Modern Healthcare’s story about some states’ efforts to change the ‘rural floor’ section of the area wage index back to state budget neutrality (“Tackling the wage index,” Feb. 27, p. 14) was missing a few key facts.
The story’s position that statewide budget neutrality for wage-index adjustments was the status quo “until the Patient Protection and Affordable Care Act” was incorrect. National budget neutrality was the law for all wage-index adjustments until 2009, when the CMS singled out the rural floor adjustment for change. All other budget neutrality provisions in the entire Medicare program, including all wage-index adjustments other than the rural floor, were applied—and still apply—on a national level. Also important to note is that nine of the hospital associations now protesting the corrective action were among the 27 state hospital associations that opposed the CMS’ unprecedented action at that time.
There is nothing in the ACA that calls for treating Massachusetts differently from any other state. The ACA provision simply restores the policy that was in place until 2009. What the statute does call for is a comprehensive examination of the entire area-wage system, which all of us can agree is complex and arcane. Any changes that are made should be based on this comprehensive review.
Lynn Nicholas President and CEO Massachusetts Hospital Association