
Medicare
Essential hospitals rely on Medicare as a vital funding source for about a quarter of their patients. A robust Medicare program ensures these patients — elderly, medically frail, and often economically vulnerable — can access the services they need.
Congress must carefully consider the potential harm to these patients and their hospitals that could result from Medicare spending reductions to meet budget goals. Recent funding cuts, such as a 2015 law that dramatically reduces Medicare payments to off-campus hospital outpatient departments, will worsen access in already underserved communities and ultimately raise health care costs.
Medicare Covers Nearly One-Third of Essential Hospitals’ Inpatients
Source: Essential Data; Our Hospitals, Our Patients. 2018
Likewise, Medicare value-based payment programs can disproportionately penalize hospitals that serve large numbers of vulnerable people – essential hospitals. In these programs, we must account for socioeconomic barriers that lie outside a hospital’s control and that can prevent successful outcomes, creating a vicious circle that reduces the very support needed to improve care.
A strong Medicare program is key to much of the work essential hospitals do for their patients and communities. We must ensure Medicare maintains and enhances support for the many services essential hospitals provide beyond their core commitment to vulnerable patients, including health care workforce training, care coordination, and telehealth.
CMS Issues FY 2023 IPPS Final Rule
Aug. 8, 2022 ||The rule from the Centers for Medicare & Medicaid Services includes numerous policy and payment changes important to essential hospitals, including a 4.3 percent increase in inpatient payment rates for fiscal year 2023.
view more »Care Compare October 2022 Preview Reports Available
Aug. 8, 2022 ||Health care providers have until Aug. 30 to download their preview reports before CMS shares quality data publicly in October.
view more »CMS Issues FY 2023 IPPS Final Rule
Aug. 2, 2022 ||The regulation contains payment and quality reporting provisions, a new designation to identify “birthing-friendly” hospitals, and a 4.3 percent increase in operating payment rates for general acute-care hospitals, compared with a proposed 3.2 percent update.
view more »CY 2023 OPPS Rule Includes 340B, Site-Neutral, and Quality Proposals
July 25, 2022 ||A proposed rule for Medicare’s Outpatient Prospective Payment System for calendar year 2023 would reverse Medicare Part B drug payment cuts to hospitals in the 340B Drug Pricing Program, continue site-neutral payment policies, and revise the inpatient-only list, among other proposed changes.
view more »CY 2023 PFS Proposed Rule Released
July 19, 2022 ||A proposed rule for the Medicare Physician Fee Schedule for calendar year 2023 would extend telehealth regulatory flexibility, make changes to the Medicare Shared Savings Program, and revise the Quality Payment Program.
view more »CMS Issues CY 2023 OPPS Proposed Rule, Plans to Reverse 340B Cuts
July 19, 2022 ||The Medicare Outpatient Prospective Payment System proposed rule for calendar year 2023 reverses cuts to 340B Drug Pricing Program hospitals and seeks comment on remedying existing cuts to 340B hospitals.
view more »CMS Issues CY 2023 Physician Fee Schedule Proposed Rule
July 12, 2022 ||CMS proposes to decrease the conversion factor determining physician payment rates for specific services by $1.53. The proposed rule also includes provisions related to Medicare reimbursement of telehealth services, vaccine administration, and the Medicare Shared Savings Program.
view more »Association Prevails at Supreme Court on OPPS Cuts to 340B Hospitals
June 20, 2022 ||In a resounding victory for essential hospitals, the U.S. Supreme Court unanimously ruled in favor of America’s Essential Hospitals in its years-long legal challenge to restore full Medicare payment rates for 340B Drug Pricing Program hospitals.
view more »MedPAC Considers Safety Net Funding, Site-Neutral Policies
June 20, 2022 ||The commission’s June report to Congress includes illustrative policies about defining and supporting Medicare safety net providers and aligning payments across outpatient settings, among other topics of interest to essential hospitals.
view more »Association Comments on FY 2023 IPPS Proposed Rule
June 20, 2022 ||America’s Essential Hospitals commented on several policy proposals of interest to essential hospitals and responded to requests for information on maternal health, equity, and climate change.
view more »CMS Outlines Behavioral Health Care Strategy
June 7, 2022 ||The agency’s strategy to strengthen behavioral health care focuses on improving access, equity, quality, and data integration.
