2021 AHA Advocacy Agenda

By all accounts 2020 was an unprecedented and historic year – one that tested our nation, our economy and our health care system like never before.

Download the 2021 AHA Advocacy Agenda

Hospitals and health systems – along with our doctors, nurses and other team members – have been on the front lines of the COVID-19 pandemic, working tirelessly to provide the best care for patients, families and communities. They have done this and continue to do this while facing daunting challenges … many of which persist today and are likely to continue for some time.

In addition, in the middle of the pandemic, a record number of Americans cast their ballots and exercised their sacred right to vote. Our joint focus with the new Congress and Administration is on providing relief, ensuring a smooth recovery and rebuilding a better health care system for the future. In addition, we need to address ongoing challenges that have been further exacerbated during the pandemic, including issues related to health equity, workforce resilience and behavioral health.

The American Hospital Association’s 2021 advocacy agenda seeks to continue to positively influence the public policy environment for patients, communities and the health care field. Our agenda focuses on:

Supporting the fight against COVID-19
Advancing affordability in health care
Sustaining the gains in health coverage
Protecting patients’ access to care
Advancing health system transformation
Enhancing quality, patient safety and equity

We will work hand in hand with our members; the state, regional and metropolitan hospital associations; national health care organizations; and other stakeholders to develop and implement an advocacy strategy to fulfill our vision.

Specifically, we urge Congress and the Administration to . . .

