/ en Sun, 11 May 2025 08:32:09 -0500 Thu, 19 Dec 24 14:36:02 -0600 <div class="container"><div class="row"><div class="col-md-8"><p>The Department of Health and Human Services (HHS) Office of the National Coordinator for Health Information Technology (ONC) Dec. 16 published a <a href="https://www.federalregister.gov/documents/2024/08/05/2024-14975/health-data-technology-and-interoperability-patient-engagement-information-sharing-and-public-health">final rule</a> implementing provisions related to the Trusted Exchange Framework and Common Agreement (TEFCA). The rule is intended to advance equity, innovation and interoperability by promoting the use and exchange of electronically captured health information as specified in certain provisions of the Health Information Technology for Economic and Clinical Health Act of 2009.</p><p>The final rule adds a new part — part 172 — to title 45 of the Code of Federal Regulations to implement certain provisions related to TEFCA. These provisions establish the qualifications necessary for an entity to receive and maintain designation as a Qualified Health Information Network (QHIN) capable of trusted exchange according to TEFCA. The final rule covers procedures governing QHINs including onboarding, designation, suspension and termination. The provisions this final rule adopts are not substantively different from those first proposed in August as part of the much larger <a href="https://www.federalregister.gov/documents/2024/08/05/2024-14975/health-data-technology-and-interoperability-patient-engagement-information-sharing-and-public-health">Health Data, Technology, and Interoperability: Patient Engagement, Information Sharing, and Public Health Interoperability (HTI-2)</a> rule and will be effective Jan. 15, 2025. Additional provisions of the HTI-2 rule, including Prior Authorization Application Programming Interfaces, more information blocking exceptions, United States Core Data for Interoperability Version 4 standards, and public health interoperability requirements are currently under review by the White House Office of Management and Budget and could be published in the future.</p><h2>AHA TAKE</h2><p>In our comments on the proposed rule, AHA supported the TEFCA objective of creating a common national framework that provides a universal technical foundation for interoperability. We also supported ONC’s proposed requirements for organizations choosing to participate in TEFCA as a QHIN. Specifically, we supported the recommendation that any organization aspiring to become a QHIN must adhere to specific privacy and security guidelines, with additional stipulations for those providing Individual Access Services.</p><p>However, we expressed concerns about what happens to the hospitals and health systems that rely on any QHIN that gets suspended or terminated from TEFCA. We appreciate that the ONC acknowledged our concerns in this area but are disappointed it declined to change the rule because the requested changes were deemed out of scope. We will continue to press this issue and encourage ONC to address it in future rulemaking. </p><p>Moreover, we also expressed concerns about the existing governance structure of TEFCA which gives QHINs the primary responsibility for ensuring that its participants abide by TEFCA’s requirements. We conveyed that this governance structure runs the risk of quickly exceeding the capabilities of both QHINs and the Recognized Coordinating Entity — the organization responsible for TEFCA’s oversite — of effectively managing participation in TEFCA. Although ONC did not change the proposed rule, the agency acknowledged these concerns and noted it “will continue to monitor TEFCA” and “will consider additional measures should circumstances arise that show that QHINs require additional oversight.”</p><h2>WHAT YOU CAN DO</h2><ul><li><strong>Share</strong> this advisory with your government relations, information systems and compliance teams to apprise them of this final rule.</li><li><strong>Contact </strong>the AHA with any questions or concerns regarding these provisions.</li><li><strong>Watch</strong> for notices of additional HTI-2 provisions published as final rules soon.</li></ul><h2>SUMMARY OF PROVISIONS</h2><ul type="disc"><li>Codifies (in new 45 CFR part 172) provisions related to TEFCA to provide greater process transparency and to further implement section 3001(c)(9) of the Public Health Service Act (PHSA), as added by the Cures Act.</li><li>Establishes the processes for an entity to qualify and maintain designation as a QHIN capable of trusted exchange under the Common Agreement.</li><li>Establishes the procedures governing the onboarding, suspension, termination and administrative appeals to the ONC for QHINs.</li><li>Codifies requirements related to QHIN attestation for the adoption of TEFCA. This subpart implements section 3001(c)(9)(D) of the PHSA and includes the requirement for ONC to publish a list on their website of the health information networks that have adopted the Common Agreement and are capable of trusted exchange pursuant to the Common Agreement.</li><li>Reenforces that adoption of TEFCA is voluntary. Section 3001(c)(9)(D)(ii) requires HHS to establish, through notice and comment rulemaking, a process for HINs that voluntarily elect to adopt TEFCA to attest to such adoption.</li><li>Finalizes the TEFCA Manner Exception, which allows an actor to limit electronic health information sharing requests to TEFCA only without being considered information blocking with no revisions.