
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 Lifts COVID-19 Vaccination Mandate for Health Care Workers
June 2, 2023 ||CMS says the withdrawal of the mandate, effective immediately, aligns with the agency’s approach to other infectious diseases.
view more »Association Urges HRSA to Clarify 340B Eligibility for Offsite Locations
May 11, 2023 ||The letter expressed concern with reports that HRSA no longer will allow hospitals to administer 340B drugs in offsite outpatient locations that have not yet appeared on a filed Medicare cost report.
view more »Association Comments on Proposed Medicare DSH Payment Rule
May 2, 2023 ||The association urged CMS to withdraw its proposal to exclude patient days related to uncompensated care pools from the Medicare disproportionate share hospital funding calculation.
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 »CMS Releases FY 2024 IPPS Proposed Rule
April 11, 2023 ||The proposed fiscal year 2024 Inpatient Prospective Payment System rule includes a request for feedback on defining safety net hospitals; CMS will accept comments until June 9.
view more »CMS Revises Part B Inflation Rebate Guidance for 340B Modifiers
March 21, 2023 ||To exclude 340B drugs from Medicare Part B inflation rebates required by the Inflation Reduction Act, providers must identify 340B drugs on Medicare claims.
view more »CMS Announces First Drugs with Reduced Medicare Copays
March 21, 2023 ||Per the Inflation Reduction Act, drug manufacturers that increase prices faster than the inflation rate will be required to pay rebates to Medicare.
view more »CMS Proposes to Revise Medicare DSH Calculation
March 13, 2023 ||The agency proposes to limit the types of patient days associated with Section 1115 waivers that are included in the Medicaid fraction of the hospital’s disproportionate patient percentage.
view more »CMS Proposes to Revise Medicare DSH Calculation
Feb. 28, 2023 ||CMS proposes to limit the types of Medicaid Section 1115 waiver days that can be included when calculating a hospital’s disproportionate patient percentage.
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 »Association Asks HHS for Swift Part B Cut Repayment
Feb. 22, 2023 ||The association asked that CMS swiftly make 340B hospitals whole for reduced Medicare Part B reimbursement from 2018 to fall 2022, plus applicable interest.
view more »CMS Publishes Initial Guidance for Medicare Drug Inflation Rebates
Feb. 14, 2023 ||Drug manufacturers that increase prices faster than the inflation rate must pay rebates to Medicare; comments on this policy are due to CMS March 11.
view more »CMS Update on COVID-19 Blanket Waivers and Flexibility
Feb. 7, 2023 ||The updated fact sheets share when specific waivers will end and whether they will continue after the public health emergency’s end on May 11.
view more »CMS Awards 200 New Residency Slots to Strengthen Workforce
Jan. 12, 2023 ||Prioritizing hospitals in health professional shortage areas, CMS awarded residency slots to 100 hospitals, including 27 essential hospitals.
view more »FY 2023 Omnibus Spending Bill Includes Essential Hospital Advocacy Priorities
Dec. 21, 2022 ||The $1.66 trillion package would extend funding for government operations through Sept. 30, 2023, including $120.7 billion for the Department of Health and Human Services, $9.9 billion more than the FY 2022 enacted level, and numerous provisions important to essential hospitals.
view more »Contact Congress Now to Support Funding for Hospitals Serving a Safety Net Role
Dec. 16, 2022 ||Lawmakers and staff are currently negotiating the final text for a year-end spending package. Targeted, financial assistance for hospitals serving a safety net role is on the table.
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 »CY 2023 OPPS Final Rule Reverses 340B Cuts
Nov. 4, 2022 ||The Medicare Outpatient Prospective Payment System final rule for calendar year 2023 reverses cuts to hospitals in the 340B Drug Pricing Program and delays developing a remedy for cuts to 340B hospitals that have been in place since 2018.
view more »CMS Issues CY 2023 Physician Fee Schedule Final Rule
Nov. 4, 2022 ||The rule finalizes the conversion factor and includes reimbursement provisions for telehealth and behavioral health services, the Quality Payment Program, and the Medicare Shared Savings Program.
view more »Association Comments on CY 2023 OPPS Proposed Rule
Sept. 20, 2022 ||America’s Essential Hospitals urges CMS to swiftly restore full Medicare Part B drug payment rates for hospitals in the 340B Drug Pricing Program and define the select group of hospitals with a safety net mission.
view more »Association Comments on CY 2023 Physician Fee Schedule Proposed Rule
Sept. 12, 2022 ||The association urged CMS to adequately reimburse off-campus, provider-based departments; refine physician quality reporting; and codify a definition of essential hospitals.
view more »Inflation Reduction Act: An Analysis for Essential Hospitals
Aug. 18, 2022 ||Notable for essential hospitals, the bill contains an extension of Affordable Care Act advance premium tax credits, and historic drug pricing provisions that give the federal government power to negotiate drug prices on behalf of Medicare beneficiaries.
view more »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 »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.
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