The AHA last week urged Congress to act on several critical hospital and health system priorities when it returns after the elections.

“America’s hospitals appreciate the leadership and support many in Congress have shown this year on numerous issues important to patients and the hospitals and health systems that serve them,” wrote AHA Executive Vice President Tom Nickels in letters to the House and Senate. “As the Congress considers year-end legislation, there are five issues in particular where we urge you to take immediate action.”

The specific issues include: addressing the consequences of the 2015 Bipartisan Budget Act on Medicare outpatient payment to hospital-based clinics that were under development at the time of the law’s passage; establishing a socioeconomic adjustment in the Medicare readmissions program; extending the Rural Community Hospital (RCH) Demonstration program; providing “25% Rule” relief for long-term care hospitals (LTCH); and ensuring flexibility in physician supervision for critical access hospitals.

Each issue has been included in legislation introduced during this session and some have already passed one body of Congress, the AHA noted. And all “would have a meaningful impact on access to care,” the association added.

Congress is expected to return to Capitol Hill on Nov. 14.


Off-campus hospital outpatient departments. As the AHA’s letter observed, the House-passed Helping Hospitals to Improve Patient Care Act, H.R. 5273, would revise Section 603 of the budget law to move the grandfather date for off-campus hospital outpatient departments – or HOPDs – under development from Nov. 2, 2015 to Dec. 31, 2016 or 60 days after enactment, whichever is later. Current law reimburses grandfathered facilities at the HOPD rate, while new facilities are capped at the lower Physician Fee Schedule rate.

The AHA called passage of H.R. 5273 a “necessary action.” It will allow “HOPDs that narrowly missed the November 2015 deadline, but will open shortly, to qualify for the higher HOPD rates,” the AHA letter states. “For those select HOPDs that would qualify, this legislation would provide significant relief.”

Because hospital construction projects take a long time to bring to completion, “some HOPDs that were underway on Nov. 2, 2015, will not be completed by Dec. 31, 2016 to qualify for the grandfather,” the AHA said as it expressed its intent to continue working with Congress to address the issue.


Socioeconomic status and Medicare readmissions. The AHA also told lawmakers that H.R. 5273 would revamp Medicare’s readmissions penalties in a way that accounts for socioeconomic and other social risk factors that are beyond hospitals’ control. 

Under the legislation, readmissions penalties would be adjusted by comparing hospitals with similar populations of Medicare and Medicaid patients. Those adjustments would eventually change to a “more refined” method based on federal analysis required by the Improving Medicare Post-Acute Care Transformation Act.


RCH demonstration. H.R. 5273 also would extend for five years the expiring RCH demonstration program. The program helps rural hospitals – those with between 26 and 51 beds – in sparsely-populated states that are too big to qualify for critical access status, but struggle to keep their doors open under Medicare’s prospective payment system. The program tests the feasibility of a cost-based payment model for these hospitals.

 “This program has become vital to participating hospitals and is providing valuable data on potential new model for these vulnerable hospitals,” the AHA told lawmakers.


“25% Rule.” The AHA expressed concern over the “25% Rule” for LTCHs, and urged Congress to pass the Sustaining Healthcare Integrity and Fair Treatment Act, H.R. 5713, which would provide regulatory relief.

Under the current policy, an LTCH is allowed to admit up to 25% of its patients from a single general acute care hospital; for patients admitted past the 25% threshold, an LTCH faces a significant Medicare reimbursement reduction. H.R. 5713 would delay further implementation of the “25% Rule” for LTCHs.


Supervision of outpatient therapeutic services. In its letter, the AHA also called for passage of legislation – in the form of a temporary stopgap measure and permanent regulatory relief – to delay enforcement of a Centers for Medicare & Medicaid Services (CMS) policy that requires a physician or certain non-physician practitioners (NPP) to provide direct supervision of routine outpatient therapeutic services at critical access hospitals and other small rural hospitals.   

Under the direct supervision requirement, relatively simple outpatient procedures like applying a cast or splint to a finger, or administering pulmonary rehabilitations exercise or nebulizer treatments must be furnished under the “direct supervision” of a physician or NPP. That means they must be immediately available to provide assistance and direction during the procedure.

The AHA noted that the Protecting Access to Rural Therapy Services Act, S. 257/H.R. 1611, would require CMS to allow a default setting of general supervision for outpatient therapy services and create an advisory panel to establish an exceptions process for risky and complex outpatient services, among other changes.