/ en Sat, 26 Apr 2025 02:31:18 -0500 Fri, 07 Feb 25 15:04:02 -0600 <div class="container"><div class="row"><div class="col-md-8"><p>In December, Congress passed a legislative package to fund the government through March 14 and extend key health care provisions through the end of March. Congressional action is needed once again to fund the government and ensure long-term stability for these critical health care programs. At the same time, House and Senate Republicans are planning a strategy to use the budget reconciliation process to accomplish some of their legislative priorities, and Congress must raise the debt ceiling in the coming months. As part of these strategies, they are considering proposals that would reduce funding for hospital care, including reductions to the Medicaid program, jeopardizing access to the 24/7 care and services that hospitals provide.</p><h2>Action Needed</h2><p><strong>Please ask your senators and representatives to prevent Medicaid disproportionate share hospital payment cuts from taking effect; extend enhanced low-volume adjustment and Medicare-dependent hospital programs that expand access to care in rural areas; and extend telehealth and hospital-at-home waivers. These policies are currently set to expire at the end of March and must be extended.</strong></p><p><strong>In your discussions with your legislators, please continue to share the valuable role your hospital or health system plays in the community they represent and urge them to reject cuts that would jeopardize access to hospital care and services that patients rely on.</strong></p><p>More details and resources to support your advocacy efforts on these important issues follow.</p><h2>Health Care Extenders</h2><p>Congress passed a legislative package in December that extended some key health care provisions through the end of March, but additional congressional action is needed.</p><ul><li><strong>Prevent Medicaid DSH Cuts.</strong> The Medicaid disproportionate share hospital (DSH) program provides essential financial assistance to hospitals that care for our nation’s most vulnerable populations — children, the impoverished, disabled and elderly. Without congressional action, billions in cuts would take effect April 1. <strong>See the </strong><a href="/system/files/media/file/2020/02/fact-sheet-medicaid-dsh-0120.pdf"><strong>Medicaid DSH fact sheet</strong></a><strong> for more details.</strong></li><li><strong>Extend Key Rural Programs.</strong> The enhanced low-volume adjustment and Medicare-dependent hospital programs provide rural, geographically isolated and low-volume hospitals additional financial support to ensure rural residents have access to care. Without congressional action, these programs will expire on April 1. <strong>See the </strong><a href="/fact-sheets/2022-08-30-fact-sheet-rural-hospital-support-act-s4009-assistance-rural-community"><strong>rural programs fact sheet</strong></a><strong> for more details.</strong></li><li><strong>Extend Telehealth and Hospital-at-Home Waivers.</strong> Congress has extended telehealth waivers and the hospital-at-home program through March 31, but additional action is needed. See the <a href="/advocacy/advocacy-issues/2024-10-31-advocacy-issue-telehealth-waivers">telehealth</a> and <a href="/fact-sheets/2024-08-06-fact-sheet-extending-hospital-home-program">hospital-at-home fact sheets</a> for more details.</li></ul><h2>Critical Issues for the 119th Congress</h2><p>Following our Feb. 5 advocacy update webinar for members, we are providing new fact sheets and primers on emerging issues of significant importance for hospitals and health systems. We will be providing updates, new resources and data on these and other issues to help your advocacy efforts throughout the year.</p><h3>Reject Cuts to Medicaid</h3><p>Republican leaders continue to have discussions about how to use reconciliation — a <a href="/issue-landing-page/2025-02-07-budget-reconciliation-process-resource-page">budget tool</a> that gives Congress a fast-track mechanism to avoid the Senate filibuster and pass legislation with a simple majority. House and Senate Republicans are expected to use the budget reconciliation process to try to pass key agenda items on taxes, energy and border security, and they may look to health program funding as a way to pay for this legislation. <strong>Such proposals could significantly reduce federal spending for the Medicaid program. Even a small portion of possible reductions could have wide-ranging negative consequences for the health and well-being of both Medicaid enrollees and the broader health care system.</strong></p><p>The AHA has developed a number of resources hospitals and health systems can use as part of their advocacy efforts, including the following:</p><ul><li><a href="/fact-sheets/2025-02-07-fact-sheet-medicaid">General Fact Sheet on Medicaid</a></li><li><a href="/fact-sheets/2025-02-07-fact-sheet-medicaid-provider-taxes">Fact Sheet on Medicaid Provider Taxes</a></li><li><a href="/fact-sheets/2025-02-07-fact-sheet-medicaid-hospital-payment-basics">Fact Sheet on Medicaid Hospital Payment Basics</a></li><li><a href="/fact-sheets/2025-02-07-fact-sheet-capita-caps-medicaid-program">Medicaid Per Capita Caps</a></li></ul><h3>Extend Enhanced Premium Tax Credits</h3><p>The federal government offers enhanced premium tax credits (EPTCs) to help eligible individuals and families purchase coverage on the health insurance marketplaces. These policies are scheduled to expire at the end of 2025. <strong>Congress should extend the EPTCs before the end of the year</strong> as they have increased access to health care coverage and high-quality care for patients and communities served by hospitals, health systems and other providers. <strong>Download the AHA fact sheet, which includes new data on the negative impact of not extending the </strong><a href="/fact-sheets/2025-02-07-fact-sheet-enhanced-premium-tax-credits"><strong>EPTCs</strong></a><strong>.</strong></p><h3>Reject Site-neutral Payment Cuts</h3><p>Congress is considering several bills that would impose billions in Medicare site-neutral payment reductions for services provided in hospital outpatient departments. <strong>Congress should reject site-neutral proposals</strong> because they would reduce patient access to vital health care services, particularly in rural and other medically underserved communities. <strong>See AHA resources on the detrimental impact of </strong><a href="/advocacy/advocacy-issues/2023-09-11-advocacy-issue-site-neutral-payment-proposals"><strong>site-neutral policies</strong></a><strong>.</strong></p><h3>Protect the 340B Drug Pricing Program</h3><p>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. However, some in Congress and the pharmaceutical industry want to see the program scaled back. <strong>Congress should protect the 340B program</strong> for all providers and ensure the program continues to help stretch limited resources and provide more comprehensive services to more patients. <strong>Download the AHA fact sheets on the </strong><a href="/340b-drug-savings-program"><strong>340B program</strong></a><strong>.</strong></p><h2>Further Questions</h2><p>Visit the <a href="/advocacy/action-center">AHA Action Center</a> for more resources on these issues and other priorities important to hospitals and health systems. Watch for more Action Alerts and resources from the AHA to assist your advocacy efforts. If you have further questions, please contact AHA at 800-424-4301.