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Summer 2015 Federal Advocacy Issues

Protect vulnerable patient populations by adjusting the readmission program to reflect the link between high readmission rates and socioeconomic factors that play a significant role in the health of a patient after discharge.

  • Co-Sponsor: Establishing Beneficiary Equity in the Hospital Readmission Program Act (H.R. 1343 / S. 688)—This legislation would reform the Hospital Readmissions Reduction Program (HRRP) to ensure hospitals serving low-income populations are properly evaluated and reimbursed fairly by requiring the Centers for Medicare & Medicaid Services (CMS) to account for patient socio-economic status when calculating the risk-adjusted readmissions penalties.

Reduce inappropriate and avoidable legal and administrative costs on hospitals through reforms to the Recovery Audit Contractor (RAC) program that ensure fair and accurate audits and promote greater payment accuracy.

  • Co-Sponsor: Medicare Audit Improvement Act (H.R. 2156)—This legislation would address misaligned financial incentives that promote overzealous auditing practices, establish transparent methodology to review RAC performance, allow hospitals to rebill for medically necessary care, and review claims based on the medical documentation available when the patient was being treated.

Preserve access to care in small and rural communities by addressing regulatory policies encumbering the delivery of essential services by rural hospitals.

  • Co-Sponsor: Critical Access Hospital Relief Act (H.R. 169 / S. 258)—This legislation would repeal the 96-hour condition of payment, which requires physicians to certify that patients admitted to a critical access hospital (CAH) will be discharged or transferred to another hospital within 96 hours. While CAHs typically maintain an annual average of 96 hours per patient, they offer some medical services that have standard lengths of stay greater than 96 hours. Enforcement of the policy may threaten patients’ access to care.
  • Co-Sponsor: Protecting Access to Rural Therapy Services Act (H.R. 1611 / S. 257)—This legislation would adopt a default standard of “general supervision” for outpatient therapy services and establish an exceptions process for procedures that require direct supervision. General supervision would allow the services to be performed under the overall direction and control of a physician or non-physician practitioner; direct supervision requires a supervising physician or non-physician practitioner to be immediately available whenever a Medicare patient receives therapeutic services.
    • H.R. 2878 / S. 1461—This legislation would provide a one-year moratorium of the physician supervision requirements.

Provide for fair and consistent review of transactions by federal antitrust agencies.

  • Co-Sponsor: Standard Merger and Acquisition Reviews Through Equal Rules (SMARTER) Act (H.R. 2745)—This legislation would address differences in the standards and process used by the U.S. Department of Justice (DOJ) and the Federal Trade Commission (FTC) in reviewing merger transactions by harmonizing preliminary injunction standards and ensuring the FTC does not pursue administrative litigation following judicial denial of a preliminary injunction request.

Support medical liability reform efforts that will promote greater patient safety, ensure continued access to critical services, and lower the cost of care.

  • Co-Sponsor: Health Care Safety Net Enhancement Act (H.R. 836 / S. 884)—This legislation would ensure medical services furnished by a hospital, emergency department, or physician or on-call provider under contract with a hospital or emergency department pursuant to the EMTALA mandate, are provided the same liability coverage (through the Federal Tort Claims Act) currently extended to Community Health Centers and health professionals who provide Medicaid services at free clinics.

Address the health care workforce challenges presented by increased demand for care resulting from an aging population, longer lifespans, increased health care utilization, improved health care access, and a growing population.

  • Co-Sponsor: Resident Physician Shortage Reduction Act (H.R. 2124 / S. 1148)—This legislation would begin to address the looming physician shortage by increasing the number of residency slots nationally by 15,000 slots from 2017 through 2021, and require half of the available slots to be used to train residents in shortage specialty residency programs.
  • Co-Sponsor: Making the Education of Nurses Dependable for Schools (MEND) Act (H.R. 977 / S. 629)—This legislation would preserve support for nurse education programs that play a key role in contributing to the nurse workforce by aligning accreditation and regulatory requirements for hospital-based programs receiving Medicare “pass-through” payments.

Improve access to behavioral health services and integration with physical health care in order to address acute and preventative needs.

  • Co-Sponsor: Improving Access to Emergency Psychiatric Care Act (S. 599)—This legislation would improve access to and the quality of emergency psychiatric care, and reduce the strain on community hospital emergency departments by extending the Medicaid Emergency Psychiatric Demonstration Program, which allows federal matching payments to freestanding psychiatric hospitals for emergency psychiatric care.


The Medicare Access and CHIP Reauthorization Act (MACRA) takes strides to allow hospitals to continue leading the transformation of the health care delivery system.

  • Permanently repeals the sustainable growth rate formula, providing greater certainty for health care providers and patients, and provides positive payment updates for physician services in each of the years 2015 through 2019, and incentivized updates thereafter.
  • Offers stability for hospitals supported by the Medicare-Dependent Hospital (MDH) program and Low-Volume (LV) adjustment by extending the programs through October 1, 2017.
         —  HAP supports the Rural Hospital Access Act (H.R. 663 / S. 332), which would support hospitals serving a large population of Medicare beneficiaries and smaller communities with limited patient volume, through a permanent extension of the MDH and LV programs.
  • Extends the two-midnight enforcement delay through September 2015, which will allow additional time to craft an appropriate payment methodology for short hospital stays.
  • Delays Medicaid Disproportionate Share (DSH) cuts until fiscal year 2018 to allow health care coverage improvements to be fully realized.
  • Continues funding for the Children’s Health Insurance Program (CHIP) through fiscal year 2017, which will promote continuity of care.
  • Enacts standards of care liability reform to ensure the establishment or implementation of any guideline or standard of a federal health care law shall not be construed to establish the standard of care or duty of care for the purposes of medical liability claims.
  • Extends the therapy cap exceptions process until January 1, 2018, to ensure patients have access to necessary therapy services.
  • Extends a 3.0 percent add-on to payments made for home health services provided to patients in rural areas through January 1, 2018.
  • Removes impediments to improving care by eliminating certain civil monetary penalties for inducements to physicians to limit services that are not medically necessary.
  • Requires a study and report on physician-hospital gainsharing, which allows hospitals and physicians to partner in quality improvements.

The Centers for Medicare & Medicaid Services (CMS) released a proposed rule in April that would offer flexibility for health care providers in adopting health information technology. The rule would modify the reporting period for the Medicare & Medicaid Electronic Health Records (EHR) Incentive Program during 2015 to a 90-day period aligned with the calendar year.

  • HAP supports the Flexibility in Health IT Reporting (Flex-IT) Act (H.R. 270), which would ensure CMS moves forward in offering targeted relief for hospitals and eligible professionals advancing meaningful use of EHR by shortening the 2015 reporting period to 90 days.

Download a copy of the Summer 2015 Federal Advocacy Issues

August 2015

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