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NASH Asks Congress for COVID-19 Aid

NASH has written to Congress to request additional COVID-19 legislation between now and the end of the year to help private safety-net hospitals respond to the health care and financial challenges posed by the pandemic.

In its letter, NASH asked Congress for:

  • additional funding for the Provider Relief Fund for assistance to hospitals;
  • extension of the temporary moratorium on continued implementation of the 2011 Budget Control Act’s Medicare sequestration; and
  • the suspension of any other federal cuts for health care providers, such as the scheduled reduction of Medicaid disproportionate share (Medicaid DSH) allocations to the states.

Read NASH’s message to Congress.

Schumer: Block Medicaid DSH Cuts

Congress should block scheduled Medicaid DSH cuts.

That’s the message Senate minority leader Chuck Schumer sent during a recent appearance in upstate New York.

“At a time when we need to be supporting our hospitals with robust funding to help them keep their doors open and doctors available, threatening them with substantial cuts to essential funding is fundamentally wrong,” Schumer said, speaking of cuts in Medicaid disproportionate share payments (Medicaid DSH) mandated by the Affordable Care Act, delayed many times by Congress, but now scheduled to take effect when the current continuing resolution funding the federal government expires on December 11.

The Medicaid DSH program was created to help hospitals that care for especially large numbers of low-income and uninsured patients – like America’s private safety-net hospitals.  The National Alliance of Safety-Net Hospitals has long called for delaying Medicaid DSH cuts and most recently urged Congress to eliminate the Medicaid DSH cut entirely, writing in a letter to members of Congress that

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 long questioned the wisdom of this cut and has never permitted it to take effect. The most recent delay expires December 11, and NASH urges you to repeal permanently the Medicaid DSH cut in any spending or COVID-19 legislation you pass this year.

To learn more about Senator Schumer’s perspective on Medicaid DSH, see the Troy Record article “Schumer calls for reversal of devastating hospital cuts.”

 

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.”

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 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.

 

NASH Raises Concerns About Proposed Budget in News Release

Medicare and Medicaid cuts detailed in the administration’s proposed FY 2021 budget could be harmful to private safety-net hospitals, the National Alliance of Safety-Net Hospitals declared in a news release issued in response to that proposed budget.

Among those cuts:  $465 billion in Medicare payments and $920 billion in Medicaid reductions over the next ten years.

“The extent of the proposed spending cuts is daunting,” said Ellen Kugler, NASH’s executive director.  “The payments that have been targeted for the biggest cuts are the very payments that enable safety-net hospitals to provide vital services to their communities.  Without them, the capacity of private safety-net hospitals across the country to continue serving the low-income, low-income elderly, uninsured, and medically vulnerable residents of their communities could be in serious jeopardy.”

Among the payments targeted for major cuts are Medicare disproportionate share (Medicare DSH), Medicaid disproportionate share (Medicaid DSH), Medicare graduate medical education payments, Medicare bad debt reimbursement, and payments for some Medicare-covered outpatient services.

Learn more about NASH’s objections to the proposed cuts in this NASH news release.