate Share Hospital PaymentsDear Administrator Brooks-LaSure:On behalf of our nearly 5,000 member hospitals, health systems and other health care organizations, our clinician partners — including more than 270,000 affiliated physicians, 2 million nurses and other caregivers — and the 43,000 health care leaders who belong to our professional membership groups, the �� Association (AHA) remains deeply concerned over the Centers for Medicare &amp; Medicaid Services’ (CMS) policies related to disproportionate share hospital (DSH) payments under the inpatient prospective payment system (IPPS). Specifically, any cuts to hospitals’ DSH payments would threaten their ability to continue providing essential services for their communities. As such, in the agency’s upcoming fiscal year (FY) 2025 IPPS final rule, we urge CMS to maintain the uninsured rate at its proposed level of 8.7%. Doing so would provide critical stability for DSH hospitals that serve low-income, uninsured and historically marginalized populations.In the FY 2025 IPPS proposed rule, CMS proposed an uninsured rate of 8.7% based on projections from National Health Expenditure Accounts (NHEA) historical data.<a href="#fn1">1</a> However, updated NHEA data<a href="#fn2">2</a> indicate that CMS will finalize a substantially lower uninsured rate of 7.6% in the FY 2025 IPPS final rule, which will lead to DSH payment cuts for hospitals once again. Indeed, as shown below, over the past two years, the uninsured rate has fluctuated by at least a percentage point between the proposed and final rules, leading to uncertainty and instability in DSH payments for those hospitals that act as safety nets for low-income and uninsured populations. We note that data and projections that have previously worked when coverage levels were more stable may no longer be adequate during these times of turmoil.<img data-entity-uuid="e2796062-5bcd-44bd-9caf-2f7237195822" data-entity-type="file" src="/sites/default/files/inline-images/Uninsured-Rates-in-Proposed-and-Final-IPPS-Rules-20240725.png" width="1072" height="647" alt="Uninsured Rates in Proposed and Final IPPS Rules.">In last year’s FY 2024 final rule, as a response to some of AHA’s concerns, the agency directed readers to NHEA projections and methodologies. It also directed readers to the Office of the Actuary’s (OACT) memorandum certifying the rate of uninsured. However, as we stated at the time, these documents are not transparent and do not provide sufficient detail. Specifically, there remains a significant lack of transparency over how the effects of the pandemic and the subsequent Medicaid redetermination process are added to NHEA’s model estimate. Indeed, the AHA since 2021 has expressed concerns over CMS’ lack of transparency regarding how it and the OACT are calculating DSH payments. The agency continues to withhold relevant information from the public, thereby depriving the AHA and others of the ability to comment on the basis for the agency’s decision. Without additional information regarding the OACT analysis, stakeholders can neither validate nor evaluate the complex calculations CMS has made in estimating the percent of uninsured and other factors used to determine DSH payments.In a year with continued turbulent coverage losses, we urge CMS to carefully reconsider its reliance on current data sources and methodologies to estimate the rate of the uninsured. However, in the meantime, to provide stability to hospitals caring for patients, we urge CMS to finalize the uninsured rate as proposed – at 8.7% – for purposes of its FY 2025 DSH calculations.Please contact me if you have questions or feel free to have a member of your team contact Shannon Wu, AHA’s director of policy, at swu@aha.org.Sincerely,/s/Ashley B. Thompson Senior Vice President Public Policy Analysis and Development<hr><ol><li id="fn1">We disagreed with this estimate given ongoing Medicaid redeterminations and other issues, as we stated in our <a href="/lettercomment/2024-06-05-aha-comments-cms-inpatient-payment-proposal-fy-2025">comment letter</a>.</li><li id="fn2"><a href="https://www.cms.gov/data-research/statistics-trends-and-reports/national-health-expenditure-data/nhe-fact-sheet" target="_blank">https://www.cms.gov/data-research/statistics-trends-and-reports/national-health-expenditure-data/nhe-fact-sheet</a></li></ol></div><div class="col-md-4"><div class="external-link spacer"><a class="btn btn-wide btn-primary" href="/system/files/media/file/2024/07/AHA-Comments-on-Potential-DSH-Cuts-in-IPPS-Final-Rule-for-FY-2025.pdf" target="_blank" title="Click here to download the AHA Comments on Potential DSH Cuts in IPPS Final Rule for FY 2025 letter PDF.">Download the Letter PDF</a></div><a href="/system/files/media/file/2024/07/AHA-Comments-on-Potential-DSH-Cuts-in-IPPS-Final-Rule-for-FY-2025.pdf" target="_blank" title="Click here to download the AHA Comments on Potential DSH Cuts in IPPS Final Rule for FY 2025 letter PDF."