
New Payment Models
As payment policies continue to evolve, essential hospitals are being called upon more frequently to provide value-based, patient-centered, and coordinated health care services.
The U.S. Department of Health and Human Services exceeded its goal of tying 30 percent of Medicare payments to alternate payment models — accountable care organizations and bundled payments, for example — by 2016. Like all hospitals, essential hospitals must adapt to an environment in which current payment systems are increasingly realigned to better reward improvements to the efficiency of care delivery and quality outcomes.

Nurses at association member NuHealth, in East Meadow, N.Y., put patients at the center of care — figuratively and literally.
America’s Essential Hospitals recognizes that improving care coordination and quality while maintaining a mission to serve the most vulnerable is a delicate balance for our members. Essential hospitals also face resource challenges as they consider investments necessary for participation, whether voluntary or mandatory, in alternative payment models.
The association closely monitors and evaluates new and existing payment and delivery models to ensure they do not put our hospitals at a disadvantage or impede essential hospitals’ progress in care coordination.
CMS Proposes Significant Changes to Directed Payments in Managed Care Rule
May 22, 2023 ||The proposed rule changes directed payment policy; access standards and monitoring; in lieu of service and setting requirements; medical loss ratio policy and reporting; and quality strategies, improvements, and reviews.
view more »CMS Opens Applications for Extended Bundled Payment Model
Feb. 28, 2023 ||Applications close May 31 for the two-year extension of the Bundled Payments for Care Improvement Advanced voluntary payment model.
view more »CMS Extends, Changes Bundled Payments Model
Oct. 17, 2022 ||CMS extends for two years the Bundled Payments for Care Improvement Advanced Model and alters the accounting process for beneficiaries with COVID-19.
view more »CMS Delays Indefinitely Radiation Oncology Model
Aug. 30, 2022 ||CMS on Aug. 29 finalized its decision to delay indefinitely implementation of the Radiation Oncology Model, which was scheduled to start Jan. 1, 2023.
view more »CMS to Hold Listening Session on End of APM Incentive Payments
July 19, 2022 ||CMS seeks feedback at a July 21 listening session on the 5 percent lump sum Alternative Payment Model Incentive Payment, set to expire at the end of 2022.
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 »Essential Hospitals Advance Equity through Hospital-At-Home Model
April 19, 2022 ||The ability to provide hospital-level care at home has been essential to managing case surges during the COVID-19 pandemic and can improve access and equity outside of a public health crisis.
view more »Guidance on Patient-Provider Dispute Resolution Process
Jan. 11, 2022 ||The Centers for Medicare & Medicaid Services released guidance and example templates for good faith estimates and the surprise billing patient-provider dispute resolution process.
view more »CMS Outlines Supplemental Payment Rules; DSH Requirements Remain Unclear
Dec. 17, 2021 ||A letter to state Medicaid directors defines supplemental payments and designates a system to submit required supplemental payment reports. CMS also notes a lack of data to determine the application of an exception to new rules on Medicaid disproportionate share hospital uncompensated care limits.
view more »Engaging Essential Hospitals in Value-Based Care
Dec. 16, 2021 ||In a new white paper, America’s Essential Hospitals discusses essential hospitals’ role in value-based payment models and makes recommendations to the Center for Medicare and Medicaid Innovation on improving equity through broader model participation.
view more »COVID-19: Pfizer Urges Expansion of Booster EUA; FEMA Funding Extended
Nov. 16, 2021 ||Pfizer and BioNTech ask the FDA to authorize their COVID-19 booster vaccine for everyone age 18 and older; FEMA COVID-19 funding will continue until April 2022.
view more »Association Urges CMS to Finalize Withdrawal of MFN Drug Model
Oct. 25, 2021 ||America’s Essential Hospitals urged CMS to finalize withdrawal of the Trump administration’s Most Favored Nation Model, citing procedural deficiencies, ongoing legal challenges, and significant reduction in provider payment rates.
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 »Association Comments on New Supplemental Payment Reporting System
Aug. 24, 2021 ||America’s Essential Hospitals sent CMS recommendations for implementing the new Medicaid supplemental payment reporting system under the Consolidated Appropriations Act of 2020. The association noted the importance of accuracy and avoiding duplicate data collection.
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 Requests Billing Data to Disburse APM Incentive Payments
July 27, 2021 ||CMS released an advisory alerting certain qualifying participants in alternative payment models that the agency does not have billing information needed to disburse incentive payments. Participants who anticipated but have not received an incentive payment should submit the necessary form by Nov. 1.
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 »New Guidance on Advancing Value-Based Care
Sept. 21, 2020 ||In a letter to state Medicaid directors, CMS outlines lessons learned from previous initiatives, offers a comprehensive toolkit and examples of value-based care models, and highlights changes to existing flexibility.
view more »New CMMI Model Options for COVID-19
June 4, 2020 ||The new options are detailed in a comprehensive table for each payment model. Notably, CMS will extend the Next Generation Accountable Care Organization model through December 2021.
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