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More Potential Budget Obstacles for Private Safety-Net Hospitals

Part two of the Trump administration’s proposed FY 2020 budget brought more potential bad news for private safety-net hospitals.

 

Last week’s “lean budget” released by the White House included a number of challenges for private safety-net hospitals and this week’s release, intended to fill in some of the blanks that last week’s document left, brought more of the same.

Proposed Medicare challenges include:

  • a call for establishing a new process for calculating Medicare disproportionate share (Medicare DSH) uncompensated care payments
  • slashing Medicare bad debt reimbursement from 65 percent to 25 percent
  • continued movement toward site-neutral payments for outpatient services provided at hospital outpatient facilities

Newly proposed Medicaid challenges include:

  • extending Medicaid disproportionate share (Medicaid DSH) cuts beyond the currently planned six years
  • redesigning the formula for allocating Medicaid DSH funds to the states
  • authorizing states to verify beneficiaries’ Medicaid eligibility more than once a year
  • permitting states to apply means tests to Medicaid eligibility

The latest FY 2020 budget proposal also calls for:

  • consolidating Medicare, Medicaid, and children’s hospital medical education payments into single new capped medical education grant program
  • reduced 340B prescription drug discount program payments for some hospitals
  • reducing the grace period for payment of premiums for health insurance purchased on an insurance exchange
  • income-based increases in premiums for low-cost insurance purchased on those exchanges

All of these changes, if implemented, would pose problems for NASH members and most private safety-net hospitals.

Learn more from this week’s White House budget document.

NASH Unveils 2019 Agenda

The National Alliance of Safety-Net Hospitals has unveiled its public policy advocacy agenda for 2019.

That agenda explains that NASH will:

  • Address Medicare issues such as continuing threats to private safety-net hospitals’ Medicare DSH payments, audits of the Medicare cost report’s S-10 form, graduate medical education payments, potential cuts in bad debt, 340B, the participation of private safety-net hospitals in value-based purchasing and alternative payment model programs, and the expected national conversation about “Medicare for all.”
  • Address Medicaid issues such as the adequacy of Medicaid DSH payments, possible reductions in Medicaid eligibility and benefits, the implications of a new proposal to define whether new immigrants and their families pose a threat of becoming “public charges,” the possible introduction of Medicaid block grants, and possible new restrictions on how states may finance their Medicaid programs.
  • Work to protect private safety-net hospitals from federal spending cuts.
  • Reintroduce itself to Congress and the administration.
  • Seek to enhance its ability to help shape government health care policy in Washington by recruiting more members.

For NASH’s complete 2019 advocacy agenda click here

CBO Targets Health Care in Options for Reducing Deficit

Every year the Congressional Budget Office publishes a menu of options for reducing federal spending and the federal budget deficit.  As in the past, this year’s compendium includes a number of options to reduce federal health care spending and raises federal revenue through health care initiatives.

The cost-cutting options include:

  • establish caps on federal spending for Medicaid
  • limit states’ taxes on health care providers
  • reduce federal Medicaid matching rates
  • change the cost-sharing rules for Medicare and restrict Medigap insurance
  • raise the age of eligibility for Medicare to 67
  • reduce Medicare’s coverage of bad debt
  • consolidate and reduce federal payments for graduate medical education at teaching hospitals
  • use an alternative measure of inflation to index social security and other mandatory programs

Options to raise additional revenue include:

  • increase premiums for Parts B and D of Medicare
  • reduce tax subsidies for employment-based health insurance
  • increase the payroll tax rate for Medicare hospital insurance

Many of these proposals, if implemented, would be damaging for private safety-net hospitals.

Learn more about the CBO’s recommendations, how they might be implemented, and their potential implications in the CBO report Options for Reducing the Deficit: 2019 to 2028.

 

President Proposes FY 2017 Budget

That budget proposal calls for numerous cuts in Medicare payments to hospitals, including significant reductions in Medicare bad debt reimbursement, medical education payments, and payments for inpatient rehabilitation services.

NAUH LogoIt also calls for restoring the Medicaid primary care payment increase through calendar year 2017.

NAUH has prepared a detailed memo outlining the potential implications of the proposed FY 2017 budget for private safety-net hospitals. Representatives of private safety-net hospitals may request a copy of this memo by using the “contact us” link at the top of this screen.

President Presents Proposed FY 2015 Budget

Yesterday the Obama administration unveiled its proposed FY 2015 federal budget.

NAUH LogoThe spending plan addresses a number of key matters for private safety-net hospitals, including proposed cuts in Medicare bad debt reimbursement, graduate medical education payments, market basket updates for selected providers, and more.

It also proposes increased spending to train more health care providers and to extend enhanced Medicaid primary care payments for another year.

The National Association of Urban Hospitals (NAUH) has prepared a memo summarizing the proposed budget with an emphasis on the issues most important to private safety-net hospitals.  To request a copy of that memo, please hit the “contact us” link here, on the home page of the NAUH web site.