Change's temporary funding program 'not even a Band-Aid,' AHA president says, as White House reportedly mulls financial relief

Provider groups have come out swinging amid the fallout from the Change Healthcare cyberattack, which happened nearly two weeks ago.

The American Hospital Association (AHA) sent letters to Congress and the head of UnitedHealth Group on Monday, demanding that actions be taken to better support providers amid ongoing disruptions. Meanwhile, the American Medical Association (AMA) put out its own long-awaited statement on the incident.

In its letter (PDF) to congressional leaders, AHA called the hack the “most significant cyberattack” on healthcare in American history and said the Department of Health and Human Services (HHS) "has yet to provide a formal response or issue mitigating solutions.” 

Change helps execute more than 100 critical functions for the system, from processing claims to drug prescriptions. As a result of its systems being disrupted, billions of dollars have stopped flowing to providers, AHA’s letter claimed.

The organization advocated for the need to direct Medicare Administrative Contractors to prioritize and expedite review and approval of hospital requests for Medicare advanced payments. It also requested that HHS issue guidance to payers that outlines expectations on periodic interim payments or advanced payments to providers, as well as waiving timely filing requirements for claims, extending timelines for appeals and not denying claims due to lack of authorization or other reasons. 

“This incident demands a whole of government response,” the letter said.

It also urged HHS to ensure UnitedHealth Group takes all necessary steps to remedy the situation and urged Congress to consider statutory limitations that may exist for any federal agencies that can assist hospitals at this critical moment.

“We urge you to press the Executive Branch for bold, swift action to prevent further fallout and to ensure a complete and fulsome response from UnitedHealth Group,” AHA said in the letter.

Friday, Change Healthcare posted a notice on its website that it had established a “temporary funding assistance support program to help with short-term cash flow needs.” The program will be administered through Optum Financial Services.

But, AHA president and CEO Richard Pollack criticized UnitedHealth Group for not doing enough to support providers, saying the company’s temporary funding assistance program is "not even a band-aid on the payment problems" that some providers are facing as a result of the disruption.

This program is not available to all organizations and only addresses payers’ inability to pay, not providers’ inability to quickly send claims to payers, Pollack wrote in a letter (PDF) sent to UnitedHealth Group on Monday.

Additionally, the related terms and conditions are “shockingly onerous,” requiring repayment of loans within five days of notice, allowing Optum to change the agreement “simply by providing notice,” requiring providers give UnitedHealth and subsidiaries access to claims payment data and more. These elements “severely undermine the intent of this program,” Pollack wrote.

“Taken together, the limited eligibility and these one-sided contractual terms severely undermine the intent of this program,” Pollack wrote. “Indeed, we have heard from some hospitals and health systems that these simply are not terms they can accept, especially when their financial future becomes more unpredictable the longer Change Healthcare is unavailable.”

Pollack called out UnitedHealth Group’s $370 billion in revenue and $22 billion in profit in 2023, saying it “can—and should” be doing more. “We need real solutions—not programs that sound good when they are announced but are fundamentally inadequate when you read the fine print,” Pollack wrote. The AHA is prepared to help UnitedHealth craft a more feasible financial assistance program, he concluded.

In a long-awaited statement, the AMA on Monday also called on the use of all available tools to mitigate the disruptions.

“This massive breach and its wide-ranging repercussions have hit physician practices across the country, risking patients’ access to their doctors and straining viability of medical practices themselves,” AMA President Jesse M. Ehrenfeld, M.D., said in the statement. “Against the backdrop of persistent Medicare cuts, rising practice costs and spiraling regulatory burdens, this unparalleled cyberattack and disruption threatens the viability of many practices, particularly small practices and those in rural and underserved areas. This is an immense crisis demanding immediate attention.”

The AMA previously sent its own letter (PDF) to Becerra outlining the concerns of physicians throughout the disruptions.

As a growing number of groups put pressure on the administration, the White House is reportedly considering short-term financial relief to support hospitals navigating the fallout of the cyberattack against Change Healthcare.

The news was first reported by Politico and attributed to an anonymous senior administration official. In a series of recent meetings at the deputy level, the White House’s National Security Council reportedly discussed options that would not require support from Congress. Instead, it is exploring ways to tap into funding programs overseen by HHS, the Centers for Medicare & Medicaid Services and the Department of Veterans Affairs to support healthcare organizations.

“This cashflow issue has been at the forefront since the beginning of last week for us,” the senior administration official told Politico. The agency is reportedly pushing UnitedHealth Group to provide more transparency about when it can restore Change systems.

The Biden administration is also considering whether to declare the hack a “significant cyber incident,” a rarely used designation that would trigger a special crisis management playbook, according to media reports.