The Aug. 1 final rule includes numerous policy and payment changes, including a 3.1 percent increase to inpatient payment rates, changes to the Medicare disproportionate share hospital payment calculation, and revised graduate medical education policies.

Proposed rules for Medicare’s OPPS and PFS for calendar year 2024 would maintain full Medicare Part B drug payment to hospitals in the 340B Drug Pricing Program, revise site-neutral payment policies, and amend price transparency policies, among other changes.

The Centers for Medicare & Medicaid Services proposes to remedy nearly five years of unlawful Part B cuts to hospitals in the 340B Drug Pricing Program with $9 billion in lump-sum Outpatient Prospective Payment System payments.

This legislation effectively postpones the debt ceiling issue for two years, dispelling concerns of a potential financial catastrophe. This Action Update summarizes the legislation and provisions of interest to essential hospitals.

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.

If CMS finalizes the proposed rule, DACA recipients would be eligible to apply for coverage through the health care marketplaces, Basic Health Programs, and some Medicaid and Children’s Health Insurance Programs.

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.

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.

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.

The proposed rule implements Section 203 of the 2021 Consolidated Appropriations Act, altering the rules for considering the costs and payments associated with Medicare and commercial dually eligible patients when calculating a hospital’s Medicaid DSH uncompensated care limit.

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.

Changes in the proposed rule seek to improve care coordination among providers and increase protections for substance use disorder patients to mitigate discrimination during treatment.

Citing policy and operational challenges with implementing the administrative dispute resolution process as created in a 2020 final rule, HRSA proposes a less formal ADR process that it believes will be less burdensome for parties submitting claims.

The final rule for calendar year 2023 continues certain flexible telehealth policies, overhauls the Medicare Shared Savings Program, and revises the Quality Payment Program.

The final rule reverses Medicare Part B drug payment cuts to hospitals in the 340B Drug Pricing Program, continues site-neutral payment policies, and revises the inpatient-only list, among other proposed changes.

The new final rule narrows the types of benefits considered in public charge determinations by excluding nonemergency Medicaid and other in-kind benefits that were in the 2019 final rule.

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.

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.

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.

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.

The proposed rule includes numerous policy and payment changes for Medicare’s Inpatient Prospective Payment System for fiscal year 2023, including a 3.2 percent increase in inpatient payment rates.

The proposed rule limits the types of benefits considered in public charge determinations to exclude nonemergency Medicaid and other in-kind benefits that were in the 2019 final rule.

The House-passed bill does not allocate additional COVID-19 relief for providers on the front lines of the pandemic. An initial version of the legislation included $15.6 billion in COVID-19 related spending — a scaled-back version of the $22.5 billion requested by the Biden administration.

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.

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.

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.

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.

CMS recently announced vaccination requirements for providers as a condition of participating in Medicare and Medicaid. Simultaneously, the Department of Labor’s Occupational Safety and Health Administration released an emergency temporary standard for employers with at least 100 employees.

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.

A total of $25.5 billion will be available, including $17 billion through the Provider Relief Fund and $8.5 billion in American Rescue Plan funding for providers serving rural patients. Providers can apply for the new funding Sept. 29.

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.

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.

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.

The Department of Health and Human Services revises reporting requirements and extends the deadlines for providers to use and report on the use of Provider Relief Fund payments.

The Health Resources and Services Administration enforcement action marks a crucial victory for essential hospitals, which have seen their access to drugs with 340B discounts cut off by manufacturers since last summer.

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.

In a set of letters, America’s Essential Hospitals urges the administration and congressional leaders to address pressing facility needs of essential hospitals and the health care safety net.

Effective March 9, the Department of Homeland Security reverted to enforcing the narrower 1999 definition of public charge, which excludes many of the benefits added by the 2019 rule. Our latest Action Update details the changes and next steps.

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.

In a recent letter to state health officials, CMS outlines opportunities for states to better address social determinants of health. The letter outlines flexibility under current law and includes examples from states already engaging in such initiatives.