view more »New Resources for GME Development in Underserved Areas
April 25, 2022 ||The Accreditation Council for Graduate Medical Education introduced two rural track program designations to accredited residency programs and seeks members for an advisory group on health care access for medically underserved areas and populations.
view more »CMS Releases Health Equity Action Plan
April 22, 2022 ||The action plan includes goals to close gaps in health care access, quality, and outcomes through data collection, outreach, and community engagement.
view more »CMS Releases FY 2023 IPPS Proposed Rule
April 19, 2022 ||The proposed fiscal year 2023 Inpatient Prospective Payment System rule would increase operating payment rates by 3.2 percent and make other changes to Medicare payment and quality reporting policies. CMS is accepting comments on the proposed rule until June 17.
view more »Association Makes Equity Measurement Recommendations to CMS
April 4, 2022 ||Recommendations for Medicare and Medicaid equity measures under development focus on standardized data collection and opportunities for testing and feedback.
view more »CMS Finalizes IPPS Provisions on GME, Organ Acquisition Costs
Jan. 18, 2022 ||A final rule with comment period from the Centers for Medicare & Medicaid Services addresses the distribution of 1,000 new graduate medical education slots and other policies.
view more »CMS Finalizes Rule to Withdraw Part B Drug Model
Jan. 10, 2022 ||The Medicare Part B drug model, also known as the most favored nation model, would have phased-in reduced payment rates for 50 Part B drugs over four years. America’s Essential Hospitals previously called on CMS to withdraw the model.
view more »CMS Releases Second IPPS Final Rule with Comment Period
Dec. 23, 2021 ||In the new rule, the agency finalizes proposals on direct and indirect graduate medical education (GME) policies in response to the COVID-19 pandemic and solicits comments on other GME issues to inform future policymaking.
view more »On the Hill: Congress Averts Medicare Sequester, PAYGO Cuts
Dec. 14, 2021 ||The legislation delays looming Medicare payment cuts and creates an expedited pathway for debt limit relief; Senate Democrats this week are expected to release legislative text for a $2 trillion debt limit increase — sufficient to last through the 2022 midterm election.
view more »Study: Significant Increase in Medicare Telehealth Use Amid Pandemic
Dec. 7, 2021 ||A new Department of Health and Human Services report finds the share of Medicare visits conducted via telehealth increased from about 840,000 in 2019 to 52.7 million in 2020. In particular, telehealth was helpful in offsetting potential foregone behavioral health care during the COVID-19 pandemic.
view more »On the Hill: Congress Averts Government Shutdown
Dec. 7, 2021 ||Congress passed a continuing resolution to maintain government funding through Feb. 18, 2022. The bill does not further suspend Medicare cuts slated to take effect in the new year. Meanwhile, the Senate continues work on the Build Back Better Act, debt limit legislation, and defense appropriations.
view more »Details of CY 2022 OPPS, PFS Final Rules
Nov. 18, 2021 ||Final rules for Medicare’s OPPS and PFS for CY 2022 continue Medicare Part B drug payment cuts to hospitals in the 340B Drug Pricing Program; continue site-neutral payment policies; and halt elimination of the inpatient-only (IPO) list.
view more »CMS Releases Hospital Co-Location Guidance
Nov. 16, 2021 ||CMS released final guidance for compliance with Medicare conditions of participation related to co-location, which occurs when two Medicare-certified hospitals or a Medicare-certified hospital and another health care entity are on the same campus or in the same building and share resources.
view more »On the Hill: House Sets Up ‘Human Infrastructure’ Vote
Nov. 9, 2021 ||The House passed the $1 trillion bipartisan physical infrastructure bill after agreeing on a path forward for the $1.75 trillion “human infrastructure” bill. New language in the human infrastructure measure calls for Medicare to negotiate certain drug prices and retains Medicaid DSH cuts.
view more »CMS Issues CY 2022 Physician Fee Schedule Final Rule
Nov. 3, 2021 ||The rule adjusts the conversion factor used to determine physician payment rates and includes provisions related to appropriate use criteria, Medicare reimbursement for telehealth services, vaccine payment rates, the Quality Payment Program, and the Medicare Shared Savings Program.
view more »CMS Finalizes Continued Outpatient Cuts, Higher Transparency Penalties
Nov. 3, 2021 ||The Medicare Outpatient Prospective Payment System final rule for calendar year 2022 continues cuts to hospitals in the 340B Drug Pricing Program and pauses elimination of the inpatient-only list. The rule also includes provisions on price transparency, rural emergency hospitals, and health equity.
