Health Care Reform
As lawmakers and other stakeholders debate the future of the Affordable Care Act (ACA) and entitlement programs, America’s Essential Hospitals will participate in the discussion on the strength of two guiding principles: supporting access to high-quality care for all people and ensuring essential hospitals have the resources they need to fulfill their vital community missions.
With these principles in mind, the association has three recommendations to policymakers to consider during discussions about repealing and replacing the ACA:
- Policymakers should pair any repeal of the ACA with simultaneous passage of a comprehensive replacement;
- Any freestanding repeal of the ACA must fully repeal the act’s steep cuts to hospital payments; and
- Policymakers should ensure all people currently insured maintain coverage until a smooth transition into a permanent, comprehensive replacement can be made.
Our hospitals are experts at providing health care to those most dramatically impacted by changes in coverage sources, and we offer ourselves and our members as resources to lawmakers.
Minnesota Offers Special Enrollment Period
May 23, 2023 ||To qualify, an individual must be enrolled in family insurance through an employer that is deemed unaffordable and has a renewal date other than Jan. 1.
view more »Florida Hospitals Required to Collect Patient Immigration Status
May 11, 2023 ||A new law requires hospitals that accept state and federal Medicaid reimbursements to include a question about immigration status on intake forms.
view more »Association Files Amicus Brief in ACA Case
May 9, 2023 ||The brief urges an appeals court to restore an Affordable Care Act requirement that most health plans cover certain preventive services.
view more »CMS Updates Hospital Price Transparency Enforcement Procedures
May 1, 2023 ||To increase compliance with the hospital price transparency rule, CMS has set new compliance timelines and no longer will issue warning notices.
view more » 
CMS Releases Guidance on Reentry Section 1115 Waiver Opportunity
May 1, 2023 ||
The agency encourages states to leverage a new Section 1115 demonstration to implement a service delivery system that facilitates reentry transitions for Medicaid-eligible individuals leaving prisons and jails.
view more »CMS Finalizes 2024 Notice of Benefit and Payment Parameters
April 28, 2023 ||The rule updates essential community provider requirements for qualified health plans and adds a special enrollment period for those losing Medicaid or CHIP coverage.
view more »HHS Proposes Rule to Expand Health Coverage for DACA Recipients
April 25, 2023 ||The rule would allow DACA recipients to be eligible for health care coverage through the Affordable Care Act marketplace, Medicaid, and the Children’s Health Insurance Program.
view more » CMS Issues FY 2024 IPPS Proposed Rule
April 24, 2023 ||
The proposal includes numerous policy and payment changes to Medicare’s Inpatient Prospective Payment System for fiscal year 2024, including a 2.8 percent increase in inpatient payment rates.
view more »No Surprises Act Payments Resume
March 21, 2023 ||The decision comes after HHS halted payment determinations following a February court ruling vacating certain provisions of the No Surprises Act.
view more »Essential Hospital Designation
Feb. 24, 2023 ||Our proposal would codify a designation of essential hospitals in statute, allowing lawmakers to better target support to improve access to care and public health.
view more »No Surprises Act Payment Determinations Halted
Feb. 17, 2023 ||HHS instructed federal independent dispute resolution entities not to issue new payment determinations in out-of-network billing payment disputes.
view more »On The Hill: Senate Sets Key Health Panel Rosters
Feb. 6, 2023 ||The Senate announced rosters for the Finance and Health, Education, Labor, and Pensions (HELP) committees, as well as for the Finance Committee’s Subcommittee on Health Care. HELP Committee Chair Sen. Bernie Sanders (I-Vt.) signaled his intention to act on prescription drug prices.
view more »On the Hill: Lawmakers Pass Continuing Resolution, Take up Omnibus Legislation
Dec. 20, 2022 ||The bill includes funding to bolster the health care workforce and extends flexible telehealth policies, including the hospital at home waiver.