</p></div><div class="col-md-4"><p><a href="/system/files/media/file/2025/02/Contact-Your-Lawmakers-and-Urge-Them-to-Extend-Key-Health-Care-Policies-Set-to-Expire-Next-Month.pdf" target="_blank" title="Click here to download the Action Alert ACTION NEEDED: Contact Your Lawmakers and Urge Them to Extend Key Health Care Policies Set to Expire Next Month PDF."><img src="/sites/default/files/inline-images/Page-1-Contact-Your-Lawmakers-and-Urge-Them-to-Extend-Key-Health-Care-Policies-Set-to-Expire-Next-Month.png" data-entity-uuid="2dd3d759-0b56-4a54-8cdb-d635ee169360" data-entity-type="file" alt="Action Alert: ACTION NEEDED: Contact Your Lawmakers and Urge Them to Extend Key Health Care Policies Set to Expire Next Month page 1." width="696" height="900"></a></p></div></div></div> Fri, 07 Feb 2025 15:04:02 -0600 Medicaid DSH /fact-sheets/2023-03-28-fact-sheet-medicaid-dsh-program <div class="container"><div class="row"><div class="col-md-8">h2 { color:#003087; } .meta.custom-lock-position { position: relative; top: 0px; right: inherit; display: block; float: right; } <h2>The Issue</h2><p>The Medicaid Disproportionate Share Hospital (DSH) program provides essential financial assistance to hospitals that care for our nation’s most vulnerable populations, including children and those who are disabled and elderly. These hospitals also provide critical community services, such as trauma and burn care, maternal and child health, high-risk neonatal care and disaster preparedness resources. Congress reduced Medicaid DSH payments in the Affordable Care Act (ACA), reasoning that hospitals would care for fewer uninsured patients as health coverage expanded. However, those coverage increases have not yet been fully realized. In addition, the Medicaid program continues to face challenges, as states continue the coverage determination process due to the expiration of maintenance of effort provisions related to the public health emergency. While the majority of beneficiaries have had their coverage renewed (57%), many Medicaid stakeholders are concerned that millions of eligible individuals may have lost coverage over the last year.</p><h2>AHA Position</h2><p>Congress should provide relief from the Medicaid DSH cuts given the vital need for the program.</p><h2>Why</h2><ul><li>The Medicaid DSH program, since its inception in the early 1980s, provides vital financial support to hospitals that serve the nation’s most vulnerable populations. This includes low- income patients, the uninsured and those with health care coverage that is insufficient to meet their health care needs.</li><li>Even with this critical supplemental funding, hospital costs for providing care to vulnerable populations are not fully met. <a href="/costsofcaring">Medicaid, on average, covers only 87 cents of every dollar spent treating Medicaid patients.</a> Now is not the time for additional cuts to funding when many hospitals are facing financial hardship.</li><li>The need for DSH payments continues. Tens of millions of Americans currently do not have health insurance, and <a href="https://www.cbo.gov/system/files/2024-06/60040-Health.pdf" target="_blank" title="Congressional Budget Office: Health Insurance Coverage for the U.S. Population, 2024 to 2034">Congressional Budget Office</a> that the uninsured rate will continue to rise over the next decade. The Medicaid redetermination process has also led to a loss of coverage for individuals who no longer qualify for the program and may not be able to afford health plans offered by their employers or on the health care exchanges.</li></ul><h2>Key Facts</h2><p>The Medicaid DSH cut for fiscal year (FY) 2025 is $8 billion and remains $8 billion for each of the next two FYs 2026-2027 ($24 billion total). The Medicaid and CHIP Payment and Access Commission in its <a href="https://www.macpac.gov/wp-content/uploads/2024/03/Chapter-3-Annual-Analysis-of-Medicaid-Disproportionate-Share-Hospital-Allotments-to-States.pdf" target="_blank" title="MACPAC: Annual Analysis of Medicaid Disproportionate Share Hospital Allotments to States">Annual Analysis of Medicaid Disproportionate Share Hospital Allotments to States</a> provides information on the DSH allotment reductions by state (Table 3A-2). The need for Medicaid DSH supplemental funding remains essential as hospitals cope with the impacts of financial instability while supporting their mission to treat all patients, regardless of ability to pay.</p></div><div class="col-md-4"><p><a href="/system/files/media/file/2020/02/fact-sheet-medicaid-dsh-0120.pdf" target="_blank" title="Click here to download the Fact Sheet: Medicaid DSH Program PDF."><img src="/sites/default/files/2025-04/fact-sheet-medicaid-dsh-program-april-2025.png" data-entity-uuid data-entity-type="file" alt="Fact Sheet: Medicaid DSH Program cover. Updated April 2025." width="695" height="899"></a></p><hr><p><div class="views-element-container"> <section class="top-level-view js-view-dom-id-84d7eb06c994a74f42007bcc194d1808df79ff02f8232d04ae1b699e8c9c1f74 resource-block"> <h3>Latest Medicaid DSH Payment Cuts Advocacy and News</h3> <div class="resource-wrapper"> <div class="resource-view"> <div class="article views-row"> <div class="views-field views-field-field-access-level"> <div class="field-content"> <div class="meta custom-lock-position"> <div class="views-field-access-level access-type-member-non-fed" data-toggle="tooltip" data-placement="bottom" title="Members only"><a href="/taxonomy/term/280" hreflang="en">Member Non-Fed</a></div> </div></div> </div><div class="views-field views-field-title"> <span class="field-content"><a href="/action-alert/2025-02-07-contact-your-lawmakers-and-urge-them-extend-key-health-care-policies-set-expire-next-month" hreflang="en">Contact Your Lawmakers and Urge Them to Extend Key Health Care Policies Set to Expire Next Month</a></span> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2025-02-07T15:04:02-06:00">Feb 7, 2025</time> </span> </div></div> <div class="article views-row"> <div class="views-field views-field-field-access-level"> <div class="field-content"> <div class="meta custom-lock-position"> <div class="views-field-access-level access-type-public" data-toggle="tooltip" data-placement="bottom" title="Members only"><a href="/taxonomy/term/278" hreflang="en">Public</a></div> </div></div> </div><div class="views-field views-field-title"> <span class="field-content"><a href="/fact-sheets/2023-03-28-fact-sheet-medicaid-dsh-program" hreflang="en">Fact Sheet: Medicaid DSH Program </a></span> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2025-01-22T08:00:00-06:00">Jan 22, 2025</time> </span> </div></div> <div class="article views-row"> <div class="views-field views-field-field-access-level"> <div class="field-content"> <div class="meta custom-lock-position"> <div class="views-field-access-level access-type-member" data-toggle="tooltip" data-placement="bottom" title="Members only"><a href="/taxonomy/term/279" hreflang="en">Member</a></div> </div></div> </div><div class="views-field views-field-title"> <span class="field-content"><a href="/special-bulletin/2024-12-21-congress-passes-bill-funding-government-current-levels-march-extending-key-health-care-provisions" hreflang="en">Congress Passes Bill Funding Government at Current Levels into March, Extending Key Health Care Provisions to Expire</a></span> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2024-12-21T09:54:45-06:00">Dec 21, 2024</time> </span> </div></div> <div class="article views-row"> <div class="views-field views-field-field-access-level"> <div class="field-content"> <div class="meta custom-lock-position"> <div class="views-field-access-level