Hospital lobbying groups have scrambled to get their next set of asks together as regulators and lawmakers set priorities for existing COVID-19 provider relief grants and another potential infusion of cash.
Members of Congress are haggling over an interim spending package to replenish funds for small business assistance that are already dwindling from a stimulus bill enacted late last month. Democrats want to double a relief fund for providers and Republicans would rather leave the issue for a later spending package.
Meanwhile, HHS has said it will soon allocate the remaining $70 billion of provider grant funding from the Coronavirus Aid, Relief, and Economic Security Act. The first $30 billion from the $100 billion fund started rolling out to providers last week.
Here's a quick look at where hospital groups are focusing their advocacy:
Infusion into provider relief fund: Hospital groups are applauding Democrats' push to double funding for the CARES Act's $100 billion provider relief fund. The money was originally designated for hospital preparedness and surge capacity, but that list has expanded to financing care for uninsured COVID-19 patients and helping providers that don't directly provide treatment to COVID-19 patients.
The American Hospital Association, Federation of American Hospitals, Association of American Medical Colleges, and America's Essential Hospitals have all called for an additional $100 billion to bolster grant funds for hospitals.
"The infusion of funds for providers from the CARES Act is a start, but unfortunately nowhere near enough. Swift action is necessary to ensure that our nation's caregivers can continue to serve all the patients who depend on them every day," the FAH said in a statement.
Money for hotspots: The Greater New York Hospital Association has railed against HHS' first round of funding for not weighing hotspots like New York heavily enough, and congressional delegations from the state and neighboring New Jersey have also asked for a more targeted funding formula.
While the two states combined have more than 40% of confirmed COVID-19 cases, they got 9% of the first round of provider relief grant funding.
Help for providers with low-income patients: America's Essential Hospitals said they were glad HHS distributed provider grants quickly, but blasted the department for using a formula that based payments on providers' share of 2019 Medicare fee-for-service reimbursements. That disadvantaging providers that disproportionately treat low-income patients in the first $30 billion tranche, the group argued.
"With no cushion left to absorb the heavy financial pressure COVID-19 creates, essential hospitals disadvantaged by today's allocation need more help now. Time is not on our side," America's Essential Hospitals President and CEO Bruce Siegel said in a statement.
In the next funding package, AEH has asked Congress to allocate more money to the provider relief fund and target grants to hospitals that have high rates of uncompensated care and Medicaid reimbursement. The group, which represents safety-net hospitals, also asked lawmakers to institute a program for advance payments in Medicaid similar to CMS' Medicare accelerated payments, increase Medicaid disproportionate-share hospital payments, ensure the hospitals can continue receiving 340B funds.
Community health centers have also rallied more than 121 members of the House of Representatives to support their request for $7.6 billion in emergency funds to help them keep doors open.
Support for rural providers: The National Rural Health Association told congressional leaders that it wants to ensure that if any additional funding is set aside for providers, 20% is earmarked for rural providers because they serve 20% of the population.
The NRHA also asked Congress to make Medicare accelerated payments forgivable if used for certain operating expenses, and to ensure that government-owned rural providers can access small business assistance.
The AHA also said it wants to see rural providers prioritized in the next $70 billion distribution from the CARES Act's provider relief fund.
Different payer mixes: The AHA also called for funding for providers with a smaller share of payment from Medicare fee-for-service such as children's hospitals and hospitals with a high percentage of payments under Medicare Advantage. The Trump administration has been supportive of Medicare Advantage plans, so some observers were surprised that MA reimbursement was left out of calculations for the first tranche of HHS provider relief funding.