/ en Sun, 15 Jun 2025 11:53:48 -0500 Sun, 08 Jun 25 18:00:41 -0500 <div class="container"><div class="row"><div class="col-md-8"><p>As we noted in our <a href="/advisory/2025-06-06-white-house-issues-presidential-memorandum-eliminating-waste-fraud-and-abuse-medicaid">June 6 Member Advisory</a>, the Administration is signaling it will make changes to State Directed Payment (SDP) programs used by managed care plans and how the payment rates for providers, including hospitals, are calculated. This change in regulatory policy could undermine legislative language in the reconciliation package passed by the House – H.R. 1, the One Big Beautiful Bill Act – on May 22. The Senate is currently reviewing H.R. 1, and draft text for the Senate Finance Committee, which has jurisdiction over taxes and Medicaid, could come as soon as this week. <strong>We understand there are efforts in the Senate to further restrict SDPs and provider taxes.</strong></p><p>The June 6 <a href="https://www.whitehouse.gov/presidential-actions/2025/06/eliminating-waste-fraud-and-abuse-in-medicaid/" target="_blank" title="The White House Presidential Actions: Eliminating Waste, Fraud, and Abuse in Medicaid">Presidential memorandum</a> outlines the Administration’s intent to ensure the Medicaid program does not pay providers through SDPs at rates which are higher than Medicare, though many states have in place payment levels that may exceed Medicare and are closer to average commercial rates (ACR). The House-passed reconciliation bill would allow for a grandfathering of existing rates, which reimburse providers above the Medicare payment level for Medicaid services, upon enactment of the legislation. It is important to note current law requires Medicaid payment for providers to be sufficient to ensure beneficiary access to services and SDPs are used to augment historically low Medicaid provider payments, including for critical community services such as maternal and behavioral health. Without supplemental payments, Medicaid fee-for-service payments in 2023 nationally paid 58 cents for every dollar that hospitals spent caring for Medicaid patients, and Medicaid managed care organizations paid 65 cents. In total, including supplemental payments, Medicaid paid hospitals $27.5 billion less than hospitals spent providing care to Medicaid beneficiaries.</p><p>The provider tax provisions in H.R. 1 disallow federal matching funds for state provider taxes that were increased (in amount or rate) after the date of enactment. This would significantly limit states’ ability to finance Medicaid using provider taxes, placing pressure on state budgets that would compound over time. Over time, the restrictions on this legitimate, vital funding tool will lead to diminished critical resources to support Medicaid beneficiaries. There are efforts in the Senate to further restrict the use of provider taxes, including by lowering the safe harbor threshold below 6% and fixing the annual revenue amount the tax currently raises into perpetuity.</p><p><span><strong>TAKE ACTION:</strong></span><strong> Please contact your senators and urge them to oppose any efforts to further weaken SDP and provider tax provisions as passed by the House. Changes under consideration by the Senate would deteriorate hospital Medicaid reimbursement rates and threaten access for all patients.</strong></p><h2>June 5 Action Alert, AHA Resources, and Upcoming Advocacy Day</h2><p>The AHA last week shared an Action Alert with new resources for hospital and health system leaders to use in conversations with their senators as they advocate for protecting Medicaid, the Affordable Care Act coverage gains, and access to health care and services in communities. <strong>Please see the </strong><a href="/action-alert/2025-06-05-act-now-ask-your-senators-protect-medicaid-and-access-care?utm_source=newsletter"><strong>June 5 Action Alert</strong></a><strong> for key messages and resources.</strong></p><p>In addition, if you haven’t registered yet, you can still make plans to join the AHA and hospital and health system leaders from across the country in Washington, D.C., June 17 for an AHA Advocacy Day. <a href="https://forms.office.com/pages/responsepage.aspx?id=QJMRube-Xk6EsjzBj3s2pnUzMzymJWtHjxrQd2BoFRpUNDNVUkdGWjYyRlJJTUNUVU8wWjVBNTRNWC4u&route=shorturl" target="_blank" title="AHA Advocacy Day Tuesday, June 17, 2025, Registration">Register today.</a></p><h2>Further Questions</h2><p>Visit the <a href="/advocacy/action-center">AHA Action Center</a> for more resources on these issues and other priorities important to hospitals and health systems. If you have further questions, please contact the AHA at 800-424-4301.</p></div><div class="col-md-4"><a href="/system/files/media/file/2025/06/ACT-NOW-Ask-Your-Senators-to-Protect-Medicaid-Payment-Rates-in-Reconciliation-Package.pdf"><img src="/sites/default/files/inline-images/ACT-NOW-Ask-Your-Senators-to-Protect-Medicaid-Payment-Rates-in-Reconciliation-Package-Page-1.png" data-entity-uuid="18ef82be-e2cf-4d13-b324-531a670bd428" data-entity-type="file" alt="Action Alert: ACT NOW: Ask Your Senators to Protect Medicaid Payment Rates in Reconciliation Package." width="695" height="900"></a></div></div></div> Sun, 08 Jun 2025 18:00:41 -0500 Member Non-Fed <div class="container"><div class="row"><div class="col-md-8"><p>The Departments of Labor, Health and Human Services, and the Treasury last week <a href="https://www.cms.gov/newsroom/press-releases/departments-labor-health-and-human-services-treasury-announce-move-strengthen-healthcare-price" title="Original URL: https://email.advocacy.aha.org/NzEwLVpMTC02NTEAAAGamPoobTykTl-7UWk9Aq_FCPDmvKVQm1NiC4yrfUT5irYfuTpqwsGoI9H2Ke-FprifWnEbC-w=. Click or tap if you trust this link.">released</a> several new guidance documents and requests for information (RFIs) on price transparency, following the February <a href="/news/headline/2025-02-26-administration-issues-executive-order-hospital-price-transparency" title="Original URL: https://email.advocacy.aha.org/NzEwLVpMTC02NTEAAAGamPoobZhvM6A6LPvxeyjTzOnFzUO3Do1TH7HM58st2c2MCd9eQbpWlVPj182ndkyQ6gAJj9M=. Click or tap if you trust this link.">executive order</a> on the same subject.</p><p>As part of this package, the Centers for Medicare & Medicaid Services (CMS) released <a href="https://www.cms.gov/files/document/updated-hpt-guidance-encoding-allowed-amounts.pdf">new guidance</a> on calculating the estimated allowed amount values in the hospital machine-readable files. Whenever possible, hospitals should continue to use the average dollar amount received over the last 12-month period (or less, if the payment methodology was only used for part of the year), which should be derived from the electronic remittance data. However, going forward, if there is not enough historic data to calculate an average, hospitals should use an expected payment amount, encoded as a dollar figure. This replaces previous guidance that allowed hospitals to use a code of nine 9s to signify that there was not sufficient historic data for that item or service over the last year. In the guidance, CMS expressed its concern that the machine-readable files featured nine 9s more frequently than expected.</p><p>At the same time, CMS released an <a href="https://www.cms.gov/priorities/key-initiatives/hospital-price-transparency/accuracy-and-completeness-rfi">RFI</a> on hospital price transparency that seeks stakeholder input on assessing the accuracy and completeness of the machine-readable files. The RFI includes the following questions:</p><ol><li>Should CMS specifically define the terms “accuracy of data” and “completeness of data” in the context of these requirements, and if yes, then how?</li><li>What are your concerns about the accuracy and completeness of the hospital price transparency machine-readable file data? Please be as specific as possible.</li><li>Do concerns about accuracy and completeness of the machine-readable file data affect your ability to use hospital pricing information effectively? For example, are there additional data elements that could be added, or others modified, to improve your ability to use the data? Please provide examples.</li><li>Are there external sources of information that may be leveraged to evaluate the accuracy and completeness of the data in the machine-readable files? If so, please identify those sources and how they can be used.</li><li>What specific suggestions do you have for improving the hospital price transparency compliance and enforcement processes to ensure that the hospital pricing data is accurate, complete and meaningful? For example, are there any changes that CMS should consider making to the CMS validator tool, which is available to hospitals to help ensure they are complying with hospital price transparency requirements, so as to improve accuracy and completeness?</li><li>Do you have any other suggestions for CMS to help improve the overall quality of the hospital price transparency machine-readable file data?</li></ol><p>The Departments of Labor, Health and Human Services, and the Treasury also released additional guidance for insurers, including <a href="https://www.cms.gov/files/document/aca-faqs-part-70.pdf">announcing</a> that there would be a new schema for the insurer machine-readable file that would reduce the file size by decreasing duplicative data, resulting in more useable files, and an <a href="https://www.dol.gov/sites/dolgov/files/ebsa/laws-and-regulations/laws/affordable-care-act/for-employers-and-advisers/rfi-regarding-prescription-drug-machine-readable-file-requirement-in-the-transparency-in-coverage-final-rule.pdf">RFI</a> on improving prescription drug price transparency.