access-type-member-non-fed" data-toggle="tooltip" data-placement="bottom" title="Members only"><a href="/taxonomy/term/280" hreflang="en">Member Non-Fed</a></div> </div></div> </div><div class="views-field views-field-title"> <span class="field-content"><a href="/special-bulletin/2024-12-21-house-passes-bill-funding-government-current-levels-march-extending-key-health-care-provisions-due" hreflang="en">House Passes Bill Funding Government at Current Levels into March, Extending Key Health Care Provisions Due to Expire at End of Year</a></span> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2024-12-21T08:06:22-06:00">Dec 21, 2024</time> </span> </div></div> <div class="article views-row"> <div class="views-field views-field-field-access-level"> <div class="field-content"> <div class="meta custom-lock-position"> <div class="views-field-access-level access-type-member-non-fed" data-toggle="tooltip" data-placement="bottom" title="Members only"><a href="/taxonomy/term/280" hreflang="en">Member Non-Fed</a></div> </div></div> </div><div class="views-field views-field-title"> <span class="field-content"><a href="/action-alert/2024-12-02-urgent-ask-your-lawmaker-prevent-medicaid-dsh-payment-cuts" hreflang="en">Urgent: Ask Your Lawmaker to Prevent Medicaid DSH Payment Cuts</a></span> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2024-12-02T11:58:46-06:00">Dec 2, 2024</time> </span> </div></div> </div> </div> <div class="more-link"><a href="/topics/medicaid-dsh">More on Medicaid DSH</a></div> </section> </div> </p></div></div></div> Wed, 22 Jan 2025 08:00:00 -0600 Medicaid DSH <div class="container"><div class="row"><div class="col-md-8"><p>The House by a vote of 366-34 Dec. 20 passed the American Relief Act <a href="https://docs.house.gov/billsthisweek/20241216/ARA%2012.20.pdf">(H.R. 10545)</a>, a bill to fund the government through March 14, 2025, provide disaster relief and farm aid, and extend for three months a number of critical programs for hospitals and health systems. The Senate early Dec. 21 passed the bill on an 85-11 vote. </p><div class="panel module-typeC"><div class="panel-heading"><h2>Key Highlights</h2><p>The bill contains provisions: </p><ul><li>Preventing cuts in Medicaid Disproportionate Share Hospital payments.</li><li>Extending critical rural Medicare programs.</li><li>Extending telehealth and hospital-at-home programs</li></ul></div></div><h2>AHA TAKE</h2><p>The AHA appreciates the bipartisan effort to fund the government and extend these critical health care policies for three months to support hospitals’ efforts to care for patients and communities. We thank Congress for their support and look forward to our continued work to ensure hospitals and health systems have the resources they need to advance health for patients and communities. </p><h2>MEDICAID AND MEDICARE </h2><p><strong>Medicaid Disproportionate Share Hospital (DSH) Relief. </strong>The bill eliminates the Medicaid DSH cuts through April 1, 2025.   </p><p><strong>Medicare Rural Extenders. </strong>The bill will extend the enhanced low-volume adjustment and the Medicare-dependent hospital programs through April 1, 2025. They were set to expire Dec. 31, 2024<strong>.</strong></p><p><strong>Medicare Telehealth and Hospital-at-home Extensions. </strong>The bill will extend key telehealth waivers and the hospital-at-home program through March 31, 2025. They were set to expire Dec. 31, 2024<strong>.</strong> </p><p><strong>Extension of the Work Geographic Index Floor under the Medicare Program. </strong>The bill will extend a 1.0 floor on the work Geographic Practice Cost Index (GPCI) through April 1, 2025. This was scheduled to expire Dec. 31, 2024. </p><p><strong>Medicare Rural Ambulance.</strong> The bill will extend add-on payments for ambulance services through March 31, 2025. These add-on payments support rural, “superrural,” and urban ambulance services. They were set to expire Dec. 31, 2024. </p><h2>OTHER ITEMS OF INTEREST </h2><p><strong>PAYGO Sequester. </strong>Under PAYGO requirements, Congress must pay for any legislative package, either by reducing entitlement spending or increasing revenue. The legislation would waive PAYGO reductions by “wiping the scorecard clean,” preventing a 4% Medicare sequester cut from taking effect in January. </p><p><strong>Disaster Relief. </strong>The bill provides $29 billion to the Federal Emergency Management Agency Disaster Relief Fund. <strong> </strong></p><h2>OFFSETS</h2><p>The health care portion of the bill includes the following offset. </p><p><strong>Medicare Improvement Fund. </strong>The bill reduces the amount of funding in the Medicare Improvement Fund from $3.197 billion to $1.241 billion. </p><h2>FURTHER QUESTIONS</h2><p>If you have further questions, please contact the AHA at 800-424-4301.</p></div><div class="col-md-4"><a href="/system/files/media/file/2024/12/congress-passes-bill-funding-government-current-levels-to-march-extending-key-health-care-provisions-bulletin-12-21-2024.pdf" target="_blank" title="Special Bulletin PDF"><img src="/sites/default/files/inline-images/cover-congress-passes-bill-funding-government-current-levels-to-march-extending-key-health-care-provisions-bulletin-12-21-2024..png" data-entity-uuid="48d278a2-1930-4eb3-93be-3a57b8fbcbd7" data-entity-type="file" alt="Special Bulletin Cover Image" width="679" height="878"></a></div></div></div> Sat, 21 Dec 2024 09:54:45 -0600 Medicaid DSH <p>The House by a vote of 366-34 today passed the American Relief Act (<a href="https://docs.house.gov/billsthisweek/20241216/ARA%2012.20.pdf" target="_blank" title="docs.house.gov: H.R. 10545">H.R. 10545</a>), a bill to fund the government through March 14, 2025, provide disaster relief and farm aid, and extend for three months a number of critical programs for hospitals and health systems. The Senate is expected to vote on the bill later tonight. In light of the overwhelming bipartisan support and signals of support from the Administration, it is highly likely the Senate will favorably consider the package. The AHA will provide updates accordingly.</p><h2>Key Highlights</h2><p>The bill contains provisions:</p><ul><li>Preventing cuts in Medicaid Disproportionate Share Hospital payments.</li><li>Extending critical rural Medicare programs.</li><li>Extending telehealth and hospital-at-home programs.</li></ul><h2>AHA Take</h2><p>The AHA appreciates the bipartisan effort to fund the government and extend these critical health care policies for three months to support hospitals’ efforts to care for patients and communities. We thank Congress for their support and look forward to our continued work to ensure hospitals and health systems have the resources they need to advance health for patients and communities.</p><h2>Medicaid and Medicare</h2><h3>Medicaid Disproportionate Share Hospital (DSH) Relief</h3><p>The bill eliminates the Medicaid DSH cuts through April 1, 2025.</p><h3>Medicare Rural Extenders</h3><p>The bill will extend the enhanced low-volume adjustment and the Medicare-dependent hospital programs through April 1, 2025. They were set to expire Dec. 31, 2024.</p><h3>Medicare Telehealth and Hospital-at-home Extensions</h3><p>The bill will extend key telehealth waivers and the hospital-at-home program through March 31, 2025. They were set to expire Dec. 31, 2024.</p><h3>Extension of the Work Geographic Index Floor under the Medicare Program</h3><p>The bill will extend a 1.0 floor on the work Geographic Practice Cost Index (GPCI) through April 1, 2025. This was scheduled to expire Dec. 31, 2024.