Over 40,000 South Dakotans do not have access to healthcare coverage, an additional 30,000 depend on the federal marketplace for coverage, and 115,000 South Dakotans access coverage through Medicaid or CHIP. SDAHO supports access to affordable health care for all South Dakotans by ensuring adequate funding for federal and state programs.
- Strengthen Federal/State Healthcare Programs: Ensure essential health care services for South Dakota communities by protecting federal funding and strengthening reimbursement for Medicare, Medicaid and CHIP, and the Marketplace.
- Protect Critical Access Hospitals (CAH): Preserve and protect the Critical Access Hospital (CAH) designation that allows cost-based Medicare reimbursement. Establish a rural emergency hospital designation with enhanced reimbursement for rural communities delivering emergency and outpatient services without requiring inpatient care. Invest in infrastructure financing for rural hospitals that allows hospitals to adapt their facilities and services to match their community’s needs.
- Protect the 340B Program: Fend off attacks by big pharma and restore payment reductions to protect the essential benefits that 340B drugs provide for vulnerable patients in rural communities. Reject rebate-models for accessing 340B drugs.
- Recognize Cost Differences Among Provider Settings: Protect access to primary care and outpatient services by rejecting additional payment cuts known as site-neutral payment policies which do not recognize legitimate differences among provider settings.
- Payment Parity for Telehealth: Ensure patients can access telehealth benefits on the same basis as traditional services by eliminating geographic and setting requirements. Promote parity in reimbursement for telehealth services that replace traditional services. Ensure adequate reimbursement for originating sites.
- Preserve not-for-profit hospital tax-exempt status. Hospitals work to make their communities healthier through numerous community outreach programs, education efforts and various wellness activities.
SDAHO aims to ensure South Dakotans can access health care when and where they need it in rural and frontier communities by strengthening our workforce.
- Advance education and training: Enhance education and training efforts to minimize workforce shortages and ensure the right mix of providers.
- Support health professional recruitment programs: Enhance opportunities for rural communities in Health Professional Shortage Areas to participate in the National Health Service Corp and Nurse Corp Programs.
- Fund direct and indirect graduate medical education (GME): Invest in our workforce by rejecting Medicare reductions for GME while increasing the number of Medicare-funded residency positions and supporting more rural residency programs.
- Support Essential Workers: Ensure essential workers have the right tools to respond to public health crises through adequate reimbursement and robust investment in healthcare infrastructure that modernizes facilities and makes them safer for patients. Promote policies that create a more resilient healthcare workforce and reduce provider burnout.
South Dakota is a leader in telehealth innovation. SDAHO supports expanding telehealth and other health technology utilization by ensuring payment policies that incentivize innovation and ensure parity in payment.
- Fund alternative payment methodology models: Promote voluntary, not mandatory, payment and care delivery models for improving quality and efficiency to allow community hospitals Invest in models that include health-related non-medical services and experiment with new technology. Ensure models have appropriate funding for facilities to transition over time without sacrificing access in our rural and frontier communities.
- Support care integration: Support policies and research for new care delivery models that integrate primary care, acute care, behavioral health, and long-term care across the continuum.
- Remove barriers to care transformation: Modernize the Anti-Kickback statute and Stark Law regulations to foster and protect arrangements to promote value-based care.
- Invest in broadband and related infrastructure: South Dakota knows telehealth works and provides valuable resources to rural and frontier communities. Invest in health care infrastructure that expands our digital infrastructure and rural broadband while strengthening the capacity and capability for emergency preparedness and response.
- Support reimbursement for innovative technology: Ensure payment in federal programs for new or expanded technology that helps monitor chronic conditions to keep patients at home instead of in institutions.
Burdensome regulations for hospitals and health systems divert resources away from patient care. SDAHO supports policies that reduce administrative burdens and allow healthcare providers to focus on what matters most – caring for patients.