</li></ul><h2>FURTHER QUESTIONS</h2><p>If you have further questions, please contact Stephen Hughes, AHA’s director of health information technology policy, at <a href="mailto:Stephen.hughes@aha.org">Stephen.hughes@aha.org</a>.</p></div><div class="col-md-4"><a href="/system/files/media/file/2024/12/hhs-publishes-tefca-provisions-of-health-data-technology-and-interoperability-rule.pdf"><img src="/sites/default/files/inline-images/cover-hhs-publishes-tefca-provisions-of-health-data-technology-and-interoperability-rule.png" data-entity-uuid data-entity-type="file" alt="Regulatory Advisory Cover" width="679" height="878"></a></div></div></div> Thu, 19 Dec 2024 14:36:02 -0600 Health Information Technology (HIT) /news/headline/2024-12-16-hhs-releases-information-blocking-rule-related-care-access <p>The Department of Health and Human Services Dec. 16 published a <a href="https://www.federalregister.gov/public-inspection/2024-29683/health-data-technology-and-interoperability-protecting-care-access">final rule</a> implementing certain provisions related to information blocking exceptions. The rule revises defined terms related to protecting access to care for purposes of the information blocking regulations.<br><br>The agency adopted select provisions first proposed in August as part of the much larger <a href="https://www.federalregister.gov/documents/2024/08/05/2024-14975/health-data-technology-and-interoperability-patient-engagement-information-sharing-and-public-health">Health Data, Technology, and Interoperability: Patient Engagement, Information Sharing, and Public Health Interoperability (HTI-2)</a> rule. The adopted provisions are designed to address concerns from patients, health care providers and other stakeholders regarding patient privacy, access to care, preferences for electronic health information sharing, and methods for achieving a balance between certainty and flexibility for entities involved in enhancing EHI interoperability and exchange.The finalized “Protecting Care Access Exception” would allow entities to restrict EHI sharing under certain conditions to mitigate the risk of legal repercussions for patients, providers or care facilitators involved in lawful reproductive health services. The provisions will be effective immediately when published Dec. 17 in the Federal Register.<br><br>This is the second rule in less than a <a href="/news/headline/2024-12-11-hhs-releases-tefca-final-rule">week</a> containing policies originally included in the proposed HTI-2 rule. As such, additional provisions of the HTI-2 rule, including prior authorization application programming interfaces, United States Core Data for Interoperability Version 4 standards and public health interoperability requirements — which are currently under review by the White House Office of Management and Budget — could be published soon.</p> Mon, 16 Dec 2024 16:01:18 -0600 Health Information Technology (HIT) /amicus-brief/2024-09-24-amicus-brief-aha-electronic-health-record-association-support-pointclickcare-technologies-inc <p class="text-align-center">No. 24-1773<br><br>IN THE UNITED STATES COURT OF APPEALS<br>FOR THE FOURTH CIRCUIT<br> </p><p class="text-align-center">REAL TIME MEDICAL SYSTEMS, INC.,<br>                                         <em>  Plaintiff-Appellee,</em><br>v.<br>POINTCLICKCARE TECHNOLOGIES, INC. D/B/A POINTCLICKCARE,<br>                                        <em>      Defendant-Appellant.</em><br> </p><p class="text-align-center">On Appeal from the United States District Court for the<br>District of Maryland at Greenbelt<br> </p><p class="text-align-center">BRIEF FOR AMICI CURIAE ELECTRONIC HEALTH<br>RECORD ASSOCIATION AND AMERICAN HOSPITAL<br>ASSOCIATION IN SUPPORT OF DEFENDANT-<br>APPELLANT AND REVERSAL</p><table><tbody><tr><td><p>James E. Tysse<br>Kelly M. Cleary<br>Margaret O. Rusconi<br>Emily I. Gerry<br>Stephanie Ondroff<br>AKIN GUMP STRAUSS<br>HAUER & FELD LLP<br>2001 K Street N.W.<br>Washington, D.C. 20006<br>202-887-4000<br>jtysse@akingump.com<br> </p><p><em>Counsel for</em> Amici Curiae</p></td></tr></tbody></table> Tue, 24 Sep 2024 10:57:15 -0500 Health Information Technology (HIT) /news/headline/2024-09-17-hhs-awards-2-million-columbia-university-hospital-ohsu-responsible-ai-behavioral-health-it-projects <p>The Department of Health and Human Services Sept. 17 <a href="https://www.hhs.gov/about/news/2024/09/17/hhs-announces-2024-leap-health-awardees-focused-data-quality-responsible-ai-accelerating-adoption-behavioral-health.html" target="_blank">announced</a> it has awarded a total of $2 million to two recipients to create tools to improve care delivery, advance research capabilities and address emerging challenges related to interoperable health information technology. Columbia University Hospital in New York will be tasked with developing innovative ways to evaluate and improve the quality of health care data used by artificial intelligence tools. Oregon Health and Science University will work on advancing the adoption of health IT in behavioral health settings. The funds were awarded through HHS' Leading Edge Acceleration Projects in Health IT program.