The Centers for Medicare & Medicaid Services issued new guidance to states on directed payments in Medicaid managed care programs. In conjunction with the guidance, CMS issued a revised version of the agency’s preprint application for directed payments. 

The new guidance and deadline apply to all provider relief fund allocations to date except the Health Resources and Services Administration uninsured program, nursing home infection control distribution, and rural health clinic testing distribution.

A new final rule from the Health Resources and Services Administration provides details on the long awaited administrative dispute resolution process, including the composition of a dispute resolution panel, types of claims covered entities and manufacturers can bring before the panel, and more.

The advisory opinion, favorable for essential hospitals, responds to actions by several drug manufacturers to restrict the ability of 340B Drug Pricing Program covered entities to receive program discounts on drugs dispensed at contract pharmacies.

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.

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.

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.

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.

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.

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.

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.

HHS has issued a notice on data reporting requirements for providers who receive funding through the Coronavirus Aid, Relief, and Economic Security Act Provider Relief Fund.

A new Department of Labor temporary rule broadens the types of health care workers who qualify for paid leave under the Families First Coronavirus Response Act by defining health care providers based on job responsibilities and duties, rather than type of employer.

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.

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.

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 meth

The final rule modifies several provisions to facilitate better care coordination and information sharing between providers treating patients with substance use disorder.

The Department of Health and Human Services July 10 announced additional, targeted allotments from the Provider Relief Fund for hospitals filling a safety-net role, specific rural hospitals, and other serving small metropolitan areas.

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.

The Department of Health and Human Services June 9 announced additional, targeted allocations from the Provider Relief Fund for hospitals filling a safety-net role and sole Medicaid and Children’s Health Insurance Program providers.

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.

The Centers for Medicare & Medicaid Services and Office of the National Coordinator for Health Information Technology have released final rules intended to advance interoperability of health information technology and improve patients’ access to their health information.

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.

The Department of Health and Human Services seeks to target future COVID-19 relief payments to hospitals and other providers that have been “particularly affected by the increased burden of caring for those with coronavirus.” Hospitals must submit data by 11:59 pm PT, April 23.

The frequently asked questions document provides guidance on how states can leverage Medicaid flexibilities in response to the novel coronavirus. Key issues for essential hospitals are detailed in our latest Action Update.

The Centers for Medicare & Medicaid Services issued various waivers to increase hospital capacity, expand the health care workforce, eliminate certain paperwork requirements, and further promote telehealth.

The $2 trillion bill includes $100 billion for a Public Health and Social Services Emergency Fund to reimburse eligible health care providers for health care–related expenses or lost revenue attributable to COVID-19.

A third major legislative response to COVID-19 would provide $75 billion in emergency funding for hospitals and health care providers, delay until fiscal year 2022 a planned $4 billion cut to Medicaid disproportionate share hospital payments, and authorize other support.

The law increases the Federal Medical Assistance Percentage to states, allows states to extend Medicaid eligibility, and requires diagnostic test coverage.

President Trump has signed the Coronavirus Preparedness and Response Supplemental Appropriations Act, which provides $8.3 billion in funding to several federal agencies for COVID-19 response.

The “Healthy Adult Opportunity” Medicaid Section 1115 demonstration waiver allows states to provide coverage for select Medicaid populations under aggregate or per-capita caps and assume increased accountability in exchange for greater flexibility to test alternative implementation approaches.

Congressional leaders have delayed for five months a $4 billion cut to Medicaid disproportionate share hospital payments under comprehensive legislation to fund federal operations for the remainder of fiscal year 2020, which started Oct. 1.

The Centers for Medicare & Medicaid Services issued a Nov. 18 proposed rule, the Medicaid Fiscal Accountability Regulation, that would make sweeping changes to how states finance the nonfederal share of their Medicaid programs.

New requirements call for hospitals to post charges and information based on rates negotiated with third-party payers, as well as standard charge data for a limited set of “shoppable” services, in a consumer-friendly manner.

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.

The Department of Health and Human Services on Oct. 9 proposed two rules that seek to eliminate barriers to care coordination and undue burden under current fraud and abuse laws.

