Legislative Priorities

The American Hospital Association (AHA) is working diligently on several legislative and regulatory fronts to support operational improvements and program enhancements for critical access hospitals (CAHs). 

KEY ISSUE AREAS

2010

Medicare Program Extensions

On May 20, the AHA was joined by 13 related organizations including the National Rural Health Association in a letter to Congressional leaders of the House and Senate requesting immediate action to address harmful Medicare policies that will go into effect on January 1, 2011 without legislative action in Congress. Many of these Medicare policies have been temporarily addressed by Congress in multiple bills over the past decade including a temporary extension of these provisions for 2010 as part of the recently passed health care reform laws. Without Congressional action by December 31, 2010 these policies will expire and revert back to the detrimental provisions that limit access, beneficiary choice, and provider reimbursement. Therefore, these Medicare extenders must be addressed immediately.
Following is a list of provisions that have been addressed by Congress in the past for which we request action to pass legislation that, at a minimum, will extend policies beyond their current expiration on December 31, 2010.

• Extension of the work geographic index floor and revisions to the practice expense geographic adjustment under the Medicare physician fee schedule. Extends a floor on geographic adjustments to the work portion of the fee schedule through the end of 2010, with the effect of increasing practitioner fees in rural areas. Also provides immediate relief to areas negatively impacted by the geographic adjustment for practice expenses, and requires the Secretary of HHS to improve the methodology for calculating practice expense adjustments.
• Extension of exceptions process for Medicare therapy caps. Extends the process allowing exceptions to limitations on medically necessary therapy.
• Extension of payment for the technical component of certain physician pathology services. Extends a provision that allows independent laboratories to bill Medicare directly for certain clinical laboratory services.
• Extension of ambulance add-ons. Extends bonus payments made by Medicare for ground and air ambulance services in rural and other areas.
• Extension of certain payment rules for long-term care hospital services and of moratorium on the establishment of certain hospitals and facilities. Extends Sections 114 (c) and (d) of the Medicare, Medicaid and SCHIP Extension Act of 2007.
• Extension of physician fee schedule mental health add-on. Increases the payment rate for psychiatric services delivered by physicians, clinical psychologists and clinical social workers by 5 percent.
• Extension of outpatient hold harmless provision. Extends the existing outpatient hold harmless provision and would allow Sole Community Hospitals with more than 100 beds to also be eligible to receive this adjustment.
• Extension of Medicare reasonable costs payments for certain clinical diagnostic laboratory tests furnished to hospital patients in certain rural areas. Reinstates the policy included in the Medicare Modernization Act of 2003 (P.L. 108-173) that provides reasonable cost reimbursement for laboratory services provided by certain small rural hospitals (expires June 30, 2011).

Hospital wage index improvement. Extends reclassifications under section 508 of the Medicare Modernization Act (P.L 108-173).

CRNA Pass-Through Through and Standby Services - H.R. 3151 and S.1585 were introduced to permit pass-through payment for reasonable costs of certified registered nurse anesthetist services in critical access hospitals despite the reclassification of such hospitals as urban hospitals, including hospitals located in "Lugar counties", and for on-call and standby costs for such services

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