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Volume 13 Number 67 News: Hospitals Halting the May 25 expiration of a moratorium on certain changes to the Medicaid program is a top issue for the American Hospital Association, and the group's members were urged to lobby their representatives and senators during the AHA's annual membership meeting in Washington April 7. "These regulations would not only help destabilize hospitals' authority to care for Medicaid patients, but they would leave gaping holes in state budgets ... which will inevitably lead states to reduce services," AHA Executive Vice President Rick Pollack told members. In addition to calling for Congress to address the Medicaid moratorium issue, AHA outlined a number of policies it says Congress should enact this year, including extending Medicare provisions set to expire in June, banning physician self-referral to limited service hospitals, and slowing the move to implement the Medicare Recovery Audit Contractor program. "We want real and fundamental change in health care," Pollack said, tying the group's aims to the larger political climate in Washington. Referring to the presidential election, he said "there will be change in Washington." AHA represents roughly 5,000 hospitals, health systems, and other health care organizations. Investor-owned hospitals are predominantly represented by the Federation of American Hospitals. Opposing Medicaid Moratorium Expiration Pollack said bipartisan legislation is needed to stop the expiration of the moratorium on the Medicaid provisions, and he encouraged members to voice support for the proposed Protecting the Medicaid Safety Net Act of 2008 (H.R. 5613). Introduced by Reps. John D. Dingell (D-Mich.) and Tim Murphy (R-Pa.) March 13, the bill would delay implementation of seven federal rules they say would reverse long-standing Medicaid policy and make significant cuts to the program (No. 51 HCDR 03/17/08 a0b6e9e1j8). According to Dingell and Murphy, the seven rules in question would negatively affect the following: Medicaid payments to public providers; coverage of rehabilitation services for people with disabilities; outreach and enrollment in schools, as well as specialized medical transportation to school for children covered by Medicaid; graduate medical education payments; coverage of hospital clinic services; case management services; state provider tax laws; and appeals filed through the Department of Health and Human Services. The AHA's efforts reinforce testimony supportive of the legislation given during an April 3 House Energy and Commerce Health Subcommittee hearing (No. 65 HCDR, 04/4/08 a0b6g6w4n6). In the Senate, meanwhile, Sens. Jay Rockefeller (D-W.Va.), Olympia Snowe (R-Maine) and Edward Kennedy (D-Mass.) April 3 introduced legislation that would impose a moratorium on the Centers for Medicare & Medicaid Services' regulations until April 1, 2009, as well (see related item in this issue a0b6g9g1r5). Pollack told members they should stress that congressional inaction would adversely affect not only Medicaid patients, but "everyone will feel the impact." Medicare Provision Expiration Pollack highlighted the need for congressional action to maintain certain Medicare provisions, extended through the Medicare, Medicaid, and SCHIP Extension Act of 2007, that are set to expire June 30 (1 HCDR, 01/3/08 a0b5p7n8g9). According to AHA, key provisions that are set to expire include:
Though no legislation has been introduced to extend these provisions, Senate Finance Chairman Max Baucus (D-Mont.) is currently preparing a bill to address, at minimum, the physician payment issue. Ending Physician Self-Referral "We also want to see action on ending self-referral to physician-owned limited service hospitals and we want to limit the growth of those facilities that do exist, because they are ripping yet another hole in the health care safety net due to their predatory practices," Pollack said. Pollack also voiced support for the Paul Wellstone Mental Health and Addiction Equity Act of 2007 (H.R. 1424). The mental health parity legislation is estimated to cost the federal government $4.3 billion over 10 years, and would be paid for, in part, by prohibiting physicians in Medicare from referring patients to hospitals in which they had an ownership interest. Recently, Rep. Patrick Kennedy (D-R.I.), a chief architect of the House parity bill, said the House could work with a compromise proposal on mental health parity legislation recently offered by two key senators (S. 558), describing the proposal as a "huge sign" from the Senate that they were serious about Congress passing parity legislation this year (No. 63 HCDR 04/2/08 a0b6g4h3f7). Slow RAC Implementation Pollack also included the Medicare Recovery Audit Contractor Program Moratorium Act (H.R. 4105) among those bills AHA members should encourage their congressmen and women to pass this year. "We support bipartisan legislation that would halt the rush to implement this program and provide extra time to evaluate and refine it," he said. On Nov. 7, 2007, Reps. Lois Capps (D-Calif.) and Devin Nunes (R-Calif.) introduced the bill, calling for a one-year halt of the RAC program. CMS had failed to address serious flaws in the RAC demonstration in three states, including California, and the moratorium would allow for a closer evaluation of work that contractors had done thus far, they said (No. 221 HCDR 11/16/07 a0b5k0e6a6). The AHA's 2008 advocacy agenda.
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