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NASH Seeks Congress’s Help With 340B

Changing hospital admissions experiences in the past year resulting from the COVID-19 pandemic could jeopardize some safety-net hospitals’ continued eligibility for the section 340B prescription drug discount program and NASH is asking for Congress’s help to prevent this.

COVID-19 led to a reduction of hospitals admissions as people deferred addressing their medical problems out of fear of contracting the virus.  These reduced admissions, a one-year anomaly, could affect safety-net hospitals’ ability to continue participating in the 340B program, which is an essential tool for  helping hospitals provide low-cost prescription drugs to low-income patients in the communities they serve.

For this reason, NASH has asked members of Congress to co-sponsor and support H.R. 3203 and S. 773, which would protect hospitals from losing eligibility for the 340B program based on one year of once-in-a-lifetime admissions pattern changes.  See NASH’s message to members of Congress.

Hospitals Lower on Resources Less Likely to Help Patients See Health Data

Hospitals with fewer resources are less likely to offer app-based approaches that enable their patients to see their medical data, according to the Office of the National Coordinator for Health Information Technology, the federal agency that oversees such matters.

While patient access to their data has increased markedly in recent years, investment in the technology to make this possible has not been even across different types of hospitals:  smaller hospitals are less likely to be able to afford such investments than larger hospitals, rural and critical access hospitals are less likely to be able to afford such investments than suburban and urban hospitals, and independent hospitals are less likely to be able to afford such investments than those affiliated with health systems.

The National Alliance of Safety-Net Hospitals has long pointed out that many private safety-net hospitals, with their greater numbers of public insured and uninsured patients, lack the resources for such investments in comparison to other hospitals that serve larger proportions of privately insured patients for whom they are paid more appropriately for the care they provide.  The disparity in the adequacy of public and private reimbursement, NASH maintains, has contributed to hindered a disparity in hospital resources that has hindered the efforts to safety-net hospitals to do more to help their patients gain access to their own medical data.

Learn more about the role that access to resources plays in hospitals’ ability to enable their patients to view their personal medical data in the Fierce Healthcare article “Low-resource hospitals behind the curve on app-based data access for patients, ONC says.”

Federal Health Policy Update for Wednesday, May 19

The following is the latest health policy news from the federal government as of 2:15 p.m. on Wednesday, May 19.  Some of the language used below is taken directly from government documents.

NASH Advocacy

  • NASH has written to all members of Congress urging them to contact Health and Human Services Secretary Xavier Becerra about directing more of its remaining CARES Act Provider Relief Fund money to private safety-net hospitals to help them serve their diverse, predominantly low-income communities during the COVID-19 emergency.  Go here to see NASH’s message to Congress.

The White House

COVID-19

Centers for Medicare & Medicaid Services

Health Policy News

Go here for links to these and other items.

Department of Health and Human Services

COVID-19

  • HHS’s Substance Abuse and Mental Health Services Administration (SAMHSA) is distributing $3 billion in American Rescue Plan funding for its mental health and substance use block grant programs.  The Community Mental Health Services Block Grant Program and Substance Abuse Prevention and Treatment Block Grant Program are distributing $1.5 billion each to states and territories to help communities addressing mental health and substance use needs during the COVID-19 pandemic.  Learn more from HHS’s news release announcing the funding.
  • HHS’s Office of the Inspector General has updated its work plan for COVID-19-related audits, evaluations, and inspections scheduled for May.
  • In conjunction with the California Justice Department and the U.S. Attorney’s Office for the Eastern District of California, HHS’s Office of the Inspector General has issued a news release advising the public that they should not be asked by providers to pay for COVID-19 vaccines and reminding providers that they may not attempt to charge or bill consumers for administering those vaccines.  See the news release here.
  • HHS’s Office of the Assistant Secretary for Preparedness and Response has published information about the challenges of providing hospice care amid the COVID-19 pandemic and about providing home care during the public health emergency.

Health Policy News

Senate Finance Committee Hearing

The Senate Finance Committee held a hearing today on COVID-19 flexibilities.