view more »On the Hill: ‘Human Infrastructure’ Package Makes Headway
Nov. 2, 2021 ||President Joe Biden last week announced a $1.75 trillion framework for “human infrastructure” reconciliation legislation; the House subsequently released updated legislative text for its human infrastructure bill that aims to close the Medicaid coverage gap.
view more »Essential Hospitals’ Year-End Priorities
Oct. 19, 2021 ||Essential hospitals continue to experience increased costs and fewer resources, including staffing, due to the pandemic. We call on Congress to address various priorities to ensure our members remain able to carry out their mission to serve people who face social and financial barriers to care.
view more »CMS Study Shows Slight Increase in Z Code Use
Oct. 12, 2021 ||The use of Z codes to document social determinants of health in Medicare fee-for-service beneficiaries increased slightly from 2017 to 2019 but remains low.
view more »Association Comments on CY 2022 Physician Fee Schedule Proposed Rule
Sept. 21, 2021 ||The calendar year 2022 Physician Fee Schedule proposed rule includes provisions on Medicare payment for telehealth services, the Quality Payment Program, and more. The association also responded to a request for information on improving health equity through data collection.
view more »Association Comments on CY 2022 OPPS Proposed Rule
Sept. 21, 2021 ||In response to the calendar year 2022 Outpatient Prospective Payment System proposed rule, America’s Essential Hospitals urged CMS to halt elimination of the inpatient-only list and to restore adequate payment to hospitals in the 340B program and to off-campus provider-based departments.
view more »CMS Issues FY 2022 IPPS Final Rule
Aug. 20, 2021 ||The rule includes numerous policy and payment changes for Medicare’s Inpatient Prospective Payment System for fiscal year 2022, including a 2.5 percent increase in inpatient payment rates.
view more »CMS Proposes to Withdraw Part B Drug Model
Aug. 9, 2021 ||CMS proposes to rescind the Trump administration’s Most Favored Nation model interim final rule, which aimed to reduce payment for 50 Medicare Part B drugs. America’s Essential Hospitals previously urged the agency to withdraw the model due to substantive and procedural issues.
view more »CMS Releases FY 2022 IPPS Final Rule
Aug. 9, 2021 ||CMS on Aug. 2 released its fiscal year 2022 Inpatient Prospective Payment System final rule, which includes payment and quality reporting provisions. The rule does not finalize provisions related to new residency slots, organ acquisition costs, or Section 1115 waiver days.
view more »Details of CY 2022 OPPS, PFS Proposed Rules
July 30, 2021 ||Proposed rules for Medicare’s Outpatient Prospective Payment System and Physician Fee Schedule would continue Medicare Part B cuts, continue site-neutral policies, and halt the phase-out of the inpatient-only list. Both rules also contain an information request on closing the health equity gap.
view more »CMS Hosts Hospital Price Transparency Webinar
July 30, 2021 ||Effective Jan. 1, 2021, hospitals are required to publish standard charges, including negotiated rates, for all services in a machine-readable format. The Centers for Medicare & Medicaid Services will host a webinar on Aug. 11 for hospitals to learn about posting standard charge information.
view more »CMS Proposes Continued Outpatient Cuts, Higher Transparency Penalties
July 20, 2021 ||The OPPS proposed rule would continue cuts to hospitals in the 340B Drug Pricing Program and off-campus provider-based departments, pause the elimination of the inpatient-only list, and increase penalties for failing to report standard charges.
view more »CMS Issues CY 2022 Physician Fee Schedule Proposed Rule
July 19, 2021 ||The rule includes provisions related to telehealth, vaccine payment rates, the Quality Payment Program, and the Medicare Shared Savings Program; comments are due to CMS by Sept. 13.
view more »Supreme Court To Review Association’s Lawsuit on OPPS Cuts
July 6, 2021 ||The Supreme Court’s decision to review the case marks a significant step in the association’s efforts to overturn harmful Medicare Part B cuts to hospitals in the 340B Drug Pricing Program. The Supreme Court will hear oral arguments in the case in its next term, with a decision likely in 2022.
view more »Association Comments on FY 2022 IPPS Proposed Rule
June 29, 2021 ||America’s Essential Hospitals commented on several policy proposals of interest to essential hospitals in the Inpatient Prospective Payment System rule and responded to a request for information on closing the health equity gap in hospital quality programs.