Of interest to essential hospitals, the rule targets emergency preparedness, hospital quality program requirements, infection control, and physical examinations.

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.

The final rule, implementing disproportionate share hospital payment cuts for fiscal years 2020–2025 should they take effect, includes revisions to the methodology for determining each state's allotment reduction for each fiscal year.

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.

An amicus brief filed in the U.S. District Court for the Northern District of California by America's Essential Hospitals and five other national hospital associations highlights how the Department of Homeland Security public charge final rule would harm hospitals and patients.

The proposed rules would revise Part 2 provisions to facilitate better care coordination and make technical corrections regarding court-authorized disclosures.

The Department of Homeland Security finalized a proposed rule that expands the definition of “public charge” in immigration application determinations to include additional types of public benefits and new immigration applicant categories.

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.

America's Essential Hospitals details key provisions of the proposed rules for the Medicare Outpatient Prospective Payment System and Physician Fee Schedule for calendar year 2020.

The final judgement, in favor of America's Essential Hospitals, does not indicate how the Department of Health and Human Services should remedy unlawful payment reductions to hospitals in the 340B Drug Pricing Program in 2018 and 2019.

A proposed rule from the Department of Health and Human Services would overhaul parts of Section 1557 of the Affordable Care Act, removing some nondiscrimination protections for transgender individuals and requirements for covered entities treating people with limited English proficiency.

America's Essential Hospitals and its association partners have created a detailed update on recent court activity in their lawsuit to reverse Medicare outpatient payment cuts to hospitals in the 340B Drug Pricing Program.

A new proposed rule for Medicare’s Inpatient Prospective Payment System for fiscal year 2020 would increase net inpatient payment rates by 3.2 percent in addition to numerous other policy and payment changes.

America’s Essential Hospitals and industry partners have officially closed the book on their successful lawsuit to force the Department of Health and Human Services to implement long-delayed rules on pharmaceutical manufacturer accountability in the 340B Drug Pricing Program.

America’s Essential Hospitals, in coalition with other national hospital associations, has filed an amicus brief urging the Fifth Circuit to uphold the Affordable Care Act and overturn a Texas district court’s decision declaring the individual mandate and, in turn, the entire law unconstitutional.

Affordable Care Act–mandated reporting requirements for tax-exempt hospitals remain in effect despite ongoing lawsuits and a Senate Finance Committee inquiry.

The lawsuit asserts that the policy adopted by the Centers for Medicare & Medicaid Services is unlawful and unenforceable because it conflicts with federal statutes and violates congressional intent.

America’s Essential Hospitals and other plaintiffs have asked the U.S. District Court for the District of Columbia to order the federal government to restore losses caused by Medicare outpatient payment cuts to 340B hospitals.

America’s Essential Hospitals and three other national hospital groups urged the Centers for Medicare & Medicaid Services to postpone its February publication of overall hospital star ratings.

A final rule for the Medicare Shared Savings Program overhauls the program and creates a pathway for accountable care organizations to more rapidly transition to performance-based risk models with the potential for greater shared savings.

The proposed rule reflects the agency’s broader strategy to relieve regulatory burden, support state flexibility, and promote transparency and innovation in the delivery of care. We encourage all members to review the proposed rule, give us feedback, and submit your own comments to CMS.

The Outpatient Prospective Payment System and Physician Fee Schedule final rules for calendar year 2019 expand damaging site-neutral payment policies and continue Medicare Part B drug payment cuts to hospitals in the 340B Drug Pricing Program.

The new law, which represents the federal government’s first comprehensive policy response to the nation’s opioid crisis, aims to advance treatment and recovery initiatives, improve prevention, protect communities, and bolster efforts to fight deadly illicit synthetic drugs.

America’s Essential Hospitals is closely reviewing the proposed rule from the Department of Homeland Security and evaluating its potential impact on our members. We encourage all members to review the provisions of the proposed rule, provide us feedback, and submit your own comments to the agency.

Elements of the proposal of interest to essential hospitals include targeting emergency preparedness, hospital quality program requirements, infection control, and physical examinations.