- Patients over Paperwork: Allow providers to spend more time on patient care rather than paperwork and ensure a level regulatory playing field. Instead of issuing punitive civil monetary penalties, promote a collaborative process related to Medicare Conditions of Participation for providers making a good faith effort towards compliance.
- Clear Guidance for States and Providers: Direct CMS and HHS to issue more timely guidance for states and providers related to final rules.
- Remove the Critical Access Hospital (CAH) 96-Hour Rule: Permanently remove the CAH 96-hour rule for physician certification that threatens access in rural and frontier communities.
- End Sequestration: End 2% Medicare sequestration cuts to hospitals and critical access hospitals.
- Extend Medicare Sequester Relief Letter March 26, 2021
- Eliminate the Recovery Audit Contractor (RAC) Contingency Fee Structure: Direct CMS to pay RACs a flat fee like other Medicare contractors and issue penalties to RACs with high rates of incorrect denials.
- Advocate for Standardization: Safeguard against unnecessary burdens in billing, prior authorization, and other HIPAA standards by advocating for improvements in transmission and technology.
- Reduce Measurement Burden: Advocate for a common set of measures for federal agencies and other healthcare payers. Ensure measures are evidence based and demonstrate meaningful improvements in patient outcomes.
- COVID-19 Pandemic Liability Relief: Shield health care facilities and professionals acting in good faith from civil and criminal liability for liability issues raised as a result of the facility or professional’s response to the COVID-19 public health emergency for the duration of the Public Health Emergency.
South Dakota healthcare providers strive to provide quality, safe, and effective care to patients. SDAHO advocates for a focus on measures that matter, so our providers can continue improving health outcomes while reducing the burden of reporting.
- Advance Integrated Care: Fund authorized programs to treat substance abuse disorders and implement policies to better integrate and coordinate behavioral health services with physical health services and increase access to care in underserved communities. Support research and policies for systems reinventing care delivery through integration.
- Focus on Measures that Matter: Continue to streamline and coordinate quality measures in state and federal programs to reduce burden on providers. Ensure patient access to accurate, meaningful quality information by suspending and modifying the faulty hospital star rating system.
- Invest in Improved Patient Outcomes: Promote advanced illness management to better honor patients’ wishes at the end-of-life and remove barriers to expanding access to palliative care services. Support Public Policies aimed at improving maternal and child health.
- Prepare for Public Health Emergencies: Ensure hospitals, health care providers, and communities are prepared to deal with public health emergencies. Continue to fund appropriations for the Hospital Preparedness Program. Invest in infrastructure improvements and workforce training to ensure adequate resources for future public health emergencies.
- Support Patient Safety and Quality Improvement Programs: Ensure small and rural American healthcare facilities have access to programs that support healthcare transformation through the identification, use, and spread of evidence-based practice through the systematic use of quality improvement science.
SDAHO works collaboratively throughout the year to ensure the stability and affordability of health care by staying vigilant against policies and regulations that threaten recent advancements in federal health policy.
- Safeguard State Authority to Issue Supplemental Payments: Preserve state control over financing arrangements that support sustainability for the Medicaid program. Eliminate Medicaid Disproportionate Share Hospital cuts.
- Preserve Gains in the Health Coverage: Promote the benefits of coverage for patients that depend on the ACA for access to health care.
- Defend Access to Care: Protect and expand access to a minimum set of essential health benefits and enforce existing federal parity laws to ensure coverage for physical and behavioral health benefits, including substance use disorder treatment.
- Protect State Innovation: Promote flexibility within state waivers (section 1115 and 1332 waivers) to extend coverage and pursue innovative delivery mechanisms with safeguards against eligibility reductions and cost-sharing increases.
Aging services plays a crucial role for thousands of older adults across the healthcare continuum. Policy priorities are identified to ensure a strong safety net for people over the age of 65 who need assistance with activities of daily living. Our goal is to allow people to age with dignity and respect and protect our most vulnerable population.
