/ en Sat, 14 Jun 2025 13:27:59 -0500 Thu, 08 May 25 16:08:29 -0500 /2025-05-08-fact-sheet-medicare-site-neutral-legislative-proposals-under-consideration-would-jeopardize-access-care-patients-and <div class="container"><div class="row"><div class="col-md-8"><h2><span><em>The Issue</em></span></h2><p>Congress is considering several proposals that would impose additional Medicare site-neutral payment reductions for services provided in hospital outpatient departments (HOPDs). A description of these proposals and the potential impact they would have on Medicare reimbursement to hospitals and health systems follow. <span><strong>The AHA is opposed to any additional site-neutral cuts, which would endanger the critical role hospitals and health systems play in their communities, including access to care for patients.</strong></span></p><h2><span><em>The Proposals Under Consideration</em></span></h2><hr><ul><li><u>Hospital On-Campus and Off-Campus Site-Neutral Proposal (MedPAC Recommendation)</u>: In its June 2023 Report to the Congress, MedPAC recommended that payments should be aligned across HOPDs, both on-campus and off-campus, ambulatory surgical centers and physician offices for certain ambulatory payment classification (APC) groups. The site-neutral payment rate that would apply to the services in each APC would be based on the Medicare payment system for the ambulatory setting in which these services are most commonly furnished. <span><strong>According to an AHA analysis, this proposal would result in a cut to hospitals of $167.1 billion over 10 years.</strong></span></li><li>The Lowering Health Costs for Seniors Framework, released by Senators Bill Cassidy, M.D. (R-LA) and Maggie Hassan (D-NH) outlines two potential options for site-neutral cuts: <ul><li>Policy Option 1: Eliminating the grandfathering exception to apply site-neutral cuts to all offcampus HOPDs</li><li>Policy Option 2: Imposing the MedPAC proposal outlined above to apply site-neutral cuts to on campus and off-campus HOPDs. As part of this option, the framework also proposes to reinvest a portion of the cuts back to certain types of rural and safety-net hospitals. <span><strong>According to an AHA analysis, accounting for the reinvestments, Policy Option 2 would result in a cut to hospitals of $114.4 billion over 10 years.</strong></span></li></ul></li><li>The <u>SITE Act</u> would expand site-neutral payment cuts for all services furnished in grandfathered off-campus HOPDs, other than evaluation and management services, which are already paid at a site-neutral rate. This would include off-campus HOPDs and some items and services that Congress had previously exempted from site-neutral payment under Medicare, including dedicated emergency departments and CMS-approved “mid-build” off-campus provider-based departments. <span><strong>According to an AHA analysis, this would result in a cut to hospitals of $32 billion over 10 years.</strong></span></li><li><u>The Lower Costs, More Transparency Act</u> contains a provision that would cut reimbursements for drug administration services at off-campus HOPDs. Phased in over four years, drug administration services furnished in grandfathered off-campus HOPDs would be paid at a site-neutral rate, delaying implementation for certain rural and cancer hospitals by one year. <span><strong>According to an AHA analysis, this Act would result in a cut to hospitals of $4 billion over 10 years.</strong></span></li></ul><p><span><em>Estimated Impact Analysis of the Hospital On-Campus and Off-Campus Site-Neutral Proposal (MedPAC Recommendation)</em></span></p><hr><img src="/sites/default/files/inline-images/image_49.png" data-entity-uuid="c23816f6-0ad4-49fa-88d2-640c490ec8c1" data-entity-type="file" width="683" height="909" alt="Estimated Impact Analysis of the Hospital On-Campus and Off-Campus Site-Neutral Proposal (MedPAC Recommendation)"><p><span><em>Estimated Impact Analysis of the Hospital On-Campus and Off-Campus Site-Neutral Proposal (MedPAC Recommendation) - (Continued)</em></span></p><img src="/sites/default/files/inline-images/image_54.png" data-entity-uuid="c93f97c7-726f-4467-bd9a-f5310f5e1e7e" data-entity-type="file" alt="Estimated Impact Analysis of the Hospital On-Campus and Off-Campus Site-Neutral Proposal (MedPAC Recommendation)" width="683" height="465"><p><span><strong>Sources:</strong></span> Centers for Medicare & Medicaid Services (CMS), calendar year (CY) 2023 outpatient prospective payment system (OPPS) final rule rate-setting and outpatient limited data set standard analytical files; CY 2025 OPPS final rule and associated public use files; CMS Provider of Services Files, 2023 and 2024; Congressional Budget Office (CBO), Medicare Baseline Projections, 2024; Medicare Payment Advisory Commission (MedPAC), “Report to the Congress: Medicare and the Health Care Delivery System,” June 2022 and June 2023. </p><p><span><strong>Notes: </strong></span></p><ol><li>In AHA’s modeling of this “All HOPDs MedPAC Site-neutral” recommendation, rather than recreating the process outlined by MedPAC in its reports to identify the impacted APCs, we used a list of APCs previously identified by MedPAC and modeled the site-neutral payment rate for services in those APCs at 40 percent of the OPPS rate, i.e., a reduction of 60 percent.</li><li>We modeled OPPS payments using CY 2023 data files and CY 2025 final rule policies. Payments were inflated to 2026 and projected through 2035 using CBO’s actual and projected payments for hospital outpatient services contained in their June 2024 Medicare baseline.