</p><h2>NEXT STEPS</h2><p>Responses to the Transparency in Coverage Prescription Drug Price Transparency RFI are due 30 days following publication in the Federal Register. Responses to the Hospital Price Transparency RFI are due July 21, 2025.</p><h2>FURTHER QUESTIONS</h2><p>If you have further questions, please contact the AHA at 800-424-4301.</p><p> </p></div><div class="col-md-4"><a href="/system/files/media/file/2025/05/departments-release-new-guidance-rfis-on-hospital-and-insurer-price-transparency-advisory-5-27-2025.pdf"><img src="/sites/default/files/inline-images/cover-departments-release-new-guidance-rfis-on-hospital-and-insurer-price-transparency-advisory-5-27-2025.png" data-entity-uuid="931300c2-58d4-4568-be2d-fc526efb5a11" data-entity-type="file" width="640" height="828" alt="Cover Image of Departments Release New Guidance, RFIs on Hospital and Insurer Price Transparency Advisory"></a></div></div></div> Tue, 27 May 2025 16:06:40 -0500 Member Non-Fed <div class="container"><div class="row"><div class="col-md-8"><p>The House of Representatives May 22 passed by a 215-214 vote H.R. 1, the <a href="https://rules.house.gov/sites/evo-subsites/rules.house.gov/files/documents/rcp_119-3_final.pdf" target="_blank">One Big Beautiful Bill Act</a>, a sweeping package that would enact many of President Trump’s legislative priorities on taxes, border security, energy and deficit reduction. The bill, which Republicans are attempting to pass through reconciliation, includes significant policy changes to Medicaid and the Health Insurance Marketplaces. See AHA’s <a href="/press-releases/2025-05-21-aha-statement-house-reconciliation-legislation">statement</a> from AHA President and CEO Rick Pollack, sent late yesterday to congressional offices prior to the House vote. The action now moves to the Senate, which is expected to make changes to the bill.</p><p>Before House passage, the bill was <a href="https://amendments-rules.house.gov/amendments/RCP_119-3_Managers_xml (002)250521201648156.pdf" target="_blank">amended</a>, including several changes that were made on May 21. The following is a summary of provisions included in the bill that affect hospitals and health systems, as well as some resources from the Congressional Budget Office regarding the impact of the bill.</p><h2>Congressional Budget Office Resources</h2><ul><li><a href="https://www.cbo.gov/publication/61420" target="_blank">Estimated Budget Effects</a></li><li><a href="https://www.cbo.gov/system/files/2025-05/61423-PAYGO.pdf" target="_blank">Potential Statutory Pay-As-You-Go Effects</a></li><li><a href="https://www.cbo.gov/system/files/2025-05/61422-Reconciliation-Distributional-Analysis.pdf" target="_blank">Preliminary Analysis of the Distributional Effects</a></li></ul><h2>AHA Summary of Provisions Impacting Hospitals and Health Systems</h2><h3>Title III — Committee on Education and Workforce</h3><h4>Section 30011: Loan limits</h4><p>Terminates the Grad PLUS loan program effective July 1, 2026, and would prohibit any new Grad PLUS loans during the 2026-2027 school year, including a three-year exception for students who were enrolled in a program of study as of June 30, 2026, and had previously received a Grad PLUS loan.</p><p>Amends the maximum annual loan limit for unsubsidized loans disbursed to graduate students to $100,000 and for professional programs, including medical school, to $150,000.</p><h4>Section 30024: Public service loan forgiveness</h4><p>Clarifies that payments made by new borrowers on or after July 1, 2025, who are serving in a medical or dental residency would not count as qualifying payments toward public service loan forgiveness.</p><h3>Title IV — Energy and Commerce</h3><h4>Subtitle D — Health</h4><h4>SUBPART A: REDUCING FRAUD AND IMPROVING ENROLLMENT PROCESSES</h4><h4>Section 44101: Moratorium on implementation of rule relating to eligibility and enrollment in Medicare Savings Programs (Effective from enactment through Jan. 1, 2035)</h4><p>Prohibits the Department of Health and Human Services (HHS) Secretary from implementing, administering or enforcing the Medicare Savings Program (MSP) rule for 10 years. This would rollback requirements that states 1) automatically enroll certain Supplemental Security Income recipients in the qualified Medicare beneficiary eligibility group of the MSP program, 2) use data from the low-income subsidy program as an application for MSPs and align the family size definitions between the MSP and Low Income Subsidy programs, and 3) accept self-attestation for certain types of income and resources.</p><h4>Section 44102: Moratorium on implementation of rule relating to eligibility and enrollment for Medicaid, CHIP and the Basic Health Program (Effective from enactment through Jan. 1, 2035)</h4><p>Prohibits the HHS secretary from implementing, administering or enforcing the eligibility and enrollment rule for 10 years. This would limit states’ ability to use other data sources (such as payroll or state vital statistics data) to determine an individual’s eligibility for Medicaid and limit states’ use of prepopulated renewal forms. It would also allow states to impose annual and/or lifetime limits on Children’s Health Insurance Program (CHIP) benefits and to disenroll CHIP beneficiaries for failure to pay premiums or enrollment fees.  </p><h4>Section 44103: Ensuring appropriate address verification under the Medicaid and CHIP programs</h4><p>Requires regular (no less than once each month) enrollee address verification and is intended to prevent individuals from enrolling in two state Medicaid or CHIP programs simultaneously. This section would require state Medicaid agencies to establish a process to collect address information for Medicaid enrollees and report certain identifying information to the HHS secretary by Jan. 1, 2027. The secretary would be required to establish a system that would identify when an individual is enrolled in two state programs simultaneously, determine in which state the individual resides, and disenroll the individual from other state Medicaid or CHIP programs. The section appropriates $10 million for fiscal year (FY) 2026 to establish a system and $20 million for FY 2029 to maintain that system.</p><h4>Section 44104: Modifying certain state requirements for ensuring deceased individuals do not remain enrolled (Effective Jan. 1, 2028)</h4><p>Requires states to review the Social Security Administration’s Death Master File to determine whether any enrollees are deceased. If a beneficiary is disenrolled in error, the state must re-enroll them retroactively to the date of disenrollment.</p><h4>Section 44105: Medicaid provider screening requirements (Effective Jan. 1, 2028)</h4><p>Requires states to regularly (no less frequently than monthly) check provider eligibility to determine whether HHS or the state has terminated the provider’s participation.</p><h4>Section 44106: Additional Medicaid provider screening requirements (Effective Jan. 1, 2028)</h4><p>Requires states to regularly (no less than quarterly) check the Death Master File to determine whether providers are deceased.</p><h4>Section 44107: Removing good faith waiver for payment reduction related to certain erroneous excess payments under Medicaid (Effective FY 2030)</h4><p>Limits the authority of the HHS secretary to waive payment reductions and requires HHS to reduce federal funding to states derived from states making erroneous excess payments for ineligible individuals or services. </p><h4>Section 44108: Increasing frequency of eligibility redeterminations for certain individuals (Effective Dec. 31, 2026)</h4><p>Requires states to redetermine eligibility once every six months for beneficiaries enrolled through the Medicaid expansion eligibility pathway.</p><h4>Section 44109: Revising home equity limit for determining eligibility for long-term care services under the Medicaid program (Effective Jan. 1, 2028)</h4><p>Revises the permissible home equity interest limit to $1,000,000 to determine allowable assets for nursing facility services and long-term care. Asset disregards are prohibited. </p><h4>Section 44110: Prohibiting federal financial participation under Medicaid and CHIP for individuals without verified citizenship, nationality or satisfactory immigration status (Effective Oct. 1, 2026)</h4><p>Prohibits federal financial participation for Medicaid and CHIP enrollees in a reasonable opportunity period unless the individual successfully verifies their citizenship or immigration status. It is optional for states to provide coverage during the verification period.</p><h4>Section 44111: Reducing expansion Federal Medical Assistance Percentage for certain states providing payments for health care furnished to certain individuals (Effective Oct. 1, 2027)</h4><p>Reduces the Federal Medical Assistance Percentage (FMAP) to 80% for the expansion population in states that use state funds to cover aliens who are not qualified aliens or lawfully residing pregnant women and children (i.e., undocumented immigrants and certain lawfully residing adults). “Coverage” is not limited to Medicaid and may include other programs established by the state to offer financial assistance to purchase health insurance coverage or to provide comprehensive health benefits coverage.</p><h3>SUBPART B: PREVENTING WASTEFUL SPENDING</h3><h4>Section 44121: Moratorium on Minimum Staffing Rule for long-term care facilities (Effective from enactment through Jan. 1, 2035)</h4><p>Prohibits HHS from implementing the Minimum Staffing Standards for long-term care facilities and the Medicaid Institutional Payment Transparency Reporting regulation for 10 years.