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.
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.
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 »
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 »
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 »
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 »
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 »
To support the sustainability of the health care safety net, policymakers should include essential hospital priorities in the final reconciliation legislative package.view more »
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 »
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 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 »
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 »
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 »
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 »
The Centers for Medicare & Medicaid Services on April 30 issued a second round of waivers and rule changes to provide flexibility to hospitals and improve access to testing for beneficiaries. These changes update waivers issued March 30 to address patient surge.view more »
Applications for the new payment models are due to the Centers for Medicare & Medicaid Services Jan. 22, 2020.view more »
An Aug. 2 final rule for Medicare’s Inpatient Prospective Payment System for fiscal year 2020 will increase inpatient operating payments and Medicare disproportionate share hospital funding and make changes to electronic health records use and quality reporting programs.view more »
To facilitate multi-payer alignment for ambulance services, the Center for Medicare and Medicaid Innovation will provide an interactive learning system.view more »
The two mandatory payment models will test prospective episode-based payments for radiation oncology therapy and end-stage renal disease treatment.view more »
The agency seeks feedback on proposed criteria for selecting direct contracting entities to participate in the new population-based payment model.view more »
The agency released a request for applications on the Emergency Triage, Treat, and Transport model for emergency ambulance services. The new model encourages treatment for Medicare beneficiaries outside the emergency department.view more »
Providers interested in the professional or global options under the new Primary Cares Initiative must submit a nonbinding letter of intent by Aug. 2.view more »
The Centers for Medicare & Medicaid Services will accept applications for its second cohort of participants in the Bundled Payments for Care Improvement Advanced Model; second cohort participants will start model year three, beginning on Jan. 1, 2020.view more »
The Primary Cares Initiative comprises five new voluntary payment model options under two paths. The new models build on the experience of the Medicare Shared Savings Program and Next Generation Accountable Care Organization model.view more »
The recently released 2017 Quality Payment Program Experience Report includes participation and performance statistics for the Merit-based Incentive Payment System and Advanced Alternative Payment Model tracks.view more »
The Emergency Triage, Treat, and Transport model for emergency ambulance services encourages treatment for Medicare beneficiaries outside the emergency department.view more »