</li></ol><p><span><em>Estimated Impact Analysis of Policy Option 2 in the Lowering Health Costs For Seniors Framework</em></span></p><img src="/sites/default/files/inline-images/image_58.png" data-entity-uuid="9aac639a-3a84-4167-a0a3-7ebaa5edc675" data-entity-type="file" alt="Estimated Impact Analysis of Policy Option 2 in the Lowering Health Costs For Seniors Framework" width="683" height="906"><p><em>Estimated Impact Analysis of Policy Option 2 in the Lowering Health Costs For Seniors Framework (Continued)</em></p><figure><img src="/sites/default/files/inline-images/image_65.png" data-entity-uuid="c365f697-1aa9-4a43-a48f-d25ef6f6bb7f" data-entity-type="file" alt="Estimated Impact Analysis of Policy Option 2 in the Lowering Health Costs For Seniors Framework (Continued)" width="683" height="469"></figure><p><span><strong>Sources:</strong></span> Centers for Medicare & Medicaid Services (CMS), calendar year (CY) 2023 outpatient prospective payment system (OPPS) final rule rate-setting and outpatient limited data set standard analytical files; CY 2025 OPPS final rule and associated public use files; CMS Provider of Services Files, 2023 and 2024; AHA Annual Survey Database, 2022; Congressional Budget Office (CBO), Medicare Baseline Projections, 2024; Medicare Payment Advisory Commission (MedPAC), “Report to the Congress: Medicare and the Health Care Delivery System,” June 2022 and June 2023</p><p><span><strong>Notes:</strong> </span></p><ol><li>In AHA’s modeling of this “All HOPDs MedPAC Site-neutral” recommendation, rather than recreating the process outlined by MedPAC in its reports to identify the impacted APCs, we used a list of APCs previously identified by MedPAC and modeled the site-neutral payment rate for services in those APCs at 40 percent of the OPPS rate, i.e., a reduction of 60 percent. </li><li>As outlined in the Lowering Health Costs For Seniors Framework, Policy Option 2 proposes possible reinvestment mechanisms for rural and safety net hospitals based on their outpatient revenue and core lines of services offered by the hospital, as well as through value-based reimbursement. We modeled the option related to outpatient revenue and core lines of service.</li><li>We modeled OPPS payments using CY 2023 data files and CY 2025 final rule policies. Payments were inflated to 2026 and projected through 2035 using CBO’s actual and projected payments for hospital outpatient services contained in their June 2024 Medicare baseline.</li></ol><p><em>Estimated Impact Analysis of the SITE Act</em></p><p><img src="/sites/default/files/inline-images/image_60.png" data-entity-uuid="a85d7b6d-8f75-4202-8442-8cc76421f8ef" data-entity-type="file" alt="Estimated Impact Analysis of the SITE Act" width="683" height="956"><img src="/sites/default/files/inline-images/image_61.png" data-entity-uuid="3e82f6e2-7f17-442f-8b97-a132e41c0674" data-entity-type="file" alt="Estimated Impact Analysis of the SITE Act" width="678" height="342"></p><p><span><strong>Sources:</strong></span> Centers for Medicare & Medicaid Services (CMS), calendar year (CY) 2023 outpatient prospective payment system (OPPS) final rule rate-setting and outpatient limited data set standard analytical files; CY 2025 OPPS final rule and associated public use files; CMS Provider of Services Files, 2023 and 2024; Congressional Budget Office (CBO), Medicare Baseline Projections, 2019-2024; Medicare Payment Advisory Commission (MedPAC), “Report to the Congress: Medicare and the Health Care Delivery System,” June 2018. </p><p><span><strong>Notes:</strong> </span></p><ol><li>In AHA’s modeling of the SITE Act, we did not model the impact of imposing site-neutral payment cuts to CMS-confirmed “mid-build” off-campus provider-based departments (PBDs) that Congress previously exempted from site-neutral payment under Medicare. Also, it is our understanding that the Act is not intended to apply to off-campus PBDs belonging to the 11 dedicated cancer hospitals, hence the impacts do not include any cuts to those PBDs.</li><li>The SITE Act would cut payment by 30 percent for items and services in off-campus dedicated emergency departments (EDs) that are located 6 or less miles from any other hospital, critical-access hospital (CAH) or rural emergency hospital (REH), including the parent hospital’s ED. Since the Medicare claims data do not contain the necessary information to model this provision, we relied on a CBO score published in the June 2018 MedPAC Report to the Congress, with a projected national impact of $50 - $250 million due to a MedPAC-proposed 30 percent reduction in payments for services provided by urban off-campus EDs that are within 6 miles of an on-campus hospital ED. We conservatively took the midpoint of this range and inflated it to 2026 using CBO’s actual and projected payments contained in their Medicare baselines. Using data contained in outpatient fee-for-service claims billed by hospitals with the “ER” modifier (outpatient items and services furnished by a provider‐based off‐campus ED), we applied the estimated state shares to the estimated national total. Since the CBO score applies only to urban off-campus EDs within 6 miles of an on-campus hospital ED, but the SITE Act applies to all off-campus EDs within 6 miles of any other hospital, CAH, or REH, including the parent hospital of such ED, the CBO score is most probably an underestimate of the actual impact that would occur.</li><li>With the exception of the off-campus ED impact methodology mentioned in note 2, for all other off-campus grandfathered non-E&M services, we estimated the site‐neutral payment rate to be 40 percent of the OPPS payment rate i.e., a reduction of 60 percent.</li><li>Puerto Rico did not report any lines for off-campus grandfathered non-E&M services in the claims data and is not shown in the table. States with very low impacts are shown in the table but have very few reported off-campus grandfathered non- E&M services.</li><li>We modeled OPPS payments using CY 2023 data files and CY 2025 final rule policies. Payments were inflated to 2026 and projected through 2035 using CBO’s actual and projected payments for hospital outpatient services contained in their June 2024 Medicare baseline.