</p><h3>Medicare Rural Ambulance</h3><p>The bill will extend add-on payments for ambulance services through March 31, 2025. These add-on payments support rural, “super-rural,” and urban ambulance services. They were set to expire Dec. 31, 2024.</p><h2>Other Items of Interest</h2><h3>PAYGO Sequester</h3><p>Under PAYGO requirements, Congress must pay for any legislative package, either by reducing entitlement spending or increasing revenue. The legislation would waive PAYGO reductions by “wiping the scorecard clean,” preventing a 4% Medicare sequester cut from taking effect in January.</p><h3>Disaster Relief</h3><p>The bill provides $29 billion to the Federal Emergency Management Agency Disaster Relief Fund.</p><h2>Offsets</h2><p>The health care portion of the bill includes the following offset.</p><h3>Medicare Improvement Fund</h3><p>The bill reduces the amount of funding in the Medicare Improvement Fund from $3.197 billion to $1.241 billion.</p><h2>Further Questions</h2><p>If you have further questions, please contact the AHA at <a href="tel:1-800-424-4301">800-424-4301</a>.</p> Sat, 21 Dec 2024 08:06:22 -0600 Medicaid DSH <div class="container"><div class="row"><div class="col-md-8"><p>Lawmakers have returned to Washington, D.C., to tackle end-of-the-year funding needs. Quick action is needed this week to address the Medicaid disproportionate share hospital (DSH) payment reductions.</p><p>The <a href="/fact-sheets/2023-03-28-fact-sheet-medicaid-dsh-program">Medicaid DSH program</a> provides essential financial assistance to hospitals that care for our nation’s most vulnerable populations — children, impoverished, disabled and elderly. Fiscal year 2025 Medicaid DSH payment reductions are scheduled to take effect on Jan. 1, 2025, with $8 billion in cuts. The AHA is asking Congress to continue to provide relief from the Medicaid DSH cuts.</p><p><strong>Contact your representative by Dec. 6 and ask them to sign on to the bipartisan </strong><a href="/system/files/media/file/2024/11/congress-dear-colleague-letter-to-stop-medicaid-disproportionate-share-hospital-dsh-payment-cuts-11-13-2024.pdf"><strong>House Dear Colleague letter</strong></a><strong> being circulated by Rep. Dan Crenshaw, R-Texas, Rep. Yvette Clarke, D-N.Y., Rep. Gus Bilirakis, R-Fla., and Rep. Diana DeGette, D-Colo., calling for the Medicaid DSH cuts to be addressed.</strong> View the <a href="/system/files/media/file/2024/11/house-medicaid-dsh-letter-signers-november-2024.pdf">list of current signers</a> to see if your representative supports the letter. If they have not signed, use <a href="/2020-10-07-get-involved?vvsrc=%2fCampaigns%2f118959%2fRespond">this form</a> to send a message asking them to sign now.</p><p>In addition, please see the recent <a href="/action-alert/2024-11-13-aha-asks-congressional-leadership-fund-hospitals-protect-health-care-workers">AHA Action Alert</a> that includes messages and resources on a number of priorities we continue to push with Congress as they work on year-end legislative packages.</p><h2>Further Questions</h2><p>Visit the <a href="/advocacy/action-center">AHA Action Center</a> for more resources on these issues and other priorities important to hospitals and health systems.</p><p>If you have further questions, please contact AHA at <a href="tel:1-800-424-4301">800-424-4301</a>.</p></div><div class="col-md-4"><p><a href="/system/files/media/file/2024/12/Action-Alert-Urgent-Ask-Your-Lawmaker-to-Prevent-Medicaid-DSH-Payment-Cuts.pdf" target="_blank" title="Click here to download the Action Alert: Urgent: Ask Your Lawmaker to Prevent Medicaid DSH Payment Cuts PDF."><img src="/sites/default/files/inline-images/Action-Alert-Urgent-Ask-Your-Lawmaker-to-Prevent-Medicaid-DSH-Payment-Cuts.png" data-entity-uuid="1171b980-eb8c-4123-a9c6-732c7353be44" data-entity-type="file" alt="Action Alert: Urgent: Ask Your Lawmaker to Prevent Medicaid DSH Payment Cuts page 1." width="695" height="900"></a></p></div></div></div> Mon, 02 Dec 2024 11:58:46 -0600 Medicaid DSH /lettercomment/2024-11-26-aha-comments-cms-fy-2025-wage-index-values <div class="container"><div class="row"><div class="col-md-8"><p>November 26, 2024</p><p>The Honorable Chiquita Brooks-LaSure<br>Administrator<br>Centers for Medicare & Medicaid Services<br>Hubert H. Humphrey Building<br>200 Independence Avenue, S.W.<br>Room 445-G<br>Washington, DC 20201</p><p><em><strong>RE: 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.</strong></em></p><p>Dear Administrator Brooks-LaSure:</p><p>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 & 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.</p><p>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.</p><p>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.</p><p>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. <strong>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. </strong>These funds supported low-wage hospitals during the COVID-19 pandemic and increased payments by roughly $300 million for the first year of policy.<sup>1</sup> 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.<sup>2,3</sup> To help ensure the financial viability of hospitals, including rural hospitals, the agency should not seek a clawback of these funds.</p><p>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.<sup>4</sup></p><p>We 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.</p><p>Sincerely,</p><p>/s/</p><p>Ashley B. Thompson<br>Senior Vice President<br>Public Policy Analysis and Development</p><hr><ol><li><small>FY 2020 Final Rule</small></li><li><small>FY 2020 Final Rule</small></li><li><small>https://www.shepscenter.unc.edu/programs-projects/rural-health/rural-hospital-closures/</small></li><li><small>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 & Hosps. v. U.S. Dep’t of Health & 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.”).</small></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><p><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></p></div></div></div> Tue, 26 Nov 2024 12:38:24 -0600 Medicaid DSH <div class="container"><div class="row"><div class="col-md-8"><p>Following the elections, lawmakers are returning to Washington, D.C., to tackle key funding issues, including Medicaid disproportionate share hospital (DSH) payment reductions and support for rural programs. They also will consider site-neutral payment proposals, oversight of health plans, continuation of telehealth and hospital-at-home waivers, and the prevention of violence against health care workers.</p><p>Before the lame-duck session ends and the 118th Congress adjourns, it is essential that federal lawmakers understand the challenges hospitals and health systems face and what is at stake for the patients and communities they represent. With several programs facing expiration at the end of this year, quick action is needed to preserve necessary funding and support for the nation’s health care organizations.</p><p>Here are the issues AHA leaders are <a href="/2024-11-12-aha-urges-congress-act-key-priorities-lame-duck-session" target="_blank" title="Issues AHA Leaders are calling on Congress to reinforce">calling on congressional leaders</a> to reinforce. Following is an overview of the issues and what you can do to assist these advocacy efforts.</p><h2>SUPPORT MEDICAID DSH DEAR COLLEAGUE LETTER</h2><p>At the beginning of the year, billions of dollars will be cut from the Medicaid DSH program, severely jeopardizing hospitals’ finances and threatening communities’ access to care. Contact your representative(s) and ask them to sign on to the bipartisan <a href="/system/files/media/file/2024/11/congress-dear-colleague-letter-to-stop-medicaid-disproportionate-share-hospital-dsh-payment-cuts-11-13-2024.pdf" target="_blank" title="House Dear Colleague Letter">House Dear Colleague letter</a> being circulated by Reps. Dan Crenshaw, R-Texas, Yvette Clarke, D-N.Y., Gus Bilirakis, R-Fla., and Diana DeGette, D-Colo., calling for Medicaid DSH cuts to be addressed. <a href="https://www.votervoice.net/AHA/Campaigns/118959/Respond">Click here</a> to send a message to your representatives.