Working to Enact Key Priorities in Year-end Legislation to Ensure Patient Access to Care
December’s holiday rush is in full swing on Capitol Hill as Congress returned to Washington this week facing a long list of to-dos and a short time to do them. The Dec. 20 deadline to fund the government is quickly approaching, and lawmakers also hope to reach agreement on several other issues including disaster aid and farm bills before the end of the year.
At this time, a short-term continuing resolution to fund the government into the early part of 2025 appears most likely, and we continue to work with Congress to include priority issues that are important to hospitals’ ability to provide the 24/7 access to care patients and communities depend on.
Our recent letter to leaders in the House and Senate highlights some of the top issues we are focused on, including:
Continued Relief from Medicaid DSH Cuts. Without congressional action, $8 billion will be cut from the Medicaid Disproportionate Share Hospital program on Jan. 1, severely jeopardizing hospitals’ finances and impacting their ability to care for our nation’s most vulnerable populations — children, impoverished, disabled and elderly.
Protect Rural Communities’ Access to Care. Congress should continue the Medicare-dependent Hospital and Low-volume Adjustment programs that provide rural, geographically isolated and low-volume hospitals additional financial support to ensure rural residents have access to care.
Reject So-called Site-neutral Payment Proposals. Congress should reject efforts to expand site-neutral payment cuts to include essential drug administration services furnished in off-campus hospital outpatient departments (HOPDs). Current Medicare payment rates appropriately recognize that there are fundamental differences between patient care delivered in HOPDs compared to other settings.
Extend Telehealth and Hospital-at-home Waivers. Congress should extend telehealth and hospital-at-home programs as these innovative efforts have expanded access for millions of Americans and allowed patients to receive high-quality care more conveniently.
Prevent Reimbursement Cuts for Physicians. Congress should mitigate the scheduled physician reimbursement cuts for 2025 and continue its work on broader reform for sustainable physician payment.
Protect America’s Health Care Workers. Congress should enact the Safety from Violence for Healthcare Employees (SAVE) Act, which would provide federal protections from workplace violence for hospital workers, similar to the protections in current law for airport and airline workers.
Streamline Prior Authorization Process. Congress should pass widely supported bipartisan legislation that would streamline the prior authorization process in the Medicare Advantage (MA) program by eliminating complexity and reducing the wide variation in prior authorization methods that frustrate both patients and providers.
While we push for MA legislation, we continue to make progress on the regulatory front on this issue. We were pleased the Centers for Medicare & Medicaid Services last week released a proposed rule that builds upon prior rulemaking to strengthen limitations on commercial insurer use of internal or proprietary coverage criteria that are more restrictive than Traditional Medicare and can compromise enrollee access to Medicare-covered services. The rule also would increase oversight of prior authorization and utilization management tools, apply important guardrails on insurer use of artificial intelligence, and update medical loss ratio reporting requirements to ensure appropriate oversight of vertically integrated insurers, among other policies.
With only a few weeks left in the 118th Congress, please see our recent Action Alert that has resources you can use to weigh in with your legislators on these important issues. Also, please know the AHA also is hard at work preparing for the incoming Administration and Congress as we expect them to hit the ground running next year.