  • Go here to read the opening statement of the committee chair, Senator Ron Wyden (D-OR) and go here to read the opening statement of the committee’s ranking minority member, Senator Mike Crapo (R-ID).
  • Go here to see the testimony of individuals who appeared at the hearing.
  • The Medicare Payment Advisory Commission has submitted a written statement to the committee.  The MedPAC statement notes that “While many of these actions have been helpful in addressing the short-term issues presented by the pandemic, continuing those changes indefinitely would have drawbacks.  Therefore, policymakers should be cautious about extending them beyond the duration of the public health emergency (PHE) or other scheduled expiration date.”  The statement pays particular attention to telehealth and post-acute care.  Go here to see the MedPAC submission “Temporary modifications of Medicare policies in response to the coronavirus public health emergency.”
  • The Government Accountability Office has submitted a report to the Senate Finance Committee on the same subject.  The GAO notes that it undertook this work, titled “Medicare and Medicaid:  COVID-19 Program Flexibilities and Considerations for Their Continuation,” because of a CARES Act provision that calls for the agency to “… conduct monitoring and oversight of the federal government’s response to the COVID-19 pandemic.”  Find the GAO submission here.

Centers for Disease Control and Prevention

COVID-19

Food and Drug Administration

COVID-19

National Institutes of Health

COVID-19

National Academy of Medicine

FEMA

Government Accountability Office

Safety-Net Hospitals Need More COVID Aid, NASH Tells Congress

The federal government should direct more of its remaining CARES Act Provider Relief Fund money to private safety-net hospitals, the National Association of Safety-Net Hospitals told members of Congress in a message delivered yesterday.

While the Provider Relief Fund has been a lifesaver for safety-net hospitals, NASH noted, the formula for distributing money put high-volume Medicaid hospitals at a disadvantage compared to the typical community hospital while separate distributions of the CARES Act money specifically for safety-net providers missed many such hospitals entirely

Last week NASH wrote to Health and Human Services Secretary Xavier Becerra to bring this situation to his attention and seek his assistance, and in its Monday message to members of Congress, NASH asked those members to convey to Secretary Becerra their support for greater aid to private safety-net hospitals in future Provider Relief Fund distributions.

See NASH’s message to members of Congress.

NASH Seeks Changes in Provider Relief Fund Distributions

Concerned that some private safety-net hospitals have not received Provider Relief Fund Phase 3 distributions and that others have not received adequate grants, the National Alliance of Safety-Net Hospitals has written to Health and Human Services Secretary Xavier Becerra to ask for changes in HHS’s approach to the CARES Act grants intended to help hospitals absorb the additional expenses they have incurred and the revenue they have lost as a result of the COVID-19 emergency.

Specifically, NASH urged HHS to:

  • Review the eligibility criteria and methodology for determining Provider Relief Fund grants to ensure that they reach true safety-net hospitals, and in particular those that serve especially large numbers of Medicaid patients.
  • Recalculate Phase 3 grants in a way that better reflects the true financial obstacles safety-net hospitals have faced throughout the COVID-19 emergency.
  • Apply more appropriate criteria and a better methodology for calculating payments in future Provider Relief Fund distributions.

Learn more from NASH’s letter to HHS Secretary Becerra.

NASH Asks HHS for Provider Relief Fund Grants

Phase 3 distributions of Provider Relief Fund grants are long overdue and sorely needed by private safety-net hospitals, the National Alliance of Safety-Net Hospitals has declared in a letter to new Department of Health and Human Services Secretary Xavier Becerra.

NASH’s letter to Becerra notes that the COVID-19 emergency has posed a special challenge to private safety-net hospitals and that in too many cases, those safety-net hospitals have not received appropriate support from the CARES Act’s Provider Relief Fund.  In its letter, NASH asks Secretary Becerra to direct HHS staff to distribute the more than $20 billion remaining in the Provider Relief Fund as soon as possible and to make safety-net hospitals a priority in that distribution.

Learn more from NASH’s letter to Secretary Becerra.

Medicaid Work Requirements on the Way Out?