</p><h4>Section 44122: Modifying retroactive under the Medicaid and CHIP programs (Effective Dec. 31, 2026)</h4><p>Limits the timeframe for retroactive Medicaid and CHIP eligibility to 30 days prior to the application date, as opposed to the current 90-day period.</p><h4>Section 44123: Ensuring accurate payments to pharmacies under Medicaid (Effective first day of the first quarter that begins six months after enactment)</h4><p>Expands transparency requirements regarding Medicaid payments to pharmacies for covered outpatient drugs. The secretary is required to conduct a survey to determine, and make publicly available, national average drug acquisition prices and cost benchmarks. Monetary penalties may be imposed on retail community pharmacies or non-retail pharmacies for failing to comply with a survey request, providing false information or otherwise failing to comply with requirements.</p><h4>Section 44124: Preventing the use of abusive spread pricing in Medicaid (Effective for contracts that begin 18 months after the date of enactment)</h4><p>This section requires that payment for drugs and related administrative services is based on a transparent prescription drug pass-through pricing model and prohibits any form of spread pricing. Payment made by the entity or pharmacy benefit manager (PBM) is limited to ingredient cost and a professional dispensing fee. The payment must be passed through in its entirety by the entity or PBM to the pharmacy or provider dispensing the drug.</p><h4>Section 44125: Prohibiting federal Medicaid and CHIP funding for gender transition procedures</h4><p>Prohibits states from receiving federal funds for specified gender transition procedures. This does not apply to certain services provided by a health care provider with parental/legal guardian consent, including puberty suppression, blocking prescription drugs to normalize puberty or an individual experiencing precocious puberty, and certain medically necessary procedures.</p><h4>Section 44126: Federal payment to prohibited entities (Effective from enactment for 10 years)</h4><p>Prohibits states from receiving federal matching funds for services rendered by providers that provide abortions (other than Hyde Amendment exceptions) and receive more than $1 million in Medicaid payments in 2024. This applies to not-for-profit, essential community providers primarily engaged in family planning services, reproductive health and related medical care. This provision would apply for 10 years, beginning on the date of enactment.</p><h3>SUBPART C: STOPPING ABUSIVE FINANCING PRACTICES</h3><h4>Section 44131: Sunsetting eligibility for increased FMAP for expansion states (Effective Jan. 1, 2026)</h4><p>Repeals the ability for states that have not yet expanded Medicaid to receive 5% enhanced FMAP funds should they later choose to expand.</p><h4>Section 44132: Moratorium on new or increased provider taxes (Effective from enactment)</h4><p>Disallows federal matching funds for state provider taxes imposed after the date of enactment or any provider taxes that were increased (in amount or rate) after the date of enactment. The draft legislation also includes a provision that prohibits states from increasing the tax base by expanding items or services, or expanding the tax base to include providers that were previously not included. This would effectively cap provider taxes at the amount in place on the date of enactment.</p><h4>Section 44133: Revising the payment limit for certain directed payments (Effective from enactment)</h4><p>Limits state-directed payments (SDPs) to no more than 110% of the published Medicare payment rate for non-expansion states and 100% of the published Medicare payment rate for expansion states, except for previously approved SDPs or preprints submitted to the HHS secretary prior to the date of enactment. However, states with SDPs in place could not increase the amount and would be required to submit grandfathered SDP preprints for CMS approval when seeking renewal. In the absence of a published Medicare rate, an equivalent rate could be used. If a state expands Medicaid after the date of enactment, SDPs would be subject to the 100% Medicare upper payment limit, including preprints for which prior approval was made before the state expanded Medicaid.  </p><h4>Section 44134: Requirements regarding waiver of uniform tax requirement for Medicaid provider tax</h4><p>Modifies the requirements regarding uniformity of provider taxes and, specifically, whether a state’s tax is considered “generally redistributive.” Under the draft legislation, a tax is not considered generally redistributive if:</p><ol type="a"><li>Lower volume Medicaid health care entities are taxed at a lower rate than higher volume Medicaid health care entities.</li><li>High Medicaid volume health care entities are taxed more heavily than non-Medicaid health care entities.</li><li>The tax establishes any target or exclusion related to a health care entity’s Medicaid participation status.</li></ol><h4>Section 44135: Requiring budget neutrality for Medicaid demonstration projects under Section 1115</h4><p>Codifies CMS practice of requiring that Section 1115 waivers not increase federal spending compared to what a state would have spent without the waiver. It also requires the secretary to specify a methodology for using waiver savings for subsequent approvals.</p><h3>SUBPART D: INCREASING PERSONAL ACCOUNTABILITY</h3><h4>Section 44141: Community engagement (work) requirements (Effective December 31, 2026)</h4><p>Establishes work requirements for certain Medicaid beneficiaries. Beginning Dec. 31, 2026, or earlier at the option of the state, states are required to establish work requirements for non-exempt expansion adults aged 19-64. Individuals must work or engage in qualifying activities (e.g., community service, educational programs, job training) for no less than 80 hours/month. Mandatory exceptions include individuals under the age of 19, pregnant or post-partum women, individuals enrolled in Medicare Part A or Part B, and institutionalized individuals. Optional exceptions for short-term hardship events include individuals receiving inpatient hospital services, nursing facility services or inpatient psychiatric services; individuals in disaster zones; and individuals in areas with high unemployment. Compliance is verified during the initial eligibility determination, as well as part of subsequent eligibility redetermination, or more frequently as determined by the state. States may use data sources like payroll data to verify compliance. If the state is unable to verify that the individual has met the community engagement requirements, the individual will have 30 days to demonstrate compliance before they are disenrolled. States must determine whether an individual would qualify for Medicaid under other eligibility pathways before disenrolling. Grants totaling $100 million are provided in FY 2026 for system development. The amended section changes a requirement that the secretary promulgate rules regarding the implementation and instead directs the secretary to issue guidance not later than Dec. 31, 2025.</p><h4>Section 44142: Modifying cost-sharing requirements for certain expansion individuals under the Medicaid program (Effective Oct. 1, 2028)</h4><p>Requires states to impose cost-sharing requirements at an amount greater than $0 and not exceeding $35 on Medicaid expansion enrollees, as determined by the state. Total cost sharing may not exceed 5% of family income. Cost-sharing requirements cannot be imposed on pregnancy-related services, primary care, mental health or substance use disorder services. States may allow providers to require payment as a condition of providing services. Providers may waive cost-sharing requirements on a case-by-case basis. This section also prohibits states from requiring Medicaid expansion enrollees to pay a premium, enrollment fee, or other such charge.</p><h3>Other Provisions Related to Medicaid</h3><h4>Section 44302: Streamlined enrollment process for eligible out-of-state providers under Medicaid and CHIP</h4><p>Streamlines enrollment requirements for eligible out-of-state providers. Eligible out-of-state providers are those who are determined by the secretary or another state Medicaid program to have limited risk of fraud, waste and abuse and have not been excluded from participation in a state Medicaid program or other federal health program.</p><h4>Section 44303: Delaying disproportionate share hospital reductions</h4><p>Delays the Medicaid disproportionate share hospital (DSH) reductions to FYs 2029 through 2031. Under current law, federal allotments for Medicaid DSH would be reduced by $8 billion for FYs 2026 through 2028. The section also extends Tennessee’s DSH allotment through 2028.</p><h3>Other Provisions Unrelated to Medicaid</h3><h4>Section 44304: Modifying update to the conversion factor under the physician fee schedule under the Medicare program</h4><p>Creates a single conversion factor for Physician Fee Schedule services under the Medicare program starting in 2026 (as opposed to the two distinct ones in place today — one for physicians participating in alternative payment models and another for those who are not). For 2026, the update to the single conversion factor would be 75% of the Medicare Economic Index (MEI), and, for 2027, it would be 10% of the MEI. This provision would not be retroactive.</p><h4>Section 44201: Addressing waste, fraud and abuse in the Accountable Care Act exchanges</h4><p>Codifies most of the proposed policies in the 2025 Marketplace Integrity rule, including:</p><ul><li>Shortening the Health Insurance Marketplace open enrollment period.</li><li>Removing the low-income special enrollment period.</li><li>Changes to the premium adjustment percentage methodology.