</p> Tue, 17 Sep 2024 15:25:44 -0500 Health Information Technology (HIT) <div class="container"><div class="row"><div class="col-md-8"><p>The Office of the National Coordinator for Health Information Technology (ONC), released the Health Data, Technology, and Interoperability: Patient Engagement, Information Sharing, and Public Health Interoperability (HTI-2) <a href="https://www.federalregister.gov/documents/2024/08/05/2024-14975/health-data-technology-and-interoperability-patient-engagement-information-sharing-and-public-health" target="_blank" title="The proposed rule text">proposed rule</a> for public comment. The HTI-2 proposed rule reflects ONC’s efforts to advance interoperability and improve information sharing among patients, providers, payers and public health authorities. Comments are due to the ONC by 5 p.m. ET, Oct. 4, 2024.</p><div class="panel module-typeC"><div class="panel-heading"><h2>Key Highlights</h2><p>The proposed rule would: </p><ul><li>Add technology and standards updates that build on the HTI-1 final rule, ranging from the capability to exchange clinical images (e.g., X-rays) to the addition of multi-factor authentication support.</li><li>Establish requirements for health IT that can be used by providers and payers to conduct streamlined electronic prior authorization.</li><li>Formally establish the Trusted Exchange Framework and Common Agreement (TEFCA) provisions in the Code of Federal Regulations.</li><li>Expand the list of Information Blocking Rule exceptions including one for the Protecting Care Access exception, to protect actors who withhold Electronic Health Information (EHI) in certain cases to reduce legal risks that may be associated with sharing EHI.</li><li>Require adoption by Jan. 1, 2028, of Version 4 of the United States Core Data for Interoperability (USCDI v4) certification criteria as the new baseline standard for EHI.</li></ul></div></div><h2>AHA TAKE</h2><p>The ONC intends for HTI-2 to advance public health interoperability, improve information sharing and support patient engagement. Much like its predecessor, HTI-1, the proposed rule predominately applies to health IT developers. However, hospitals and health systems will be affected by the updates in technology standards and other recommended changes. These updates should improve the accessibility and free exchange of clinical imaging data, such as X-rays and MRI results, and introduce reasonable security requirements, like multi-factor authentication and server encryption requirements for systems that handle electronic medical records. The AHA supports the security recommendations in the proposed rule that aligns with existing HIPAA Security Rule Safeguards and the Healthcare and Public Health Sector Cybersecurity Performance Goals. The AHA is also pleased the ONC is proposing to remove barriers to patient care and streamline the prior authorization process. It does so by supporting the technical requirements in CMS’s Interoperability and Prior Authorization final rule and requires payers to shift to electronic prior authorization. </p><p>The AHA is unclear, however, on what the ONC would accomplish with the other provisions in this proposed rule. The AHA is concerned about the TEFCA provisions because we have not seen widespread adoption of the framework by hospitals and health systems and it is not clear how adherence to the provisions will measurably improve patient access to care. Furthermore, the interaction of TEFCA with the rules on information blocking and the minimum-necessary requirement of HIPAA is unknown. These all require careful consideration of various legal, technical and privacy-related factors before TEFCA can be the accepted standard for clinical data sharing or a regulatory mandate for clinical data exchange. </p><p>Additionally, the AHA appreciates the ONC’s recognition of the complexity, safety issues and added work that arises from the manual processes required by hospitals and health systems to share information with public health authorities. However, the AHA questions whether the ONC has the authority to influence the way public health authorities manage and share electronic health records. Lastly, the AHA is disappointed that the ONC missed another opportunity to clearly define information blocking by offering specific examples and continues trying to define the rule by what it is not while just adding more exceptions. Although some of these new exceptions, such as broader definitions of “infeasibility,” could help protect providers from frivolous complaints, the other proposed exceptions are confusing, and their intended benefits are difficult to quantify. </p><h2>WHAT YOU CAN DO</h2><ul><li><strong>Share</strong> this advisory with your government relations, information systems and  compliance teams to apprise them of this proposed rule.</li><li><strong>Share</strong> any concerns and feedback on these provisions with the AHA.</li><li><strong>Submit</strong> by Oct. 4 to the ONC a comment letter explaining the rule’s impact on your hospital or health system.</li><li><strong>Watch</strong> for notice of a possible comment letter from the AHA on this topic.</li></ul><p>View the detailed Regulatory Advisory below.</p></div><div class="col-md-4"><p><a href="/system/files/media/file/2024/08/hhs-proposes-expansion-of-health-data-technology-and-interoperability-rule-advisory-8-15-2024.pdf" target="_blank" title="Download the Regulatory Advisory: HHS Proposes Expansion of Health Data, Technology and Interoperability Rule PDF."