view more »MedPAC Recommendations on GME, APMs
June 22, 2021 ||In its June report to Congress, the Medicare Payment Advisory Commission issues recommendations on issues of importance to essential hospitals, including payment for Part B drugs, alternative payment models, indirect medical education payments, and Medicare coverage of vaccines, among other topics.
view more »On the Hill: Senate Confirms CMS Administrator
May 25, 2021 ||The Senate confirmed Chiquita Brooks-LaSure as head of the Centers for Medicare & Medicaid Services. Several Senate committees last week examined issues of importance to essential hospitals, including telehealth, hospital consolidation, and the medical supply chain.
view more »CMS Releases Guidance on Interoperability Rule
May 18, 2021 ||The interpretive guidance includes information on hospital admission, discharge, and transfer notification requirements outlined in CMS’ May 2020 interoperability and patient access final rule.
view more »CMS Issues FY 2022 IPPS Proposed Rule
May 12, 2021 ||A proposed rule from CMS includes numerous changes for Medicare’s Inpatient Prospective Payment System for fiscal year 2022, including a 2.8 percent increase in inpatient payment rates and updates to quality reporting programs and the Medicare Shared Savings Program.
view more »CMS Changes Wage Index Reclassification Rules
May 11, 2021 ||In a new interim final rule with comment period, the Centers for Medicare & Medicaid Services revises the rules for certain hospitals seeking a wage index reclassification with the Medicare Geographic Classification Review Board.
view more »CMS Releases FY 2022 IPPS Proposed Rule
April 28, 2021 ||The Centers for Medicare & Medicaid Services’ proposed fiscal year 2022 Inpatient Prospective Payment System rule would increase operating payment rates by 2.8 percent, repeal market-based data collection, and add 1,000 new graduate medical education teaching slots, among other provisions.
view more »On the Hill: Congress Focuses on Medicare Cut, Infrastructure Funding
April 13, 2021 ||The House will vote as early as tonight to extend the moratorium on the 2 percent Medicare sequester cut; CMS has held provider claims in anticipation of this bill passing. Meanwhile, lawmakers continue conversations on infrastructure funding and workplace violence prevention.
view more »On the Hill: Senate Votes to Extend Moratorium on Medicare Cut
March 30, 2021 ||The Senate advanced legislation extending the moratorium on a 2 percent Medicare sequester cut; however, it is unlikely the House will take up the measure before April 1, when the cut is scheduled to take effect. The association submitted a letter of support for the LIFT America Act.
view more »On the Hill: House Votes to Avert Medicare Cuts; Becerra Confirmed
March 23, 2021 ||The House voted to extend the moratorium on a 2 percent Medicare sequester cut, but the bill lacks support from Senate Republicans. The Senate confirms Xavier Becerra. A reintroduced bipartisan bill would ensure 340B hospitals can maintain program eligibility while responding to COVID-19.
view more »MedPAC Report Addresses Telehealth, 340B Cuts
March 23, 2021 ||In its March report to Congress, the Medicare Payment Advisory Commission recommends payment updates in fee-for-service payment systems, including for hospital inpatient and outpatient services. The panel also outlines Medicare coverage of telehealth services during the pandemic and beyond.
view more »On the Hill: Averting Medicare Cuts, Funding Hospital Infrastructure
March 16, 2021 ||The House this week will vote on legislation to extend the moratorium on a 2 percent Medicare sequester cut. House Democrats unveil an infrastructure package that prioritizes funding for construction and modernization activities to bolster public health preparedness and cyberattack prevention.
view more »President Biden Signs American Rescue Plan Act
March 15, 2021 ||The legislation includes $8.5 billion in funding for certain rural providers that serve Medicare and Medicaid beneficiaries and a a temporary increase in Medicaid disproportionate share hospital allotments.
view more »FAQs for Reporting Median Payer-Specific Negotiated Charges
Jan. 26, 2021 ||The document outlines acceptable approaches to calculate and report median payer-specific negotiated charges by Medicare Severity Diagnosis Related Group for reporting periods ending on or after Jan. 1, 2021.
view more »CMS to Reprocess 2019 OPPS Claims at Site Neutral Rates
Jan. 15, 2021 ||The Centers for Medicare & Medicaid Services will begin reprocessing outpatient claims to excepted off-campus provider-based departments at the lower site neutral payment rate it established in the calendar year 2019 Outpatient Prospective Payment System final rule.