</p><h2><strong>LEGISLATIVE ACTION NEEDED</strong></h2><p><strong>Address the Medicaid</strong> <strong>DSH Payment Reductions. </strong>The <a href="/fact-sheets/2023-03-28-fact-sheet-medicaid-dsh-program" target="_blank" title="Medicare DSH Program Information">Medicaid DSH program</a> provides essential financial assistance to hospitals that care for our nation’s most vulnerable populations — children, impoverished, disabled and elderly. The fiscal year 2025 Medicaid DSH payment reductions are scheduled to be implemented on Jan. 1, 2025, when $8 billion in reductions take effect. The AHA calls on Congress to continue to provide relief from the Medicaid DSH cuts.</p><p><strong>Protect Rural Communities’ Access to Care.</strong> The AHA urges Congress to continue the <a href="/advocacy/advocacy-issues/2024-10-31-advocacy-issue-rural-mdh-and-lva-programs" target="_blank" title="Medicare-dependent Hospitals and Low-volume Adjustment programs">Medicare-dependent Hospitals and Low-volume Adjustment programs</a>. These programs provide rural, geographically isolated and low-volume hospitals additional financial support to ensure rural residents have access to care. These programs expire on Dec. 31, 2024. Congress should also enact a technical correction to remove barriers for Rural Emergency Hospitals to receive hospital-level reimbursement for outpatient services under Medicaid<strong>.</strong> </p><p><strong>Reject Site-neutral Payment Proposals.</strong> The AHA strongly opposes efforts to expand <a href="/advocacy/advocacy-issues/2023-09-11-advocacy-issue-site-neutral-payment-proposals" target="_blank" title="Site-neutral payment cuts information">site-neutral payment cuts</a> to include essential drug administration services furnished in off-campus hospital outpatient departments (HOPDs). Current Medicare payment rates appropriately recognize that there are fundamental differences between patient care delivered in HOPDs compared to other settings. HOPDs have higher patient safety and quality standards, and, unlike other sites of care, hospitals take important additional steps to ensure drugs are prepared and administered safely for both patients and providers. </p><p>The AHA also calls on Congress to reject legislative efforts requiring each off-campus HOPD to be assigned a separate unique health identifier from its provider as a condition of payment under Medicare or group health plans. Hospitals are already required to be transparent about the location of care delivery. This requirement would be duplicative and impose unnecessary and onerous administrative burdens and costs by needlessly requiring the overhaul of current billing practices and systems.</p><p><strong>Hold Commercial Health Plans Accountable.</strong> Certain health plan practices, such as inappropriate care denials and delayed payments, threaten patient access to care. These practices also contribute to clinician burnout and add excessive administrative costs and burdens to the health care system. The AHA urges Congress to pass the<a href="/lettercomment/2024-06-12-aha-support-house-improving-seniors-timely-access-care-act" target="_blank" title="Improving seniors timely access to care"> Improving Seniors Timely Access to Care Act</a> (H.R. 8702/ S. 4532), bipartisan legislation supported by more than half of the members of the House and Senate. The bill would streamline the prior authorization process in the Medicare Advantage program by eliminating complexity and promoting uniformity to reduce the wide variation in prior authorization methods that frustrate both patients and providers.</p><p><strong>Extend </strong><a href="/system/files/media/file/2024/05/fact-sheet-2024-telehealth-advocacy-agenda.pdf" target="_blank" title="Telehealth information"><strong>Telehealth</strong></a><strong> and </strong><a href="/system/files/media/file/2024/07/Fact-Sheet-Extending-the-Hospital-at-Home-Program-20240719.pdf" target="_blank" title="Hospitals-at-home information"><strong>Hospital-at-home</strong></a><strong> Waivers.</strong> During the COVID-19 public health emergency, Congress established a series of waivers expanding access for millions of Americans and increasing convenience in caring for patients. Telehealth provides a tremendous ability to leverage geographically dispersed provider capacity to support patient demand. The AHA calls on Congress to permanently adopt telehealth waivers and expand the telehealth workforce. </p><p>The AHA also urges Congress to pass the <a href="/lettercomment/2024-05-23-aha-support-house-bill-hospital-inpatient-services-modernization-act-2024" target="_blank" title="Hospitals Inpatient Services Modernization Act">Hospital Inpatient Services Modernization Act</a> (H.R. 8260/S. 4350), extending the hospital-at-home waiver for five years through 2029. Congressional action will reassure hospitals and health systems that are interested in developing such programs for their communities. </p><p><strong>Prevent Reimbursement Cuts for Physicians. </strong>Congress should take action to mitigate the scheduled physician reimbursement cuts for 2025 and to continue its work on broader reform for sustainable physician payment. Physicians have dealt with over two decades of conversion factor decrements, as well as significant staffing shortages and rising inflation in recent years. The scheduled 2.8% payment reduction in the 2025 Physician Fee Schedule would result in a significant risk to patients’ access to care.</p><p><strong>Protect America’s Health Care Workers.</strong> The AHA calls on Congress to enact the <a href="/system/files/media/file/2022/09/Fact-Sheet-Workplace-Violence-and-Intimidation-and-the-Need-for-a-Federal-Legislative-Response.pdf" target="_blank" title="SAVE Act information">Safety from Violence for Healthcare Employees (SAVE) Act</a> (H.R. 2584/S. 2768). This bipartisan bill would provide federal protections from workplace violence for hospital workers, similar to the protections in current law for airport and airline workers.</p><h2>FURTHER QUESTIONS</h2><p>Visit the <a href="/advocacy/action-center" target="_blank" title="AHA Action Center">AHA Action Center</a> for more resources on these issues and other priorities important to hospitals and health systems.</p><p>If you have further questions, please contact AHA at 800-424-4301.<br> </p></div><div class="col-md-4"><a href="/system/files/media/file/2024/11/aha-asks-congressional-leadership-to-fund-hospitals-protect-health-care-workers-alert-11-13-2024.pdf"><img src="/sites/default/files/inline-images/cover-aha-asks-congressional-leadership-to-fund-hospitals-protect-health-care-workers-alert-11-13-2024.png" data-entity-uuid="40f68d4b-dfe5-4e56-af78-6f8af97f13ca" data-entity-type="file" alt="Action Alert Cover Image" width="640" height="834"></a></div></div><p> </p></div> Wed, 13 Nov 2024 14:05:33 -0600 Medicaid DSH /2024-11-12-aha-urges-congress-act-key-priorities-lame-duck-session <p>November 12, 2024</p><table><tbody><tr><td>The Honorable Mike Johnson<br>Speaker<br>U.S. House of Representatives<br>Washington, DC 20515</td><td>The Honorable Hakeem Jeffries<br>Democratic Leader<br>U.S. House of Representatives<br>Washington, D.C. 20515</td></tr><tr><td>The Honorable Charles E. Schumer<br>Majority Leader<br>United States Senate<br>Washington, DC 20510</td><td>The Honorable Mitch McConnell<br>Republican Leader<br>United States Senate<br>Washington, DC 20510</td></tr></tbody></table><p><br>Dear Speaker Johnson, Leader Schumer, Leader Jeffries, and Leader McConnell:</p><p>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 forthcoming government funding deadline.