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FAH Letter to Congress Recommends Future Actions to Protect Access to Care

April 29, 2020 | FAH Policy Blog Team

Category: Legislation, Statement

WASHINGTON - The Federation of American Hospitals recently a letter to congressional leaders outlining recommendations for future COVID-19 relief legislation.

FAH President and CEO Chip Kahn expressed appreciation to congressional leadership and President Trump for acting swiftly to support hospitals on the front lines but emphasized more effort is necessary to assure the resources and regulatory relief are there to keep hospital doors open for our patients.

“Maintaining patient access to hospitals is critical if we are to defeat COVID-19 and provide the care Americans need. Congress can accomplish that goal by focusing future legislation on three important fronts,” Kahn said.

“First, ensure that the resources already allocated are flowing to the right places at the right time and any repayment is fair and reasonable. Second, it is also crucial that we protect health coverage for the newly unemployed so they can continue to get the care they depend on and provide access to affordable health insurance for those currently without it. Third, enact liability protections for caregivers and facilities,” he added.

FAH’s letter, which was sent to House Speaker Nancy Pelosi, Senate Majority Leader Mitch McConnell, House Minority Leader Kevin McCarthy and Senate Minority Leader Chuck Schumer, outlines ways to accomplish these important objectives. They include:

  • Strengthen Programs that Provide Immediate Financial Support to Hospitals
    • Revise the Medicare Accelerated Payments Program Terms
      • Increase the amount hospitals can advance from 3 or 6 months to 12 months
      • Extend the period before repayment begins (currently 120 days) to at least 12 months
      • Reduce the amount of the claim offset from 100% to 25% during the repayment period
      • Extend the repayment period for acute and post-acute providers from 12 months (or 210 days) to a minimum 36 months before hospitals must pay the outstanding balance and before interest begins to accrue
      • Waive the interest; at a minimum the interest rate should be no more than 2%
      • Ensure funding is allocated from general revenues
      • Consider forgiving repayment for hospitals and health systems that are struggling
    • Better Target the Public Health and Social Services Emergency Fund (PHSSEF)
      • Ensure additional funds are available, if needed, based on a triggering event
      • Require distribution of the Fund based on actual extraordinary COVID-19 costs and lost revenues
  • Ensure and Maintain Health Insurance Coverage
    • Eliminate Cost-sharing for Treatment
      • Eliminate out-of-pocket expenses for the treatment of COVID-19 patients
      • Ensure hospitals receive waived cost-sharing (copayments, coinsurance, deductibles) directly from the government or applicable insurer
      • Remove prior authorization requirements related to COVID-19 and post-acute care
    • Maintain Employer-Sponsored Insurance
      • Provide subsidies/tax credits to employers to maintain health coverage for employees
      • Offset the full cost of coverage through COBRA for the recently unemployed
      • Extend the COBRA election period from 60 to 180 days
    • Bolster and Enhance Health Insurance Enrollment for the Unemployed and Uninsured
      • Provide a special enrollment period for the Federally Facilitated Exchanges (FFEs)
      • Waive or reduce premiums for the newly unemployed
      • Expand eligibility for premium tax credits and lower the premium caps associated with the eligibility thresholds
      • Ensure enrollees are not dropped from the Exchanges due to a reduction in income
      • Provide a unique funding allocation for COVID-19 treatment for those remaining uninsured
      • Ensure presumptive and retroactive eligibility for Medicaid
  • Provide Liability Protection for Clinicians and Facilities Responding to the COVID-19 Pandemic
  • Support Frontline Health Care Workers
    • Establish a COVID-19 Medical Professional Loan Forgiveness Program to provide forgiveness or tax credits (if loans are already paid in full) to frontline providers regardless of the tax status of the facility at which they work  
    • Waive location and specialty limitations on health care providers with H-1B and J-1 visas and protect the immigration status of their families in the event of the health care worker’s death or disability due to COVID-19
  • Expand Access to Telehealth/Broadband
    • Ensure tax-paying hospitals’ eligibility for the FCC COVID-19 Telehealth Program and for H.R. 6474, The Healthcare Broadband Expansion During COVID-19 Act
  • Provide Additional Stability to Hospitals and Health Systems
    • Halt finalization of the CMS Medicaid Fiscal Accountability Regulation (MFAR)
    • Ensure COVID-19 temporary hospital beds do not reduce teaching hospitals’ indirect medical education (IME) payment (i.e., do not include those beds in the resident/bed ratio)
    • Adopt S. 3559 / H.R. 6365, Immediate Relief for Rural Facilities and Providers Act
  • Bolster Behavioral Health Funding and Telehealth Coverage
    • Waive the Medicaid IMD Exclusion for at least the duration of the COVID-19 crisis
    • Waive the Medicare 190-day lifetime limit for free-standing psychiatric hospital stays
    • Improve compliance with mental health parity requirements
    • Ensure hospital outpatient departments (HOPDs) can provide and bill for telehealth for outpatient therapy and psychiatry programs
    • Allow critical access hospitals (CAHs) to directly bill for behavioral health telehealth services regardless of their billing method
  • Suspend Payment Impacts of CMS Penalty and Performance-based Payment Programs and Hold Harmless Participants in Alternative Payment Models (APMs)
    • Suspend payment impacts of CMS payment-based performance programs for any fiscal year impacted by COVID-19
    • Hold harmless APM participants (e.g., ACO’s, BPCI-A) from 2020 performance year losses and prohibit CMS from mandating participants move to higher risk levels in 2021 
    • Sunset the Comprehensive Care for Joint Replacement Model (CJR) this December
  • Support Resumption of Medically Necessary Services
    • Enable hospitals to resume scheduled procedures and services to meet the needs of non-COVID-19 patients by increasing access to testing and personal protective equipment

You can find the complete FAH letter here and a summary here.

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