view more »Essential Hospitals Need Targeted Federal Support
Dec. 5, 2022 ||Hospitals that fill a safety net role need targeted funding to remain on the front lines of public health emergencies and serve the nation’s most underrepresented patients and marginalized communities.
view more »Protect and Strengthen the Health Care Workforce
Dec. 5, 2022 ||The United States faces a significant and pervasive health care workforce shortage, especially in underserved communities. As policymakers discuss how to address current and future workforce shortages, we urge Congress to expand, protect and fund the health care workforce.
view more »Extend Telehealth and Hospital-At-Home Flexibility
Dec. 5, 2022 ||As Congress continues to consider legislation during and after the pandemic, it should make permanent policies that allow providers to expand access to care, including telehealth and hospital-at-home, to improve the health of their communities.
view more »CMS Delays Enforcement of Surprise Billing Co-Provider Requirement
Dec. 5, 2022 ||The agency will not enforce a surprise billing requirement that requires good faith estimates to include cost estimates from co-providers and co-facilities.
view more »New CMS Resources for Hospital Price Transparency Requirements
Nov. 18, 2022 ||The agency shared three sample formats to help hospital staff build machine readable files to comply with the Hospital Price Transparency Rule.
view more » CY 2023 PFS Final Rule Includes Telehealth, Equity Provisions
Nov. 15, 2022 ||
The final rule for calendar year 2023 continues certain flexible telehealth policies, overhauls the Medicare Shared Savings Program, and revises the Quality Payment Program.
view more »GAO Report on Recruiting and Retaining Behavioral Health Workers
Nov. 1, 2022 ||Financial, educational, and workplace challenges pose obstacles to recruiting and retaining a diverse behavioral health workforce.
view more »Health Affairs Commentary Argues for Essential Hospital Designation
Oct. 3, 2022 ||In a new Forefront commentary, the association’s current, immediate past, and incoming board chairs say essential hospitals’ indispensable role, unique characteristics, and financial fragility argue for recognizing them as a distinct class in public health and policymaking.
view more »HHS Issues RFI on No Surprises Act Requirements
Sept. 20, 2022 ||HHS seeks input on the No Surprises Act’s advanced explanation of benefits and good faith estimate requirements for insured individuals; comments are due Nov. 15.
view more »Administration Publishes No Surprises Act Final Rule
Aug. 23, 2022 ||The rule finalizes disclosure requirements for the qualifying payment amount and select provisions for the related independent dispute resolution process.
view more »On the Hill: Inflation Reduction Act Provisions of Note
Aug. 22, 2022 ||Lawmakers return to their states and districts for August recess following last week’s passage of the Inflation Reduction Act. The bill includes provisions of note for essential hospitals, including those to extend Affordable Care Act subsidies and fight climate change.
view more »On the Hill: Biden Signs Inflation Reduction Act
Aug. 16, 2022 ||President Joe Biden signed the legislation Aug. 16 after the House sent it to his desk with a 220-207, party-line vote. It extends Affordable Care Act subsidies through 2025 and makes other changes of interest to essential hospitals.
view more »HHS Reinstates, Adds ACA Nondiscrimination Protections
Aug. 9, 2022 ||The proposed rule expands the definition of discrimination “on the basis of sex” and explicitly includes telehealth services in nondiscrimination policies.
view more »On the Hill: Senate Works to Finish Reconciliation before Recess
Aug. 2, 2022 ||The $433 billion Inflation Reduction Act would allow Medicare to negotiate prescription drug prices and would extend expanded Affordable Care Act subsidies for three years. It also includes tax provisions and new investments related to energy and climate change.
view more »Oregon Builds Health Care Bridge Program, Prioritizes Equity
May 10, 2022 ||The bridge program task force will create a proposal for affordable, continuous health insurance coverage for individuals with frequent income fluctuations.
view more »2023 Marketplace Benefit and Payment Parameters Finalized
May 3, 2022 ||The final rule raises the essential community provider threshold from 20 to 35 percent and uses wait time standards to evaluate qualified health plans for network adequacy.
