NASH Seeks Help From End-of-Year Legislation

Eliminate Medicaid disproportionate share hospital cuts (Medicaid DSH), appropriate additional resources for the Provider Relief Fund, and extend the current suspension of the two percent sequestration of Medicare spending, the National Alliance of Safety-Net Hospitals asked members of Congress in a letter NASH sent yesterday.

The request comes as Congress returns to Washington to take up the funding of the federal government at a time when authorization for spending under a continuing resolution ends on December 11.  In addition to addressing federal funding, Congress also may consider COVID-19 legislation.

Learn more from NASH’s letter to Congress.

MACPAC Meets

The Medicaid and CHIP Payment and Access Commission met for two days last week in Washington, D.C.

The following is MACPAC’s own summary of the sessions.

The October 2020 MACPAC meeting opened with a panel discussion on restarting Medicaid eligibility redeterminations when the public health emergency ends.  It included Jennifer Wagner, director of Medicaid eligibility and enrollment at the Center on Budget and Policy Priorities; René Mollow, deputy director for health care benefits and eligibility at the California Department of Health Care Services; and Lee Guice, director of policy and operations at the Department for Medicaid Services, Kentucky Cabinet for Health and Family Services.

After a break, Commissioners heard a panel discussion with Kevin Prindiville, executive director at Justice in Aging; Mark Miller, executive vice president of healthcare at Arnold Ventures; and Charlene Frizzera, senior advisor at Leavitt Partners, on creating a new program for dually eligible beneficiaries. Later, staff presented preliminary findings from a mandated report on non-emergency medical transportation. The day concluded with a report on nursing facility acuity adjustment methods.

On Friday, the day began with a session on access to mental health services for adults in Medicaid. It was followed by a related panel discussion on mental health services with Sandra Wilkniss, director of complex care policy and senior fellow at Families USA; Melisa Byrd, senior deputy director for the District of Columbia Department of Health Care Finance; and Dorn Schuffman, director of the CCBHC Demonstration Project at the Missouri Department of Mental Health.

Next, the Commission considered the merits of extending Medicaid coverage for pregnant women beyond 60 days postpartum. Staff then provided an update on a statutorily required analysis of disproportionate share hospital (DSH) allotments, as well as an analysis of addressing high-cost drugs and the challenges they present to Medicaid.

The meeting concluded with comment on the Secretary’s report to Congress on Reducing Barriers to Furnishing Substance Use Disorder (SUD) Services Using Telehealth and Remote Patient Monitoring for Pediatric Populations under Medicaid. The Commission decided to send a letter to Congress and the Secretary commenting on this report.

Supporting the discussion were the following briefing papers:

  1. Mandated Report on Non-Emergency Medical Transportation: Work Plan and Preliminary Findings
  2. Changes in Nursing Facility Acuity Adjustment Methods
  3. Access to Mental Health Services for Adults in Medicaid
  4. Considerations in Extending Postpartum Coverage
  5. Required Annual Analysis of Disproportionate Share Hospital (DSH) Allotments
  6. Addressing High-Cost Drugs and Pipeline Analysis
  7. Comment on Secretary’s Report to Congress on Reducing Barriers to Substance Use Disorder Services Using Telehealth for Pediatric Populations under Medicaid

Because they serve so many Medicaid and CHIP patients – more than the typical hospital – MACPAC’s deliberations are especially important to private safety-net hospitals.

MACPAC is a non-partisan legislative branch agency that provides policy and data analysis and makes recommendations to Congress, the Secretary of the U.S. Department  of Health and Human Services, and the states on a wide variety of issues affecting Medicaid and the State Children’s Health Insurance Program.  Find its web site here.

Congress Gives Hospitals Medicaid DSH Relief

Medicaid DSH allocations to states will not be reduced right away thanks to a new continuing resolution to fund the federal government through December 11.

