The American Medical Association will lobby Congress to enforce greater oversight on how nonprofit hospitals comply with the community benefit requirements that accompany their tax-free status after adopting a new policy during its semiannual meeting.
The 700-member AMA House of Delegates met in Orlando, Florida, from Friday through Tuesday to consider hundreds of policy recommendations, including some related to nonprofit hospitals and health insurance prior authorizations.
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Here are some highlights from the 2024 AMA House of Delegates Interim Meeting:
Nonprofit hospitals
The AMA set up a potential lobbying fight with the hospital sector by enacting a stronger position in favor of greater oversight of nonprofit facilities.
Federal and state authorities should toughen enforcement of community benefit requirements and penalize or revoke the tax-exempt status of nonprofit hospitals that "provide little or no community benefit," the AMA said in a news release Monday.
In addition, Congress should establish minimum standards for nonprofit hospital charity care programs, require hospitals to screen all patients for eligibility and standardize what counts as a “community benefit,” which would impact how hospitals’ community outreach is quantified, the AMA House of Delegates voted.
Prior authorizations
The AMA reiterated its call for the government to curb the use of prior authorizations to delay or deny care.
The delegates accepted a policy supporting a federal ban on insurers refusing to pay claims for "medically necessary" services they precertified and advocated legal actions against health insurance companies that won't reimburse for services already provided.
“Prior authorization, once granted, should be sufficient to guarantee payment,” AMA trustee Dr. Marilyn Heine said in a news release Wednesday. “It is unacceptable that a health plan gives a 'green light' to medically necessary care and then retains or creates barriers to payment."
The AMA already has been pleading with Congress and the Centers for Medicare and Medicaid Services to crack down on prior authorization denials and improve transparency.
Medicare enrollment
CMS should simplify the Medicare sign-up process and provide more clarity about the late-enrollment penalties that Medicare-eligible people face when they don't join the program at age 65, the AMA House of Delegates decided. The agency should create a checklist for people who are nearing 65 years old to help ensure they don't experience gaps in coverage or costly penalties, according to the AMA policy.
Medical education
AMA recommended the Health Resources and Services Administration review the methodology it uses to calculate Health Professional Shortage Areas, which are an important factor in workforce development policies such as Medicare graduate medical education slot distribution and loan repayment for members of the National Health Service Corps.
