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.

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