America’s Essential Hospitals is the voice for hospitals committed to caring for vulnerable people. Our members also provide vital services to all, such as level I trauma care; train health professionals; deliver comprehensive, coordinated care; and advance public health. We support their innovative efforts to transform hospital care, and we advocate for strong, sustainable federal support for the safety net. These are our recent accomplishments:
Responding to Threats to the Safety Net
In March 2017, as Congress considered potentially devastating policy changes under the American Health Care Act (AHCA), America’s Essential Hospitals mounted a vigorous campaign to protect its members and the safety net. The association applied pressure on Congress through lobbying, data analysis, and media relations to contribute to the bill’s ultimate demise. The association was alone among trade groups with staff in the room for all 27 consecutive hours of committee markups of the bill. Through this diligence, they identified technical errors that could have harmed essential hospital funding, and they persuaded the bill’s drafters to make corrections. The association also often was the first and only hospital group quoted in news accounts of the debate by major national and trade media.
Ensuring Equity in Incentive Programs
America’s Essential Hospitals and its members achieved a major advocacy victory in December 2016 with enactment of the 21st Century Cures Act. The law requires, for the first time, socioeconomic risk adjustment of federal hospital readmissions measures. It mandates that the Centers for Medicare & Medicaid Services (CMS) risk adjust penalties in the Medicare Hospital Readmissions Reduction Program to account for the socioeconomic challenges of vulnerable patients. Next, we will monitor rulemaking closely to ensure regulators apply risk adjustment consistent with the statute.
Fighting Federal Cuts to Medicaid
America’s Essential Hospitals has successfully delayed Affordable Care Act (ACA) cuts to Medicaid disproportionate share hospital (DSH) payments for fiscal years 2014 through 2017, saving essential hospitals $3.5 billion. Cuts through 2020 now are substantially lower than in the original law—down from $17.1 billion to $9 billion today. We also won a requirement for annual federal reporting of uninsured and uncompensated care levels to base DSH funding decisions on evidence.
The harmful Medicaid DSH cuts remain scheduled to start on October 1, 2017. America’s Essential Hospitals is working with congressional leaders and allied organizations to ensure Congress further delays or eliminates the cuts before that date. We also are executing a regulatory strategy through the rulemaking process to mitigate the damage these pending cuts would cause by encouraging CMS to develop a methodology that considers the vital role DSH funding plays in support for essential hospitals.
Ensuring Access to Outpatient Care Services
America’s Essential Hospitals won partial relief from a damaging policy in the Bipartisan Budget Act (BBA) of 2015 that dramatically reduced payments to off-campus hospital outpatient departments established after November 1, 2015. As part of the 21st Century Cures Act, outpatient departments already under development at the time of BBA passage were excepted from the cuts.
While this relief is welcome, many essential hospitals still face economic obstacles to ensuring vulnerable patients and underserved communities have access to outpatient services. The association believes this site-neutral policy should exempt all essential hospital clinics, and we will continue to push for legislation to achieve this goal. We also will work for regulatory changes that protect essential hospitals and their vulnerable patients, including flexibility that would allow outpatient departments established before the law’s enactment to remain exempt from payment cuts if they relocate or change ownership.
Protecting the 340B Drug Pricing Program
The association and its members achieved a significant advocacy victory in January 2017, when the administration withdrew from Office of Management and Budget review potentially damaging 340B program “mega-guidance.” We vigorously opposed the guidance on several fronts, including on Capitol Hill, in regulatory agencies, and in the media, and successfully argued that it would severely narrow the program’s scope and leave many patients without access to lifesaving drugs. We believe these arguments resonated with policymakers.
We will continue to advocate a permanent withdrawal of the mega-guidance and will make this case strongly to the new administration. We will continue to work for policies that strengthen the 340B program and protect program integrity, while ensuring vulnerable patients and their hospitals maintain access to affordable drugs.
Preserving Medicare DSH
The association has worked to preserve Medicare DSH payments for essential hospitals. As the Medicare DSH cuts increase, essential hospitals must stretch their resources further to continue ensuring access to care. We have strongly advocated a freeze on Medicare DSH cuts, which would give Congress time to study the structure, role, and need for Medicare DSH, as well as how the cuts would impact essential hospitals.
Protecting Vital Supplemental Payments
In late May 2016, CMS released the Medicaid managed care final rule, which prohibits states from directing supplemental payments under managed care arrangements. Earlier objections by America’s Essential Hospitals resulted in CMS giving states new latitude on supplemental payments—specifically the ability to establish provider classes (which could include public hospitals, teaching hospitals, or other state-created classifications) that could receive varying levels of supplemental payments. But CMS recently issued a final rule that now significantly limits pass-through payments that the May 2016 rule had deemed permissible during a 10-year phase down of these critical lines of reimbursement. We will follow this regulation and educate members as developments arise.
Fostering Innovation in Medicaid Delivery
We support members’ understanding of and participation in Medicaid Delivery System Reform Incentive Payment program waivers. We advocate the value of these waivers to members and promote information sharing among members and key CMS staff. Educational components include extensive onsite programming at our annual conference, a dedicated annual waiver summit, numerous distance learning opportunities, and research and policy briefs.
Raising the Visibility of Essential Hospitals
America’s Essential Hospitals stands as the nation’s foremost expert and trusted source on Medicaid and hospital care for vulnerable populations. Through proactive media campaigns, the association educates the nation about essential hospitals and the ongoing need to invest in their work to care for vulnerable patients. We also help our members make their voices heard in local and national reports on hospitals and health care. In 2016, the association further raised the visibility of its members on Capitol Hill by establishing the Essential Hospitals Political Action Committee.