Following a White House meeting, the president and House Republican leaders Thursday said they will continue talking about ways to end the government shutdown and avoid a looming federal debt crisis.
Before meeting with the president, House GOP leaders had proposed a temporary increase in the federal debt ceiling to allow for negotiations on larger deficit-reduction issues. After the talks, the White House said in a brief statement that “no specific determination was made,” but the president “looks forward to making continued progress with members on both sides of the aisle.”
Democrats have said they will only negotiate after Republicans vote to increase the debt ceiling and end the government shutdown that is in its 11th day. The House Republican leadership’s plan did not address the ongoing shutdown.
The president’s meeting with House Republicans is part of a series of meetings at the White House with lawmakers from both parties to focus on the government shutdown and the debt ceiling. Senate Republican leaders are meeting today with the president. The meeting comes as some senior Senate Republicans are talking to Senate Democrats about a proposal to reopen the government and raise the debt ceiling until Nov. 22.
The shutdown so far isn’t affecting Medicare or Medicaid payments to hospitals. Medicare Administrative Contractors continue to process and pay Medicare fee-for-service claims. States continue to have funding for Medicaid and the Children’s Health Insurance Program due to the advanced appropriation enacted in the fiscal year 2013 appropriations legislation.
The debt-limit dispute could be another matter. The AHA’s concern is that any agreement to raise the debt limit in exchange for deficit-reduction measures could lead to policy changes that cut Medicare and Medicaid funding for hospital services.
Congress must raise the debt ceiling, the legal limit on borrowing by the federal government, before the end of the month to prevent the nation from defaulting on its financial obligations. And a third deadline – fixing physician payments – must be addressed by the end of the year.
Republicans have been calling on Democrats to negotiate over a short-term spending bill and a debt-ceiling increase. The president says he is ready to negotiate over any topic – once the House passes legislation to re-open the government and raise the U.S. borrowing limit without any conditions.
With hospitals vulnerable to cuts as part of a possible debtlimit agreement or as an offset to the cost of a “doc fix,” the AHA is urging hospital leaders to tell Congress “enough is enough.” Many will get that opportunity when they attend the AHA’s Oct. 29 Advocacy Day briefing in Washington. Hospital and health system leaders will visit Capitol Hill, where they will urge their legislators and staff to reject funding cuts and provide relief from excessive and harmful regulations that they say will undermine hospitals’ ability to care.
As part of their relief message, hospitals will push for passage of legislation that includes the “DSH Reduction Relief Act,” H.R. 1920/S. 1555, which eliminates the first two years of planned cuts to disproportionate share hospital payments; and the “Medicare Audit Improvement Act,” H.R. 1250/S. 1012, which reins in overly aggressive Medicare auditors; as well as legislation to help ensure financially vulnerable small and rural hospitals can maintain their patients’ access to care.
They also seek relief from the Centers for Medicare & Medicaid Services’ controversial admission and review criteria or the “twomidnight” rule for determining whether a patient is admitted to a hospital or there for observation, which is when patients are admitted for fewer than two days.
The policy’s admission and medical review criteria includes a two-midnight “benchmark,” which serves as guidance for admitting practitioners to identify when an inpatient admission is generally appropriate for payment. It also includes a twomidnight “presumption,” which instructs review contractors to presume that hospital claims with lengths of stay greater than twomidnights after a physician order for admission are reasonable, necessary and generally appropriate for Medicare Part A payment.
Hospitals are reimbursed for observation care under Medicare’s Part B program. Additionally, unlike full-fledged hospitalization, Medicare observation care requires 20% per-service co-payments.
In a Sept. 26 statement, AHA President and CEO Rich Umbdenstock said the policy lacked clarity and that the “only workable approach is to suspend this rule and immediately start dialog on a new policy direction.”