><img src="/sites/default/files/2024-08/cover-hhs-proposes-expansion-of-health-data-technology-and-interoperability-rule-advisory-8-15-2024-667px.png" data-entity-uuid data-entity-type="file" alt="Regulatory Advisory:HHS Proposes Expansion of Health Data, Technology and Interoperability Rule cover." width="NaN" height="NaN"></a></p></div></div></div> Thu, 15 Aug 2024 08:25:08 -0500 Health Information Technology (HIT) /news/headline/2024-07-10-hhs-releases-proposed-rule-designed-improve-patient-engagement-information-sharing-interoperability <p>The Department of Health and Human Services July 10 released a <a href="https://www.healthit.gov/sites/default/files/page/2024-07/ONC_HTI-2_Proposed_Rule.pdf">proposed rule</a> designed to improve health information sharing and interoperability. The Health Data, Technology, and Interoperability: Patient Engagement, Information Sharing, and Public Health Interoperability (HTI-2) proposed rule includes two sets of certification criteria designed to enable health information technology for public health and payers to be certified under the Office of the National Coordinator for Health Information Technology's Health IT Certification Program. The criteria would improve public health response, advance value-based care delivery and focus on standards-based application programming interfaces to improve end-to-end interoperability between health care providers and public health organizations or payers. <br><br>The rule proposes a new set of certification criteria to support the technical requirements included in the Centers for Medicare & Medicaid Services’ Jan. 2024 Interoperability and Prior Authorization <a href="https://www.govinfo.gov/content/pkg/FR-2024-02-08/pdf/2024-00895.pdf">final rule</a> to facilitate electronic prior authorization. The proposed rule also responds to patient, provider and other communities’ concerns about patient privacy and care access by expanding exceptions and clarifying the definitions of information blocking. HHS plans to publish the notice in the Federal Register with a 60-day comment period.</p> Wed, 10 Jul 2024 15:43:17 -0500 Health Information Technology (HIT) /news/headline/2024-03-27-onc-releases-federal-strategic-plan-electronic-health-information <p>The Department of Health and Human Services’ Office of the National Coordinator for Health Information Technology March 27 released for comment through May 28 a federal strategic <a href="https://www.healthit.gov/topic/draft-2024-2030-federal-health-it-strategic-plan" target="_blank">plan</a> for health information technology over the next five years. The plan outlines federal goals and strategies to support electronic health information access, exchange and use. Federal agencies will use the final plan to prioritize and coordinate their efforts and signal priorities to the private sector. According to <a href="https://www.hhs.gov/about/news/2023/03/27/new-federal-health-strategy-sights-heathier-innovative-equitable-health-care-experience.html" target="_blank">ONC</a>, the draft plan aligns with HHS’ previous concept <a href="https://www.hhs.gov/about/news/2023/12/06/hhs-announces-next-steps-ongoing-work-enhance-cybersecurity-health-care-public-health-sectors.html" target="_blank">paper</a> and voluntary <a href="/news/headline/2024-01-24-hhs-releases-voluntary-cybersecurity-goals-health-care" target="_blank">Cybersecurity Performance Goals</a>.<br><br>“AHA appreciates that Health and Human Services is incorporating the voluntary Cybersecurity Performance Goals based on the cyber resiliency best practices and strategies identified by cybersecurity industry experts and the public-private partnership between federal agencies and several representatives of the health care sector, including the AHA,” said John Riggi, AHA’s national advisor for cybersecurity and risk.<br><br>“However, HHS continues to push its misguided concept paper, which calls for mandatory cybersecurity requirements for hospitals alone. This will not improve the overall cybersecurity posture of the health care sector. HHS’ repeated references to this concept paper demonstrates the logically flawed emphasis on hospitals as the primary source of cyber risk in health care. To make meaningful progress in the war on cybercrime, the federal government must be willing to take a strategic and holistic approach to this national security threat, not focusing on just one facet of the health care sector — hospitals. Any defensive strategy imposed on the health care sector must also be accompanied by an equally aggressive offensive cyber strategy by the government to counter the true source of cyber risk — foreign bad guys. <br><br>“As the painful experience of the Change Healthcare crisis reminded us, hospitals and our patients are more likely to be the victims or collateral damage of cyberattacks, and not the primary source of cyber risk exposure facing the health care sector. That well-documented source of risk originates from vulnerabilities in third-party technology and service providers, and not hospitals’ primary systems. <br><br>“The AHA cannot support proposals for mandatory cybersecurity requirements being levied on hospitals as if they were at fault for the success of hackers in perpetrating a crime. Imposing fines or cutting Medicare payments would diminish hospital resources needed to combat cybercrime and would be counterproductive to our shared goal of preventing cyberattacks.”