����������

Dear Secretary Azar and Administrator Verma:

On behalf of our nation’s hospitals and other health care providers, we are writing in response to
the recent agreement between Congress and the Trump Administration regarding the federal
government’s support of hospitals and health care providers as the nation comes together to
collectively respond to and defeat the novel coronavirus (COVID-19).

On Tuesday, the United States Senate passed the Paycheck Protection Program and Health
Care Enhancement Act. The House of Representatives announced plans to pass the Act today,
and the President is expected to sign it soon thereafter. Our organizations deeply appreciate
Congress’ and the Administration’s recognition of COVID-19’s significant, damaging impact on
hospitals and health systems across the country. The Act provides a much-needed infusion into
the Provider Relief Fund, and our members look forward to the Department of Health and
Human Services’ (HHS) swift and well-targeted release of these vital resources.

We understand there will also be efforts to make improvements to the Medicare Accelerated
and Advance Payment Programs. These include significantly lowering the interest rate on such
payments (currently 9.625 percent), increasing the length of the repayment period and
allocating the funds from general revenues rather than from the Medicare Hospital Insurance
Trust Fund.

We strongly support these and other improvements to the Accelerated and Advance Payment
Programs. Such improvements are necessary to ensure that a program designed to address
hospitals’ and other health care providers’ cash-flow issues associated with responding to
COVID-19 does not inadvertently exacerbate these issues once the repayment period begins.
We urge you to promptly exercise the significant existing regulatory and statutory authorities
available to HHS and CMS to make the following changes to the Programs and provide
certainty and stability for hospitals and the patients they serve:

• Increase the amount that can be advanced to hospitals from three or six months ofMedicare payments to 12 months of Medicare payments;
• Extend the period before repayment begins from four months to at least 12 months;
• Reduce the amount of the Medicare claim reduction during repayment from 100 percent to no more than 25 percent
• Extend the repayment period before interest begins to accrue from 12 months to aminimum of 36 months; and
• Waive the interest rate (or the collection of interest); at a minimum, the interest rateshould be no more than two percent.

Hospitals and health systems across the country are struggling financially under the weight of
the COVID-19 pandemic, and will continue to struggle beyond this initial response period. The
changes we have suggested will have a material impact on the ability of our facilities to respond
to COVID-19, plan for the future and continue to provide vital care to our patients and our
communities.

Sincerely,

America’s Essential Hospitals
���������� Association
Association of American Medical Colleges
Catholic Health Association of the United States
Federation of ����������s
National Association for Behavioral Healthcare
Premier healthcare alliance
Vizient, Inc.
cc:
The Honorable Mitch McConnell
The Honorable Nancy Pelosi
The Honorable Charles Schumer
The Honorable Kevin McCarthy