Medicaid work requirements appear to be going away in the wake of the Supreme Court agreeing to a Biden administration request to postpone arguments in a case brought by the Trump administration seeking to reverse previous court rulings blocking implementation of such requirements.

To date, 12 states have received federal approval to implement Medicaid work requirements although only one such effort, in Arkansas, ever got off the ground.  All of the efforts eventually stalled in the face of legal challenges and administrative obstacles.  Upon taking office, the Biden administration informed the 12 states that it was considering withdrawing their approvals to proceed, and now, the Justice Department has told the Supreme Court that the administration will be reversing the approvals and asked the court not to hear arguments to enable those states to proceed.  As a result, the Supreme Court canceled oral arguments for the case that were scheduled for later this month.

NASH has long been skeptical about Medicaid work requirements, concerned that safety-net hospitals could be left with large amounts of uncompensated care provided to former Medicaid patients who have lost their eligibility for benefits under Medicaid work requirements.

Learn more about the latest development in the long-running effort to introduce Medicaid work requirements – and the almost-as-long campaign to prevent such requirements – in the Healthcare Dive article “SCOTUS drops Medicaid work requirement arguments at Biden administration’s request.”

2019 Change in Public Charge Rule to Disappear

Shortly after taking office the Biden administration stopped enforcing 2019 changes in the so-called public charge rule and now the Supreme Court has agreed to a Justice Department request to dismiss an upcoming case challenging that rule.

The public charge rule, as updated in 2019, calls for all legal immigrants enrolled in Medicaid and certain other safety-net programs to be designated public charges and denied access to permanent U.S. residency and green card status.  Hospitals – including private safety-net hospitals and the National Association of Safety-Net Hospitals – feared that the revised rule would have a chilling effect on the willingness of some legal citizens and legal non-citizens to seek out government health care programs for which they legally qualify.  This, they feared, could lead to many low-income legal citizens and non-citizens choosing not to seek the care to which they are entitled by law and ignoring serious illnesses and injuries until they become a crisis.  This could lead to continuing health problems for such individuals and a potential surge of uncompensated care for the safety-net hospitals to which such individuals turn when their medical conditions absolutely require medical attention – a surge that could jeopardize jobs at those hospitals and access to care in the generally low-income communities safety-net hospitals serve.

Between this action by the Justice Department and the Supreme Court agreement not to hear the case, it appears that the next step will be for the administration, which has already directed its agencies to review such regulations, either to revise or rescind the 2019 changes in the public charge rule.

NASH expressed its opposition to the 2019 changes in the public charge rule on several occasions, including in this letter to the Department of Homeland Security when the changes were proposed and in this 2019 position statement.

Learn more about the public charge rule and recent actions affecting it in the article “Supreme Court agrees to dismiss challenge to Trump public charge rule,” from the online publication The Hill.

NASH Stresses Three Needs From COVID Relief Bill

Extension of the current moratorium on Medicare sequestration.

Additional resources for the Provider Relief Fund.

Another delay in hospital repayment of funds they received from the federal government through the Medicare Accelerated and Advance Payments Program.

These are the three greatest needs of NASH members and private safety-net hospitals that NASH communicated to members of Congress on Thursday afternoon as the Senate begins consideration of the COVID-19 relief bill.

Learn more from NASH’s message to members of Congress.

NASH Unveils 2021 Advocacy Agenda

NASH has introduced its 2021 agenda.

In the coming year, NASH will:

  • Work to ensure that private safety-net hospitals receive the federal resources and regulatory assistance they need to help their low-income, medically underserved communities through the COVID-19 crisis.
  • Advocate the development and implementation of laws, regulations, and programs that enhance the ability of private safety-net hospitals to serve their communities more effectively.
  • Pursue enhanced access to Medicaid and to affordable, high-quality health insurance.
  • Urge Congress and the administration to work with safety-net hospitals and do more to address the social determinants of health to bring about health equity and better health outcomes in diverse and underserved communities.

To see NASH’s complete 2021 advocacy agenda, go here.