NASH Comments on Proposed Changes in S-10 Uncompensated Care Reporting

NASH has expressed support for several new federal proposals on hospital uncompensated care data reporting and conveyed its opposition to other proposed changes in federal data collection requirements in a new letter to the Centers for Medicare & Medicaid Services.

In response to changes CMS has proposed in the uncompensated care data hospitals must submit to the federal government, NASH expressed:

  • Support for CMS’s proposal to clarify aspects of how hospitals must report data on the uncompensated care they provide on the Medicare cost report’s S-10 form.
  • Expressed concern that some of the new data reporting requirements violate current HIPAA requirements.
  • Asked CMS to defer reporting on the rates hospitals negotiate with Medicare Advantage plans until after the end of the COVID-19 public health emergency.

NASH is especially interested in proposed changes in uncompensated care data reporting on the S-10 form because that form is used in the calculation of private safety-net hospitals’ Medicare disproportionate share payments (Medicare DSH).  Those Medicare DSH payments are a vital tool in helping these hospitals serve the low-income and uninsured residents of the communities in which they are located.

Learn more about NASH’s response to CMS’s proposed new information collection activities in this NASH letter to CMS.

NASH Asks Congress to Help Hospitals Keep Provider Relief Fund Grants

Safety-net hospitals could lose some or all of their CARES Act Provider Relief Fund grant money and the National Alliance of Safety-Net Hospitals is asking members of Congress to intervene to prevent it.

At issue are financial reporting requirements that at first directed hospitals to estimate their anticipated revenue losses and extra expenses associated with the COVID-19 pandemic in one way and then shifted to a new approach.  The first grant distribution was based on the original reporting requirements, and now, hospitals fear that the change in reporting requirements could leave them vulnerable to a demand that they return some, much, or all of that grant money.

The Department of Health and Human Services announced one set of reporting requirement in June and then proposed modifying them in September.  In response to widespread expressions of concern, including from NASH, HHS revised those proposed changes – but not enough, according to many stakeholders, leaving them concerned that HHS would ask them to return some of their grant money.  Now, NASH is asking the same members of Congress who asked HHS to reconsider the reporting requirements to do so again.

See NASH’s letter members of Congress asking them to sign onto a bipartisan letter asking HHS to revise its reporting requirements once again.  Go here to see the letter members of Congress are being asked to sign.

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.

NASH Statement on Nomination of Xavier Becerra

Statement of the National Alliance of Safety-Net Hospitals on the Nomination of  Xavier Becerra to be Secretary of the U.S. Department of Health and Human Services

The National Alliance of Safety-Net Hospitals is extremely pleased with President-elect Biden’s nomination of Xavier Becerra to serve as his Secretary of the Department of Health and Human Services.  As Attorney General of California, Mr. Becerra has been a staunch, effective defender of the role of the Affordable Care Act in helping to reduce the number of uninsured Americans.  As a member of Congress, private safety-net hospitals worked often with Mr. Becerra and came to recognize him as a leader among his colleagues in working to preserve the country’s health care safety net, of which private safety-net hospitals are an integral part.  We look forward to the opportunity to resume our relationship with this strong advocate for health care for all Americans and to work together to ensure access to care in our country.


Coronavirus Update for Friday, December 4

The following is the latest COVID-19 information from the federal governments as of 2:45 p.m. on Friday, December 4.

NASH Advocacy

NASH has written to Congress to request additional COVID-19 legislation between now and the end of the year.  NASH asked Congress for additional funding for the Provider Relief Fund; 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.

Centers for Medicare & Medicaid Services

  • CMS has updated its FAQs on Medicare fee-for-service billing with 14 new questions that address administration and billing for monoclonal antibody therapy.  The new questions can be found on pages 33-34, p. 34, pp. 120-121, p. 121, pp. 121-124, pp. 124-125, p. 125 (four questions), p. 126, pp. 126-127, p. 127, and pp. 127-128.
  • CMS covers much the same ground in an updated version of its document “Medicare Monoclonal Antibody COVID-19 Infusion Program Instruction.”
  • CMS has published a statement on its intended use of its enforcement discretion on skilled nursing facility consolidated billing for COVID-19 vaccines and monoclonal antibody infusions.  Through the exercise of this discretion, CMS will permit Medicare-enrolled immunizers to bill directly and receive direct reimbursement from the Medicare program.  Go here to see the complete statement.