view more »CMS Opens Federal IDR Portal
April 19, 2022 ||The independent dispute resolution process can be initiated to resolve payment disputes between health care providers and issuers.
view more »CMS Issues FAQs on Surprise Billing, Good Faith Estimates
April 11, 2022 ||Two new documents provide guidance for health care providers on No Surprises Act compliance and good faith estimates for uninsured or self-pay patients.
view more »Guidance Released for IDR Entities
Jan. 4, 2022 ||New guidance from the Centers for Medicare & Medicaid Services reviews the timeline for open negotiations and initiating the federal independent dispute resolution process under the No Surprises Act.
view more »CMS Issues FAQ on Surprise Billing Good Faith Estimates for Uninsured
Dec. 23, 2021 ||The new document explains various provisions under part II surprise billing regulations, including that all financial assistance should be reflected in the good faith estimate regardless of the amount or type of discount. The new regulations take effect Jan. 1, 2022.
view more » House Passes ‘Human Infrastructure’ Bill
Nov. 19, 2021 ||
The House voted 220–213 to pass the $1.75 trillion Build Back Better Act. It contains essential hospital priorities related to Medicaid, maternal health, and the health care workforce but also includes harmful cuts to Medicaid disproportionate share hospital and uncompensated care pool payments.
view more »On the Hill: CBO Score Expected on ‘Human Infrastructure’ Bill
Nov. 16, 2021 ||The Congressional Budget Office this week is expected to release a full score of the $1.75 trillion “human infrastructure” package. Meanwhile, congressional leaders say it is unlikely appropriators will reach an agreement to fund the federal government for fiscal year 2022 by the Dec. 3 deadline.
view more »Association Gives Senate Panel Comments on Mental Health Care
Nov. 12, 2021 ||The letter from America’s Essential Hospitals to the Senate Committee on Finance responded to the panel’s request for information on improving access to and enhancing mental and behavioral health care.
view more »Preview Healthcare.gov Plans Before Open Enrollment
Oct. 26, 2021 ||Consumers now can preview health plans and prices on healthcare.gov ahead of open enrollment, which runs Nov. 1, 2020, through Jan. 15, 2021.
view more » Part II of Surprise Billing Regulations Outline IDR Process, Uninsured Protections
Oct. 19, 2021 ||
Released on Oct. 7, part II of the No Surprises Act interim final rule outlines the independent dispute resolution process for out-of-network services and protections for uninsured and self-pay patients.
view more »Administration Releases Part II of Surprise Billing Regulations
Oct. 5, 2021 ||The departments of Health and Human Services (HHS), Treasury, and Labor and the Office of Personnel Management issued Part II of the No Surprises Act interim final rule with comment period.
view more »Final Rule on ACA Marketplace for 2022 Plan Year
Sept. 21, 2021 ||The rule, released by the Department of Health and Human Service and the Department of Treasury, extends open enrollment, adds a new special enrollment period, expands navigator responsibilities, and modifies Section 1332 innovation waivers.
view more »On the Hill: Reconciliation Markup Deadline Looms for House Panels
Sept. 14, 2021 ||The House is scheduled to return to Capitol Hill next week, but House committees continue to meet and craft their sections of the Build Back Better Act, a “human infrastructure” reconciliation bill. House committees aim to complete markups by Sept. 15, with a full House vote possible before October.
view more »Association Comments on First Part of Surprise Billing Rules
Sept. 7, 2021 ||In a letter to the Centers for Medicare & Medicaid Services, America’s Essential Hospitals commented on the first interim final rule implementing the No Surprises Act. The association urged HHS to delay implementation until after the COVID-19 public health emergency, among other requests.
view more »On the Hill: House Committees Begin Reconciliation Markups
Sept. 7, 2021 ||House committees begin marking up portions of the forthcoming “human infrastructure” reconciliation package, which is expected to include provisions to expand health coverage and lower prescription drug prices. The association’s calls for government relations professionals will resume Sept. 9.