><img src="/sites/default/files/inline-images/Page-1-AHA-Comments-on-Potential-DSH-Cuts-in-IPPS-Final-Rule-for-FY-2025.png" data-entity-uuid="f115fd01-c61d-4dec-b72c-71a25442d338" data-entity-type="file" alt="AHA Comments on Potential DSH Cuts in IPPS Final Rule for FY 2025 letter page 1." width="692" height="900"></a></div></div></div> Thu, 25 Jul 2024 14:59:36 -0500 Medicare DSH Supreme Court to hear case challenging HHS’ interpretation of DSH formula /news/headline/2024-06-10-supreme-court-hear-case-challenging-hhs-interpretation-dsh-formula The Supreme Court June 10 agreed to review a case challenging how the Department of Health and Human Services applies Congress’ formula for calculating Disproportionate Share Hospital payments. In February, the AHA and five other national hospital associations representing hospitals <a href="/news/headline/2024-02-02-aha-others-urge-supreme-court-review-challenge-hhs-interpretation-dsh-formula">urged</a> the Court to review the case.&nbsp; “The AHA is pleased that the Supreme Court agreed to consider this case,” said Chad Golder, AHA general counsel and secretary. “As we explained in our amicus brief urging the Court to grant certiorari, it is critical to hospitals and health systems that HHS interpret the DSH fraction consistently across the statute. The agency’s longstanding failure to do so has cost hospitals more than a billion dollars each year, directly harming the hospitals that serve America’s most vulnerable patients. We look forward to the Supreme Court rectifying this legal error next term.”&nbsp; In February’s friend-of-the-court brief, the organizations argued that HHS incorrectly adopted the view that a patient is entitled to Supplemental Security Income benefits only if the patient actually received cash SSI payments during a hospital stay, an interpretation inconsistent with the Court’s reasoning in Becerra v. Empire Health Foundation.&nbsp; “This case concerns a question that is critical to calculating the Medicare DSH fraction: When are patients ‘entitled to’ SSI benefits and so counted in the numerator? Is it when they are eligible for SSI benefits, or when they are actually receiving cash SSI benefits,” the organizations <a href="/system/files/media/file/2024/02/aha-others-amicus-brief-for-advocate-christ-medical-center-et-al-vs-xavier-becerra-secretary-of-health-and-human-services.pdf">wrote</a>.&nbsp; “The correct interpretation of the DSH formula is vitally important to America’s hospitals,” the brief adds. “Although HHS has refused to share the data that would allow hospitals to accurately count the SSI-eligible patients whom the agency’s approach excludes, the available estimates suggest that hospitals will lose more than a billion dollars each year in DSH funds. What’s more, a hospital’s eligibility for DSH payments affects its entitlement to other federal benefits designed to help hospitals 'provide a wide range of medical services' to vulnerable populations. ... HHS’s error thus has far-reaching implications for hospitals, patients, and the American healthcare system.”&nbsp; Mon, 10 Jun 2024 15:42:30 -0500 Medicare DSH Making our Voice Heard and Leading the Way to Advance Health in America /news/perspective/2024-02-15-making-our-voice-heard-and-leading-way-advance-health-america Two presidents that America honors with a federal holiday on Monday shared a number of memorable traits. George Washington and Abraham Lincoln were blessed with the gifts of vision, courage and leadership — qualities that played a central role in guiding the country through the enormous challenges of their times.Both men also understood the power of words and ideas to inspire their fellow citizens and light the fire of progress. The American ideal of democracy is the enduring legacy of Washington, and the fact that we are still the United States of America is due to Lincoln’s refusal to allow the nation to split apart.It is important for us to continue to exercise the principles of democracy that Washington and the Founding Fathers fought so hard for and speak up, asking hard questions of candidates in this election year and evaluating their thinking on the issues that affect our field.To that end, AHA’s <a href="https://wecarewevote.aha.org/" title="We Care We Vote">We Care We Vote</a> is an opportunity to encourage good citizenship through voter registration and participation in the electoral process.Our initiative suggests questions that place a candidate on record about many of the issues most important to our field, such as: What actions have you taken to support your hospitals and health systems during these uncertain times? What efforts do you support to address the ongoing