view more »CMS Announces New Direct Contracting Model for Dual Eligibles
Jan. 12, 2021 ||Managed care organizations can participate in direct contracting for their populations dually eligible for Medicare and Medicaid. The model builds on direct contracting opportunities that test risk-sharing arrangements to reduce Medicare expenditures while preserving or enhancing quality of care.
view more »Courts Pause Most Favored Nation Drug Model Rule
Jan. 5, 2021 ||Two federal courts halted implementation of the Centers for Medicare & Medicaid Services’ most favored nation model interim final rule. The seven-year model was set to begin Jan. 1, 2021, phasing in a reduced payment rate for 50 Medicare Part B drugs.
view more »CY 2021 OPPS, PFS Rules Include 340B, Site-Neutral, and Star Rating Policies
Dec. 18, 2020 ||Final rules for Medicare’s Outpatient Prospective Payment System and Physician Fee Schedule for calendar year 2021 continue Medicare Part B drug payment cuts to hospitals in the 340B Drug Pricing Program and site-neutral payment policies.
view more »CMS, OIG Finalize Changes to Stark Law and Anti-Kickback Statute
Dec. 4, 2020 ||The two rules, finalized Nov. 20, aim to eliminate barriers to care coordination and undue burden under current fraud and abuse laws. One provides exceptions to the physician anti-referral law, and one modifies existing safe harbor protections under the anti-kickback statute.
view more »OPPS Final Rule Continues 340B, Site-Neutral Cuts
Dec. 4, 2020 ||The Medicare Outpatient Prospective Payment System final rule for calendar year 2021 continues cuts to hospitals in the 340B Drug Pricing Program and off-campus provider-based departments, and updates the overall hospital star ratings methodology.
view more »CMS Finalizes CY 2021 Physician Fee Schedule Rule
Dec. 3, 2020 ||CMS establishes a conversion factor of $32.41 — a decrease of $3.68 from CY 2020. The final rule also includes provisions related to Medicare reimbursement for telehealth services, the Quality Payment Program, and the Medicare Shared Savings Program.
view more »CMS Proposes Changes to Medicare Cost Reports
Dec. 3, 2020 ||In a notice of proposed information collection, the Centers for Medicare & Medicaid Services announced its intention to make changes to the Medicare cost report and accompanying instructions.
view more »CMS Finalizes Most Favored Nation Medicare Drug Model
Nov. 23, 2020 ||In an interim final rule with comment period, CMS announces a seven-year mandatory payment model set to go into effect Jan. 1. The Most Favored Nation rule builds on an International Pricing Index model; by issuing an interim final rule, the agency bypasses releasing a proposed rule.
view more »Association Comments on Hospital COVID-19 Data Reporting
Nov. 3, 2020 ||In Nov. 2 comments on the interim final rule, America’s Essential Hospitals strongly opposed new hospital conditions of participation related to reporting COVID-19 data and urged the Centers for Medicare & Medicaid Services to withdraw these requirements.
view more »HHS, CMS Taking Email Questions on Data Collection, Enforcement
Oct. 29, 2020 ||New email inboxes set up by the Department of Health and Human Services (HHS) and Centers for Medicare & Medicaid Services (CMS) will take questions about the updated guidance for hospital COVID-19 data reporting requirements as part of Medicare conditions of participation.
view more »Medicaid DSH Third-Party Payer Litigation Concludes
Oct. 20, 2020 ||Following the Supreme Court’s denial of hospitals’ appeal petition, the D.C. Circuit’s decision upholding CMS’ third-party payer final rule will stand. This allows CMS to require the offset of third-party payments in calculating the hospital-specific disproportionate share hospital payment limit.
view more »HHS Webinar Series on Hospital COVID-19 Data Reporting
Oct. 20, 2020 ||The webinar series for hospitals and other stakeholders will review new requirements for reporting COVID-19 data as a Medicare condition of participation and feature administration subject matter experts.
view more »Association Comments on CY 2021 OPPS, PFS Proposed Rules
Oct. 13, 2020 ||The proposed rules would deepen Medicare Part B cuts to hospitals in the 340B Drug Pricing Program, continue site-neutral payment policies, and revise the overall hospital star rating methodology. The association urged CMS to protect funding for essential hospitals and access to care.