The Medicare disproportionate share allocation cuts to the states, mandated by the Affordable Care Act but delayed by Congress several times, were delayed again earlier this year but scheduled to take effect on November 11.  With the latest continuing resolution, the cuts will be delayed yet another month.

Learn more about the delay of Medicaid DSH cuts and other aspects of the continuing resolution that affect hospitals in the Healthcare Dive article “Providers win Medicare loan extension, DSH relief but lose other asks in stop-gap spending law.”

Coronavirus Update for Wednesday, September 23

The following is the latest COVID-19 information from the federal government as 2:30 p.m. on Wednesday, September 23.

Continuing Resolution to Fund the Federal Government

  • The House has passed, and the Senate is expected to take up and pass as soon as this week, a continuing resolution to fund the federal government from the beginning of the new fiscal year, on October 1, through December 11; the president is expected to sign the measure.  Key health care provisions in this continuing resolution include:
    • Changes in the Medicare Accelerated and Advance Payment Program that extend the period before repayment begins and the period before the balance must be repaid in full; reduce the recoupment percentage; and lower the interest rates for this and comparable programs.
    • A delay in the Affordable Care Act-mandated reduction of Medicaid disproportionate share (Medicaid DSH) allotments to the states through December 11.
    • Extended funding for Community Health Centers, the National Health Services Corps, and the Teaching Health Centers Graduate Medical Education Program through December 11.
    • Extended funding for the Special Diabetes Program through December 11.
    • Extended authorization for the certified community behavioral health clinics demonstration program through December 11.
    • Clarification that drugs and biologicals used for medication-assisted treatment, which must be covered by Medicaid beginning on October 1, will continue to be eligible for rebates under the Medicaid program.

Provider Relief Fund

  • HHS’s Provider Relief Fund FAQ has been updated with four new questions that address nursing home quality payments.  The new questions, all marked “Added 9/18/2020,” can be found on pages 46 through 48 of the FAQ.

Department of Health and Human Services

Centers for Medicare & Medicaid Services

  • On Thursday, September 24 at 4:00 (eastern), CMS and CDC will hold a “CMS-CDC Fundamentals of COVID-19 Prevention for Nursing Home Management Call.”  Go here for information on how to register and submit questions.

Food and Drug Administration

  • The FDA has updated the question-and-answer appendix in its guidance “Conduct of Clinical Trials of Medical Products during COVID-19 Public Health Emergency.”  The updated guidance includes a new question and answer about a clinical trial investigator’s responsibility to review all investigational new drug application safety reports, including reports that will not result in a change of the investigator brochure, informed consent, or protocol.

Federal Reserve System

  • The Federal Reserve System has updated its FAQs for the Main Street Lending Program, which supports lending to small and medium-sized for-profit businesses and non-profit organizations that were in sound financial condition before the COVID-19 pandemic but lack access to credit on reasonable terms.  Go here for the announcement of the updated FAQs and for links to the FAQs themselves.

Eliminate Medicaid DSH Cut, NASH Asks Congress

A Continuing Resolution to fund the federal government in FY 2021 should eliminate a cut in Medicaid disproportionate share (Medicaid DSH) allotments to the states, the National Alliance of Safety-Net Hospitals has written in a letter to congressional leaders.

The cut was mandated by the 2010 Affordable Care Act but has never been implemented.

In its letter to congressional leaders, NASH wrote that

The Medicaid DSH cut was predicated on the expectation that the Affordable Care Act would greatly reduce the number of uninsured Americans, and while it has, millions remain uninsured. Just this week the Centers for Disease Control and Prevention reported that the number of Americans without health insurance rose in 2019 – for the third consecutive year – and the job loss associated with COVID-19 is expected to continue this trend in 2020. As a result, private safety-net hospitals and others like them, serving communities with large numbers of low-income and uninsured residents, have never needed the resources afforded by Medicaid DSH more than they do today. Congress has always questioned the wisdom of this cut and has never allowed those cuts to go into effect. The most recent delay expires after November 30.

