Menendez, MacArthur Visit Deborah Heart and Lung, Announce Legislation to Allow Hospital to Further Mission of Treating Seniors on Medicare

Menendez, MacArthur Visit Deborah Heart and Lung, Announce Legislation to Allow Hospital to Further Mission of Treating Seniors on Medicare

‘Fairness for Our Hospitals Act’ would bring Medicare reimbursements for rural NJ hospitals in line with those in other states

BROWNS MILLS NJ – U.S. Senator Bob Menendez and Congressman Tom MacArthur today announced a legislative fix for New Jersey hospitals in rural communities being denied equitable Medicare reimbursement rates.  This will allow Deborah Heart and Lung Center in Burlington County to continue its mission of providing patients with access to high-quality care. 

“The legislation we’re announcing today is a continuation of the work I’ve done throughout my entire tenure in the United States Senate on behalf of New Jersey’s hospitals and the patients they serve,” said Sen. Menendez.  “Deborah’s mission of providing the best cardiac, pulmonary and vascular care—while never once billing a patient—is the model of what a hospital should be, and I will continue my efforts to ensure the Medicare program doesn’t discriminate against hospitals in New Jersey and other all-urban states.  I’ve been working closely with Deborah and the Department of Health and Human Services (HHS) for years to ensure they’re not unfairly penalized due to the fact New Jersey is an all-urban state.  This legislation will ensure that federal law equitably recognizes our hospitals.”

“The care Deborah provides for our residents is among the best in the nation, and I’m pleased to partner with Senator Menendez on this important legislative fix to ensure Deborah can continue providing state-of-the-art health care and services to our community,” said Rep. MacArthur.  “Our bipartisan legislation will make sure rural hospitals like Deborah, are never punished for serving the seniors in our communities. 

Menendez, McArthur greet patients in Deborah waiting room

Menendez meets Deborah hospital staff 

An ultrafast CT Scan 

The Fairness for Our Hospitals Act would close an unfair loophole in federal law that prevents rural hospitals in smaller states, like New Jersey, from receiving fair Medicare reimbursement levels from the Medicare Dependent Hospital Program (MDH).

New Jersey is designated as one of only three “all-urban” states, along with Delaware and Rhode Island.  As a result, local hospitals that would otherwise qualify, like Deborah, are denied additional Medicare reimbursements; this inequality is unfair and against the intent and goals of the Medicare program. 

To qualify for rural MDH payments, the hospital must be in a rural area; have 100 or fewer beds during the cost reporting period; cannot already be classified as Sole Community Hospital (another rural-only hospital designation); and at least 60% of its patients use Medicare.

Deborah is a not-for-profit specialty hospital dedicated to cardiac and pulmonary care located in the heart of New Jersey’s Pine Barrens.  It accepts Medicare and other insurance, but has traditionally provided its patients with high-quality care at zero out-of-pocket expense.

“We are thankful that our representatives in Congress have championed our cause.  Taking action to right this wrong will help Deborah to continue to care for the large number of Medicare patients that come to us from our surrounding rural areas,” Deborah President and CEO Joseph Chirichella said.

As a senior member of the Senate Finance Committee with sole jurisdiction over Medicare, Sen. Menendez has repeatedly pushed HHS and CMS to provide equitable Medicare reimbursement rates for New Jersey’s rural hospitals.  He twice introduced bills aimed at more broadly providing for urban hospitals, called the Urban Medicare-Dependent Care Act, in the 111th and 112th Congresses, and introduced the measure as an amendment to the Affordable Care Act (ACA). 

In 2014, the Provider Reimbursement Review Board (PRRB), an independent panel within CMS to which a certified Medicare provider may appeal its reimbursement rate if it is dissatisfied with a final determination by CMS or its Medicare contractor, determined that Deborah must be treated as a rural hospital retroactive to July 18, 2011. 

Sen. Menendez immediately sent a letter to then-CMS Administrator Marilyn Tavenner—joined by Sen. Cory Booker (D-N.J.), Rep. Bill Pascrell Jr. (D-N.J.-09) and former-Rep. John Runyan (R-N.J.-03)—voicing strong support for the PRRB’s decision, but Tavenner reversed the PRRB’s decision, ensuing that the PRRB’s correct interpretation of current statute isn’t subject to further overruling or manipulation.

Sen. Menendez and Rep. MacArthur introduced the Fairness for Our Hospitals Act in their respective Houses in July.  It is cosponsored by Sens. Booker, Tom Carper (D-Del.) and Christopher Coons (D-Del.) in the Senate, and Reps. Pascrell, Jr. and John Carney (D-Del.) in the House of Representatives.