</li></ol><p><em>Estimated Impact Analysis of Site-neutral Cut in the Lower Costs, More Transparency Act</em></p><p><img src="/sites/default/files/inline-images/image_62.png" data-entity-uuid="6a70d03d-6911-42c0-bee3-ea8a1faa896a" data-entity-type="file" alt="Estimated Impact Analysis of Site-neutral Cut in the Lower Costs, More Transparency Act" width="683" height="931"></p><p>Estimated Impact Analysis of Site-neutral Cut in the Lower Costs, More Transparency Act (Continued)</p><p><img src="/sites/default/files/inline-images/image_64.png" data-entity-uuid="4cb2a443-a514-45df-9ae0-ede70db33577" data-entity-type="file" alt="Estimated Impact Analysis of Site-neutral Cut in the Lower Costs, More Transparency Act" width="683" height="389"></p><p><span>Sources:</span> Centers for Medicare & Medicaid Services (CMS), calendar year (CY) 2023 outpatient prospective payment system (OPPS) final rule rate-setting and outpatient limited data set standard analytical files; CY 2025 OPPS final rule and associated public use files; CMS Provider of Services Files, 2023 and 2024; Congressional Budget Office (CBO), Medicare Baseline Projections, 2024. </p><p><span><strong>Notes: </strong></span></p><ol><li>The Lower Costs, More Transparency Act defines off-campus grandfathered drug administration services as those that are assigned to designated ambulatory payment classification (APC) groups. While it does not explicitly list the APCs, an AHA coding expert identified four drug administration APCs: 5691-5694. Hence, we used these APCs in our modeling.</li><li>We estimated the site‐neutral payment rate to be 40 percent of the OPPS payment rate i.e., a reduction of 60 percent.</li><li>Since the Lower Costs, More Transparency Act calls for a 4-year transition period, we assumed that cuts would result in 25 percent of the full impact in 2026, 50 percent in 2027, 75 percent in 2028 and 100 percent (full implementation) in 2029 and beyond. It is possible that CMS could adopt a different schedule for the transition period. The impacts shown do not include a one-year delay in implementation for certain rural and cancer hospitals.</li><li>Wyoming and Puerto Rico did not report any lines for off-campus grandfathered drug administration services in the claims data and are not shown in the table. States with very low impacts are shown in the table but have very few reported off-campus grandfathered drug administration services.</li><li>We modeled OPPS payments using CY 2023 data files and CY 2025 final rule policies. Payments were inflated to 2026 and projected through 2035 using CBO’s actual and projected payments for hospital outpatient services contained in their June 2024 Medicare baseline.</li></ol></div><div class="col-md-4"><div class="external-link spacer"><a class="btn btn-wide btn-primary" href="/system/files/media/file/2025/05/fact-sheet-medicare-site-neutral-legislative-proposals-under-consideration-would-jeopardize-access-to-care-for-patients-and-communities.pdf" target="_blank" title="Click here to download the Fact Sheet: Medicare Site-neutral Legislative Proposals Under Consideration Would Jeopardize Access to Care for Patients and Communities PDF.">Download the Fact Sheet PDF</a></div><p><a href="/system/files/media/file/2025/05/fact-sheet-medicare-site-neutral-legislative-proposals-under-consideration-would-jeopardize-access-to-care-for-patients-and-communities.pdf"><img src="/sites/default/files/2025-05/cover-fact-sheet-medicare-site-neutral-legislative-proposals-under-consideration-would-jeopardize-access-to-care-for-patients-and-communities.png" data-entity-uuid data-entity-type="file" alt="Cover Fact Sheet: Medicare Site-neutral Legislative Proposals Under Consideration Would Jeopardize Access to Care for Patients and Communities" width="695" height="899" class="align-center"></a></p></div></div></div> Thu, 08 May 2025 16:08:29 -0500 Site-Neutral Payment Proposals /fact-sheets/2025-05-08-fact-sheet-estimated-impact-hospital-campus-and-campus-site-neutral-proposal <div class="container"><div class="row"><div class="col-md-8"><p>Legislative efforts to enact a Medicare Payment Advisory Commission (MedPAC) proposal that would impose site-neutral payment cuts on hospitals for certain outpatient services — including those occurring in both on-campus and off-campus hospital outpatient departments (HOPDs) — would lead to significant and unacceptable Medicare cuts for hospitals and health systems, jeopardizing access to hospital care for millions of Americans.</p><p>The AHA remains firmly opposed to proposals that would expand site-neutral payment cuts for hospitals. Current Medicare payment rates, despite paying substantially less than the cost of care, recognize that hospital outpatient departments (HOPDs) are unique. HOPDs treat sicker, more complex patients from medically underserved populations; they also follow more rigorous licensing, accreditation and regulatory requirements compared to other care settings.</p><p>Hospitals and health systems, including their HOPDs, need the financial and operational resources to provide high acuity services that only hospitals can provide. This includes maintaining 24/7 capacity to respond to natural and man-made disasters, public health emergencies, and other unexpected traumatic events. It also means being available to care for all individuals experiencing an emergency<br>regardless of their ability to pay. Further site neutral cuts could result in hospitals closing or reducing these vital services, reducing patient access in communities nationwide, particularly in rural and underserved areas.