</p><p>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.  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.</p><p>As Congress begins to focus on its end-of-the-year work, America’s hospitals and health systems respectfully request that you consider the following priorities.</p><p><strong>Address the Medicaid</strong> <strong>Disproportionate Share Hospital (DSH) Payment Reductions. </strong>The Medicaid DSH program provides essential financial assistance to hospitals that care for our nation’s most vulnerable populations — children, impoverished, disabled and elderly. The fiscal year 2025 Medicaid DSH payment reductions are scheduled to be implemented on Jan. 1, 2025, when $8 billion in reductions take effect. Congress should continue to provide relief from the Medicaid DSH cuts.</p><p><strong>Protect Rural Communities’ Access to Care.</strong> We urge Congress to continue the Medicare-dependent Hospitals and Low-volume Adjustment programs. These programs provide rural, geographically isolated and low-volume hospitals additional financial support to ensure rural residents have access to care. These programs expire on Dec. 31, 2024. Congress should also enact a technical correction to remove barriers for Rural Emergency Hospitals to receive hospital level reimbursement for outpatient services under Medicaid<strong>.</strong></p><p><strong>Reject Site-neutral Payment Proposals.</strong> We strongly oppose efforts to expand site-neutral payment cuts to include essential drug administration services furnished in off-campus hospital outpatient departments (HOPDs). Current Medicare payment rates appropriately recognize that there are fundamental differences between patient care delivered in HOPDs compared to other settings. HOPDs have higher patient safety and quality standards, and, unlike other sites of care, hospitals take important additional steps to ensure drugs are prepared and administered in a safe manner for both patients and providers.</p><p>HOPDs provide care for Medicare patients who are more likely to be sicker and more medically complex than those treated at physicians’ offices. This is especially true in rural and other medically underserved communities. Additional cuts will directly impact the level of care and services available to vulnerable patients in these communities.</p><p>We also call on Congress to reject legislative efforts requiring each off-campus HOPD to be assigned a separate unique health identifier from its provider as a condition of payment under Medicare or group health plans. Hospitals are already required to be transparent about the location of care delivery. This requirement would be duplicative and impose unnecessary and onerous administrative burdens and costs by needlessly requiring the overhaul of current billing practices and systems.</p><p><strong>Hold Commercial Health Plans Accountable.</strong> Certain health plan practices, such as inappropriate care denials and delayed payments, threaten patient access to care. These practices also contribute to clinician burnout and add excessive administrative costs and burdens to the health care system. We urge Congress to pass the Improving Seniors Timely Access to Care Act (H.R. 8702/ S. 4532), bipartisan legislation supported by more than half of the members of the House and Senate. The bill would streamline the prior authorization process in the Medicare Advantage program by eliminating complexity and promoting uniformity to reduce the wide variation in prior authorization methods that frustrate both patients and providers.</p><p><strong>Extend Telehealth and Hospital-at-home Waivers.</strong> During the public health emergency, Congress established a series of waivers expanding access for millions of Americans and increasing convenience in caring for patients. Telehealth provides a tremendous ability to leverage geographically dispersed provider capacity to support patient demand. Congress should permanently adopt telehealth waivers and expand the telehealth workforce.</p><p>Hospital-at-home programs are a safe, innovative way to care for patients in the comfort of their homes. With over 300 hospitals with hospital-at-home programs, many other hospitals and health systems indicate they are interested in developing programs for their communities but are reluctant to do so without congressional action. We urge Congress to pass the Hospital Inpatient Services Modernization Act (H.R. 8260/S. 4350), extending the hospital-at-home waiver for five years through 2029.</p><p><strong>Prevent Reimbursement Cuts for Physicians. </strong>Congress should take action to mitigate the scheduled physician reimbursement cuts for 2025 and to continue its work on broader reform for sustainable physician payment. Physicians have dealt with over two decades of conversion factor decrements, as well as significant staffing shortages and rising inflation in recent years. The scheduled 2.8% payment reduction in the 2025 Physician Fee Schedule would result in a significant risk to patients’ access to care.</p><p><strong>Protect America’s Health Care Workers.</strong> Congress should enact the Safety from Violence for Healthcare Employees (SAVE) Act (H.R. 2584/S. 2768). This bipartisan bill would provide federal protections from workplace violence for hospital workers, similar to the protections in current law for airport and airline workers.</p><p>We appreciate your leadership and look forward to working together to ensure patients continue to have access to quality care in their communities.</p><p>Sincerely,</p><p>/s/</p><p>Richard J. Pollack<br>President & Chief Executive Officer</p> Tue, 12 Nov 2024 14:38:12 -0600 Medicaid DSH <div class="container"><div class="row"><div class="col-md-8"><p>Lawmakers have returned to their districts for October after passing a continuing resolution that will keep the government funded through Dec. 20. Following the November election, lawmakers will return to Washington for a busy lame-duck session when key funding issues, including Medicaid disproportionate share hospital (DSH) and rural programs, will be on the agenda.</p><p>Now, while lawmakers are in their district, it is important for the field to engage with members of Congress to remind them of the importance of preserving access to care by continuing to fund vital programs and avoiding harmful policies such as site-neutral payments. It is essential that federal lawmakers understand the challenges hospitals and health systems face and what is at stake for the patients and communities they represent.</p><p>While AHA makes the case in Washington, D.C., we also continue to increase our efforts to engage the field with their lawmakers. It is important that hospital and health system leaders reinforce these messages back home. Your legislators listen to you because you live, work, vote and provide care in their communities. Lawmakers need to hear how congressional support is necessary to ensure hospitals can provide the 24/7 access to care patients and communities depend on.</p><h2>WHAT YOU CAN DO</h2><ul><li><strong>Contact</strong> your lawmakers and arrange conversations about the challenges your organization is facing and why additional support is needed.