view more » Administration Releases First Phase of Surprise Billing Regulations
July 16, 2021 ||
The rule, released by the departments of Health and Human Services, the Treasury, and Labor and the Office of Personnel Management, bars health care insurers, carriers, and providers from billing patients more than in-network cost sharing amounts in certain circumstances.
view more »New Rule Aims to Protect Patients from Surprise Billing
July 6, 2021 ||On July 1, the Biden administration released part 1 of the No Surprises Act interim final rule. Passed as part of the Consolidated Appropriations Act of 2021, the rule establishes new patient protections from balanced billing and excessive cost-sharing, known as surprise billing.
view more »Proposed Rule on ACA Marketplace for 2022 Plan Year
July 1, 2021 ||The departments of the Treasury and Health and Human Services proposed extending open enrollment in the Affordable Care Act marketplaces, adding a new special enrollment period, expanding navigator responsibilities, and modifying Section 1332 innovation waivers.
view more »Nevada Enacts Public Option
June 22, 2021 ||Nevada is the second state to pursue a public option health coverage plan, after Washington implemented a public option in 2019. The law requires the Nevada Department of Health and Human Services, Division of Insurance, and Silver State Health Insurance Exchange to create a public option by 2026.
view more »Supreme Court Dismisses Lawsuit Challenging Affordable Care Act
June 17, 2021 ||The lawsuit, brought by individual plaintiffs and 18 Republican-led states, argued the ACA’s individual mandate was unconstitutional and that the entire ACA had to be dismantled as a result. The court’s decision was made on procedural grounds and did not rule on the underlying merits of the case.
view more »CMS Announces $80M in Grant Funding for Navigators
June 7, 2021 ||The Centers for Medicare & Medicaid Services is issuing $80 million in grant funding for navigators in states using the federal insurance marketplace for the 2022 plan year.
view more »HHS Announces Navigator Funding, New Open Enrollment Report
May 2, 2021 ||The Department of Health and Human Services announced $80 million in grants to increase access to marketplace enrollment assistance for consumers. The agency’s 2021 open enrollment report shows more than 12 million consumers selected a marketplace plan during the 2021 open enrollment period.
view more »Special ACA Enrollment Period Extended to Aug. 15
March 26, 2021 ||The Centers for Medicare & Medicaid Services is extending until Aug. 15 the special enrollment period for 36 states using the federal health insurance marketplace, giving consumers more time to view new options under the American Rescue Plan, including lower premiums and plan upgrades.
view more »Federal Court Vacates Provisions in 2019 Marketplace Rule
March 12, 2021 ||A federal court vacated several policies in the Trump Administration’s 2019 health insurance marketplace rule for violating federal law, including provisions related to review of network adequacy, standardized options, income verification requirements, and reducing medical loss ratio rebates.
view more »Reimagining the Health Care Safety Net
March 12, 2021 ||Essential hospitals rely heavily on a patchwork of federal financial support and resources to meet their mission. Congress must bolster the individual components that form the fabric of the health care safety net.
view more »COVID-19 Protections and Support for Essential Hospitals
March 12, 2021 ||Essential hospitals lead the nation in the battle against COVID-19 but new challenges—including COVID variants, vaccination distribution management, and long-term hospitalizations—show more help is needed to ensure providers on the front lines can maintain access to care.
view more »Special Enrollment for ACA Coverage Began Feb. 15
Feb. 16, 2021 ||The special enrollment period, intended to ensure access to health coverage amid the the COVID-19 pandemic, will continue through May 15. The enrollment period applies to consumers in the 36 states that use the federal marketplace platform.
view more »Biden Signs Executive Order to Strengthen Medicaid, ACA
Feb. 1, 2021 ||President Biden released an executive order to strengthen Medicaid and the Affordable Care Act. The order calls for a special enrollment period on the federally facilitated exchange for uninsured or underinsured individuals — particularly those hardest hit by the COVID-19 pandemic.