</p><p>Site-neutral policies also threaten the viability of local economies, which hospitals support through job creation and investments in local goods and services. Every dollar a hospital spends in their community generates an additional <span><strong>$3.49</strong></span> in business activity. Thus, large hospital payment cuts, like those proposed by MedPAC, will result in devastating ripple effects that would disrupt economic activity across communities.</p><p>An AHA analysis found that this framework would result in approximately $167 billion in cuts to hospitals and health systems over 10 years. Using data from Lightcast, the AHA found that this amount of revenue loss would result in:</p><ul><li><span>42,000</span> fewer hospital jobs in the first year alone.</li><li><span>169,000</span> fewer jobs in hospitals’ local communities in the first year alone.</li><li>Nearly <span>$600 billion</span> in reduced 10-year total economic activity.</li></ul><p>These losses are simply unsustainable for hospitals and the communities they serve.</p><p>The AHA urges Congress to reject site-neutral payment cuts to avoid jeopardizing access to essential hospital care and weakening economic growth in communities across the country.<br>__________</p><p><small class="sm"><sup>1</sup></small><a href="/system/files/media/file/2023/03/Comparison-of-Medicare-Beneficiary-Characteristics-Between-2 Hospital-Outpatient-Departments-and-Other-Ambulatory-Care-Settings.pdf" target="_blank" title="Medicare Beneficiary Characteristics PDF"><small class="sm">/system/files/media/file/2023/03/Comparison-of-Medicare-Beneficiary-Characteristics-Between-2 Hospital-Outpatient-Departments-and-Other-Ambulatory-Care-Settings.pdf</small></a></p><p><small class="sm">2 AHA analysis of Lightcast (2023), “Impact Scenario Detailed Effect – General Medical and Surgical Hospitals,” at lightcast.io.</small></p></div><div class="col-md-4"><div class="external-link spacer"><a class="btn btn-wide btn-primary" href="/system/files/media/file/2025/05/fact-sheet-estimated-impact-of-hospital-on-campus-and-off-campus-site-neutral-proposal.pdf" target="_blank" title="Click here to download the Fact Sheet: Estimated Impact of Hospital On-campus and Off-campus Site-Neutral Proposal PDF.">Download the Fact Sheet PDF</a></div><p><a href="/system/files/media/file/2025/05/fact-sheet-estimated-impact-of-hospital-on-campus-and-off-campus-site-neutral-proposal.pdf"><img src="/sites/default/files/2025-05/cover-fact-sheet-estimated-impact-of-hospital-on-campus-and-off-campus-site-neutral-proposal.png" data-entity-uuid data-entity-type="file" alt="Cover Fact Sheet: Estimated Impact of Hospital On-campus and Off-campus Site-Neutral Proposal" width="695" height="899" class="align-center"></a></p></div></div></div> Thu, 08 May 2025 15:55:13 -0500 Site-Neutral Payment Proposals /advocacy-alliance-update/2025-05-08-aha-site-neutral-advocacy-alliance-may-8-2025 <p><strong>New AHA fact sheets, resources for your site-neutral payment policy advocacy efforts</strong></p><p>To help with your ongoing advocacy efforts to push back against potential Medicare site-neutral payment cuts, the AHA is releasing two new materials. The first provides federal and state-level <a href="https://nam11.safelinks.protection.outlook.com/?url=https%3A%2F%2Femail.advocacy.aha.org%2FNzEwLVpMTC02NTEAAAGaUOXhEPRhwtvtjAnZghFlxs4uekmnuiLgShkcAKOtsXjecKXmaYPI04cshXxkdVWSZr2207s%3D&data=05%7C02%7Cdsamuels%40aha.org%7Ccfa22a81619a4fe38fd808dd8e7c3c28%7Cb9119340beb74e5e84b23cc18f7b36a6%7C0%7C0%7C638823386442443846%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=3hjOrNACwuGEGD7ZoOgrQxea4H1%2B4wSfOw0%2Br1Mi0fE%3D&reserved=0" target="_blank">financial impacts</a> to hospitals and health systems for four site-neutral policies that Congress has previously considered. The <a href="https://nam11.safelinks.protection.outlook.com/?url=https%3A%2F%2Femail.advocacy.aha.org%2FNzEwLVpMTC02NTEAAAGaUOXhEK3CRxFZ4JY7iK6Klq3ngPaCZi0A0wQNSx0BqweD3SvBzJ_teuSYqUI1tEyBH2xt5eU%3D&data=05%7C02%7Cdsamuels%40aha.org%7Ccfa22a81619a4fe38fd808dd8e7c3c28%7Cb9119340beb74e5e84b23cc18f7b36a6%7C0%7C0%7C638823386442456887%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=3d7ZTw79%2BgI0mpeaDPIk%2FYuAkBiUclxKjgI5jS4bh1s%3D&reserved=0" target="_blank">second</a> shows how the policy with the greatest impact will also threaten the viability of local communities and result in fewer jobs and reduced economic activity in communities throughout the country.<br><br>As a reminder, visit the AHA’s <a href="https://nam11.safelinks.protection.outlook.com/?url=https%3A%2F%2Femail.advocacy.aha.org%2FNzEwLVpMTC02NTEAAAGaUOXhEIlBrlSbLrSv4d5cX-oyMZpHk0Z0T8jJcrFy8pFe-Wd2nv9pAUyefcZ5Q4AU5Q9eFIg%3D&data=05%7C02%7Cdsamuels%40aha.org%7Ccfa22a81619a4fe38fd808dd8e7c3c28%7Cb9119340beb74e5e84b23cc18f7b36a6%7C0%7C0%7C638823386442468841%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=eZA%2FGRoFokyNuG3mZXiFSTv62Qjd6omtwuCGl3dJ4zg%3D&reserved=0" target="_blank">Advocacy Issue Page</a> to access all the site-neutral advocacy materials.</p><p><strong>Further questions</strong><br><br>If you have further questions, please contact Jason Kleinman, AHA’s director of federal relations, at <a href="https://nam11.safelinks.protection.outlook.com/?url=https%3A%2F%2Femail.advocacy.aha.org%2FNzEwLVpMTC02NTEAAAGaUOXhEBTLQyo-2PHkxFpx2odlWxsWLQDQTYqqVXDYfshcr9igENFxzy-RhTdX5hufWRA3e60%3D&data=05%7C02%7Cdsamuels%40aha.org%7Ccfa22a81619a4fe38fd808dd8e7c3c28%7Cb9119340beb74e5e84b23cc18f7b36a6%7C0%7C0%7C638823386442480561%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=pVt0XD5c3%2B02cYolWNrG4OrVgdEPbRfGylDi9B7MH8k%3D&reserved=0" target="_blank">jkleinman@aha.org</a>.