Texas Association for Home Care & Hospice Applauds Introduction of the Prompt and Fair Pay Act - Your Advocacy in Action
U.S. Representatives Lloyd Doggett (D-TX), Ranking Member of the Ways and Means Health Subcommittee, and Health Subcommittee member Greg Murphy, M.D. (R-NC) introduced bipartisan legislation to require Medicare Advantage (MA) to adequately reimburse health care providers for services offered to enrollees of these private plans. The Prompt and Fair Pay Act establishes a floor requiring MA plans to reimburse for all covered health care items and services at least what would have been paid under Medicare Parts A and B; plans and providers may continue to negotiate higher reimbursement rates. The legislation also establishes prompt payment rules for clean in-network claims, which are requirements that would mirror those under Medicare Part D.
Prior to filing H.R. 4559, TAHC&H joined America's Essential Hospitals, American Academy of Family Physicians, American College of Physicians, American Occupational Therapy Association, LeadingAge, National Rural Health Association, Premier, Texas Hospital Association, Texas Organization of Rural and Community Hospitals, and the American Association of Nurse Anesthesiology in support of the bipartisan bill. "For too long, home health providers have been forced to navigate a broken reimbursement system that delays care, burdens clinicians with excessive red tape, and underpays for essential services," said Rachel Hammon, Executive Director of the Texas Association for Home Care & Hospice. "This bipartisan legislation is a vital step toward restoring fairness, transparency, and financial stability-ensuring that patients can continue to access high-quality care in their homes and communities." (see statement).
On Tuesday, July 22nd, the Ways & Means Health and Oversight Committee conducted a joint hearing on Medicare Advantage. Your advocacy on this subject came through in many of the comments made by our Texas leaders we have worked with over the years. "I've heard from hospitals, home healthcare providers and other professionals who are experiencing increasing administrative burdens, delays in reimbursement, and smaller payments that are falling below what traditional Medicare would've paid. Together with my colleague Dr. Murphy, we've authored the PROMPT and Fair Pay Act, bipartisan legislation that we filed this week to ensure MA plans at least pay what traditional Medicare pays for covered items and services. Our bill also establishes prompt payment requirements modeled after the requirements in Part D." Ranking member Lloyd Doggett (D-TX). Additionally, Representative Nathaniel Moran (R-TX) didn't hold back when he asked, "Dr. Basal you mentioned in your testimony items relating to the prior authorization issue as well, in particular about post-acute care, which generally results in longer hospital stays that are costly when the prior authorizations don't come through. I can tell you I heard from a number of my home health groups back in the district who shared stories where they were unable to provide care because the authorizations would've taken too long and they simply had to move on to other patients. What impact does this have on the care patients desperately need, the costs associated with the care ultimately received, and what needs to change in this process to correct these issues?"
TAHC&H was asked and submitted comments for the hearing (see comments). Those comments highlighted the ongoing payment delays, inadequate reimbursement rates and opaque administrative processes that have created an unstable environment for providers. We capitalized on the opportunity to comment on the Association's priority to keep Hospice out of Managed Care highlighting the significant failure of the VBID demonstration that was ended seven years early. Our advocacy came through as Representative Beth Van Duyne (R-TX) commented, "And it's not just the patients and the providers, but it's also the families who are left bearing the emotional and the logistical burden of these delays. And that's especially true at the end of life, which is why we should be cautious about the charges to end of life care, ensuring that we don't add more red tape or uncertainty for families already facing incredibly difficult moments."
The next important step in this process is to get cosigners on the bill. This is where you and your unified voice come in! We will continue to use this forum and widespread action alerts to circulate information on how you can contact your Member of Congress to co-sign this bill. Stay tuned and stay vigilant as we keep our voices front and center.
Thank you!
Rachel Hammon, BSN, RN
Executive Director
tahch.org | 800.880.8893 | Austin, TX
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