</li><li><strong>Invite</strong> your elected officials to visit your organization to show them firsthand the important service you provide to their communities.</li><li><strong>Explain</strong> to your elected lawmakers how government funding programs such as Medicaid DSH, enhanced low-volume adjustment (LVA) and Medicare-dependent hospitals (MDH), and others impact your ability to provide care in your community, and what would happen if those programs were not extended.</li><li><strong>Share</strong> this alert with your government affairs and media relations staff, leadership team and governance board to ensure a cohesive narrative around issues impacting hospitals and health systems. Be prepared to give specific examples of what services could be at stake.</li></ul><h2>AREAS OF FOCUS</h2><p><strong>Prevent damaging cuts to hospitals. </strong>The <a href="/fact-sheets/2023-03-28-fact-sheet-medicaid-dsh-program">Medicaid DSH program</a> provides essential financial assistance to hospitals that care for our nation’s most vulnerable populations — children, impoverished, disabled and elderly. The Medicaid DSH payment reductions are scheduled to be implemented on Jan. 1, 2025, when $8 billion in reductions take effect. <u>Congress should provide relief from the Medicaid DSH cuts.</u></p><p>In addition, <a href="/fact-sheets/2022-08-30-fact-sheet-rural-hospital-support-act-s4009-assistance-rural-community">MDH and LVA programs</a> provide rural, geographically isolated and low-volume hospitals additional financial support to ensure rural residents have access to care. These programs are set to expire Dec. 31, 2024. <u>Congress should extend or make these critical rural programs permanent.</u> AHA member hospitals participating in the MDH and/or LVA programs received an Alert with data on the impact on their organization if these programs expire.</p><p><a href="/issue-landing-page/2023-09-11-advocacy-issue-site-neutral-payment-proposals"><strong>Reject so-called site-neutral payment proposals.</strong></a><strong> </strong>When Congress returns from recess, AHA expects to see continued efforts to push proposals that would enact additional site-neutral payment cuts. <u>Urge your lawmakers to oppose any site-neutral payment proposal</u> as they would impose billions of dollars in additional Medicare payment cuts for services provided by hospital outpatient departments. It’s important to emphasize that these proposals would reduce patient access to vital health care services, particularly in rural and other medically underserved communities.</p><p><strong>Hold commercial health plans accountable. </strong>Certain health plan practices threaten patient access to care, contribute to clinician burnout and add excessive administrative costs and burden to the health care system. Regulators should increase their oversight of health plans<strong> </strong>and implement a comprehensive simplification agenda, beginning with streamlining prior authorization requirements and processes and monitoring for abusive payment delays and denials. <u>Urge Congress to pass the </u><a href="/lettercomment/2024-06-12-aha-support-house-improving-seniors-timely-access-care-act">Improving Seniors Timely Access to Care Act</a><u> — bipartisan legislation that would streamline the prior authorization process in the Medicare Advantage program.</u></p><p><strong>Permanently adopt </strong><a href="/system/files/media/file/2024/05/fact-sheet-2024-telehealth-advocacy-agenda.pdf"><strong>telehealth</strong></a><strong> and </strong><a href="/system/files/media/file/2024/07/Fact-Sheet-Extending-the-Hospital-at-Home-Program-20240719.pdf"><strong>hospital-at-home</strong></a><strong> waivers. </strong>During the public health emergency, Congress established a series of waivers expanding access for millions of Americans and increasing convenience in caring for patients. Telehealth holds tremendous potential to leverage geographically dispersed provider capacity to support patient demand. <u>Congress should permanently adopt telehealth waivers and expand the telehealth workforce</u>.</p><p>Hospital-at-home programs are a safe, innovative way to care for patients in the comfort of their homes. With over 300 hospitals with hospital-at-home programs, many other hospitals and health systems indicate they are interested in developing programs for their communities but are reluctant to do so without congressional action. <u>Urge</u> <u>Congress to pass the Hospital Inpatient Services Modernization Act (</u><a href="/lettercomment/2024-05-23-aha-support-house-bill-hospital-inpatient-services-modernization-act-2024">H.R. 8260</a><u>/</u><a href="/lettercomment/2024-05-23-aha-support-senate-bill-hospital-inpatient-services-modernization-act-2024">S. 4350</a><u>), extending the hospital-at-home waiver for five years through 2029.</u> The current waiver is set to expire Dec. 31, 2024.</p><p><strong>Protect America’s health care workers. </strong>Enactment of the <a href="/action-alert/2024-06-07-urge-congress-protect-health-care-workers-violence-passing-save-act">Safety from Violence for Healthcare Employees (SAVE) Act</a> (H.R. 2584/S. 2768) is a top priority for the AHA and the hospital field. This bipartisan bill would provide federal protections from workplace violence for hospital workers, similar to the protections in current law for airport and airline workers. <u>Urge your lawmakers to cosponsor the bipartisan SAVE Act.</u></p><h2>RESOURCES</h2><ul><li><a href="https://www.senate.gov/legislative/resources/pdf/2024_calendar.pdf">Senate</a> and <a href="https://www.majorityleader.gov/uploadedfiles/2024_house_calendar_-_one_page_-_revised_april_2024.pdf">House</a> 2024 calendars.</li><li><a href="/2024-03-01-congressional-site-visits-during-and-after">Congressional Site Visits</a>: Before, During and After — AHA’s comprehensive resource to help you and your staff plan a lawmaker’s visit.</li><li><a href="https://youtu.be/T-RlDRPzJCE">Video </a>of Bruce White, CEO of Knox Community Hospital in Ohio, describing his experience hosting a site visit.</li></ul><p>See AHA’s additional tips and best practices to enhance your advocacy <a href="/advocacy/2023-03-07-advocacy-tips-and-best-practices">here</a>.</p><h2>FURTHER QUESTIONS</h2><p><strong>To support your efforts to communicate effectively with lawmakers and their staff, visit the </strong><a href="/advocacy/action-center"><strong>AHA Action Center</strong></a><strong> for more resources on these issues and other priorities important to hospitals and health systems. </strong></p><p>If you have further questions, please contact AHA at 800-424-4301.</p></div><div class="col-md-4"><a href="/system/files/media/file/2024/09/action-needed-contact-lawmakers-on-important-issues-facing-hospitals-and-health-systems-9-30-2024.pdf" target="_blank" action alert><img src="/sites/default/files/2024-09/cover-action-needed-contact-lawmakers-on-important-issues-facing-hospitals-and-health-systems-9-30-2024.png" data-entity-uuid data-entity-type="file" alt="Cover Action Alert: ACTION NEEDED: Contact Lawmakers on Important Issues Facing Hospitals and Health Systems" width="NaN" height="NaN"></a></div></div></div> Mon, 30 Sep 2024 13:20:55 -0500 Medicaid DSH <div class="container"><div class="row"><div class="col-md-8"><p>Lawmakers have returned to Washington for three weeks to consider government funding, which expires Oct. 1. Congress must pass a continuing resolution (CR) by Sept. 30 to avoid a government shutdown. Leading into the election, lawmakers will return to their home districts but return to Washington in November for a busy lame-duck session when key funding issues, including Medicaid disproportionate share hospital (DSH) and rural programs, will be on the agenda.