</li><li>Allowing insurers to require that enrollees pay past-due premiums before renewing coverage.</li><li>Disallowing DACA recipients from receiving premium tax credits or cost-sharing reductions.</li><li>Prohibiting gender-affirming care as an essential health benefit.</li><li>Greater eligibility verification processes.</li></ul><p>The draft legislation does not include the proposal to improve transparency of agency, broker and web-broker behavior, and varies in its language regarding the de minimus range, which impacts the value of coverage within each metal tier.</p><h4>Section 44202: Funding cost-sharing reduction payments</h4><p>Restores federal funding for the cost-sharing reduction (CSR) payments, which reduce costs for low-income marketplace enrollees. The federal government stopped funding these payments beginning in the 2018 plan year, as Congress did not appropriate the funds. To address the lack of funding, insurers increased the cost of silver plan premiums in a practice known as "silver-loading." This increased the cost of premium tax credits, which are based on the second-lowest cost silver plan premium. By funding the CSR payments, insurers will no longer need to silver load, which will lower the value of the premium tax credits and generate savings for the federal government.</p><h3>Title XI — Committee on Ways and Means, ‘‘The One, Big, Beautiful Bill’’</h3><h4>SUBPART A: MAKE AMERICAN FAMILIES AND WORKERS THRIVE AGAIN</h4><h4>Section 110112: Reinstatement of partial deduction for charitable contributions of individuals who do not elect to itemize</h4><p>Creates a temporary deduction for non-itemizing taxpayers up to $150 for single filers ($300 for married filing jointly) for charitable cash contributions for tax years 2025 through 2028. The charitable contribution must be made to a qualified charity and cannot be made to Donor-Advised Funds or supporting organizations.</p><h4>Sections 110201-110203: Custom Health Option and Individual Care Expense (CHOICE) arrangements</h4><p>Regulations finalized in 2019 created “individual coverage health reimbursement arrangements (ICHRAs),” which allow employers to offer their employees financial support to purchase health insurance on the individual markets, in addition to other medical expenses. This bill would codify those regulations, rename ICHRAs as Custom Health Option and Individual Care Expense (CHOICE) arrangements, and remove some of the administrative barriers to implementation. In addition, the bill would create a tax credit for businesses with fewer than 50 employees to implement CHOICE arrangements by offering a $100 per employee tax credit in the first year of implementation and a $50 per employee tax credit in the second year.</p><h4>Sections 110204, 110206, 110208-110213: Health savings account provisions</h4><p>Health savings accounts (HSAs) are tax-advantaged savings accounts for high-deductible health plan (HDHP) enrollees. There are strict regulations around who can utilize HSAs and how their funds can be used. This bill would expand HSA access to individuals enrolled in Medicare Part A if they are also still enrolled in their private HDHP, and to individuals enrolled in bronze or catastrophic health plans in the individual market. The bill would also create more flexibility in how individuals contribute, for example, by allowing eligible individuals to contribute even if their spouse has a flexible spending arrangement, and what services can be covered by HSA funds. Finally, the bill would increase HSA contribution limits for individuals with annual income that is less than $75,000 individually or $150,000 for a family.</p><h4>Section 110205: Treatment of direct primary care service arrangements</h4><p>Excludes direct primary care (DPC) service arrangements from classification as a health plan for the purposes of HSA eligibility so long as the primary care arrangement is for only primary care services, the individual pays a fixed monthly fee, and that amount doesn’t exceed $150 for an individual (twice the amount for coverage of more than one person). Would clarify that anesthesia, prescription drugs and lab services would not qualify as DPC services. Would allow for DPC services to be qualified medical expenses by excluding DPC arrangements from the definition of “health insurance” for which HSAs could not be utilized. Would also provide for cost-of-living adjustments for DPC arrangements. In general, this provides additional flexibility for HSAs to be used for DPC arrangements, which may increase beneficiary enrollment in these types of plans.</p><h4>SUBPART B: MAKE RURAL AMERICA AND MAIN STREET GROW AGAIN</h4><h4>Section 111201: Expanding the definition of rural emergency hospital under the Medicare program</h4><p>This provision allows for the conversion to a rural emergency hospital (REH) if state licensure is not currently provided but will be licensed as such within one year of the state providing such licensure. It also allows for a facility located less than 35 miles away from another hospital, critical access hospital (CAH) or REH, to be an REH, provided that annually, the facility must demonstrate more than 50% of the services provided are emergency and observation care for Medicare Part A and B patients. The provision permits eligibility for conversion from CAHs and small rural (<50 beds) hospitals opened between Jan. 1, 2014, and Dec. 26, 2020. Additionally, outpatient prospective payment system plus 5% payment to facilities located less than 35 miles away from another hospital, CAH or REH are disallowed. The provision also disallows a monthly facility payment to facilities located less than 10 miles away from another hospital, CAH or REH.</p><h4>SUBPART C: MAKE AMERICA WIN AGAIN</h4><h4>Section 112003: Termination of qualified commercial clean vehicles credit</h4><p>Eliminates the qualified commercial clean vehicles credit at the end of 2025. Provides an exception for vehicles placed in service before 2033 and under a binding contract entered into before May 2025.</p><h4>Section 112004: Termination of alternative fuel vehicle refueling property credit</h4><p>Eliminates the alternative fuel vehicle refueling property credit at the end of 2025.</p><h4>Section 112009: Restrictions on clean electricity investment credit</h4><p>Restricts the clean electricity investment credit by making zero credit available after Dec. 31, 2028. This provision restricts access to the credit for certain prohibited foreign entities.</p><p>This provision restricts access to the credit for certain prohibited foreign entities. Specifically:</p><ol type="1"><li>No credit is allowed for a facility that commences construction a year after the enactment of this bill that includes any material assistance from a prohibited foreign entity.</li><li>No credit is allowed for taxable years beginning after enactment if the taxpayer is a specified foreign entity.</li><li>No credit is allowed for tax years that begin two years after the date of enactment for foreign influence entities or if the taxpayer makes fixed, determinable, annual or periodic (FDAP) amount payments to a prohibited foreign entity that are more than 5% of total expenditures related to the credit generating activity or 15% in aggregate</li></ol><h4>Section 112015: Phase-out of credit for certain energy property</h4><p>Aligns the expiration of the investment tax credit for geothermal heat pumps with the clean electricity investment tax credit. There is a 20% credit reduction for facilities placed in service in calendar year 2029, a 40% reduction for facilities placed in service in 2030, a 60% reduction for facilities placed in service in 2031 and no credit available after Dec. 31, 2031.</p><p>This provision restricts access to the credit for certain prohibited foreign entities. Specifically:</p><ol type="1"><li>No credit is allowed for taxable years beginning after enactment if the taxpayer is a specified foreign entity.</li><li>No credit is allowed for tax years that begin two years after the date of enactment for a foreign-influenced entity.</li></ol><h4>Section 112019: Excessive employee renumeration from controlled group members and allocation of deduction</h4><p>Applies aggregation rules for the deduction limitation and allocation of deduction applied under Internal Revenue Code (IRC) section 162(m) as it relates to certain excessive employee remuneration.</p><h4>Section 112021: Modification of excise tax on investment income of certain private colleges and universities</h4><p>Amends the current excise tax on net investment income framework for certain private colleges and universities under IRC section 4968 with a tiered system based on an institution’s student-adjusted endowment (see table below). For purposes of calculating an institution's student-adjusted endowment, this section amends such calculation by excluding students who do not meet the requirements under Section 484(a)(5) of the Higher Education Act of 1965. This section also provides an exemption from being considered an applicable educational institution, provided the institution meets certain requirements related to being a qualified religious institution. Additionally, this section includes student loan interest income and certain royalty income to calculate a school’s net investment income.