SUPPORT THE FIGHT AGAINST COVID-19
- Ensure the declaration of a public health emergency (PHE) continues through the duration of the COVID-19 crisis to safeguard needed flexibilities, including critical 1135 waivers.
- Provide appropriate liability protections for facilities and front-line medical providers treating patients amid the COVID-19 crisis.
- Ensure state Medicaid programs have the resources they need by providing enhanced federal funding during the PHE, including through an increase to both the Federal Medical Assistance Percentages (FMAP) and the Disproportionate Share Hospital (DSH) program.
- Protect against loss of Medicaid coverage during the PHE by rescinding recent rules that weaken maintenance-of-effort protections for Medicaid enrollees and allowing states to delay Medicaid eligibility recertification during this time.
- Expand coverage and zero-cost-sharing for COVID-19 treatment, in addition to prevention, testing and testing-related services, as is already required by federal law. Apply this in all forms of public and private coverage.
- Ensure access to coverage for the uninsured and those who lose their job-based coverage by covering Consolidated Omnibus Budget Reconciliation Act (COBRA) costs, increasing eligibility for federal Health Insurance Marketplace subsidies and establishing a special enrollment period for the Marketplaces coverage.
- Provide additional money to the Provider Relief Fundto help ensure hospitals and health systems have resources to better prevent, prepare for, and treat COVID-19, such as by covering lost revenue, purchasing supplies and equipment, standing up emergency testing centers, and construction and retrofitting of facilities. In addition, ensure that the rules governing the use of these funds provide needed flexibility.
- Support state efforts to expand scope of practice laws, allowing non-physicians to practice at the top of their licenses.
- Reauthorize nursing workforce development programs to support recruitment, retention and advanced education for nurses and other allied health professionals.
- Promote medical licensure reciprocity to allow practitioners to work across state lines.
- Address physician shortages, including shortages of behavioral health providers and providers of color, by increasing the number of residency slots eligible for Medicare funding and rejecting reductions to Medicare funding for direct and indirect graduate medical education.
- Foster wellbeing for physicians, nurses and others so they can deliver safe and high-quality care by providing additional funding and flexibility for behavioral health needs and funding for best practices to prevent burnout.
- Make permanent certain telehealth flexibilities, including lifting geographic and originating site restrictions, allowing Rural Health Clinics and Federally Qualified Health Centers to serve as distant sites, expanding practitioners who can provide telehealth, and allowing hospital outpatient billing for virtual services, among others.
- Enhance payments for behavioral telehealth services rendered during the pandemic.
- Increase annual appropriations for the Hospital Preparedness Program (HPP) to at least $515 million and ensure that the majority of the HPP funding is awarded to hospitals and health systems in order to develop, update and sustain their emergency preparedness and surge capacity.
- Provide flexibility in quality measure programs by temporarily waiving quality reporting in time periods most affected by the pandemic, and ensuring the Centers for Medicare & Medicaid Services (CMS) can waive readmissions and Hospital-Acquired Conditions’ penalties for those fiscal years whose performance periods were affected by COVID-19.
- Partner with Department of Health and Human Services (HHS) and other stakeholders to ensure hospitals and health systems are empowered and have resources to participate effectively in the national effort to vaccinate Americans against COVID-19.
- Implement a communication effort on vaccine safety, particularly among segments of the population who justifiably mistrust such efforts, and ensure tracking to understand better long-term outcomes and effectiveness.
- Ensure the availability of personal protective equipment, breathing support devices and other resources needed to fight the pandemic.
ADVANCE AFFORDABILITY IN HEALTH CARE
- Ensure that regulations to implement surprise medical billing protections for patients result in timely and reasonable reimbursement to providers to maintain patient access to care.
- Support price transparency efforts by ensuring patients have access to the information they need to make informed health care decisions, including their expected out-of-pocket costs when appropriate, and exercise enforcement discretion through the PHE and take actions to permanently rescind the rules requiring the disclosure of privately-negotiated rates between hospitals and payers as they will introduce widespread confusion, accelerate anticompetitive behavior among health insurers and inhibit innovations in value-based care delivery.
- Ensure patients and providers can access critical drug therapies by establishing fair and sustainable drug pricing practices and reimbursement mechanisms.
- Protect the 340B drug savings programto ensure vulnerable communities have access to more affordable drug therapies by reversing harmful policies and holding drug manufacturers accountable to the rules of the program, especially as it relates to community pharmacy arrangements.
- Test new approaches to delivering high-quality care at lower costs through alternative payment models, including expanding access to non-medical services that impact health, experimenting with using technology in new and innovative ways, and providing training and education to support effective rollout.
- Enact technological, legislative and regulatory solutions to reduce administrative waste, such as by streamlining prior authorization requirements and processes for hospitals and post-acute care providers, so that clinicians can spend more time on patients rather than paperwork.
- Promote greater efficiency and safeguards against unnecessary burden in HIPAA administrative standards and other rules related to billing and ensure an achievable roadmap toward greater adoption of standard transactions.
- Reduce unnecessary costs in the system by passing comprehensive medical liability reform, including caps on non-economic damages and allowing courts to limit attorneys’ contingency fees.
SUSTAIN THE GAINS IN HEALTH COVERAGE
- Preserve the gains in health coverage made over the past decade and further expand coverage.
- Expand Medicaid in states that have not yet expanded.
- Ensure the stability and affordability of the Health Insurance Marketplaces by expanding eligibility for and the level of subsidies, implementing a reinsurance program, ensuring sufficient federal outreach and enrollment efforts, and protecting consumers from health plans that do not meet all of the consumer protections established in federal law, such as health sharing ministries and shortterm limited duration coverage products.
- Ensure patients can access all of the services necessary to get and stay healthy by protecting access to a minimum set of essential health benefits and enforcing existing federal parity laws to ensure coverage for physical and behavioral health benefits, including substance use disorder treatment.
- Encourage states to extend coverage and care to their population through expansion of innovative state waivers (section 1115 and 1332 waivers) with appropriate safeguards against eligibility reductions and cost-sharing increases as well as better integration of social and health services.
- Repeal the Medicaid Institutions for Mental Disease (IMD) exclusion, which prohibits the use of federal Medicaid funds to cover inpatient mental health services for patients aged 21 to 64 in certain freestanding psychiatric facilities.
- Eliminate Medicare’s 190-day lifetime limit for inpatient behavioral psychiatric admissions.
- Protect against reductions in the number of insured by advancing solutions to improve the sustainability of public coverage through the Medicaid program, including protecting non-DSH supplemental payments, provider assessments, intergovernmental transfers and certified public expenditures.
- Rescind or withdraw policies that could result in coverage losses, such as the Public Charge Rule.
