Federal Advocacy (and Update on ACA Repeal/Replacement) January 10, 2017
While the exact timing of when Congress will consider the repeal of all or part of the ACA remains unclear, a budget resolution for reconciliation in the Senate was introduced last week and could be considered this week. It instructs the three key Committees (Senate HELP and Finance and House Energy and Commerce) to make their recommendations for changes to the ACA by January 27th with the goal of getting something to the President by February 20th.
However, this morning, it was suggested this January date could be pushed back to March sometime given there is a movement in the Senate that some Republicans have joined saying that repeal and replace must occur at the same time. Approximately 9 Republicans in the Senate have indicated they will not support a repeal effort without immediate replacement. This is putting pressure on the leadership to rethink the strategy as it could impact the votes necessary to pass a repeal. As they say, the devil is in the details so more to come as details are shared on what such a package may look like, the timing of repeal, etc.
In the interim, it is important for all Members of the CA Delegation to hear from their district/municipal public hospitals on the importance of the ACA – To that end, we urge you to reach out to your Members of Congress THIS WEEK with the following message:
All CA Delegation Members should be contacted – if you need assistance in identifying your Members of Congress, please reach out to Charity Bracy, DHLF Federal Advocate (Cbracy@umich.edu).
Key Members to reach out to given their leadership or Committee Membership include:
Majority Leader Kevin McCarty
Minority Leader Pelosi
Rep Raul Ruiz (Energy and Commerce Committee)
Rep Doris Matsui (Energy and Commerce Committee)
Rep Anna Eshoo (Energy and Commerce Committee)
Rep Mimi Walters (Energy and Commerce Committee)
Rep Scott Peters (Energy and Commerce Committee)
Rep Tony Cardenas (Energy and Commerce Committee)
Rep Jerry McNerney (Energy and Commerce Committee)
Rep Devin Nunes (Ways and Means Committee)
Rep Mike Thompson (Ways and Means Committee)
Rep Linda Sanchez (Ways and Means Committee)
As you make phone calls or send emails, please let DHLF staff now of any feedback or questions you are getting. This will help us with our advocacy efforts.
Federal Hospital Outpatient Site Neutral Payments:
Dear Hospital Colleagues:
As discussed previously, language was included in the signed Federal Budget Act of 2015 that changes the way hospital outpatient clinics, including how District hospital clinics are paid for the services they provide to Medicare patients. The Forum has been working to address this issue, with CHA and others in the industry, over the last several months. To that end, a letter is being circulated by Reps Nunes and Crowley in the House to the CMS Administrator asking for flexibility when they implement this law. It is critical that we get as many co-signers on this letter as possible; The total number target is 218 so securing as many from the California Congressional Delegation will be critical. Please reach out to your Member of Congress immediately and ask for them to sign onto the letter. The deadline is May 13th. The letter is attached to this email.
Background: Under the change in policy, new off-campus outpatient facilities developed or acquired by a hospital will not be reimbursed under the outpatient prospective payment system. Instead, they will be reimbursed under either the Medicare physician fee schedule or ambulatory surgical center prospective payment system, as applicable. The provision (in Section 603) requires “site-neutral” payment reductions for all new hospital outpatient departments located more than 250 yards from the main hospital campus.
The site-neutral provision means that any outpatient service provided by a hospital in a facility off of the main hospital campus will be reimbursed at the same, lower amount paid to physicians beginning January 1, 2017 if it is located more than 250 yards from the main hospital campus. Only outpatient facilities that were operational and billing Medicare before November 2, 2015, will be “grandfathered” under the old rules and will continue to be paid at the existing hospital reimbursement rate. This very limited grandfather provision means that hospitals that are in various stages of project development of outpatient programs, but have not yet completed them, will now be subject to reduced payment rates. It also means that hospitals that have plans to move existing clinics to another location will be subject to reduced payment rates.
This change in reimbursement will mean hundreds of millions dollars annually to hospitals statewide, including District hospitals, and could impact access to care in local communities.
Please let me know if you have any questions.
Support of Waiver Legislation:
The two state bills which will implement Medi-Cal 2020 (and the PRIME program) are set to be heard in the Assembly and Senate Health Committees in late April. Since PRIME is such an important program to district/municipal hospitals, your advocacy team has requested all district/municipal hospitals to weigh in supporting the two bills. A sample letter is attached. If possible, please use the third paragraph as noted to describe the projects (or a sample of the projects if you have several) specific to your hospital. Please put on your hospital letterhead and otherwise personalize as noted or as you would like.
If you have any questions, please let me know. And thank you for taking a moment to put together a letter supporting this program and its associated funding.