</p><table><thead><tr><th>Student-Adjusted Endowment</th><th>Excise Tax Rate</th></tr></thead><tbody><tr><td>$500,000-$749,999</td><td>1.4% (current rate)</td></tr><tr><td>$750,000-$1,249,999</td><td>7%</td></tr><tr><td>$1,250,000-$1,999,999</td><td>14%</td></tr><tr><td>$2,000,000+</td><td>21%</td></tr></tbody></table><h4>Section 112022: Increase tax rate on net investment income of certain private foundations</h4><p>Amends the current excise tax on net investment income framework for tax-exempt private foundations under IRC section 4940(a) with a tiered system that maintains the current excise tax rate for private foundations with less than $50 million in total assets but applies higher excise tax rates on private foundations reporting $50 million or more in total assets (see table below).</p><table><thead><tr><th>Size of Private Foundation (in assets)</th><th>Excise Tax Rate</th></tr></thead><tbody><tr><td>$0-$49,999,999</td><td>1.39% (current rate)</td></tr><tr><td>$50,000,000-$249,999,999</td><td>2.78%</td></tr><tr><td>$250,000,000-$4,999,999,999</td><td>5%</td></tr><tr><td>$5,000,000,000+</td><td>10%</td></tr></tbody></table><h4>Section 112024: Unrelated business taxable income increased by the amount of certain fringe benefit expenses for which deduction is disallowed</h4><p>Amends IRC section 512 to increase the unrelated business taxable income of a tax-exempt organization by including the amount paid or incurred for any qualified transportation fringe benefit.</p><h4>Section 112025: Name and logo royalties treated as unrelated business taxable income</h4><p>Amends IRC sections 512 and 513 to increase the unrelated business taxable income of a tax-exempt organization by including the income from any sale or licensing by an organization of its name or logo.</p><h4>Section 112026: Exclusion of research income limited to publicly available research</h4><p>Amends IRC section 512 to increase the unrelated business taxable income of a tax-exempt organization by including the income generated from non-public research for an organization whose tax-exempt purpose is to provide publicly available research as unrelated business income.</p><h4>Section 112101: Permitting premium tax credit only for certain individuals</h4><p>Eliminates premium tax credit eligibility for undocumented immigrants and only allows eligibility for Lawful Permanent Residents, certain Cuban immigrants, and individuals living in the U.S. through a Compact of Free Association.</p><h4>Section 112102: Certain aliens treated as ineligible for premium tax credit</h4><p>Prohibits individuals with immigration status granted by asylum (or pending an asylum application), parole, temporary protected status, deferred enforced departure and withholding of removal from receiving premium tax credits.</p><h4>Section 112103: Disallowing premium tax credit during periods of Medicaid ineligibility due to alien status</h4><p>Strikes the loophole that allows undocumented immigrants who report income below 100 percent of the federal poverty level and are in their five-year Medicaid waiting period (due to immigration status) to receive premium tax credits to purchase health insurance on the Exchange.</p><h4>Section 112201: Requiring Exchange verification of eligibility for health plan</h4><p>Prohibits an individual from claiming the premium tax credit if the individual’s eligibility related to income, enrollment and other requirements is not actively verified annually. This would prohibit automatic reenrollment for enrollees receiving premium tax credits by requiring them to actively prove tax credit eligibility each year. Over half of all returning enrollees in 2025 enrolled through automatic reenrollment.</p><h4>Section 112202: Disallowing premium tax credit in case of certain coverage enrolled in during the special enrollment period</h4><p>Prohibits individuals from receiving premium tax credits if they enroll in health coverage on the Exchange through a special enrollment period associated with their income.</p><h4>Section 112203: Eliminating limitation on recapture of advance payment of premium tax credit</h4><p>Removes the repayment limits and requires affected individuals to reimburse the Internal Revenue Service for the full amount of excess tax credit received.</p><h4>Section 112204: Implementing artificial intelligence tools to reduce and recoup improper payments under Medicare</h4><p>Provides $25 million for the HHS secretary to contract with artificial intelligence contractors and data scientists to examine Medicare improper payments and recoup overpayments. Additionally, the secretary is required to report to Congress on progress in decreasing the number of Medicare improper payments.</p><h4>SUBPART D: INCREASE IN DEBT LIMIT</h4><h4>Section 113001: Modification of limitation on the public debt</h4><p>Increases the statutory debt limit by $4 trillion.</p><h2>Further Questions</h2><p>If you have further questions, please contact AHA at <a href="tel:1-800-424-4301">800-424-4301</a>.</p><p><a href="/system/files/media/file/2025/05/Legislative-Advisory-AHA-Summary-of-One-Big-Beautiful-Bill-Acts-Provisions-Impacting-Hospitals-and-Health-Systems.pdf"><span><em><strong>Read the complete Legislative Advisory.</strong></em></span></a></p></div><div class="col-md-4"><a href="/system/files/media/file/2025/05/Legislative-Advisory-AHA-Summary-of-One-Big-Beautiful-Bill-Acts-Provisions-Impacting-Hospitals-and-Health-Systems.pdf"><img src="/sites/default/files/inline-images/Page-1-Legislative-Advisory-AHA-Summary-of-One-Big-Beautiful-Bill-Acts-Provisions-Impacting-Hospitals-and-Health-Systems.png" data-entity-uuid="7b4d504a-d7a3-4f38-b807-ac4bd58ba5fb" data-entity-type="file" alt="Legislative Advisory: AHA Summary of One Big Beautiful Bill Act’s Provisions Impacting Hospitals and Health Systems page 1." width="696" height="900"></a></div></div></div> table, th, td { border: 1px solid; } Thu, 22 May 2025 15:08:44 -0500 Member Non-Fed <div class="container"><div class="row"><div class="col-md-8"><p>The House of Representatives May 22 passed by a 215-214 vote H.R. 1, the <a href="https://rules.house.gov/sites/evo-subsites/rules.house.gov/files/documents/rcp_119-3_final.pdf" target="_blank">One Big Beautiful Bill Act</a>, a sweeping package that would enact many of President Trump’s legislative priorities on taxes, border security, energy and deficit reduction. The bill, which Republicans are attempting to pass through reconciliation — a <a href="/issue-landing-page/2025-02-07-budget-reconciliation-process-resource-page">budget tool</a> that gives Congress a fast-track mechanism to avoid the Senate filibuster and pass legislation with a simple majority — includes significant policy changes to Medicaid and the Health Insurance Marketplaces that will jeopardize access to care for communities. The action now moves to the Senate, which is expected to make changes to the bill.</p><p>This Special Bulletin includes several updates and resources related to the bill, including:</p><ul><li><strong>Changes Made to the Bill.</strong> The House late yesterday made several <a href="https://amendments-rules.house.gov/amendments/RCP_119-3_Managers_xml (002)250521201648156.pdf?_gl=1*1jziwmj*_ga*MTIyNTg0MjE4Ny4xNjg5MTcxMjMz*_ga_N4RTJ5D08B*czE3NDc5MTgyNDIkbzEkZzEkdDE3NDc5MTg1MTYkajAkbDAkaDA" target="_blank">changes</a> to the bill before its passage. See some of the changes below and watch for an updated Legislative Advisory with a summary of provisions included in the bill.</li><li><strong>AHA Statement Submitted to Congressional Offices.</strong> The AHA, prior to the House vote, shared a <a href="g/press-releases/2025-05-21-aha-statement-house-reconciliation-legislation">statement</a> from AHA President and CEO Rick Pollack with congressional offices and the media.</li><li><strong>Advocacy Resources.</strong> The AHA has many resources that hospital and health system leaders can use as part of their advocacy efforts as attention turns to the Senate.</li></ul><h2>Changes to the Bill</h2><p>The House made several changes to the bill, including provisions that would affect Medicaid and the Health Insurance Marketplaces. Some of the changes include:</p><p>Watch for an updated Legislative Advisory for a detailed summary of provisions that affect hospitals and health systems.</p><h2>AHA Statement Shared with Congressional Offices and Media</h2><p>Prior to the House voting on the bill, AHA shared the following <a href="/press-releases/2025-05-21-aha-statement-house-reconciliation-legislation">statement</a> from AHA President and CEO Rick Pollack with congressional offices and the media.</p><p>“On behalf of our nearly 5,000 member hospitals, health systems and other health care organizations, our clinician partners — including more than 270,000 affiliated physicians, 2 million nurses and other caregivers — and the 43,000 health care leaders who belong to our professional membership groups, the ���������� Association (AHA) is sharing our concerns about the One Big Beautiful Bill Act (OBBBA) that is being considered on the House floor this week.</p><p>“Our hospitals and health systems have significant concerns regarding the harmful Medicaid and Health Insurance Marketplace provisions currently included in the bill. The sheer magnitude of the level of reductions to the Medicaid program alone will impact all patients, not just Medicaid beneficiaries, in every community across the nation. Hospitals — especially in rural and underserved areas — will be forced to make difficult decisions about whether they will have to reduce services, reduce staff and potentially consider closing their doors. Other impacts could include longer waiting times to receive care, more crowded emergency departments, and hospitals not being able to invest in technology and innovations for clinical care.