health care worker shortage and protect health care workers from rising rates of physical and verbal abuse? What proposals do you support to expand access to behavioral health care?Their answers matter a great deal.During this political season, we must also make clear to our elected officials that despite the challenges we face, we are united as a field in facing similar issues and having common solutions regardless of location, size, ownership, or type of hospital.This means a united front in favor of preserving the moratorium on Medicaid disproportionate share hospital cuts and staving off harmful so-called site-neutral payment policies that don’t account for the differences in the care hospitals provide 24/7.This means continuing to shine a spotlight on the practices of some commercial insurers that do not meet the letter or spirit of the law in terms of the coverage they provide.This means pushing back against chronic underpayments from Medicare that do not meet the cost of care, continue to put hospitals’ ability to provide quality and accessible care 24/7 to all who need it at risk, and hobble hospitals’ ability to fight growing cybersecurity threats, reinvest in people and communities, expand or upgrade facilities, or to pursue the research and technological advances that advance health for all.There is no light between us on these and many other issues.To paraphrase Abraham Lincoln, the better angels of our nature are the dedicated caregivers who do their best every minute of the day for the people and communities they serve.This President’s Day, let’s put the tools of democracy and unity to use once again, and stand firm for the future of America’s health care. Thu, 15 Feb 2024 15:42:19 -0600 Medicare DSH AHA, others urge Supreme Court to review challenge to HHS interpretation of DSH formula    /news/headline/2024-02-02-aha-others-urge-supreme-court-review-challenge-hhs-interpretation-dsh-formula The AHA, joined by five other national associations representing hospitals, Feb. 2 urged the U.S. Supreme Court to review a case challenging how the Department of Health and Human Services applies Congress’ formula for calculating Disproportionate Share Hospital payments. In a <a href="/amicus-brief/2024-02-02-aha-others-amicus-brief-support-advocate-christ-medical-center-et-al-v-xavier-becerra-secretary-health">friend-of-the-court brief</a>, the organizations said HHS has adopted the view that a patient is entitled to Supplemental Security Income benefits only if the patient actually received cash SSI payments during a hospital stay, an interpretation that is inconsistent with the Supreme Court’s reasoning in Becerra v. Empire Health Foundation and continues the agency’s “long history of undermining the DSH program.” “The correct interpretation of the DSH formula is vitally important to America’s hospitals,” the brief adds. “Although HHS has refused to share the data that would allow hospitals to accurately count the SSI-eligible patients whom the agency’s approach excludes, the available estimates suggest that hospitals will lose more than a billion dollars each year in DSH funds. What’s more, a hospital’s eligibility for DSH payments affects its entitlement to other federal benefits designed to help hospitals ‘stretch scarce Federal resources,’ including the 340B Drug Discount Program. … HHS’s error thus has wide-reaching implications for hospitals, patients, and the American healthcare system." The Association of American Medical Colleges, America’s Essential Hospitals, Catholic Health Association, Federation of ��s, and National Rural Health Association joined AHA in the brief. Fri, 02 Feb 2024 16:01:00 -0600 Medicare DSH AHA Urges Congress to Eliminate Medicaid DSH Cuts, Reject Site-neutral Payments /lettercomment/2024-01-10-aha-urges-congress-eliminate-medicaid-dsh-cuts-reject-site-neutral-payments January 10, 2024<table><tbody><tr><td>The Honorable Mike Johnson Speaker U.S. House of Representatives Washington, DC 20515</td><td>The Honorable Charles Schumer Majority Leader United States Senate Washington, DC 20510</td></tr><tr><td> The Honorable Hakeem Jeffries Democratic Leader U.S. House of Representatives Washington, DC 20515</td><td> The Honorable Mitch McConnell Republican Leader United States Senate Washington, DC 20510</td></tr></tbody></table> Dear Speaker Johnson, Leader Schumer, Leader Jeffries, and Leader McConnell:On behalf of our nearly 5,000 member hospitals, health systems and other health care organizations, our clinician partners — including more than 270,000 affiliated physicians, 2 million nurses and other caregivers — and the 43,000 health care leaders who belong to our professional membership groups, the �� Association (AHA) writes regarding the ongoing government funding discussion.The AHA supports the elimination of