view more » DSH Relief, Other Essential Hospital Wins in Year-End Spending Bill
Dec. 23, 2020 ||
The $2.3 trillion package to fund the government, provide new COVID-19 relief, and stimulate the economy would eliminate a $4 billion cut to Medicaid disproportionate share hospital payments and add $3 billion to the Provider Relief Fund, among numerous other changes.
view more »HHS Proposes Changes to HIPAA Privacy Rule
Dec. 15, 2020 ||The Department of Health and Human Services’ Office of Civil Rights proposed modifications to the Health Insurance Portability and Accountability Act privacy rule as part of the agency’s regulatory sprint to coordinated care.
view more » CMS Finalizes Medicare Most Favored Nation Drug Model
Dec. 3, 2020 ||
The rule builds on an International Pricing Index model CMS first outlined in an advance notice of proposed rulemaking in late 2018. The mandatory model will include most providers and suppliers who purchase and receive reimbursement for Medicare Part B drugs.
view more »HHS Finalizes Changes to Stark Law and Anti-Kickback Statute
Nov. 23, 2020 ||The Office of Inspector General (OIG) and the Centers for Medicare & Medicaid Services (CMS) finalized rules in conjunction with HHS’ regulatory sprint to coordinated care. The OIG rule modifies safe harbor protections; CMS’ rule targets undue burden of the physician self-referral law, or Stark law.
view more » CMS Streamlines Medicaid Managed Care Regulations
Nov. 23, 2020 ||
On Nov. 9, CMS issued a final rule largely adopting policies overhauled by the Obama administration in 2016. The final rule reflects the agency’s broader strategy to relieve regulatory burden, support state flexibility, and promote transparency and innovation in the delivery of care.
view more » Interim Final Rule Aims to Ensure Timely Access to COVID-19 Vaccines
Nov. 9, 2020 ||
In its fourth interim final rule during the COVID-19 public health emergency, the Centers for Medicare & Medicaid Services implements several measures to ensure timely access to a vaccine.
view more » HHS Revises Provider Relief Fund Reporting Guidance
Oct. 29, 2020 ||
In response to stakeholder and congressional feedback, the Department of Health and Human Services revised reporting requirements for health care providers who receive more than $10,000 total in Provider Relief Fund payments.
view more »On the Hill: Barrett Confirmed, PRF Reporting Changed
Oct. 27, 2020 ||Responding to concerns raised by the association and lawmakers, the Department of Health and Human Services has altered detrimental reporting requirements for the Provider Relief Fund, including one regarding lost revenue.
view more »CMS Issues Temporary Policy For Marketplace Premium Reductions
Aug. 11, 2020 ||The agency is using its discretion to allow premium credits to support continuity of coverage for individuals and families impacted by the COVID-19 public health emergency and facing difficulties paying premiums.
view more »SAMHSA Finalizes Revisions for 42 CFR Part 2
July 14, 2020 ||The changes aim to remove barriers to care coordination and allow additional information sharing for providers treating patients with substance use disorder.
view more » HHS Removes Protections for Gender Identity, Language Services
July 2, 2020 ||
HHS finalized a rule overhauling the ACA to remove some nondiscrimination protections for transgender individuals and requirements for treating people with limited English proficiency. In a statement, the association said the decision puts the health and safety of vulnerable populations at risk.
view more »On the Hill: House Votes on ACA Enhancement, Hospital Construction
June 29, 2020 ||The House passed legislation to strengthen the ACA and is expected to pass an infrastructure bill authorizing $10 billion for hospital construction and modernization; the Senate is unlikely to consider the bills. The association responds to a congressional request for lessons learned from COVID-19.
view more »Final Rule Removes Gender Identity, Language Access Protections
June 16, 2020 ||The Department of Health and Human Services finalized a rule overhauling parts of the Affordable Care Act to remove nondiscrimination protections for transgender individuals and certain language access requirements for providing health care services to people with limited English proficiency.
view more »