view more »CMS Announces New Repayment Terms for Medicare Loans
Oct. 12, 2020 ||Providers will have one year from the issuance date of their Medicare Accelerated and Advance Payment Program funds before they must begin to repay their loans. Providers may apply for an extended repayment schedule and may not use Provider Relief Fund dollars to pay back the Medicare loans.
view more »Guidance for Hospital Reporting of COVID-19 Data
Oct. 9, 2020 ||CMS shares new guidance and FAQs on implementation of an interim final rule requiring COVID-19 data reporting as a Medicare condition of participation. The agency on Oct. 7 began sending letters regarding compliance status; hospitals that do not comply face termination from the Medicare program.
view more »CMS Launches Price Transparency Rule Webpage
Oct. 6, 2020 ||The webpage includes checklists, step-by-step instructions, and FAQs to help hospitals comply with the Hospital Price Transparency Rule, effective Jan. 1, 2021. It also offers information to help consumers use the data.
view more »CMS Issues Final IPPS Rule for FY 2021
Sept. 11, 2020 ||Policies finalized for the 2021 Medicare Inpatient Prospective Payment System call for increasing inpatient payment rates by 2.9 percent, reducing Medicare disproportionate share hospital payments, and collecting median Medicare Advantage charge data.
view more »CMS Merges Health Care Compare Tools
Sept. 8, 2020 ||Care Compare merges the agency’s eight health care provider comparison tools into one interface; price and provider data are now available through an application programming interface.
view more »CMS Finalizes FY 2021 IPPS Rule
Sept. 3, 2020 ||The finalized fiscal year 2021 Inpatient Prospective Payment System rule includes payment and quality reporting provisions. The rule goes into effect Oct. 1; CMS has waived the 60-day delay in effective date due to the COVID-19 public health emergency.
view more »Interim Final Rule Establishes COVID-19 Data Reporting as Medicare Condition of Participation
Aug. 31, 2020 ||In the interim final rule, the Centers for Medicare & Medicaid Services establishes that hospitals and critical access hospitals must report certain information, at a frequency and in a standardized format, as specified by the Department of Health and Human Services during the COVID-19 public health emergency.
view more »Data Collection as a Medicare Condition of Participation
Aug. 28, 2020 ||The Centers for Medicare & Medicaid Services in an interim final rule announced new Medicare condition of participation requirements for hospitals to report COVID-19 cases and related data to the Department of Health and Human Services.
view more »OPPS, PFS Rules Include 340B, Site-Neutral, and Star Rating Policies
Aug. 28, 2020 ||Proposed rules for Medicare’s Outpatient Prospective Payment System and Physician Fee Schedule for calendar year 2021 would deepen Medicare Part B drug payment cuts to hospitals in the 340B Drug Pricing Program, continue site-neutral payment policies, and revise the overall hospital star rating methodology.
view more »CMS to Require Positive Test for COVID-19 Add-on Payment
Aug. 25, 2020 ||Positive tests must be demonstrated using only the results of viral testing (i.e., molecular or antigen), consistent with CDC guidelines. The test may be performed either during or prior to the hospital admission.
view more »CMS Rule Addresses Medicare DSH Payment Calculation
Aug. 18, 2020 ||The agency announced that Medicare Part C enrollee days, otherwise known as Medicare Advantage days, would be included in the calculation of the Medicare fraction used to determine Medicare disproportionate share hospital payments for years prior to fiscal year 2014.
view more »HHS Opens Application Portal for Provider Relief Fund
Aug. 14, 2020 ||Medicare providers that did not receive payment from the $20 billion distribution from the general allocation can apply for additional funding through the portal; applications are due Aug. 28. HHS also announced a $5 billion allocation for nursing homes and long term–care facilities.
view more »OPPS Proposed Rule Continues 340B, Site-Neutral Cuts
Aug. 4, 2020 ||The Medicare Outpatient Prospective Payment System proposed rule for calendar year 2021 would deepen cuts to hospitals in the 340B Drug Pricing Program, continue cuts to off-campus provider-based departments, and update the overall hospital star ratings methodology.
view more »CMS Issues CY 2021 Physician Fee Schedule Proposed Rule
Aug. 4, 2020 ||CMS proposes to decrease the conversion factor determining physician payment rates for specific services by $3.83. The proposed rule also includes provisions related to Medicare reimbursement of telehealth services, the Quality Payment Program, and the Medicare Shared Savings Program.
