AHA Statement on Legislative Proposals to Be Considered by the Energy and Commerce Committee on September 18

On behalf of our nearly 5,000 member hospitals, health systems and other healthcare organizations, our clinician partners—including more than 270,000 affiliated
physicians, 2 million nurses and other health care workers — and the 43,000 health care leaders in our professional groups, the American Hospital Association (AHA) appreciates the opportunity to comment on the legislative proposals scheduled to be considered by the House Energy and Commerce Committee on September 18.

We would like to provide feedback on the revised sections of H.R. 7623 (H7623-FC-AINS_01.XML) and HJ Resolution No. 139.

HR 7623, Telemedicine Modernization Act

AHA supports two-year extensions of key telehealth flexibilities before they expire on December 31, 2024, to maintain patient access to high-quality virtual care. We appreciate the committee’s commitment to ensuring that key telehealth flexibilities are extended so that patients continue to receive high-quality care. The expansion of telehealth services has transformed the delivery of care, expanded access for millions of Americans, and increased the convenience of care for patients, especially those with transportation or mobility limitations.

In addition, the AHA supports Section 104, which would require the dissemination of best practices to support individuals with limited English proficiency in accessing telemedicine services, and Section 105, which would allow patients to receive home telemedicine care for cardiac rehabilitation services provided in hospitals or hospital outpatient departments.

The AHA supports Section 102 to extend the home hospitalization waiver for five years, through the end of 2029. Over the past few years, hospitals and health systems have expressed a need for long-term stability in the H@H program. Establishing an H@H program requires logistical and technical work, with an investment of time, staff, and money. In addition to approving the federal waiver, some providers must navigate additional regulatory requirements at the state level. For some, the entire process can take a year or more before the first patient can be seen at home.

However, the AHA opposes Section 404 which would require a separate identification number and certificate for each outpatient clinic of a given medical provider outside the university.
AHA calls on the committee to remove this paragraph which would require each off-campus hospital outpatient department (HOPD) to be assigned a separate, unique health identifier. Hospitals and other providers bill under federal regulations that require them to bill all payers—Medicare, Medicaid, and private payers—using codes that indicate the location where the service is provided. As a result, this rule would impose an unnecessary and burdensome administrative burden on providers and unnecessarily increase Medicare’s administrative costs.

This section would also require that, as a condition of payment, hospitals submit a certification of compliance with Medicare’s provider-based provisions for each of their off-campus HOPDs within two years of enactment. Given hospitals’ experience with reviewing and approving similar certifications in the past, we are concerned that this requirement would be extremely burdensome for hospitals and Medicare contractors, and we therefore urge the committee to reject this provision.

HJRes.139, PROVIDING FOR FAILURE OF CONGRESS TO APPROVE UNDER CHAPTER 8 OF TITLE 5, UNITED STATES CODE, A REGULATION SUBMITTED BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES REGARDING “MEDICARE AND MEDICAID PROGRAMS: MINIMUM STAFFING STANDARDS FOR LONG-TERM CARE FACILITIES AND TRANSPARENCY IN MEDICAID PAYMENT REPORTING”

AHA supports HJRes.139 for Congress to repeal this rule and prohibit the Secretary of Health and Human Services from implementing or enforcing this rule. The AHA and its members are committed to ensuring safe staffing to provide high-quality, equitable, and patient-centered care in all health care facilities, including long-term care (LTC) facilities. However, the process of safely staffing any health care facility involves more than achieving an arbitrary number set by regulation. The Centers for Medicare & Medicaid Services (CMS) One Size Fit All minimum staffing rule for LTC facilities creates more problems than it solves and could jeopardize access to all types of care across the continuum, particularly in rural and underserved communities that may not have sufficient staff to meet these requirements.

We believe that this final rule could worsen already severe shortages of nurses and skilled nursing staff across the continuum of care. The Agency estimates that 79 percent of long-term care facilities would need to increase staffing to meet the proposed standards, including the new standard requiring 24-hour nurse staffing. Given the massive structural shortages described in recent studies, it is unclear where this supply of nurses will come from, and it is inconceivable that long-term care facilities will be able to meet these standards without negatively impacting the availability of workers across the continuum of care. Strengthening the health care workforce requires investment and innovation, not inflexible mandates.

APPLICATION

Thank you for considering AHA’s comments on these legislative proposals. We look forward to continuing to work with you to address these important issues on behalf of our patients and communities.