A proposed rule for the Medicare Shared Savings Program would overhaul participation tracks to create a "glide path" along which accountable care organizations could transition from a rewards-only model to a two-sided model with risk and the potential for greater rewards.

The Centers for Medicare & Medicaid Services final rule for Medicare’s Inpatient Prospective Payment System for FY 2019 increases inpatient operating payment rates and Medicare disproportionate share hospital payments.

The Centers for Medicare & Medicaid Services has released Outpatient Prospective Payment System and Physician Fee Schedule proposed rules for calendar year 2019 that would expand site-neutral payment policies and continue Medicare Part B drug payment cuts to 304B hospitals.

America’s Essential Hospitals and the other plaintiffs are coordinating next steps and plan to promptly refile the case in district court.

What comes next after the June 29 court ruling that vacated the U.S. Department of Health and Human Services approval of a Section 1115 waiver that allowed Kentucky to impose community engagement and work requirements on Medicaid beneficiaries.

Responding to concerns raised by America’s Essential Hospitals and other stakeholders, the Centers for Medicare & Medicaid Services has announced it will postpone the July public release of overall hospital star ratings.

The new proposed IPPS rule for FY 2019 contains numerous policy and payment changes, including increasing net inpatient payment rates by 1.75 percent.

On May 4, America’s Essential Hospitals and fellow plaintiffs will make oral arguments in a legal battle to reverse damaging Medicare cuts to hospitals in the 340B Drug Pricing Program; The public can watch via livestream.

The Centers for Medicare & Medicaid Services noted that the provisions aim to increase flexibility, improve affordability, strengthen program integrity, empower consumers, promote stability, and reduce regulatory burden in the individual and small group marketplaces.

The House of Representatives approved a $1.3 trillion fiscal year 2018 omnibus spending bill that includes nearly $4 billion to combat the opioid crisis and increased funding for the National Institutes of Health.

America’s Essential Hospitals thanks its member hospitals and congressional champions for their hard work and advocacy during the lengthy process to finalize a two-year delay of Medicaid disproportionate share hospital funding cuts.

The Senate needs 60 votes to avoid a filibuster and pass the continuing resolution. There are only 51 Republicans in the Senate, and several have said they won’t vote for the bill in its current form.

Under the new payment model, a single bundled payment will cover services furnished by various providers across care settings. Participants can earn additional payment if they reduce costs over the course of a beneficiary’s 90-day episode of care while meeting quality benchmarks.

In a Jan. 11 letter to state Medicaid directors, the Centers for Medicare & Medicaid Services outlined new guidance designed to assist states seeking section 1115 demonstration waivers that include work and community engagement requirements for nondisabled, working-age adult Medicaid beneficiaries.

America’s Essential Hospitals will continue its fight to stop the onset of these cuts, and have assurances that lawmakers are committed to a two-year delay. We urge Congress to act swiftly to delay the Medicaid DSH cuts when lawmakers return in January.

The new document details the use of two Medicare outpatient, claims-based modifiers hospitals will be required to report, starting Jan. 1, for drugs purchased through the 340B Drug Pricing Program.

The cancellation of three episode payment models and an incentive payment model comes in response to stakeholder feedback about the burden of these models.

Final regulations for Medicare physician payments will increase merit-based payments to account for complex patients, allow physicians to participate in virtual groups, adjust the threshold for defining low-volume practices, and make numerous other changes.

Both the House and Senate versions of the bill contain several provisions of concern to essential hospitals. This Action Update details the status of these issues in both versions.

America’s Essential Hospitals is closely reviewing the final rules and pursuing strategies to protect our members from these devastating cuts. Key aspects of the recently released final rules are summarized in this Action Update.

The proposed rule would expand the role of states in administering marketplace plans and give states additional flexibility to define essential health benefits.

The move jeopardizes coverage for millions of working Americans, could substantially raise premiums for those who remain in marketplace plans, and could increase uncompensated care costs at essential hospitals.

Reductions to Medicaid disproportionate share hospital (DSH) payments, as mandated by the Affordable Care Act, went into effect on Oct. 1. A total of $2 billion will be cut from Medicaid DSH funding in fiscal year 2018 alone.

