{"database": "press", "table": "releases", "rows": [["https://www.bennet.senate.gov/2024/10/17/press-releases-id-a84bd683-ce9f-426f-87e2-170738465508/", "Bennet, Hickenlooper, Colleagues Urge Defense Secretary to Fix Rule Hurting Colorado Springs Children\u2019s Hospitals", "2024-10-17", "2024", "2024-10", "Democrat", "Senate", "CO", "Michael F. Bennet", "B001267", "www.bennet.senate.gov", "bennet", "https://www.bennet.senate.gov/news/page/", "scraper", "Denver \u2014 Colorado U.S. Senators Michael Bennet and John Hickenlooper and U.S. Representatives Doug Lamborn and Jason Crow, along with 16 of their Senate and House colleagues, sent a letter to U.S. Department of Defense (DoD) Secretary of Defense Lloyd Austin. The letter urges the Defense Health Agency (DHA) to address the financial burden caused by a change in the way children\u2019s hospitals are reimbursed for the care provided to military families covered by TRICARE, the government health care program for active duty service members and their families.\n\n\u201cWe write to express our deep concerns about a 2023 Defense Health Agency (DHA) rule that catalyzed a major shift in the TRICARE reimbursement methodology for children\u2019s hospitals,\u201d wrote Bennet and the lawmakers. \u201cChildren\u2019s hospitals situated in defense communities in our home states are now grappling with the impacts of this change.\u201d\n\nEach year over 2.4 million children obtain care from children\u2019s hospitals through TRICARE, and the change has placed an outsized burden on children\u2019s hospitals in major defense communities, like Colorado Springs. Specifically, Children\u2019s Hospital Colorado said one in five patients in their Colorado Springs facility pay with TRICARE. The DHA previously exempted children\u2019s hospitals from the adult Medicare reimbursement process because the program\u2019s policies weren\u2019t applicable to the care children typically need. The rule change is expected to cost the hospital over $25 million annually.\n\nThe Children\u2019s Hospital Association (CHA) sent letters to DoD in 2020 and 2023 expressing their concerns about the proposed rule. However, they did not receive a response before the DHA implemented the change in October 2023.\n\nThe lawmakers specifically asked the following questions:\n\nWhat dialogue has DHA had with the affected children\u2019s hospitals to understand how this new reimbursement methodology impacts operations and access to care?\n\nWhat data and sources informed the agency\u2019s analysis of the impact on children\u2019s hospitals that care for TRICARE patients?\n\nHow did the agency account for the financial impacts of military families traveling for care in circumstances where local services are no longer available?\n\nHow did the agency develop the contingency payment and why did the DHA set a lower contingency payment for pediatrics?\n\nCan the agency verify the number of children\u2019s hospitals that are expected to qualify for the contingency payment that is outlined in the rule?\n\nThe text of the letter is available HERE and below.\n\nDear Secretary Austin:\n\nAs members of Congress representing military-connected children, we write to express our deep concerns about a 2023 Defense Health Agency (DHA) rule that catalyzed a major shift in the TRICARE reimbursement methodology for children\u2019s hospitals. Specifically, we urge the Department of Defense (DOD) and DHA to expeditiously meet with the affected hospitals to discuss administrative policy options to preserve access to pediatric care for military dependents.\n\nCollectively, we represent a significant number of the 2.4 million children who obtain care in children\u2019s hospitals through TRICARE each year. These hospitals provide specialized treatment for a spectrum of concerns, including minor health issues and complex, long-term health conditions. They play an essential role in the wellbeing of our nation\u2019s military families.\n\nUntil recently, since 2008, TRICARE exempted children\u2019s hospitals from the adult Medicare Outpatient Prospective Payment System (OPPS). This exemption made logical sense, as very few children who seek care in children\u2019s hospitals are covered by Medicare and the program policies do not adequately reflect children\u2019s health needs.\n\nIn 2019, however, DHA proposed a rule to eliminate this exemption. In response, children\u2019s hospitals with larger TRICARE volumes collectively submitted comments through the Children\u2019s Hospital Association (CHA), outlining a number of concerns and asking DHA to extend the comment and implementation timelines pending the provision of more information. Instead, DHA\u2019s final rule, TRICARE; Reimbursement of Ambulatory Surgery Centers and Outpatient Services Provided in Cancer and Children\u2019s Hospitals, was finalized without any response and took effect on October 1, 2023.\n\nChildren\u2019s hospitals situated in defense communities in our home states are now grappling with the impacts of this change, as well as the ripple effects that the ensuing financial challenges may have on the provision of care for military families. For states with large military populations and no specialty children\u2019s hospital, any reduction in access to care would further complicate military family\u2019s choices by increasing burdens placed on families who already have to travel outside of their own state for medical services. Given the significant concerns expressed by children\u2019s hospitals about how the rule may impact military families\u2019 access to timely health care, we request that you provide us with responses to the following questions:\n\nDialogue: What dialogue has DHA had with the affected children\u2019s hospitals to understand how this new reimbursement methodology impacts operations and access to care?\n\nFinancial Data: What data and sources informed the agency\u2019s analysis of the rule\u2019s impact on children\u2019s hospitals that care for TRICARE patients? How did the agency account for the financial impacts of military families traveling for care in circumstances where local services are no longer available?\n\nContingency Payment: How did the agency develop the contingency payment and why did the DHA set a lower contingency payment for pediatrics? Can the agency verify the number of children\u2019s hospitals that are expected to qualify for the contingency payment that is outlined in the rule?", 1, "2026-03-30T01:40:41Z", "2026-04-06T18:55:29Z"]], "columns": ["url", "title", "date", "year", "month", "party", "chamber", "state", "member_name", "bioguide_id", "domain", "scraper", "source", "date_source", "text", "has_text", "collected_at", "updated_at"], "primary_keys": ["url"], "primary_key_values": ["https://www.bennet.senate.gov/2024/10/17/press-releases-id-a84bd683-ce9f-426f-87e2-170738465508/"], "units": {}, "query_ms": 1.2749300803989172, "source": "dwillis/congress-press", "source_url": "https://github.com/dwillis/congress-press", "license": "MIT", "license_url": "https://github.com/dwillis/congress-press/blob/main/LICENSE"}