Coronavirus (COVID-19) Stakeholder Calls 

CMS hosts recurring stakeholder engagement sessions to share information about the agency’s response to COVID-19.  These sessions are open to members of the health care community and are intended to provide updates, share best practices among peers, and offer participants an opportunity to ask questions of CMS and other subject matter experts.

COVID-19 Office Hours Call

Tuesday, December 8 at 5:00 (eastern)

Toll Free Dial-In:  833-614-0820; Access Passcode:  3129517

Audio Webcast link:  go here.

Tuesday, December 22 at 5:00 (eastern)

Toll Free Dial In:  833-614-0820; Access Passcode:  3968359

Audio Webcast link:  go here.

Conference lines are limited so CMS encourages interested parties to join via audio webcast.

To listen to the audio files and read the transcripts for past stakeholder calls, go here.

Department of Health and Human Services

  • HHS has issued a fourth amendment to the Declaration under the Public Readiness and Emergency Preparedness Act (PREP Act) to increase access to critical countermeasures against COVID-19, including greater use of telehealth.  Go here for a more detailed description of what the amendment authorizes.

Food and Drug Administration

  • On Tuesday, December 8 at noon (eastern) the FDA will host a webinar on its enforcement policy for sterilizers, disinfectant devices, and air purifiers during the COVID-19 pandemic as part of its series on respirators and other personal protective equipment for health care personnel use during the pandemic.  Go here for further information about the webinar and how to participate.
  • The FDA has issued emergency use authorization for a bioburden-reduced N95 respirator.  See the FDA’s letter of authorization and its fact sheet for health care providers.

Centers for Disease Control and Prevention


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.

Off-Again, On-Again Public Charge Rule is Off Again

A federal rule that would have limited immigration to the U.S. for people who might at some point become dependent on public aid programs has been put on hold again by a federal judge.

Implementation of the rule, delayed by several courts and then authorized by the U.S. Supreme Court until the merits of challenges could be heard, was delayed again by a federal court, which said the rule contained “numerous unexplained flaws” that made it “arbitrary and capricious.”

Health care advocates feared the rule would discourage some immigrants to whom the rule does not even apply from seeking to participate in certain public aid programs and even encourage some to whom the rule does not apply to disenroll from the public aid programs, such as Medicaid, in which they are already legally enrolled.  A recent study published in the journal Health Affairs found that the parents of a projected 260,000 children have disenrolled their children from Medicaid or the Children’s Health Insurance Program (CHIP) because of their fear of the rule’s implications for their families.

NASH has conveyed its opposition to the public charge rule on a number of occasions, including in this 2019 position statement.

Learn more about the rule and this latest court decision in the New York Times article “Trump’s ‘Public Charge’ Immigration Rule Is Vacated by Federal Judge

NASH Asks Congress to Help Preserve Federal COVID-19 Aid for Hospitals

Protect the COVID-19 aid the federal government has given to private safety-net hospitals, NASH has asked in a letter to Congress.

The letter refers to changes in how the Department of Health and Human Services wants hospitals to calculate the revenue they lost as a result of COVID-19 – the justification in part for the Provider Relief Fund payments hospitals have received through the CARES Act.  In June, HHS told hospitals how to make that calculation but late last month it changed those directions in ways that could force many private safety-net hospitals and others to return some or even much of the federal aid they received.

In the letter, NASH asks members of Congress to sign a bipartisan letter asking HHS Secretary Alex Azar to restore the June instructions for calculating COVID-19-related lost hospital revenue.

Go here to read NASH’s message to Congress.


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.”