</p> Wed, 27 Mar 2024 16:39:10 -0500 Health Information Technology (HIT) /news/headline/2024-02-28-aha-podcast-chatgpt-practical-health-care-data-analytics <p>AHA experts discuss how ChatGPT and artificial intelligence are transforming health care data analytics and some of the potential pitfalls. <a href="/advancing-health-podcast/2024-02-28-chatgpt-it-practical-health-care-data-analytics?utm_source=newsletter&utm_medium=email&utm_campaign=aha-today"><strong>LISTEN NOW</strong></a><br> </p><div></div> Wed, 28 Feb 2024 16:06:00 -0600 Health Information Technology (HIT) <div class="container"><div class="row"><div class="col-md-8"><p>Rural hospitals and health systems are committed to ensuring local access to high-quality, affordable health care. However, these hospitals continue to experience ongoing challenges that jeopardize their ability to provide local access to care and essential services. These include severe underpayments by Medicare and Medicaid, which threaten the financial stability of the health care system; challenges imposed by commercial and Medicare Advantage plans; and a heavy regulatory burden.</p><div class="raw-html-embed"> <div class="col-md-12 cc_tabs"> /* reset */ .cc_tabs ul.a-container { margin: 0; padding: 0; list-style: none; } .cc_tabs input[type=checkbox] { display: none; } /* style */ .cc_tabs .a-container { width: 100%; margin: 20px auto; } .cc_tabs .a-container label { display: block; position: relative; cursor: pointer; font-size: 18px; font-weight: bold; padding: 10px 20px; color: #63666a; background-color: #eee; border-bottom: 1px solid #ddd; -webkit-transition: all .2s ease; -moz-transition: all .2s ease; -ms-transition: all .2s ease; -o-transition: all .2s ease; transition: all .2s ease; margin-bottom:15px } .cc_tabs .a-container label:after { content: ""; width: 0; height: 0; border-top: 8px solid #aaa; border-right: 6px solid transparent; border-bottom: 8px solid transparent; border-left: 6px solid transparent; position: absolute; right: 10px; top: 16px; } .cc_tabs .a-container input:checked + label, .cc_tabs .a-container label:hover { background-color: #003087; color: #fff; } .cc_tabs .a-container input:checked + label:after { border-top: 8px solid transparent; border-right: 6px solid transparent; border-bottom: 8px solid #fff; border-left: 6px solid transparent; top: 6px; } .cc_tabs .a-content { padding: 0 20px 20px; display: none; height:auto; max-height: 40vh; overflow: auto } .cc_tabs .a-container input:checked ~ .a-content { display: block; } /* Style the tab */ .cc_tabs .tab { background-color: #fff; width: auto; height: auto; overflow: auto; } /* Style the buttons inside the tab */ .cc_tabs .tab button { display: block; background-color: lightgray; color: #003087; padding: 10px 16px 10px 20px; width: calc(50% - 30px); border: solid 1px lightgray; outline: none; text-align: center; cursor: pointer; transition: 0.3s; font-size: 20px; float: left; overflow: auto; margin: 0px 15px; -webkit-border-top-left-radius: 15px; -webkit-border-top-right-radius: 15px; -moz-border-radius-topleft: 15px; -moz-border-radius-topright: 15px; border-top-left-radius: 15px; border-top-right-radius: 15px; font-weight: 700; } @media (max-width:452px){ .cc_tabs .tab button{ padding: 10px 5px 10px 5px; width: calc(50% - 4px); font-size: 17px; margin: 0px 2px; } } /* Change background color of buttons on hover */ .cc_tabs .tab button:hover { background-color: #003087; color:#fff } /* Create an active/current "tab button" class */ .cc_tabs .tab button.active { background-color: #003087; color: #ffffff } /* Style the tab content */ .cc_tabs .tab .tabcontent { float: left; padding: 15px 12px; border: 1px solid #ccc; width: 100%; height: auto; } .cc_tabs .tablinks:after { content: '\2610'; color: #777; font-weight: bold; float: right; margin-left: 5px; } .cc_tabs .tablinks.active:after { content: "\2611"; } Get CertifiedRecertify </div> --> <div class="tabcontent" id="General"> <a id="patienttools"> </a> <a id="patienttools"></a> <ul class="a-container"> <li class="a-items"> SUPPORT FLEXIBLE PAYMENT MODELS <div class="a-content"> <p> As the health care field continues to change at a rapid pace, flexible approaches and multiple options for reimbursing and delivering care are more critical than ever to sustain access to services in rural areas. </p> <p> <span><strong>Medicare-dependent Hospital (MDH) and Low-volume Adjustment (LVA).</strong></span> MDHs are small, rural hospitals where at least 60% of admissions or patient days are from Medicare patients. MDHs receive the inpatient prospective payment system (IPPS) rate plus 75% of the difference between the IPPS rate and their inflation-adjusted costs from one of three base years. <span><strong>AHA supports making the MDH program permanent and adding an additional base year that hospitals may choose for calculating payments.</strong></span> The LVA provides increased payments to isolated, rural hospitals with a low number of discharges. <span><strong>AHA also supports making the LVA permanent.</strong></span> The MDH designation and LVA protect the financial viability of these hospitals to ensure they can continue providing access to care. </p> <p> <span><strong>Necessary Provider Designation for Critical Access Hospitals (CAHs).</strong></span> The CAH designation allows small rural hospitals to receive cost-based Medicare reimbursement, which can help sustain services in the community. Hospitals must meet several criteria, including a mileage requirement, to be eligible.  A hospital can be exempt from the mileage requirement if the state certifies the hospital as a necessary provider, but only hospitals designated before Jan. 1, 2006 are eligible. <span><strong>AHA urges Congress to reopen the necessary provider CAH program to further support local access to care in rural areas.