- Ensure care for veterans by working with hospitals and health systems and the Department of Veterans Affairs as they implement the next generation of comprehensive community care for veterans.
PROTECT PATIENTS’ ACCESS TO CARE
- Ensure that essential health care services are available in all communities by protecting vital federal funding for Medicare, Medicaid, the Children’s Health Insurance Program and the Health Insurance Marketplaces.
- Protect rural communities’ access to care by preserving and improving Medicare rural hospital designations, including re-opening the necessary provider critical access hospital (CAH) designation, removing the 96-hour condition of payment for CAHs and clarifying and facilitating co-location policy compliance.
- Ensure patient access to primary care and other outpatient services by rejecting additional payment cuts that don’t recognize legitimate differences among provider settings (also known as site-neutral payment policies).
- Modernize the Improving Medicare Post-acute Care Transformation (IMPACT) Act of 2014 to ensure the unified payment model for post-acute care is required to reflect both new insights from the pandemic and the major payment reforms underway for the existing post-acute care payment systems.
- Eliminate cuts that will result in long-term care hospital site-neutral payments falling even further below the cost of providing care, which will jeopardize access for these medically complex patients.
- Ensure stability for providers in post-acute care settings by avoiding new payment reductions or administrative burdens that would magnify the challenges of managing the COVID-19 response plus the major payment reforms currently underway.
- Continue to fight for improvements to Office of Inspector General audits, including of inpatient rehabilitation facilities (IRFs), which routinely contain significant errors and inaccurate recommendations.
- Encourage CMS to change its approach to its recently proposed Review Choice Demonstration for IRFs. Rather than using an across-the-board approach that impacts all IRFs in the four initial target states, CMS should use data analysis to forgo auditing providers with no indication of inappropriate practices.
- Call upon the Department of Justice’s Antitrust Division to take advantage of the elimination of the McCarran-Ferguson Act antitrust protection for commercial health insurers by more actively challenging their anticompetitive conduct.
- Protect not-for-profit hospitals’ tax-exempt status.
- Prevent and mitigate drug shortages by strengthening requirements for drug manufacturers to disclose the root causes and expected duration of shortages; extending reporting requirements to active pharmaceutical ingredients manufacturers; and requiring manufacturers have contingency plans to ensure ongoing supply.
ADVANCE HEALTH SYSTEM TRANSFORMATION
- Explore the creation of some form of predictable, upfront pre-payment by government payers to improve the financial stability of hospitals and health systems.
- Build on the progress in modernizing the Stark Law and Anti-kickback Statute regulations that better protect arrangements that promote value-based care.
- Expand use of telehealth, broadband and new technologies by providing Medicare and Federal Communications Commission funding, coverage, and reimbursement for such services, technology and workforce training.
- Allow providers to determine how best to utilize electronic health records (EHRs) and other technologies while promoting interoperability and access to health information for clinical care and patient engagement.
- Provide robust incentives to ensure electronic communication between acute care hospitals and psychiatric hospitals and providers, and to assist psychiatric hospitals and mental health providers to optimally use EHRs.
- Advance use of innovative technologies and software (e.g., clinical decision support algorithms) without increasing regulatory burden by supporting policies that enable clinicians to have the data they need to treat patients and improve health outcomes.
- Invest in health care infrastructure by expanding access to virtual care technologies and rural broadband, strengthening the capacity and capability for emergency preparedness and response, assisting hospitals in “right-sizing” to meet the needs of their communities, and ensuring adequate financing mechanisms are in place for hospitals and health systems, including for training the workforce.
- Develop and refine payment models that address health equity and the social determinants of health, such as improvements to the Center for Medicare and Medicaid Innovation Accountable Care Communities 2.0 model.
- Advance rural health care alternatives to ensure sustainable care delivery and financing including: exploring rural pre-payment models; supporting additional inpatient/outpatient transformation strategies; promoting virtual care strategies; allowing innovative partnerships; and refining existing models that support hospitals serving vulnerable communities.
- Explore a new payment mechanism for vulnerable urban critical access hospitals that treat a disproportionate number of government funded or uninsured patients.
- Implement policies to better integrate and coordinate behavioral health services with physical health services.
- Assist in protecting health care services, data and patients from cyberattacks while supporting efforts to increase government cybersecurity assistance and information sharing.
- Promote the value of coordinated systems of care.
ENHANCE QUALITY, PATIENT SAFETY AND EQUITY
- Continue to streamline and coordinate quality measures in national programs to focus on the “measures that matter” most to improving health and outcomes while reducing burden on providers. These measures should be based on evidence that demonstrates meaningful improvements in patient outcomes are achievable by improving adherence to the measures.
- Advocate for improved conditions of participation, interpretative guidance and Joint Commission standards that hold hospitals accountable for taking actions that lead to higher-quality and safer care. Eliminate additional conditions of participation for behavioral health hospitals.
- Pursue strategies and support public policies aimed at improving maternal and child health outcomes with a particular focus on eliminating racial and ethnic disparities.
- Enhance the effectiveness of the physician quality payment program by advocating for more accurate and meaningful cost measures and data-driven implementation of new program approaches.
- Promote inclusion of adjustment for sociodemographic factors in quality measurement programs where appropriate to ensure fair performance comparisons and payment adjustments.
- Support coordinated collection of race and ethnicity data across federal agencies to elevate understanding of health care needs in communities of color.
- Increase funding for the health equity infrastructure in the Department of Health and Human Services, including the National Institute on Minority Health and Health Disparities, to better research and address the needs of communities of color.
- Promote health equity by encouraging cultural competency training in medical residency programs and in-service training for health care professionals.
- Support efforts to increase diversityin the health care workforce, including through federal grants to minority-serving institutions for scholarships.
- Repeal the June 2020 final rule that narrowed the scope of non-discrimination protections under Section 1557 of the Affordable Care Act.
- Rescind Executive Order 13950, Combating Race and Sex Stereotyping, which has a detrimental effect on diversity and inclusion training in federal agencies, grantees, contractors and beyond.
- Promote advanced illness managementto better honor patients’ wishes at the end-of-life and remove barriers to expanding access to palliative care services.
- Enhance care coordination and improve patient safety by implementing through rulemaking Sec. 3221 of the Coronavirus Aid, Relief, and Economic Security (CARES) Act, which revises and better aligns the outdated 42 CFR Part 2 regulations with HIPAA, allowing the responsible sharing of substance use disorder treatment records for the purposes of treatment, payment and health care operations.

Please visit www.aha.org/advocacy/action-center to get involved and learn more about the American Hospital Association’s 2021 public policy advocacy agenda.