</p> Thu, 08 May 2025 14:38:32 -0500 Site-Neutral Payment Proposals <div class="container"><div class="row"><div class="col-md-8"><p>Congressional committees have begun marking up their portions of a reconciliation bill to enact key pieces of President Trump’s agenda. The House Energy and Commerce Committee, which has primary jurisdiction over Medicaid and other health care programs, may mark up its part of the bill as soon as the week of May 5. The E&C Committee has been instructed to reduce deficits by not less than $880 billion, so significant Medicaid cuts are being considered, although no specifics have been released yet. In addition, the House Ways and Means Committee, which has primary jurisdiction over Medicare and taxes, is expected to mark up its part of the bill in mid-May. <br><br>The AHA April 29 sent a letter to <a href="/lettercomment/2025-04-29-aha-letter-congressional-leadership-potential-medicaid-eptc-policy-changes" target="_blank">House and Senate leaders</a> expressing support for the Medicaid program and urging Congress to refrain from considering disruptive policy changes to Medicaid and other health care coverage that could impact access to health care for tens of millions of Americans.  <br><br><strong>Please contact your lawmakers today and urge them to reject harmful funding cuts to Medicaid and other health care programs. Explain how cuts to Medicaid and other programs would reduce access to care and services for their constituents. The following AHA resources can assist your advocacy efforts.  </strong><br> </p><h2 class="text-align-center"><a href="/2020-10-07-get-involved" target="_blank"><span><u>TAKE ACTION NOW</u></span></a></h2><h3>MEDICAID RESOURCES  </h3><p><strong>Explain how vital Medicaid is to your communities</strong>. The AHA has developed several resources that hospitals and health systems can use:   </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" target="_blank">toolkit</a> includes a Medicaid Made Simple video, sample social media messages, sample stakeholder messages and newsletter copy.</li><li><strong>Advocacy Message</strong>. Take action by sending your member of Congress a message detailing the impact of Medicaid cuts in your community. <a href="https://www.votervoice.net/AHA/Campaigns/125909/Respond" target="_blank" title="Advocacy Message Link">Share the link</a> with your stakeholders to encourage broad action</li><li><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" target="_blank">infographic</a> to demonstrate the national hospital impact of potential Medicaid cuts and the enhanced premium tax credits (EPTCs) expiring.</li><li><strong>What’s at Stake</strong>. Use this <a href="/fact-sheets/2025-04-14-whats-stake-medicaid-covers-people-you-know" target="_blank">fact sheet</a> to show the makeup of Medicaid coverage across the country and what’s at stake if Congress cuts the program. Use these <a href="/issue-brief/2025-05-01-state-infographics-whats-stake-medicaid-covers-people-you-know" target="_blank">new infographics</a> to show what's at stake for each state. </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 a number of digital resources and tools that can assist your advocacy efforts. </li></ul><p>In addition, the following fact sheets can help explain how Medicaid ensures hospitals and health systems can care for their communities:</p><ul><li><a href="/fact-sheets/2025-02-07-fact-sheet-medicaid" target="_blank">General Fact Sheet on Medicaid</a></li><li><a href="/fact-sheets/2025-02-07-fact-sheet-medicaid-provider-taxes" target="_blank">Fact Sheet on Medicaid Provider Taxes</a></li><li><a href="/fact-sheets/2025-02-07-fact-sheet-medicaid-hospital-payment-basics" target="_blank">Fact Sheet on Medicaid Hospital Payment Basics</a></li><li><a href="/fact-sheets/2025-02-07-fact-sheet-capita-caps-medicaid-program" target="_blank">Medicaid Per Capita Caps</a> </li></ul><h3>ADDITIONAL RESOURCES ON EPTCs, SITE-NEUTRAL AND 340B</h3><ul><li><strong>Explain why Congress should </strong><a href="/fact-sheets/2025-02-07-fact-sheet-enhanced-premium-tax-credits" target="_blank"><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.</li><li><strong>Tell your lawmakers why they should </strong><a href="/advocacy/advocacy-issues/2023-09-11-advocacy-issue-site-neutral-payment-proposals" target="_blank"><strong>reject site-neutral policies</strong></a>, as they would reduce patient access to vital health care services, particularly in rural and other medically underserved communities.</li><li><strong>Ask your lawmakers to </strong><a href="/340b-drug-savings-program" target="_blank"><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. </li></ul><h3>FURTHER QUESTIONS </h3><p>Visit the <a href="/advocacy/action-center" target="_blank">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 AHA at 800-424-4301.<br> </p></div><div class="col-md-4"><p><a href="/system/files/media/file/2025/04/act-now-urge-your-members-of-congress-to-protect-medicaid-and-other-crucial-programs-alert-4-30-2025.pdf" target="_blank" title="Click here to download the Action Alert ACT NOW: Urge Your Members of Congress to Protect Medicaid and Other Crucial Programs PDF."><img src="/sites/default/files/2025-04/cover-act-now-urge-your-members-of-congress-to-protect-medicaid-and-other-crucial-programs-alert-4-30-2025.png" data-entity-uuid data-entity-type="file" alt="Cover Action Alert ACT NOW: Urge Your Members of Congress to Protect Medicaid and Other Crucial Programs." width="NaN" height="NaN"></a></p></div></div></div> Thu, 01 May 2025 08:00:00 -0500 Site-Neutral Payment Proposals /news/headline/2025-04-16-administration-issues-executive-order-prescription-drug-prices-340b-site-neutral-payment <p>The White House April 15 released an <a href="https://www.whitehouse.gov/presidential-actions/2025/04/lowering-drug-prices-by-once-again-putting-americans-first/">executive order</a> directing federal agencies to undertake a broad range of tasks aimed at reducing the costs of prescription drugs.  <br><br>Among the tasks, the order directs:  <br><br>•    The Department of Health and Human Services to ensure within 90 days grants to federally funded health centers are conditioned upon offering insulin and injectable epinephrine at or below the discounted price paid by the health center grantee or sub-grantee under the 340B Prescription Drug Program to eligible patients.  <br>•    HHS to evaluate and propose regulations, as appropriate, within 180 days to ensure payment within Medicare is not encouraging a shift in drug administration volume away from physician office settings to hospital outpatient departments.  <br>•    HHS to carry out within 180 days an acquisition cost survey for covered outpatient drugs at hospital outpatient departments. HHS must then propose any appropriate adjustments consistent with budget neutrality provisions. <br>•    HHS to develop and implement rulemaking within 60 days for a new payment model for high-cost prescription drugs. <br><br>In a statement, Lisa Kidder Hrobsky, AHA senior vice president of advocacy and political affairs, said, “The AHA welcomes President Trump and his Administration focusing on the high price of drugs. As major purchasers of drugs for patient care, hospitals and health systems have strained under their rising prices. <br> <br>“However, we continue to strongly oppose site-neutral policies that do not account for the unique circumstances of providing care in the hospital outpatient setting, where patients are demonstrably sicker and require more complex care. In addition, hospitals and health systems are the providers of 24/7, 365 days a year care to their patients and provide a wide range of services that allow for healthy communities.   <br> <br>“Finally, 340B is an essential program that helps hospitals advance health in communities across the country. We will work closely with the Administration to convey the critical role 340B plays for patients and communities, especially those in rural and other medically underserved areas.”</p> Wed, 16 Apr 2025 16:01:24 -0500 Site-Neutral Payment Proposals <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 Site-Neutral Payment Proposals /advocacy-alliance-update/2025-02-26-aha-site-neutral-advocacy-alliance <p><strong>Register for March 6 AHA Site-neutral Advocacy Alliance call</strong></p><p>The AHA’s Site-neutral Advocacy Alliance will meet on Thursday, March 6 at 2 p.m. ET. This call will feature updates on the various site-neutral provisions Congress may be considering soon as well as an overview of new advocacy materials available to help with your outreach on this issue.</p><p><a href="https://nam11.safelinks.protection.outlook.com/?url=https%3A%2F%2Femail.advocacy.aha.org%2FNzEwLVpMTC02NTEAAAGY4cG0FGh5yFmAKDnS8U42rNAArtTQ2YLDgT5GW2oKWYO5r-shLxSTgEK1G5uYFRGq4o4ku7c%3D&data=05%7C02%7Cdsamuels%40aha.org%7C26c986483f034176cc7f08dd5676c424%7Cb9119340beb74e5e84b23cc18f7b36a6%7C0%7C0%7C638761790304937777%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=K6R7E6mY3iOsEXSTIUDVo0Y1f2CiC6rc9FElYNv1SK8%3D&reserved=0" target="_blank">Register for the March 6 call</a>.</p><p><strong>Tell Congress to reject site-neutral payment cuts; join AHA’s advocacy day in Washington, D.C.</strong><br>Congress continues to consider policies and proposals that would impact hospital patient care funding. The Senate and House introduced budget reconciliation frameworks, bringing Congress closer to a full reconciliation package that would have significant implications for hospitals. See the AHA’s recent <a href="https://nam11.safelinks.protection.outlook.com/?url=https%3A%2F%2Femail.advocacy.aha.org%2FNzEwLVpMTC02NTEAAAGY4cG0FNTbSj9_EG3V8ez02HVJ8YxKNlWaQbzQ8SI3MXA6BQ2eb-Wme-h3ndQNlL88Pvqdv60%3D&data=05%7C02%7Cdsamuels%40aha.org%7C26c986483f034176cc7f08dd5676c424%7Cb9119340beb74e5e84b23cc18f7b36a6%7C0%7C0%7C638761790304949672%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=DEWUf82N4OpK44Dt5FLB7ducpN6qlW%2B2Ffp%2FipyRoSQ%3D&reserved=0" target="_blank">Action Alert</a> for our key advocacy messages and resources that can assist you in conversations with lawmakers.</p><p>Hospital and health system leaders can <a href="https://nam11.safelinks.protection.outlook.com/?url=https%3A%2F%2Femail.advocacy.aha.org%2FNzEwLVpMTC02NTEAAAGY4cG0FFx0glaj1drddg7wYHzU_8iYaK0Q3o2sqH1vUHmnqRS7J-ObMXgnhWAqXExDz_ZBwFw%3D&data=05%7C02%7Cdsamuels%40aha.org%7C26c986483f034176cc7f08dd5676c424%7Cb9119340beb74e5e84b23cc18f7b36a6%7C0%7C0%7C638761790304961263%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=3Sk%2FgkCYiiD8sQWxfWkksw1HD7s5DWA70hBDqNBlNq4%3D&reserved=0" target="_blank">register</a> for a March 4 AHA Advocacy Day event in Washington, D.C. 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. This event is for AHA members only.</p><p>If you cannot make it to Washington, the AHA will virtually broadcast a live briefing for AHA members beginning at 10 a.m. ET. <a href="https://nam11.safelinks.protection.outlook.com/?url=https%3A%2F%2Femail.advocacy.aha.org%2FNzEwLVpMTC02NTEAAAGY4cG0FKdedaAdqINweCF_WsVgbblA4svNEdYUErc5zsMHUX3kjGOeUC5WdOkw7u80VgUA1aI%3D&data=05%7C02%7Cdsamuels%40aha.org%7C26c986483f034176cc7f08dd5676c424%7Cb9119340beb74e5e84b23cc18f7b36a6%7C0%7C0%7C638761790304974592%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=FCHMlCdXSGl%2BdyQP1b0BC9NavU%2Bid%2FTPXQfl5u3CBeQ%3D&reserved=0" target="_blank">Register for the virtual session</a>.</p><p><strong>Site-neutral advocacy resources</strong><br>Visit the AHA’s Site-neutral Payment Proposals <a href="https://nam11.safelinks.protection.outlook.com/?url=https%3A%2F%2Femail.advocacy.aha.org%2FNzEwLVpMTC02NTEAAAGY4cG0FIbs8y5II7xgCfE3VcTzcfJc3JFZjX44O7ZpZCueH8-X58ORNXYhiIRNYLnSPgdiFF8%3D&data=05%7C02%7Cdsamuels%40aha.org%7C26c986483f034176cc7f08dd5676c424%7Cb9119340beb74e5e84b23cc18f7b36a6%7C0%7C0%7C638761790304986003%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=gtbXQnWilklt0clIhuj74%2BiRDXNMvjonGsbxVsEtgMI%3D&reserved=0" target="_blank">Advocacy Issue page</a> for additional resources to assist in your advocacy efforts.