view more »On the Hill: Republicans Release New COVID-19 Package
July 28, 2020 ||The highly anticipated bill would add $25 billion to the Provider Relief Fund and extend Medicare telehealth flexibility. It would not block the Medicaid Fiscal Accountability Regulation or delay the Medicaid disproportionate share hospital payment cut scheduled for Dec. 1.
view more »COVID-19: Public Data Hub Launch; Transmission-Based Precautions
July 21, 2020 ||The HHS Coronavirus Data Hub goes live; CDC guidance recommends a symptom-based strategy for COVID-19 patients. CMS data show an increase in telehealth use among Medicare beneficiaries. The IRS extends the deadline for tax-exempt hospitals to conduct a community health needs assessment.
view more »ASPE Examines Effects of Social Risk Factors in Medicare Payment Programs
July 6, 2020 ||In this second report on the topic, the agency describes three findings: there is no systematic or standard collection of social risk data; dual enrollment in Medicare and Medicaid remains a predictor of poor outcomes; and there are limited efforts to identify effective and scalable interventions.
view more »CMS Clarifies Use of COVID-19 Modifier, Condition Code
June 2, 2020 ||CMS has issued blanket waivers and flexible options to increase hospital capacity, expand access to COVID-19 testing, promote telehealth, and augment the health care workforce. CMS is clarifying what requires usage of modifier “CR” or condition code “DR” when submitting claims to Medicare.
view more »CMS Issues Proposed IPPS Rule for FY 2021
May 18, 2020 ||The proposed rule would increase inpatient payment rates by 3.1 percent, reduce Medicare disproportionate share hospital payments by about $0.9 billion compared with fiscal year 2020, and collect median third-party charge data on Medicare cost reports.
view more »House Passes New COVID-19 Bill with Key Aid for Essential Hospitals
May 15, 2020 ||The House approved the HEROES Act by a narrow margin. While the bill will not become law, it contains a number of provisions important to essential hospitals and for which the association will advocate in any final COVID-19 supplemental legislation.
view more »CMS Releases FY 2021 IPPS Proposed Rule
May 12, 2020 ||The Centers for Medicare & Medicaid Services released its proposed fiscal year 2021 Inpatient Prospective Payment System rule, which includes payment and quality reporting provisions.
view more »CMS Issues Waivers, New Rules Amid COVID-19 Patient Surge
March 31, 2020 ||The new waivers and flexible options are designed to increase hospital capacity, rapidly expand the health care workforce, temporarily eliminate certain paperwork requirements, and promote telehealth in Medicare.
view more »COVID-19 Accelerated Payment, Paid Leave, and Hospital Reporting Updates
March 30, 2020 ||The administration has issued guidance making policy changes related to Medicare payment, mandated paid leave, and hospital reporting requirements related to COVID-19.
view more »Summary of Take Responsibility for Workers and Families Act
March 24, 2020 ||As the Senate continues work on a third legislative package to address public health and economic needs during the COVID-19 crisis, House Democrats introduced an alternative that includes provisions important to essential hospitals and key changes absent in the Senate bill.
view more »CMS Proposes Extension, Changes to Joint Model
Feb. 25, 2020 ||A new proposed rule would extend the Comprehensive Care for Joint Replacement (CJR) model by three years and add outpatient knee and hip replacement to the definition of a CJR episode. Comments are due to CMS by April 24.
view more »Supreme Court Allows Public Charge Rule to Take Effect
Jan. 27, 2020 ||DHS now can enforce the public charge rule everywhere but Illinois. The stay on the injunction will remain in place until the Court of Appeals for the Second Circuit makes a final decision on the merits of the government’s appeal.
view more »Study Reviews Use of Z Codes for Social Determinants of Health
Jan. 27, 2020 ||Despite a growing awareness of the impact of social determinants of health on patient health outcomes, the CMS study found challenges to consistent data collection, including a lack of standardized screening tools and inconsistent use of electronic health record codes.
view more »CMS Reverses 2019 Site-Neutral Cut, Files Appeal
Dec. 16, 2019 ||Beginning Jan. 1, 2020, CMS will start to adjust claims that were paid at the reduced rate. The agency also filed a notice appealing its case to the U.S. Court of Appeals for the District of Columbia Circuit.