</p><p>“In particular, the Medicaid legislative proposals severely restrict the use of legitimate state funding resources and supplemental payment programs, including provider taxes and state directed payments, under the guise of eliminating waste, fraud and abuse. We reject this notion as these critical, legitimate and well-established Medicaid financing programs are essential to offset decades of chronic underpayments of the cost of care provided to Medicaid patients. These new policies are estimated to decimate federal support for the Medicaid program by more than $700 billion over 10 years and will displace health care coverage for millions of Americans, moving them from insured to uninsured status.</p><p>“In addition to jeopardizing access to patient care and services, these abrupt policy changes would upend state government budgets and threaten the viability of the health care system to provide essential services to this population. Since these changes are effective immediately upon enactment of the legislation, states will have little or no time to prepare for the significant financial impact on state budgets.</p><p>“Given the substantial reduction in Medicaid payments and cuts to the Health Insurance Marketplaces, including allowing the enhanced premium tax credits to expire, millions will lose health care coverage. Therefore, the AHA urges the House to reject efforts to dismantle these vital programs in the OBBBA and preserve health care access for our nation’s vulnerable and working families.”</p><h2>Advocacy Resources and Engage Your Senators</h2><p>After the House passage of the bill, attention now shifts to the Senate, which is expected to consider changes to the bill. Hospital and health system leaders are encouraged to use the upcoming Memorial Day recess to contact their senators and urge them to reject harmful provisions that would jeopardize access to coverage and care for millions of Americans across the country.</p><p>As you tell the story about what the bill’s impact would mean for your patients and communities and your organization’s ability to provide 24/7 care and services, please use the following AHA resources to assist your efforts.</p><ul><li><strong>Digital Toolkit.</strong> Use this toolkit to engage stakeholders, such as your hospital or health system teams and community leaders, in joining the fight to protect Medicaid. The <a href="/advocacy/advocacy-issues/medicaid">toolkit</a> includes a Medicaid Made Simple video, sample social media posts, stakeholder messages and newsletter copy.</li><li><strong>Fact Sheets and Infographics.</strong> The AHA has developed a series of fact sheets and infographics to inform your advocacy efforts. Visit the <a href="/advocacy/advocacy-issues/medicaid">Medicaid Advocacy Issue</a> page.</li><li><strong>Coalition to Strengthen America’s Health Care Resources.</strong> The <a href="https://strengthenhealthcare.org/" target="_blank">Coalition to Strengthen America’s Healthcare</a>, of which the AHA is a founding member, has many digital resources and tools that can assist your advocacy efforts.</li></ul><h2>Further Questions</h2><p>Visit the <a href="g/advocacy/action-center">AHA Action Center</a> for more resources on these issues and other priorities important to hospitals and health systems. If you have further questions, please contact the AHA at <a href="tel:1-800-424-4301">800-424-4301</a>.</p></div><div class="col-md-4"><a href="/system/files/media/file/2025/05/SB-House-Passes-Reconciliation-Bill-with-Significant-Policy-Changes-and-Reductions-to-Medicaid-Other-Health-Care-Programs.pdf"><img src="/sites/default/files/inline-images/Page-1-SB-House-Passes-Reconciliation-Bill-with-Significant-Policy-Changes-and-Reductions-to-Medicaid-Other-Health-Care-Programs.png" data-entity-uuid="6b4a4438-2190-4839-b61f-e7b9d51060e8" data-entity-type="file" alt="Special Bulletin: House Passes Reconciliation Bill with Significant Policy Changes and Reductions to Medicaid, Other Health Care Programs page 1." width="695" height="900"></a></div></div></div> Thu, 22 May 2025 12:31:14 -0500 Member Non-Fed <div class="container"><div class="row"><div class="col-md-8"><p>The House of Representatives and Senate have passed a combined budget resolution, allowing the chambers to move forward with the <a href="/issue-landing-page/2025-02-07-budget-reconciliation-process-resource-page">reconciliation process</a> as Republicans try to enact a key piece of the president’s agenda. House and Senate committees will begin drafting legislation consistent with their instructions from the budget resolution.</p><p>Specifically, the House Energy and Commerce Committee, which has primary jurisdiction over Medicaid and other health care programs, has been instructed to reduce deficits by not less than $880 billion so significant Medicaid cuts are being considered.</p><h2><span>Take Action</span></h2><p><strong>With your senators and representatives home in their states and districts for the next two weeks, please reach out to your lawmakers and urge them to reject funding cuts to Medicaid and other health care programs as part of reconciliation bill. Please tell your lawmakers how cuts to Medicaid and other programs would reduce access to care and services for patients in your communities. The AHA has a number of resources, including new ones on Medicaid, that can assist your advocacy efforts.</strong></p><h2>AHA Resources</h2><h3>Medicaid and Enhanced Premium Tax Credits (EPTC)</h3><p><strong>Explain how vital Medicaid is to your communities.</strong> The AHA has developed several resources hospitals and health systems can use.</p><ul><li><span><strong>NEW!</strong></span><strong> Protect Access to Care.</strong> Use this <a href="/fact-sheets/2025-04-14-protect-access-care-reject-cuts-medicaid-program-and-premium-hikes-working-families">infographic</a> to demonstrate the national hospital impact of potential Medicaid cuts and EPTCs expiring.</li><li><span><strong>NEW!</strong></span><strong> What’s at Stake.</strong> Use this <a href="/fact-sheets/2025-04-14-whats-stake-medicaid-covers-people-you-know">fact sheet</a> to show the makeup of Medicaid coverage across the country and what’s at stake if Congress cuts the program.</li></ul><p>In addition, the AHA has a series of additional resources to assist you in your advocacy to protect Medicaid, including the following:</p><ul><li><a href="/fact-sheets/2025-02-07-fact-sheet-medicaid">General Fact Sheet on Medicaid</a></li><li><a href="/fact-sheets/2025-02-07-fact-sheet-medicaid-provider-taxes">Fact Sheet on Medicaid Provider Taxes</a></li><li><a href="/fact-sheets/2025-02-07-fact-sheet-medicaid-provider-taxes">Fact Sheet on Medicaid Hospital Payment Basics</a></li><li><a href="/fact-sheets/2025-02-07-fact-sheet-capita-caps-medicaid-program">Medicaid Per Capita Caps</a></li></ul><p><strong>Explain why Congress should </strong><a href="/fact-sheets/2025-02-07-fact-sheet-enhanced-premium-tax-credits"><strong>extend the EPTCs</strong></a> before they expire at the end of the year as they have increased access to health care coverage and high-quality care for patients and communities served by hospitals, health systems and other providers.</p><h3>Site-neutral Payment Policies</h3><p><strong>Tell your lawmakers why they should </strong><a href="/advocacy/advocacy-issues/2023-09-11-advocacy-issue-site-neutral-payment-proposals"><strong>reject site-neutral policies</strong></a><strong>,</strong> as they would reduce patient access to vital health care services, particularly in rural and other medically underserved communities.</p><h3>340B Drug Pricing Program</h3><p><strong>Ask your lawmakers to </strong><a href="/340b-drug-savings-program"><strong>preserve the 340B program</strong></a> to ensure the program continues to help eligible hospitals stretch limited resources and provide more comprehensive services to more patients.</p><h2>Further Questions</h2><p>Visit the <a href="/advocacy/action-center">AHA Action Center</a> for more resources on these issues and other priorities important to hospitals and health systems.</p><p>If you have further questions, please contact AHA at <a href="tel:1-800-424-4301">800-424-4301</a>.</p></div><div class="col-md-4"><p><a href="/system/files/media/file/2025/04/Action-Alert-TAKE-ACTION-Urge-Lawmakers-to-Reject-Medicaid-Cuts-Protect-Access-to-Care.pdf" target="_blank" title="Click here to download the Action Alert TAKE ACTION: Urge Lawmakers to Reject Medicaid Cuts, Protect Access to Care PDF."><img src="/sites/default/files/inline-images/Page-1-Action-Alert-TAKE-ACTION-Urge-Lawmakers-to-Reject-Medicaid-Cuts-Protect-Access-to-Care.png" data-entity-uuid="6711b1a3-0cbf-4224-bfd8-94cda212c07f" data-entity-type="file" alt="Action Alert TAKE ACTION: Urge Lawmakers to Reject Medicaid Cuts, Protect Access to Care page 1." width="695" height="900"></a></p></div></div></div> Mon, 14 Apr 2025 12:15:37 -0500 Member Non-Fed <div class="container"><div class="row"><div class="col-md-8"><p>Congress continues to consider policies and proposals that would impact hospital funding for patient care. In the coming weeks, Congress must act to fund the government with the current continuing resolution set to expire on March 14 and ensure long-term stability for critical health care programs also expiring soon, including:</p><ul><li><a href="/system/files/media/file/2020/02/fact-sheet-medicaid-dsh-0120.pdf">Medicaid disproportionate share hospital</a> program cuts that take effect April 1.</li><li><a href="/fact-sheets/2022-08-30-fact-sheet-rural-hospital-support-act-s4009-assistance-rural-community">Enhanced low-volume adjustment and Medicare-dependent hospital</a> programs expiring April 1.</li><li><a href="/advocacy/advocacy-issues/2024-10-31-advocacy-issue-telehealth-waivers">Telehealth</a> and <a href="/fact-sheets/2024-08-06-fact-sheet-extending-hospital-home-program">hospital-at-home waivers</a> that were extended through March 31.