the Medicaid disproportionate share hospital (DSH) reductions for two years. Without congressional action, hospitals will find it challenging to serve vulnerable patients in their communities. In addition, we strongly oppose efforts to expand site-neutral payment cuts. We also oppose proposed policies that would increase regulatory burdens on hospitals and health systems through changes in the Hospital Price Transparency Rule and changes to current billing practices to require the use of unique identifiers for off-campus hospital outpatient departments (HOPDs). The unique identifier provision is duplicative and unnecessary since federal regulations already require hospitals to be transparent about the location of care delivery to patientsCurrent Medicare payment rates appropriately recognize that there are fundamental differences between patient care delivered in HOPDs compared to other settings. HOPDs provide care for Medicare patients who are more likely to be sicker and more medically complex than those treated at physicians’ offices while also being held to stricter safety and regulatory requirements.This is especially true in rural communities. Medicare beneficiaries in rural areas — including those who are dually eligible for Medicaid — disproportionately rely on HOPDs to meet their increased health care needs since they have less access to office-based physicians. Additional Medicare cuts to these facilities will have a direct impact on the level of care and services available to vulnerable patients in rural communities.Efforts to expand site-neutral payment cuts to include essential drug administration services furnished in off-campus HOPDs would disregard important differences in patient safety and quality standards required in these facilities. <a href="/system/files/media/file/2023/11/Reject-Site-Neutral-Payment-for-Lower-Standards-of-Infusion-Care.pdf" target="_blank">Unlike other sites of care</a>, hospitals take important additional steps to make certain that drugs are prepared and administered in a safe manner for both patients and providers. For example, hospital pharmacists must confirm safe dosing and check for drug-drug interactions and protections must be in place to prevent employee exposure to hazardous drugs. In addition, hospitals are required to remain in compliance with important safety standards such as those required by the Food and Drug Administration, U.S. Pharmacopeia, and The Joint Commission.It is unconscionable to impose these cuts at a time when so many hospitals are already facing serious financial challenges. This is largely due to the fact that Medicare already significantly underpays hospitals for the cost of caring for patients. The <a href="/system/files/media/file/2024/01/medicare-significantly-underpays-hospitals-for-cost-of-patient-care-infographic.pdf" target="_blank">latest analysis</a> shows that on average Medicare pays only 82 cents for every dollar of hospital care provided to Medicare beneficiaries, leaving hospitals with nearly $100 billion in Medicare shortfalls in 2022 alone. As a result, two-thirds of all hospitals reported negative Medicare margins in 2022. Enacting these site-neutral cuts would pave the way for commercial insurers to implement additional site-neutral cuts in the private market. We urge you not to prioritize commercial insurers’ interests at the expense of patients in your communities.The AHA also is concerned about the regulatory burden proposed changes to the Hospital Price Transparency Rule would have on hospitals and health systems. These changes would unfairly penalize hospitals that have spent significant capital to comply with the current regulation. In addition, recent <a href="https://blog.turquoise.health/moving-into-2024-state-of-price-transparency/" target="_blank">data</a> shows that 90.7% of hospitals have met the requirement to post a machine-readable file. While the AHA supports efforts to provide clarity about hospital prices, eliminating the price estimator tools as a method to meet the shoppable services requirement would financially harm those hospitals and health systems that have invested considerable time and resources in developing these tools to provide patients with a user-friendly summary of their potential out-of-pocket costs. In addition, the AHA urges Congress to continue to allow the Centers for Medicare &amp; Medicaid Services to determine the maximum civil monetary penalty assessed to hospitals deemed to be out of compliance with the statute.Thank you for your consideration of our concerns. We appreciate your leadership and look forward to working together to ensure patients continue to have access to quality care in their communities.Sincerely,/s/Richard J. Pollack President and Chief Executive Officer Wed, 10 Jan 2024 13:59:57 -0600 Medicare DSH