</strong></span> </p> <p> <span><strong>Rural Emergency Hospital (REH) Model.</strong></span> REHs are a Medicare provider type that small rural and critical access hospitals can convert to in order to provide emergency and outpatient services without needing to provide inpatient care. REHs are paid a monthly facility payment and the outpatient prospective payment system (OPPS) rate plus 5%. <span><strong>AHA continues to support strengthening and refining the REH model to ensure sustainable care delivery and financing.</strong></span> </p> <p> <span><strong>Rebasing for Sole Community Hospitals (SCHs).</strong></span><strong> </strong>SCHs must show they are the sole source of inpatient hospital services reasonably available in a certain geographic area to be eligible. They receive increased payments based on their cost per discharge in a base year. <span><strong>AHA supports adding an additional base year that SCHs may choose for calculating their payments.</strong></span> </p> </div> </li> <li class="a-items"> ENSURE FAIR REIMBURSEMENT, ACCESS TO CAPITAL & REGULATORY RELIEF <div class="a-content"> <p> Medicare and Medicaid pay only 82 cents for every dollar spent caring for patients, according to the latest AHA data. <strong>Given the challenges of providing care in rural areas, reimbursement rates across payers need to be updated to cover the cost of care.</strong> </p> <p> <span><strong>Telehealth.</strong></span><strong> </strong>Telehealth services are a crucial access point for many patients. AHA supports legislation to make permanent coverage of certain telehealth services made possible during the pandemic, including lifting geographic and originating site restrictions, allowing Rural Health Clinics and Federally Qualified Health Centers to serve as distant sites, expanding practitioners who can provide telehealth and allowing hospital outpatient billing for virtual services, among others. </p> <p> <span><strong>Infrastructure Financing for Rural Hospitals.</strong></span> Many rural hospitals were constructed following the passage of the Hill-Burton Act of 1947, which provided grants and loans for the construction and modernization of hospitals. Currently, many rural hospitals need to update their facilities and services to continue meeting the needs of their community. Yet, narrow financial margins limit rural hospitals’ ability to retain earnings and secure access to capital or qualify for U.S. Department of Agriculture or U.S. Department of Housing and Urban Development mortgage guarantees. Without those resources, rural hospitals are sometimes unable to update facilities. <span><strong>The AHA urges Congress to help ensure that vulnerable communities are able to preserve access to essential health care services by providing infrastructure funding for hospitals that restructure their facilities and services to meet community needs.</strong></span> </p> <p> <span><strong>Reverse Rural Health Clinic (RHC) Payment Cuts.</strong></span> RHCs provide access to primary care and other important services in rural, underserved areas.<strong> </strong><span><strong>AHA urges Congress to repeal payment caps on  provider-based RHCs</strong></span> that limit access to care. </p> <p> <span><strong>Maternal and Obstetric Care.</strong></span><strong> </strong>Maternal health is a top priority for AHA and its rural members. We urge Congress to continue to fund programs that improve or maintain access to maternal and obstetric care in rural areas, including supporting the maternal workforce, promoting best practices and educating health care professionals. </p> <p> <span><strong>Wage Index Floor.</strong></span> AHA supports legislation that would place a floor on the area wage index, effectively raising the area wage index for hospitals below that threshold with new money. </p> <p> <span><strong>96-hour Rule</strong></span>. <span><strong>We urge Congress to pass legislation to permanently remove the 96-hour physician certification requirement for CAHs.</strong></span><strong> </strong>These hospitals still would be required to satisfy the condition of participation requiring a 96-hour annual average length of stay, but removing the physician certification requirement would allow CAHs to serve patients needing critical medical services that have standard lengths of stay greater than 96 hours. </p> <p> <span><strong>Ambulance Add-on Payment.</strong></span> Rural ambulance service providers ensure timely access to emergency medical care but face higher costs than other areas due to lower patient volume. <span><strong>We support permanently extending the existing rural and “super rural” ambulance add-on payments to protect access to these essential services.</strong></span> </p> <p> <span><strong>Regulatory Burden</strong></span><strong>.</strong> Reduce regulatory burden by identifying and advocating for the repeal of unnecessary and duplicative Conditions of Participation that increase hospital inefficiency and reduce the time providers can spend caring for their patients. </p> </div> </li> <li class="a-items"> COMMERCIAL INSURER ACCOUNTABILITY <div class="a-content"> <p> Underpayment by commercial insurance plans and systematic and inappropriate payment delays for medically necessary care are putting patient access to care at risk.  </p> <p> <span><strong>Cost-based Reimbursement for Critical Access Hospitals (CAHs) from Medicare Advantage (MA) Plans</strong></span>. Congress created a special statutory payment designation for CAHs in recognition of the unique role they play in preserving access to health care services in rural areas. As certain MA plans in rural communities rapidly grow, there is an erosion of this important financial protection. A greater portion of a CAH’s revenue will be subject to negotiations with MA plans that often result in below-cost payment terms and involve onerous plan requirements that contribute to administrative burden, unnecessary delays and denials in approving and paying for patient care, and additional strains on the health care workforce.<span><strong> We support legislation to ensure CAHs receive cost-based reimbursement for MA patients. </strong></span> </p> <p> <span><strong>Prompt Pay</strong></span>. Ensure prompt payment from insurers for medically necessary, covered health care services delivered to patients. <span><strong>We support policies to increase oversight and accountability of health plans including establishing more stringent standards for timely payment</strong></span> to address certain insurer tactics to delay and deny payment to health care providers.  </p> <p> <span><strong>Prior Authorization</strong></span>. Hold commercial health insurers accountable for ensuring patients have timely access to care, including by reducing the excessive use of prior authorization, ensuring expeditious prior authorization decisions and eliminating inappropriate denials for services that should be covered. <span><strong>We support building on recent regulations and legislation that further streamline and improve prior authorization processes.</strong></span> </p> <div class="a-content"> <a> </a> <p class="MsoNormal"> <span></span> </p> <p> Underpayment by commercial insurance plans and systematic and inappropriate payment delays for<br> medically necessary care are putting patient access to care at risk. </p> <strong> <p> <span><strong>Cost-based Reimbursement for Critical Access Hospitals (CAHs) from Medicare Advantage (MA) Plans.</strong></span><strong> </strong>Congress created a special statutory payment designation for CAHs in recognition of the unique role they play in preserving access to health care services in rural areas. As certain MA plans in rural communities rapidly grow, there is an erosion of this important financial protection. A greater portion of a CAH’s revenue will be subject to negotiations with MA plans that often result in below-cost payment terms and involve onerous plan requirements that contribute to administrative burden, unnecessary delays and denials in approving and paying for patient care, and additional strains on the health care workforce.  <span><strong>We support legislation to ensure CAHs receive cost-based reimbursement for MA patients.</strong></span> </p> <p> <span><strong>Prompt Pay.</strong></span><strong> </strong>Ensure prompt payment from insurers for medically necessary, covered health care services delivered to patients. <span><strong>We support policies to increase oversight and accountability of health plans including establishing more stringent standards for timely payment </strong></span>to address certain insurer tactics to delay and deny payment to health care providers. </p> <p> <span><strong>Prior Authorization.</strong></span> Hold commercial health insurers accountable for ensuring patients have timely access to care, including by reducing the excessive use of prior authorization, ensuring expeditious prior authorization decisions and eliminating inappropriate denials for services that should be covered. <span><strong>We support building on recent regulations and legislation that further streamline and improve prior authorization processes.</strong></span> </p> </strong> </div> <strong> </strong> </div> </li> <li class="a-items"> BOLSTER THE WORKFORCE <div class="a-content"> <p> Recruitment and retention of health care professionals is an ongoing challenge and expense for rural hospitals. Nearly 70% of the primary care health professional shortage areas (HPSAs) are located in rural or partially rural areas. Targeted programs that help address workforce shortages in rural communities should be supported and expanded. Workforce policies and programs also should encourage nurses and other allied professionals to practice at the top of their license.  </p> <p> <span><strong>Graduate Medical Education</strong></span>. We urge Congress to enact legislation that would lift existing caps on the number of Medicare-funded residency slots, which would help alleviate physician shortages in rural and other underserved areas and improve patients’ access to care. We also support robust funding for rural residency track programs, which provide medical residents additional training opportunities in rural areas.  </p> <p> <span><strong>Conrad State 30 Program</strong></span>. We urge Congress to make permanent and expand the Conrad State 30 J-1 visa waiver program, which waives the requirement for physicians holding J-1 visas to return home for a period if they agree to stay in the U.S. for three years and practice in underserved areas.  </p> <p> <span><strong>Loan Repayment Programs</strong></span>. We urge Congress to pass legislation to provide incentives for clinicians to practice in rural HPSAs. We support expanding the National Health Service Corps and the National Nurse Corps, which incentivize health care graduates to provide health care services in underserved areas.  </p> <p> <span><strong>Visa Recapture</strong></span>. We urge Congress to pass legislation to recapture up to 40,000 unused employment visas for foreign-trained workers (25,000 for nurses and 15,000 for physicians). </p> </div> </li> <li class="a-items"> PROTECT THE 340B PROGRAM <div class="a-content"> <p> The 340B Drug Pricing Program helps CAHs, Sole Community Hospitals, Rural Referral Centers and other disproportionate share hospitals serving vulnerable populations stretch scarce resources. Section 340B of the Public Health Service Act requires pharmaceutical companies participating in Medicaid to sell outpatient drugs at discounted prices to organizations that care for many uninsured and low-income patients. </p> <p> Hospitals use 340B savings, for example, to provide free care for uninsured patients, offer free vaccines, provide services in mental health clinics and implement medication management and community health programs. The AHA opposes any efforts to undermine the 340B program and harm the patients and communities it serves, including drug company efforts to diminish the program by limiting contract pharmacy arrangements and attempting to change access to 340B pricing from an upfront discount to a back-end rebate. </p> </div> </li> </ul> </div> <strong> <div class="col-md-12 cc_tabs"> /* reset */ .cc_tabs ul.a-container { margin: 0; padding: 0; list-style: none; } .cc_tabs input[type=checkbox] { display: none; } /* style */ .cc_tabs .a-container { width: 100%; margin: 20px auto; } .cc_tabs .a-container label { display: block; position: relative; cursor: pointer; font-size: 18px; font-weight: bold; padding: 10px 20px; color: #63666a; background-color: #eee; border-bottom: 1px solid #ddd; -webkit-transition: all .2s ease; -moz-transition: all .2s ease; -ms-transition: all .2s ease; -o-transition: all .2s ease; transition: all .2s ease; margin-bottom:15px } .cc_tabs .a-container label:after { content: ""; 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} Get CertifiedRecertify </div> --> </div> </strong> </div> <strong> <p class="a-items"> <ul class="a-container"> item 1 <div class="a-content"> <p> ==== </p> </div> </li> </ul> <div> --> function openCity(evt, cityName) { var i, tabcontent, tablinks; tabcontent = document.getElementsByClassName("tabcontent"); for (i = 0; i < tabcontent.length; i++) { tabcontent[i].style.display = "none"; } tablinks = document.getElementsByClassName("tablinks"); for (i = 0; i < tablinks.length; i++) { tablinks[i].className = tablinks[i].className.replace(" active", ""); } document.getElementById(cityName).style.display = "block"; evt.currentTarget.className += " active"; } // Get the element with id="defaultOpen" and click on it document.getElementById("defaultOpen").click(); </p> </strong> </div><p> </p><p class="a-items"> Get CertifiedRecertify </div> --> <ul class="a-container"> item 1 <div class="a-content"> <p> ==== </p> </div> </li> </ul> <div> --> function openCity(evt, cityName) { var i, tabcontent, tablinks; tabcontent = document.getElementsByClassName("tabcontent"); for (i = 0; i < tabcontent.length; i++) { tabcontent[i].style.display = "none"; } tablinks = document.getElementsByClassName("tablinks"); for (i = 0; i < tablinks.length; i++) { tablinks[i].className = tablinks[i].className.replace(" active", ""); } document.getElementById(cityName).style.display = "block"; evt.currentTarget.className += " active"; } // Get the element with id="defaultOpen" and click on it document.getElementById("defaultOpen").click(); </p></div><div class="col-md-4"><p class="text-align-center"><a class="btn btn-primary" href="/system/files/media/file/2025/02/2025-Rural-Advocacy-Agenda.pdf">Download the Rural Advocacy Agenda</a><br> </p><p><a href="/system/files/media/file/2025/02/2025-Rural-Advocacy-Agenda.pdf"><img src="/sites/default/files/inline-images/cover-2025-Rural-Advocacy-Agenda_0.png" data-entity-uuid="43454eb5-2a7a-44ba-a764-b47efb669806" data-entity-type="file" width="655" height="847" alt="AHA 2025 Rural Advocacy Agenda page 1."></a></p><p> </p><p><a class="btn btn-wide btn-primary" href="/advocacy/2020-01-27-rural-advocacy-agenda-archives">View the Rural Advocacy Agenda Archives</a></p><p><a class="btn btn-wide btn-primary" href="/advocacy-agenda" title="2025 AHA Advocacy Agenda PDF">View the AHA 2025 Advocacy Agenda</a></p></div></div></div> Fri, 23 Feb 2024 23:01:00 -0600 Health Information Technology (HIT) /news/headline/2024-01-16-individual-hospitals-state-associations-support-aha-lawsuit-and-urge-court-set-aside-ocr-online <p><a href="/amicus-brief/2024-01-12-state-hospital-associations-amicus-brief-aha-vs-hhs-office-civil-rights-litigation">Seventeen state hospital associations</a> and <a href="/2024-01-12-amicus-brief-thirty-hospitals-and-hospital-systems-support-plaintiffs-motion-summary-judgment-aha-vs-hhs-office">30 hospitals and health systems</a> Jan. 12 filed friend-of-the-court briefs supporting the AHA in its lawsuit challenging a Department of Health and Human Services’ Office for Civil Rights rule that restricts the use of standard third-party web technologies that capture IP addresses on portions of hospitals’ public-facing webpages. The groups say the rule threatens crucial tools that hospital websites use to disseminate reliable health information to the public, noting that the federal government uses the same types of tools, and that outlawing them would create a vacuum for misinformation.</p> Tue, 16 Jan 2024 16:02:00 -0600 Health Information Technology (HIT)