</li></ul><p>At the same time, the Senate and House continue to move forward with their <a href="/issue-landing-page/2025-02-07-budget-reconciliation-process-resource-page">budget reconciliation frameworks</a>, bringing Congress closer to a full reconciliation package that would have significant implications for hospitals.</p><p><strong>Hospital and health system leaders can </strong><a href="https://forms.office.com/r/4j1bpiayvP" target="_blank"><strong>register</strong></a><strong> for a March 4 AHA Advocacy Day event in Washington, D.C.</strong> AHA President and CEO Rick Pollack and other AHA leaders will provide a briefing on the current congressional landscape and share key messages that they can deliver to their representatives and senators on Capitol Hill. <strong>This event is for AHA members only.</strong></p><p><strong>If you cannot make it to Washington, the AHA will virtually broadcast a live briefing for AHA members beginning at 10 a.m. ET. Please </strong><a href="http://aha.windrosemedia.com/" target="_blank"><strong>register for the virtual session</strong></a><strong>. You must register in advance to participate in the briefing.</strong></p><p>Please see our recent <a href="/action-center">AHA Action Alert</a> for our key advocacy messages and resources that can assist you in conversations with your lawmakers.</p><h2>Coalition Advertising Campaign, Resources to Protect Medicaid</h2><p>House and Senate Republicans are attempting to use the budget reconciliation process to pass key agenda items on taxes, energy and border security, and they may look to health program funding as a way to pay for this legislation. Such proposals could significantly reduce federal spending for the Medicaid program. Even a small portion of possible reductions could have wide-ranging negative consequences for the health and well-being of both Medicaid enrollees and the broader health care system.</p><p><strong>The </strong><a href="https://strengthenhealthcare.org/" target="_blank"><strong>Coalition to Strengthen America’s Healthcare</strong></a><strong>, of which the AHA is a founding member, has launched a multimedia advertising campaign, highlighting the value of Medicaid coverage for everyday Americans.</strong> The ad campaign includes a new <a href="https://www.youtube.com/watch?v=XRVxw6uJ2sc" target="_blank">television commercial</a> warning of potentially devastating cuts to Medicaid and urging Congress to protect Medicaid and ensure access to care for patients. The commercial will be running on TV nationally, in Washington, D.C., and other targeted markets. The ad campaign also includes digital targeting of key elected officials as well as publications inside the Beltway and influential new media outlets.</p><p>In addition to the advertising campaign, the Coalition has developed and shared digital resources that hospitals and health systems can use as part of their advocacy efforts to protect Medicaid. <strong>See the </strong><a href="https://docs.google.com/document/d/1BRNuvabV4VqmE5lPufY2EFML5pL7wGwNxhVzs9SvitQ/edit?tab=t.0" target="_blank"><strong>Coalition resources</strong></a><strong> and </strong><a href="https://strengthenhealthcare.org/" target="_blank"><strong>website</strong></a><strong> for more details.</strong></p><h2>Further Questions</h2><p>For questions on the March 4 Advocacy Day, please contact Monica Day at <a href="mailto:mday@aha.org?subject=RE: March 4 Advocacy Day">mday@aha.org</a>. For questions on the Coalition advertising campaign or resources, please contact Kristina Weger, executive director of the Coalition, at <a href="mailto:kweger@aha.org?subject=RE: Coalition advertising campaign and resources">kweger@aha.org</a>.</p></div><div class="col-md-4"><p><a href="/system/files/media/file/2025/02/Special-Bulletin-Register-for-March-4-AHA-Advocacy-Day-in-Washington-DC-New-Resources-to-Protect-Medicaid.pdf" target="_blank" title="Special Bulletin: Register for March 4 AHA Advocacy Day in Washington, D.C.; New Resources to Protect Medicaid PDF"><img src="/sites/default/files/inline-images/Page-1-Special-Bulletin-Register-for-March-4-AHA-Advocacy-Day-in-Washington-DC-New-Resources-to-Protect-Medicaid.png" data-entity-uuid="7d9fa957-7044-4fe0-b941-3b27e8cbd405" data-entity-type="file" alt="Special Bulletin: Register for March 4 AHA Advocacy Day in Washington, D.C.; New Resources to Protect Medicaid PDF page 1." width="695" height="900"></a></p></div></div></div> Tue, 25 Feb 2025 06:00:00 -0600 Member Non-Fed <div class="container"><div class="row"><div class="col-md-8"><p>In December, Congress passed a legislative package to fund the government through March 14 and extend key health care provisions through the end of March. Congressional action is needed once again to fund the government and ensure long-term stability for these critical health care programs. At the same time, House and Senate Republicans are planning a strategy to use the budget reconciliation process to accomplish some of their legislative priorities, and Congress must raise the debt ceiling in the coming months. As part of these strategies, they are considering proposals that would reduce funding for hospital care, including reductions to the Medicaid program, jeopardizing access to the 24/7 care and services that hospitals provide.</p><h2>Action Needed</h2><p><strong>Please ask your senators and representatives to prevent Medicaid disproportionate share hospital payment cuts from taking effect; extend enhanced low-volume adjustment and Medicare-dependent hospital programs that expand access to care in rural areas; and extend telehealth and hospital-at-home waivers. These policies are currently set to expire at the end of March and must be extended.</strong></p><p><strong>In your discussions with your legislators, please continue to share the valuable role your hospital or health system plays in the community they represent and urge them to reject cuts that would jeopardize access to hospital care and services that patients rely on.</strong></p><p>More details and resources to support your advocacy efforts on these important issues follow.</p><h2>Health Care Extenders</h2><p>Congress passed a legislative package in December that extended some key health care provisions through the end of March, but additional congressional action is needed.</p><ul><li><strong>Prevent Medicaid DSH Cuts.</strong> The Medicaid disproportionate share hospital (DSH) program provides essential financial assistance to hospitals that care for our nation’s most vulnerable populations — children, the impoverished, disabled and elderly. Without congressional action, billions in cuts would take effect April 1. <strong>See the </strong><a href="/system/files/media/file/2020/02/fact-sheet-medicaid-dsh-0120.pdf"><strong>Medicaid DSH fact sheet</strong></a><strong> for more details.</strong></li><li><strong>Extend Key Rural Programs.</strong> The enhanced low-volume adjustment and Medicare-dependent hospital programs provide rural, geographically isolated and low-volume hospitals additional financial support to ensure rural residents have access to care. Without congressional action, these programs will expire on April 1. <strong>See the </strong><a href="/fact-sheets/2022-08-30-fact-sheet-rural-hospital-support-act-s4009-assistance-rural-community"><strong>rural programs fact sheet</strong></a><strong> for more details.</strong></li><li><strong>Extend Telehealth and Hospital-at-Home Waivers.</strong> Congress has extended telehealth waivers and the hospital-at-home program through March 31, but additional action is needed. See the <a href="/advocacy/advocacy-issues/2024-10-31-advocacy-issue-telehealth-waivers">telehealth</a> and <a href="/fact-sheets/2024-08-06-fact-sheet-extending-hospital-home-program">hospital-at-home fact sheets</a> for more details.</li></ul><h2>Critical Issues for the 119th Congress</h2><p>Following our Feb. 5 advocacy update webinar for members, we are providing new fact sheets and primers on emerging issues of significant importance for hospitals and health systems. We will be providing updates, new resources and data on these and other issues to help your advocacy efforts throughout the year.</p><h3>Reject Cuts to Medicaid</h3><p>Republican leaders continue to have discussions about how to use reconciliation — a <a href="/issue-landing-page/2025-02-07-budget-reconciliation-process-resource-page">budget tool</a> that gives Congress a fast-track mechanism to avoid the Senate filibuster and pass legislation with a simple majority. House and Senate Republicans are expected to use the budget reconciliation process to try to pass key agenda items on taxes, energy and border security, and they may look to health program funding as a way to pay for this legislation. <strong>Such proposals could significantly reduce federal spending for the Medicaid program. Even a small portion of possible reductions could have wide-ranging negative consequences for the health and well-being of both Medicaid enrollees and the broader health care system.