</p><p>During the next few weeks and again following the election, the field needs to engage with members of Congress to remind them of the importance of preserving access to care by continuing to fund vital programs and avoid harmful policies such as site-neutral payments. It is essential that federal lawmakers understand the challenges hospitals and health systems face and what is at stake for the patients and communities they represent.</p><p>While AHA makes the case in Washington, D.C., hospital and health system leaders must reinforce these important messages back home. Your legislators listen to you because you live, work, vote and provide care in their communities. Lawmakers need to hear how congressional support is necessary to ensure hospitals can provide the 24/7 access to care patients and communities depend on.</p><h2>What You Can Do</h2><ul><li><strong>Contact</strong> your lawmakers and arrange conversations about the challenges your organization is facing and why additional support is needed.</li><li><strong>Explain</strong> to your elected lawmakers how government funding programs such as Medicaid DSH, enhanced low-volume adjustment (LVA) and Medicare-dependent hospitals (MDH), and others impact your ability to provide care in your community, and what would happen if those programs were not extended.</li><li><strong>Share</strong> this alert with your government affairs and media relations staff, leadership team and governance board to ensure a cohesive narrative around issues impacting hospitals and health systems. Be prepared to give specific examples of what services could be at stake.</li></ul><h2>Areas of Focus and AHA Resources</h2><h3>Prevent Damaging Cuts to Hospitals</h3><p>The <a href="g/fact-sheets/2023-03-28-fact-sheet-medicaid-dsh-program">Medicaid DSH program</a> provides essential financial assistance to hospitals that care for our nation’s most vulnerable populations — children, impoverished, disabled and elderly. The Medicaid DSH payment reductions are scheduled to be implemented on Jan. 1, 2025, when $8 billion in reductions take effect. <strong>Congress should provide relief from the Medicaid DSH cuts.</strong></p><p>In addition, <a href="/fact-sheets/2022-08-30-fact-sheet-rural-hospital-support-act-s4009-assistance-rural-community">MDH and LVA programs</a> provide rural, geographically isolated and low-volume hospitals additional financial support to ensure rural residents have access to care. These programs are set to expire Dec. 31, 2024. <strong>Congress should extend or make these critical rural programs permanent.</strong> AHA member hospitals participating in the MDH and/or LVA programs received an Alert with data on the impact on their organization if these programs expire.</p><h3><a href="/issue-landing-page/2023-09-11-advocacy-issue-site-neutral-payment-proposals"><span><u>Reject So-called Site-neutral Payment Proposals</u></span></a></h3><p>When Congress returns from recess, AHA expects to see continued efforts to push proposals that would enact additional site-neutral payment cuts. <strong>Urge your lawmakers to oppose any site-neutral payment proposal</strong> as they would impose billions of dollars in additional Medicare payment cuts for services provided by hospital outpatient departments. It’s important to emphasize that these proposals would reduce patient access to vital health care services, particularly in rural and other medically underserved communities.</p><h3>Hold Commercial Health Plans Accountable</h3><p>Certain health plan practices threaten patient access to care, contribute to clinician burnout and add excessive administrative costs and burden to the health care system. Regulators should increase their oversight of health plans and implement a comprehensive simplification agenda, beginning with streamlining prior authorization requirements and processes and monitoring for abusive payment delays and denials. <strong>Urge Congress to pass the </strong><a href="/lettercomment/2024-06-12-aha-support-house-improving-seniors-timely-access-care-act"><strong>Improving Seniors Timely Access to Care Act</strong></a><strong> — bipartisan legislation that would streamline the prior authorization process in the Medicare Advantage program.</strong></p><h3>Permanently Adopt <a href="/system/files/media/file/2024/05/fact-sheet-2024-telehealth-advocacy-agenda.pdf"><span><u>Telehealth</u></span></a> and <a href="/system/files/media/file/2024/07/Fact-Sheet-Extending-the-Hospital-at-Home-Program-20240719.pdf"><span><u>Hospital-At-Home</u></span></a> Waivers</h3><p>During the public health emergency, Congress established a series of waivers expanding access for millions of Americans and increasing convenience in caring for patients. Telehealth holds tremendous potential to leverage geographically dispersed provider capacity to support patient demand. <strong>Congress should permanently adopt telehealth waivers and expand the telehealth workforce.</strong></p><p>Hospital-at-home programs are a safe, innovative way to care for patients in the comfort of their homes. With over 300 hospitals with hospital-at-home programs, many other hospitals and health systems indicate they are interested in developing programs for their communities but are reluctant to do so without congressional action. <strong>Urge Congress to pass the Hospital Inpatient Services Modernization Act (</strong><a href="/lettercomment/2024-05-23-aha-support-house-bill-hospital-inpatient-services-modernization-act-2024"><strong>H.R. 8260/S. 4350</strong></a><strong>), extending the hospital-at-home waiver for five years through 2029.</strong> The current waiver is set to expire Dec. 31, 2024.</p><h3>Protect America’s Health Care Workers</h3><p>Enactment of the <a href="/action-alert/2024-06-07-urge-congress-protect-health-care-workers-violence-passing-save-act">Safety from Violence for Healthcare Employees (SAVE) Act</a> (H.R. 2584/S. 2768) is a top priority for the AHA and the hospital field. This bipartisan bill would provide federal protections from workplace violence for hospital workers, similar to the protections in current law for airport and airline workers. <strong>Urge your lawmakers to cosponsor the bipartisan SAVE Act.</strong></p><h2>Further Questions</h2><p><strong>To support your efforts to communicate effectively with lawmakers and their staff, visit the </strong><a href="/advocacy/action-center"><strong>AHA Action Center</strong></a><strong> for more resources on these issues and other priorities important to hospitals and health systems.</strong></p><p>If you have further questions, please contact AHA at <a href="tel:1-800-424-4301">800-424-4301</a>.</p></div><div class="col-md-4"><p><a href="/system/files/media/file/2024/09/ACTION-NEEDED-Contact-Lawmakers-Now-on-Important-Issues-Facing-Hospitals-and-Health-Systems.pdf" target="_blank" title="Click here to download the Action Alert ACTION NEEDED: Contact Lawmakers Now on Important Issues Facing Hospitals and Health Systems PDF."><img src="/sites/default/files/inline-images/Page-1-ACTION-NEEDED-Contact-Lawmakers-Now-on-Important-Issues-Facing-Hospitals-and-Health-Systemsf.png" data-entity-uuid="2e8c2f84-9dc6-4e48-83ce-2eba6ca54423" data-entity-type="file" alt="ACTION NEEDED: Contact Lawmakers Now on Important Issues Facing Hospitals and Health Systems page 1." width="696" height="900"></a></p></div></div></div> Mon, 09 Sep 2024 16:30:00 -0500 Medicaid DSH