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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.

Administration to Review Public Charge Rule

President Biden has ordered a review of the federal public charge rule.

The controversial rule, which would limit immigration to the U.S. for people who might at some point become dependent on public aid programs, has been the subject of litigation since it was proposed in 2019.

The White House executive order directs

…the Secretary of State, the Attorney General, the Secretary of Homeland Security, and the heads of other relevant agencies, as appropriate…[to] review all agency actions related to implementation of the public charge ground of inadmissibility…

The officials were ordered to report their findings to the president within 60 days.

The public charge rule authorizes the U.S. Citizenship and Immigration Services to deny a green card to any immigrant who receives certain public benefits – such as food stamps, public housing vouchers, welfare, or Medicaid – for more than 12 months within any three-year period.  The expressed purpose of the rule is to deny green cards to individuals who may become dependent on publicly funded services – a so-called “public charge.”

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.

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

Implementation of the rule, which was proposed in 2019 and took effect in September of last year, was delayed in November by a federal court.

Learn more about the administration’s latest action in this presidential executive order.

NASH Presents COVID-19 Relief Needs to Congress

The next COVID-19 relief bill should include more resources for the Provider Relief Fund, additional targeted funding for safety-net hospitals, help with staffing, an extension of the current moratorium on the Medicare sequestration, and forgiveness for safety-net hospitals for loans they received under the Medicare Accelerated and Advance Payment Program.

This was the message the National Alliance of Safety-Net Hospitals conveyed this week in a letter to congressional leaders.  See that letter here.

NASH Supports Becerra Nomination to Lead HHS

NASH has expressed its public support for the nomination of Xavier Becerra to serve as the next Secretary of the U.S. Department of Health and Human Services.

In a letter to the chair and ranking minority member of the Senate Finance Committee, which reviews such nominations, NASH wrote that

We worked with Mr. Becerra when he was a member of Congress and served on the House Ways and Means Committee and can attest to his understanding of the distinct challenges low-income and underserved communities face and his sincere interest in using public policy to help address those challenges. We would welcome an opportunity to work with a Secretary who understands these challenges and also understands the underlying health equity challenges that we must address as a nation.

Go here to see NASH’s letter to the Senate Finance Committee.

NASH Writes to President About COVID-19 Plan

NASH has written to President Biden and Vice President Harris to express its support for their planned response to the COVID-19 public health emergency as expressed in the administration’s new “National Strategy for the COVID-19 Response and Pandemic Preparedness.”

NASH also conveyed its support for the strategy’s emphasis on measures to promote health equity in diverse, low-income, underserved communities – the very communities so often served by private safety-net hospitals.

Go here to read NASH’s letter to the President and Vice President.

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.