</strong></p><p>The AHA has developed a number of resources hospitals and health systems can use as part of their advocacy efforts, including the following:</p><ul><li><a href="/fact-sheets/2025-02-07-fact-sheet-medicaid">General Fact Sheet on Medicaid</a></li><li><a href="/fact-sheets/2025-02-07-fact-sheet-medicaid-provider-taxes">Fact Sheet on Medicaid Provider Taxes</a></li><li><a href="/fact-sheets/2025-02-07-fact-sheet-medicaid-hospital-payment-basics">Fact Sheet on Medicaid Hospital Payment Basics</a></li><li><a href="/fact-sheets/2025-02-07-fact-sheet-capita-caps-medicaid-program">Medicaid Per Capita Caps</a></li></ul><h3>Extend Enhanced Premium Tax Credits</h3><p>The federal government offers enhanced premium tax credits (EPTCs) to help eligible individuals and families purchase coverage on the health insurance marketplaces. These policies are scheduled to expire at the end of 2025. <strong>Congress should extend the EPTCs before the end of the year</strong> as they have increased access to health care coverage and high-quality care for patients and communities served by hospitals, health systems and other providers. <strong>Download the AHA fact sheet, which includes new data on the negative impact of not extending the </strong><a href="/fact-sheets/2025-02-07-fact-sheet-enhanced-premium-tax-credits"><strong>EPTCs</strong></a><strong>.</strong></p><h3>Reject Site-neutral Payment Cuts</h3><p>Congress is considering several bills that would impose billions in Medicare site-neutral payment reductions for services provided in hospital outpatient departments. <strong>Congress should reject site-neutral proposals</strong> because they would reduce patient access to vital health care services, particularly in rural and other medically underserved communities. <strong>See AHA resources on the detrimental impact of </strong><a href="/advocacy/advocacy-issues/2023-09-11-advocacy-issue-site-neutral-payment-proposals"><strong>site-neutral policies</strong></a><strong>.</strong></p><h3>Protect the 340B Drug Pricing Program</h3><p>For more than 30 years, the 340B Drug Pricing Program has provided financial help to hospitals serving vulnerable communities to manage rising prescription drug costs. However, some in Congress and the pharmaceutical industry want to see the program scaled back. <strong>Congress should protect the 340B program</strong> for all providers and ensure the program continues to help stretch limited resources and provide more comprehensive services to more patients. <strong>Download the AHA fact sheets on the </strong><a href="/340b-drug-savings-program"><strong>340B program</strong></a><strong>.</strong></p><h2>Further Questions</h2><p>Visit the <a href="/advocacy/action-center">AHA Action Center</a> for more resources on these issues and other priorities important to hospitals and health systems. Watch for more Action Alerts and resources from the AHA to assist your advocacy efforts. If you have further questions, please contact AHA at 800-424-4301.</p></div><div class="col-md-4"><p><a href="/system/files/media/file/2025/02/Contact-Your-Lawmakers-and-Urge-Them-to-Extend-Key-Health-Care-Policies-Set-to-Expire-Next-Month.pdf" target="_blank" title="Click here to download the Action Alert ACTION NEEDED: Contact Your Lawmakers and Urge Them to Extend Key Health Care Policies Set to Expire Next Month PDF."><img src="/sites/default/files/inline-images/Page-1-Contact-Your-Lawmakers-and-Urge-Them-to-Extend-Key-Health-Care-Policies-Set-to-Expire-Next-Month.png" data-entity-uuid="2dd3d759-0b56-4a54-8cdb-d635ee169360" data-entity-type="file" alt="Action Alert: ACTION NEEDED: Contact Your Lawmakers and Urge Them to Extend Key Health Care Policies Set to Expire Next Month page 1." width="696" height="900"></a></p></div></div></div> Fri, 07 Feb 2025 15:04:02 -0600 Member Non-Fed <p>The House by a vote of 366-34 today passed the American Relief Act (<a href="https://docs.house.gov/billsthisweek/20241216/ARA%2012.20.pdf" target="_blank" title="docs.house.gov: H.R. 10545">H.R. 10545</a>), a bill to fund the government through March 14, 2025, provide disaster relief and farm aid, and extend for three months a number of critical programs for hospitals and health systems. The Senate is expected to vote on the bill later tonight. In light of the overwhelming bipartisan support and signals of support from the Administration, it is highly likely the Senate will favorably consider the package. The AHA will provide updates accordingly.</p><h2>Key Highlights</h2><p>The bill contains provisions:</p><ul><li>Preventing cuts in Medicaid Disproportionate Share Hospital payments.</li><li>Extending critical rural Medicare programs.</li><li>Extending telehealth and hospital-at-home programs.</li></ul><h2>AHA Take</h2><p>The AHA appreciates the bipartisan effort to fund the government and extend these critical health care policies for three months to support hospitals’ efforts to care for patients and communities. We thank Congress for their support and look forward to our continued work to ensure hospitals and health systems have the resources they need to advance health for patients and communities.</p><h2>Medicaid and Medicare</h2><h3>Medicaid Disproportionate Share Hospital (DSH) Relief</h3><p>The bill eliminates the Medicaid DSH cuts through April 1, 2025.</p><h3>Medicare Rural Extenders</h3><p>The bill will extend the enhanced low-volume adjustment and the Medicare-dependent hospital programs through April 1, 2025. They were set to expire Dec. 31, 2024.</p><h3>Medicare Telehealth and Hospital-at-home Extensions</h3><p>The bill will extend key telehealth waivers and the hospital-at-home program through March 31, 2025. They were set to expire Dec. 31, 2024.</p><h3>Extension of the Work Geographic Index Floor under the Medicare Program</h3><p>The bill will extend a 1.0 floor on the work Geographic Practice Cost Index (GPCI) through April 1, 2025. This was scheduled to expire Dec. 31, 2024.</p><h3>Medicare Rural Ambulance</h3><p>The bill will extend add-on payments for ambulance services through March 31, 2025. These add-on payments support rural, “super-rural,” and urban ambulance services. They were set to expire Dec. 31, 2024.</p><h2>Other Items of Interest</h2><h3>PAYGO Sequester</h3><p>Under PAYGO requirements, Congress must pay for any legislative package, either by reducing entitlement spending or increasing revenue. The legislation would waive PAYGO reductions by “wiping the scorecard clean,” preventing a 4% Medicare sequester cut from taking effect in January.</p><h3>Disaster Relief</h3><p>The bill provides $29 billion to the Federal Emergency Management Agency Disaster Relief Fund.</p><h2>Offsets</h2><p>The health care portion of the bill includes the following offset.</p><h3>Medicare Improvement Fund</h3><p>The bill reduces the amount of funding in the Medicare Improvement Fund from $3.197 billion to $1.241 billion.</p><h2>Further Questions</h2><p>If you have further questions, please contact the AHA at <a href="tel:1-800-424-4301">800-424-4301</a>.</p> Sat, 21 Dec 2024 08:06:22 -0600 Member Non-Fed <div class="container"><div class="row"><div class="col-md-8"><p>Lawmakers have returned to Washington, D.C., to tackle end-of-the-year funding needs. Quick action is needed this week to address the Medicaid disproportionate share hospital (DSH) payment reductions.</p><p>The <a href="/fact-sheets/2023-03-28-fact-sheet-medicaid-dsh-program">Medicaid DSH program</a> provides essential financial assistance to hospitals that care for our nation’s most vulnerable populations — children, impoverished, disabled and elderly. Fiscal year 2025 Medicaid DSH payment reductions are scheduled to take effect on Jan. 1, 2025, with $8 billion in cuts. The AHA is asking Congress to continue to provide relief from the Medicaid DSH cuts.</p><p><strong>Contact your representative by Dec. 6 and ask them to sign on to the bipartisan </strong><a href="/system/files/media/file/2024/11/congress-dear-colleague-letter-to-stop-medicaid-disproportionate-share-hospital-dsh-payment-cuts-11-13-2024.pdf"><strong>House Dear Colleague letter</strong></a><strong> being circulated by Rep. Dan Crenshaw, R-Texas, Rep. Yvette Clarke, D-N.Y., Rep. Gus Bilirakis, R-Fla., and Rep. Diana DeGette, D-Colo., calling for the Medicaid DSH cuts to be addressed.</strong> View the <a href="/system/files/media/file/2024/11/house-medicaid-dsh-letter-signers-november-2024.pdf">list of current signers</a> to see if your representative supports the letter. If they have not signed, use <a href="/2020-10-07-get-involved?vvsrc=%2fCampaigns%2f118959%2fRespond">this form</a> to send a message asking them to sign now.</p><p>In addition, please see the recent <a href="/action-alert/2024-11-13-aha-asks-congressional-leadership-fund-hospitals-protect-health-care-workers">AHA Action Alert</a> that includes messages and resources on a number of priorities we continue to push with Congress as they work on year-end legislative packages.</p><h2>Further Questions</h2><p>Visit the <a href="/advocacy/action-center">AHA Action Center</a> for more resources on these issues and other priorities important to hospitals and health systems.</p><p>If you have further questions, please contact AHA at <a href="tel:1-800-424-4301">800-424-4301</a>.</p></div><div class="col-md-4"><p><a href="/system/files/media/file/2024/12/Action-Alert-Urgent-Ask-Your-Lawmaker-to-Prevent-Medicaid-DSH-Payment-Cuts.pdf" target="_blank" title="Click here to download the Action Alert: Urgent: Ask Your Lawmaker to Prevent Medicaid DSH Payment Cuts PDF."><img src="/sites/default/files/inline-images/Action-Alert-Urgent-Ask-Your-Lawmaker-to-Prevent-Medicaid-DSH-Payment-Cuts.png" data-entity-uuid="1171b980-eb8c-4123-a9c6-732c7353be44" data-entity-type="file" alt="Action Alert: Urgent: Ask Your Lawmaker to Prevent Medicaid DSH Payment Cuts page 1." width="695" height="900"></a></p></div></div></div> Mon, 02 Dec 2024 11:58:46 -0600 Member Non-Fed <p>AHA members can watch a replay of the November 18 webcast during which AHA President and CEO Rick Pollack, AHA Executive Vice President of Government Relations and Public Policy Stacey Hughes and other experts discussed what the end of the year looks like on Capitol Hill, as well as the big health care issues the new Congress and Administration will focus on in 2025.</p><hr> Thu, 21 Nov 2024 08:55:00 -0600 Member Non-Fed