</p><p><strong>Further questions</strong><br>If you have further questions, please contact Jason Kleinman, AHA’s director of federal relations, at <a href="https://nam11.safelinks.protection.outlook.com/?url=https%3A%2F%2Femail.advocacy.aha.org%2FNzEwLVpMTC02NTEAAAGY4cG0FF9tLM_oa5Jw_IDf6raWyt-MmLuzhi88tKMSfDJqtybn2F2j0QRhB_yzS4UdPq_NYuA%3D&data=05%7C02%7Cdsamuels%40aha.org%7C26c986483f034176cc7f08dd5676c424%7Cb9119340beb74e5e84b23cc18f7b36a6%7C0%7C0%7C638761790304997370%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=S4z6vePrBmO174kJ%2BZR2JU6QvKY06hmQXduxz2J4jpM%3D&reserved=0" target="_blank">jkleinman@aha.org</a>.</p> Wed, 26 Feb 2025 10:36:54 -0600 Site-Neutral Payment Proposals /fact-sheets/2025-02-20-fact-sheet-facility-fees <div class="container"><div class="row"><div class="col-md-8"><h2><span><em>The Issue</em></span></h2><p>Facility fees are the portion of a health care treatment bill that covers all the costs of delivering patient care, except for those that are billed by physicians and other professionals. Congress has introduced several pieces of legislation that would limit hospitals’ ability to charge these fees in the context of Medicare hospital outpatient payments (also known as “site-neutral” provisions). These proposals would cut anywhere from approximately $3 billion to $180 billion from hospitals over 10 years without providing any alternative mechanism for funding the essential health care services that only hospitals provide. Increasingly, policymakers are also looking at policies to limit facility fees in the context of commercial coverage.</p><h2><span><em>AHA Take</em></span></h2><p>The AHA urges Congress to oppose any legislation that would cut resources to hospitals through the use of facility fees to help finance the care they provide to their communities.</p><h2><span><em>Why?</em></span></h2><ul><li>Facility fees provide hospitals with the resources necessary to make available the high-acuity services only they can provide on a 24/7 basis, such as emergency and trauma care. This includes around the- clock nursing and physician services, medical equipment, drug therapies and maintaining critical building and community infrastructure.</li><li>Hospital outpatient departments and affiliated physician offices are not the same as independent physician offices and other ambulatory sites of care. They care for sicker patients and treat a higher rate of uninsured. They also must meet higher regulatory standards. For example, unlike most independent physician offices or ambulatory surgery centers, hospital outpatient departments and affiliated physician practices do not call 911 if their patient experiences a medical emergency. Instead, they work as an integrated system to immediately transfer the patient to the hospital emergency department or other appropriate care setting.</li><li>Facility fees are increasingly used to cover the true cost of providing physician services, which hospitals do by subsidizing physicians’ pay above the underpayment that they are reimbursed from both public and private payers. These payers have pushed physician compensation so low that many physicians have no choice but to either seek employment or require subsidies from the facilities in which they work.</li><li>Restrictions on the use of facility fees could result in hospitals having to make challenging decisions to end the provision of certain services. This would result not only in a loss of access to care in the community but also in jobs.</li></ul><h2><span><em>Key Facts</em></span></h2><p>Hospital bills cover two types of expenses — professional fees and facility fees. Professional fees cover the cost of the physician providing the care. Facility fees cover everything else — both the direct and indirect costs that allow hospitals to continue to provide comprehensive care to patients and serve the needs of their communities. However, as both Medicare and commercial payers increasingly compensate physicians below the cost of delivering care, hospitals have needed to use a portion of facility fees to subsidize physician practices. These fees may be combined into one bill or separated into multiple bills.</p><img src="/sites/default/files/inline-images/image_45.png" data-entity-uuid="28fe6d72-8d14-4593-9e8e-28274902c28f" data-entity-type="file" alt="Professional fees chart" width="850" height="525"></div><div class="col-md-4"><a href="/system/files/media/file/2025/02/fact-sheet-facility-fees.pdf"><img src="/sites/default/files/inline-images/cover-fact-sheet-facility-fees.png" data-entity-uuid="2fd7d096-f108-4c23-b2c6-8deb529a5869" data-entity-type="file" alt="Cover of Fact Sheet" width="682" height="882"></a></div></div></div> Thu, 20 Feb 2025 14:55:33 -0600 Site-Neutral Payment Proposals <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 Site-Neutral Payment Proposals /fact-sheets/2023-03-21-fact-sheet-medicare-hospital-outpatient-site-neutral-payment-policies h2 { color: #003087; } <div class="container"><div class="row"><div class="col-md-8"><h2>AHA Take</h2><p><strong>The AHA strongly opposes site-neutral payment cuts, which would reduce access to critical health care services, especially in rural and other underserved communities.</strong></p><p>Hospital outpatient departments (HOPDs) — such as hospital-owned clinics that provide complex cancer, infectious disease, and mental health services — should not be paid the same Medicare rate as a standalone physician office. These outpatient departments treat more patients from medically underserved populations who tend to be sicker and more complex to care for than Medicare patients treated in independent physician offices and ambulatory surgical centers. They also are held to more rigorous licensing, accreditation and regulatory requirements. Implementing site-neutral payment policies could force outpatient clinics to close or cut back on critical services, resulting in reduced patient access and job losses.