view more »On the Hill: Rx Pricing, Health Care Extenders Bill Released
Dec. 10, 2019 ||Bipartisan Senate committee leaders released drug pricing legislation that includes a provision to eliminate $12 billion of Medicaid disproportionate share hospital cuts over two years. House and Senate committees announced bipartisan legislation to end surprise billing.
view more »CMS Finalizes Price Transparency Requirements
Nov. 18, 2019 ||The agency published new requirements for hospitals to publicly post standard charges, including information based on rates negotiated with third-party payers.
view more »CY 2020 OPPS, PFS Rules Include 340B, Site-Neutral Policies
Nov. 8, 2019 ||The final rules for Medicare’s Outpatient Prospective Payment System and Physician Fee Schedule for calendar year 2020 also
expand access to opioid use disorder treatment and establish a prior authorization process for certain services.
NQF Panel Urges Transparency, Clarity in Hospital Star Ratings
Nov. 8, 2019 ||A new brief summarizes program recommendations from an expert panel, which included America’s Essential Hospitals staff.
view more »Hospital Compare January Preview Reports Include Star Ratings
Nov. 5, 2019 ||Health care providers have until Dec. 3 to download their preview reports, which include overall hospital quality star ratings.
view more »CMS Issues CY 2020 Physician Fee Schedule Final Rule
Nov. 4, 2019 ||The final rule includes provisions related to the Quality Payment Program, evaluation and management services, telehealth services, and the Medicare Shared Savings Program.
view more »OPPS Final Rule Continues 340B, Site-Neutral Cuts
Nov. 4, 2019 ||In a separate, forthcoming final rule, the Centers for Medicare & Medicaid Services will summarize and respond to the more than 1,400 public comments it received about proposed requirements for hospitals to make public their standard charges.
view more »State Department Seeks Comment on Public Charge Form
Nov. 1, 2019 ||The agency seeks comment on a questionnaire to enforce its revised public charge standard for visa applicants. Separately, the department sought comment and emergency review of information collection to enforce the presidential proclamation suspending the entry of immigrants without health coverage.
view more »CMS Refreshes Hospital Compare Data
Nov. 1, 2019 ||The October refresh does not include an update of overall star ratings, which were last updated in February.
view more »On the Hill: House Postpones Vote on Rx Pricing Bill
Oct. 28, 2019 ||A House vote on the Lower Drug Costs Now Act of 2019, scheduled for this week, has been postponed to allot more time for the Congressional Budget Office (CBO) to score the bill.
view more »State Department Revises Public Charge Definition
Oct. 17, 2019 ||The rule intends to align the State Department’s public charge definition with the Department of Homeland Security public charge final rule.
view more »Federal Judges Halt Enforcement of Public Charge Rule
Oct. 15, 2019 ||America’s Essential Hospitals applauded the decision, noting that the rule threatens the health of millions and the stability of essential hospitals.
view more »President Trump Signs Medicare Executive Order
Oct. 7, 2019 ||The order directs the Department of Health and Human Services to alter the Medicare Advantage program, increase cost and quality transparency, and continue site-neutral payment policies.
view more »CMS Finalizes Medicare Burden Reduction Rule
Oct. 3, 2019 ||Of interest to essential hospitals, the rule targets emergency preparedness, hospital quality program requirements, infection control, and physical examinations.
view more »CMS Finalizes Discharge Planning Requirement Changes
Oct. 3, 2019 ||The final rule gives patients and their families access to information that encourages active participation in post-acute care planning and that might reduce their chances of being rehospitalized.
view more »CMS Finalizes Burden Reduction Rule
Sept. 26, 2019 ||The final rule revises conditions of participation and conditions for coverage and also targets emergency preparedness, quality reporting, infection control, and physical examination requirements.
view more »Judge Overturns CMS’ Site-Neutral Payment Cut
Sept. 19, 2019 ||A U.S. District Court judge has invalidated a Centers for Medicare & Medicaid Services policy that made a $380 million payment cut this year to off-campus, provider-based departments previously exempt from site-neutral reductions.
view more »CMS Delays Exact Match Requirement Implementation
Sept. 17, 2019 ||Beginning in April 2020, hospitals with multiple service locations must accurately enter the service facility address of their off-campus, provider-based departments.
view more »Quality Reporting Exceptions to Providers Affected by Hurricane Barry
Sept. 17, 2019 ||Facilities located in areas designated as emergency or major disaster areas will be exempt from provisions of Medicare quality reporting programs.
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