Federal Legislative Priorities: Fall 2019
Surprise Balance Billing
H.R. 3630, the No Surprises Act, and S. 1895, the Lower Health Care Costs Act, both contain language intended to protect patients from balance billing, when a patient is billed for the difference between what a provider bills and the insurance company pays. But the legislation defines how providers will be paid—rate-setting—by establishing a benchmark rate, which HAP opposes. HAP has advocated to protect patients from surprise medical bills by prohibiting balance billing and holding patients harmless to in-network cost sharing obligations. HAP urges Congress to protect patients first, and allow providers and insurers to resolve payment disputes without government interference, such as rate-setting. HAP also has emphasized that Congress should not impose new requirements that place a significant burden on health care providers that are not meaningful to patients.
Medicaid Disproportionate Share Hospital (DSH) Program Cuts
The Medicaid Disproportionate Share Hospital (DSH) program provides payments to hospitals that serve a high proportion of Medicaid beneficiaries and uninsured patients. The payments are essential for hospitals to offset their uncompensated care costs from treating low-income patients. A series of payment cuts are scheduled for Fiscal Years 2020 through 2025, beginning with a $4 billion reduction during 2020. HAP opposes the deep payment cuts, which if put in place, would reduce Pennsylvania’s Medicaid DSH allotment by approximately $242 million during FY 2020.
Preserving Payments for Legitimate Differences Between Sites of Care
A recent payment policy issued by the Centers for Medicare & Medicaid Services (CMS) expands the application of so-called “site-neutral” payments, cutting the payments hospitals receive for outpatient clinic visits.
So-called “site-neutral” payments policies reimburse hospitals for services across various sites of services at payment levels irrespective of the critical role hospitals play in our health care system—providing emergency standby services and specialized services such as trauma, psychiatric, obstetrics, and pediatric emergency care; treating more vulnerable patients; adhering to strict regulatory requirements that protect health and safety; and serving as the backbone of our emergency preparedness infrastructure.
The hospital community challenged the payment policy and a federal judge has ruled in favor of the American Hospital Association and other hospital plaintiffs, saying CMS did not have the authority to implement these new site-neutral payment cuts. Despite the judge's ruling, the 2020 final rule for the Medicare Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment System and quality reporting programs retained a two-year phase-in of the “site neutral” policy. The rule takes effect January 1, 2020.
340B Drug Pricing Program
The 340B Drug Pricing Program helps hospitals that care for large numbers of uninsured and low-income patients and serve rural communities to manage the impact of high cost drugs by purchasing discounted medications from drug manufacturers. Savings are used to increase access to care or help patients secure prescription drugs at significantly reduced costs, or no cost at all. A 2018 Medicare regulation implemented reductions in the amount of the savings hospitals can recoup and reinvest in health care. The 2020 final rule for the Medicare Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment System and quality reporting programs continues to reduce hospital reimbursement by maintaining a nearly 30 percent pay cut to certain participants in the federal 340B Drug Pricing Program, despite a federal judge's ruling against the reductions during both 2018 and 2019. HAP opposes the reductions that undercut the value of a crucial program helping hospitals and patients manage the burden of high prescription drug costs.
HAP urges 340B hospitals to sign the 340B Good Stewardship pledge.
Get more details about these federal priorities and other key health care issues at the HAP Resource Center.