The Center for Medicare and Medicaid Services (CMS) must stop imposing unfunded mandates and modernize the survey process from the archaic 1987 punitive review to a new, collaborative, quality improvement review for better resident outcomes.
- Elder Justice Reauthorization Act of 2020 (S. 4555 / H.R. 8079) Reauthorizing the Elder Justice Act and appropriating funds for FY 2021.
- SAFE To Work Act (S. 4317) Establishing federal liability standards for COVID-related litigation.
- Emergency Support for Nursing Home and Elder Justice Reform Act of 2020 (S. 4182) Establishing standards for COVID-specific nursing homes, reauthorizing the Elder Justice Act, and providing additional reporting requirements and studies.
- RUSH Act of 2020 (S. 3447 / H.R. 6209) Authorizing risk-based Medicare demonstration program for selected nursing homes and emergency physicians, utilizing telehealth to reduce unnecessary hospital readmissions.
- Nursing Home Workforce Quality Act (H.R. 4468 / S. 2993) Reinstate Certified Nursing Assistant (CNA) training when all deficiencies for which the civil monetary penalty was assessed has been remedied.
- SNF Proposed Rule Comments Letter
Promote federal rulemaking that ensures affordable access to home and community-based services for beneficiaries who wish to remain in their own home with appropriate reimbursement and resources for service providers. Protect the Medicare Home Health Rural Add-On and allow for reimbursement of remote patient monitoring services and virtual visits.
- Home Health Emergency Access to Telehealth Act (HEAT) (S. 4854 / H.R. 8677) Provides home health agencies the ability to receive reimbursement for providing telehealth visits with appropriate guardrails to protect patients and families.
- Improving Care in Home Health Agencies Act (H.R. 7006) Allows for documented verbal orders for home health agencies during emergencies.
- Home Care Planning and Improvement Act (S. 296 / H.R. 2150) Allows Medicare payment for home health services ordered by a nurse practitioner, clinical nurse specialist, certified nurse-midwife, or physician assistant.
- EMPOWER Care Act (S. 548 / H.R. 1342) Ensuring Medicaid Provides Opportunities for Widespread Equity, Resources and Care Act extending funding through FY2023 for the Money Follows the Person Rebalancing Demonstration Program to assist states in increasing the use of home and community care for long-term care and decreasing the use of institutional care.
- Home Health Payment Innovation Act of 2019 (S. 433 / H.R. 2573) Eliminate the behavioral assumptions regarding the implementation of specified changes to units of payment and case-mix adjustment factors.
Protect the integrity and structure of the Medicare hospice benefit. Ensure appropriate reimbursement to provide quality end-of-life care and expand the options for individuals with Alzheimer’s disease. Fully integrate hospice and palliative care services into the continuum of care.
- Hospice Respite Care Relief Act of 2020 (S. 4423 / H.R. 8322) Allow hospices to have increased flexibility in providing respite care during emergencies.
- Rural Access to Hospice Act of 2019 (S. 1190 / H.R. 2594) Provide for payments for certain rural health clinic and federally qualified health center services furnished to hospice patients under the Medicare program.
- Palliative Care & Hospice Education and Training Act (PCHETA) (H.R. 647 / S. 2080) Promote education and research in palliative care and hospice and support the development of faculty careers in academic palliative care.
- Hospice Proposed Rule Comments Letter
Preserve the ability and discretion of states to regulate assisted living. Ensure assisted living is a HCBS option for Medicaid beneficiaries. Prioritize funding and programs for elderly housing under the Housing and Urban Development Section 202 program.
- Task Force on the Impact of the Affordable Housing Crisis Act (S. 1772 / H.R. 3211) Support the task force to fully understand the impact of affordable housing.
- Direct CARE Opportunity Act (S. 2521 / H.R. 4397) Directs the Department of Labor to award grants to recruit, retain or provide advancement opportunities to direct care workers.