Learn more from NASH’s Medicaid DSH letter to congressional leaders.

CMS Provides Guidance on Medicaid DSH Calculations

State Medicaid program accounting for hospital uncompensated care when calculating hospital-specific Medicaid disproportionate share limits is the subject of new guidance from the Centers for Medicare & Medicaid Services.

In the guidance, the Centers for Medicare & Medicaid Services explains that because of several court rulings, states can decide for themselves whether to offset third-party payer payments from costs in their Medicaid DSH calculations for periods prior to June 2, 2017 but that beginning with that date,  CMS will enforce its own interpretation of the policy.

In new guidance, CMS presents two methodologies for accounting for its mid-year policy change and reminds stakeholders about its new methodology for calculations after June 2, 2017.  Learn more from this Medicaid notice and from its accompanying CMS informational bulletin “Treatment of Third Party Payers (TPP) in Calculating Uncompensated Care Costs (UCC).”

NASH Asks Senate for COVID-19 Help

Private safety-net hospitals need help with the challenges posed by the COVID-19 public health emergency, NASH wrote yesterday in a letter to Senate majority leader Mitch McConnell and minority leader Charles Schumer.

In its letter, NASH asked for:

  • An additional $100 billion for hospitals.
  • Forgiveness for money provided to hospitals through the federal CARES Act’s Accelerated and Advance Payment Program.
  • Action to prevent implementation of the Medicaid fiscal accountability regulation.
  • An increase in the federal Medicaid matching rate (FMAP).
  • An increase in states’ Medicaid disproportionate share (Medicaid DSH) allotments.
  • A moratorium on changes in hospital eligibility for the 340B prescription drug discount program, Medicare indirect medical education program, Medicare disproportionate share (Medicare DSH) program, and other programs.

See NASH’s letter here.

 

NASH Calls for More COVID-19 Legislation

On Tuesday the National Alliance of Safety-Net Hospitals wrote to Senate leaders and asked them to advance legislation with five major COVID-19-related policy initiatives that private safety-net hospitals seek:

  1. An additional $100 billion for hospitals.
  2. A 14-point increase in the federal medical assistance percentage (FMAP).
  3. A 2.5 percent increase in states’ Medicaid disproportionate share (Medicaid DSH) allotments and another delay in implementation of Affordable Care Act-mandated cuts in those allotments.
  4. Reduced interest rates and a longer payback period for Medicare payments advanced to hospitals through the CARES Act’s Accelerated and Advance Payment Program.
  5. Prevention of implementation of the Medicare fiscal accountability regulation (MFAR).

Learn more from NASH’s letter to Senate majority leader Mitch McConnell and Senate minority leader Chuck Schumer.

NASH Pitches Policy Proposals to Congress

Following the introduction of the Health and Economic Recovery Omnibus Emergency Solutions Act (“HEROES Act”), the National Alliance of Safety-Net Hospitals wrote to congressional leaders to ask for six specific policy initiatives in the next COVID-19 legislation:

See NASH’s letter on behalf of private safety-net hospitals here.

 

NASH Seeks Assistance With COVID-19 Needs

Provide special assistance to private safety-net hospitals to help them serve their communities during the COVID-19 national health emergency, NASH has asked in a letter to Senate majority leader Mitch McConnell and minority leader Charles Schumer.

In particular, NASH asked the Senate leaders to include three things in future COVID-19/stimulus legislation:

  1. Funding to ensure cash flow for hospitals that are investing heavily in anticipation of a major influx of challenging patients while foregoing revenue from elective procedures.
  2. The permanent elimination of Affordable Care Act-mandated cuts in Medicaid disproportionate share (Medicaid DSH) funding.
  3. Protection from any new, burdensome regulations in any legislation adopted to facilitate the fight against COVID-19.

Go here to read NASH’s letter to senators McConnell and Schumer.