</p><p>The cost of care delivered in hospitals and health systems, including HOPDs, is fundamentally different than other sites of care and thus needs to take into account the unique benefits that only they provide to their communities. This includes maintaining standby capacity for natural- and man-made disasters, public health emergencies, other unexpected traumatic events, and the delivery of 24/7 emergency care to all who come through their doors, regardless of ability to pay or insurance status. Since the hospital safety-net and emergency standby roles are funded through the provision of all outpatient services, expanding site-neutral cuts to additional HOPDs and the outpatient services they provide would endanger the critical role that they play in their communities, including access to care for patients, especially the most medically complex.</p><h2>Why?</h2><h3>Site-neutral payment policies endanger hospitals’ ability to continue to provide 24/7 access to emergency care and standby capability and capacity for disaster response.</h3><p>Hospitals have a higher cost structure than independent physician offices and ambulatory surgery centers (ASCs) due in part to the costs of standby capability and capacity. Existing site-neutral policies reimburse certain offcampus HOPDs less for services while still expecting them to continue to provide the same level of service to their patients and communities. Hospitals are the only health care provider that must maintain emergency standby capability 24 hours a day, 365 days a year. This standby role is built into the cost structure of hospitals and supported by revenue from direct patient care — a situation that does not exist for any other type of provider. Following several years in which the nation experienced multiple emergencies and disruptions, we must do everything we can to ensure that hospitals have the resources needed to prepare for, and respond to, future disasters.</p><h3>HOPDs provide services that are not otherwise available in the community for vulnerable patient populations.</h3><p>Expanding site-neutral payment cuts would greatly endanger the critical role that HOPDs play in their communities, including providing convenient access to care for the most vulnerable and medically complex beneficiaries. HOPDs are more likely to treat Medicare beneficiaries who have both more chronic conditions and more severe chronic conditions; are dually eligible for Medicare and Medicaid; are more likely to have a prior hospitalization and higher prior emergency department (ED) use; and are more likely to live in communities with lower incomes.<a href="#fn1"><sup>1</sup></a> This is especially true in rural areas. Medicare beneficiaries in rural communities disproportionately rely on HOPDs to meet their increased health care needs. The more rural the county that a beneficiary lives in, the more likely it is that their visits will take place in an HOPD rather than a physician office.<a href="#fn1"><sup>1</sup></a></p><h3>HOPDs have more comprehensive licensing, accreditation and regulatory requirements than independent physician offices and ASCs.</h3><p>Hospitals’ safety net roles means that they also are subject to more comprehensive licensing, accreditation and regulatory requirements than other settings. This includes the Emergency Medical Treatment and Labor Act (EMTALA), stricter requirements for disaster preparedness and response, stringent ventilation and infection control codes, quality assurance, accreditation, and fire and life safety codes. Site-neutral payment policies fail to account for these fundamental differences between hospitals and other sites of ambulatory care.</p><h3>Medicare already pays substantially less than the cost of caring for its beneficiaries.</h3><p>Medicare significantly underpays hospitals for the cost of providing care to patients. On average, Medicare pays only 82 cents for every dollar of hospital care provided to Medicare patients, leaving hospitals with $100 billion in annual Medicare shortfalls. As a result, two-thirds of all hospitals report negative Medicare margins.<a href="#fn2"><sup>2</sup></a> Additional site-neutral cuts will only exacerbate these shortfalls and reduce access to care for seniors.</p><p><strong>The AHA strongly opposes any further site-neutral payment cuts, which threaten access to care. Treating services as the same regardless of the site of care ignores the fact that only certain providers are capable of caring for the most acute and vulnerable — and therefore resource- intensive — patients. In addition, these same providers are the sole source of a wide range of high-acuity essential services, such as emergency and trauma care, the costs for which must be shared across all services.</strong></p><hr><h3>Notes</h3><ol><li id="fn1"><a href="/2024-01-25-analysis-hospitals-and-health-systems-are-critical-preserving-access-care-rural-communities">aha.org/2024-01-25-analysis-hospitals-and-health-systems-are-critical-preserving-access-care-rural-communities</a></li><li id="fn2"><a href="/2024-01-10-infographic-medicare-significantly-underpays-hospitals-cost-patient-care">aha.org/2024-01-10-infographic-medicare-significantly-underpays-hospitals-cost-patient-care</a></li></ol></div><div class="col-md-4"><a href="/system/files/media/file/2023/03/fact-sheet-medicare-hospital-outpatient-site-neutral-payment-policies-march-2023.pdf" target="_blank"><img src="/sites/default/files/inline-images/Page-1-Fact-Sheet-Medicare-Hospital-Outpatient-Site-Neutral-Payment-Policies-20250122.png" data-entity-uuid="43b22e2d-7f00-4638-9120-3d1946d47cdc" data-entity-type="file" alt="Fact Sheet: Medicare Hospital Outpatient Site-Neutral Payment Policies Updated January 2025, page 1." width="695" height="900"></a></div></div></div> Wed, 22 Jan 2025 12:00:00 -0600 Site-Neutral Payment Proposals