America's Essential Hospitals continues to advance our opposition to the Senate's Graham-Cassidy-Heller-Johnson proposal.

After receiving comments from stakeholders about the burden of mandatory models, the Centers for Medicare & Medicaid Services proposes to cancel all three episode payment models and the cardiac rehabilitation incentive payment model.

The new rule would affect inpatient operating payments, Medicare disproportionate share hospital payments, and the Hospital Readmissions Reduction Program.

In the rule, the Centers for Medicare & Medicaid Services proposes a disproportionate share hospital (DSH) health reform methodology to determine each state’s DSH allotment reduction for each fiscal year.

America's Essential Hospitals provides a detailed analysis of the Quality Payment Program proposed rule for calendar year 2018.

America’s Essential Hospitals provides an overview of community benefit requirements, which hospitals must comply, and the penalties for failure to comply.

Three new amendments garnered enough Republican support to pass the bill in a 217-213 vote; CBO has not scored the bill since the amendments were added.

The rule would raise inpatient operating payment rates, revise Medicare DSH payment methodology, and apply a transitional methodology for HRRP penalties.

It requires Medicare payments for beneficiaries dually eligible for Medicaid, and other third-party payments be included in uncompensated care calculations.

The committees on Energy & Commerce and Ways & Means passed ACA repeal and replacement bills that could affect coverage and essential hospital funding.

The American Health Care Act offers some relief for the safety net, but the association remains deeply concerned about substantial changes to Medicaid.

Whether you join us or support the fight from home, urge lawmakers to ensure continued coverage access and stable, equitable, sustainable Medicaid funding.

The House plan to repeal and replace the Affordable Care Act would rescind Medicaid disproportionate share hospital cuts and impose per-capita caps on Medicaid funding.

The proposed rule aims to provide flexibility by targeting network adequacy reviews & inclusion of essential community providers in qualified health plans.

On February 16, a policy brief by House Republicans on how they would repeal and replace the Affordable Care Act (ACA) was leaked in Washington. Learn more about what was included.

A memo instructs all executive departments and agencies to temporarily halt pending regulations until incoming department or agency heads can review them.

Jan. 18 rule finalizes additional restrictions proposed in November 2016 on the ability of states to increase or add new pass-through payments under Medicaid managed care plan contracts.

CMS also expanded the Comprehensive Care for Joint Replacement (CJR) model to include surgical hip/femur fracture treatment.

Essential hospitals should be equipped with key information to understand this procedural tool that likely will be used early next year to begin the process of dismantling the Affordable Care Act (ACA).

The legislation, expected to quickly receive the president's signature, includes two key advocacy goals for the association: risk adjustment of the Hospital Readmissions Reduction Program and partial relief from hospital outpatient department payment cuts.

The proposed rule would codify additional restrictions, first outlined in July 2016, on the ability of states to increase or add new pass-through payments under plan contracts.

Under the rule, CMS would increase the OPPS payment rate by 1.65 percent and provide flexibility in the meaningful use of EHRs, among other things.

CMS provides more flexibility than previously proposed, ensuring non-grandfathered, off-campus hospital outpatient departments will be reimbursed in 2017.

An Oct. 14 final rule establishes a new approach to physician payment required by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA): the Quality Payment Program.

In the final rule, CMS sets forth national requirements for Medicare and Medicaid participating providers and suppliers to ensure health care facilities are prepared during emergencies.

The rule would codify the interpretation that the calculation be based on uncompensated care costs for Medicaid beneficiaries not covered by another source.

The rule addresses the controversial two-midnight policy, Medicare DSH, the Hospital-Acquired Condition Reduction Program, Value-Based Purchasing, and more.

Model will test new episode payment models for acute myocardial infarction and coronary artery bypass graft, as well as expansion of the current CJR model.

The proposed rule updates the payment rate for services provided in hospital outpatient departments and provisions relating to quality reporting.

The proposed rule would implement Section 603 of the Bipartisan Budget Act, which reduced payments for new, off-campus hospital outpatient departments.

America’s Essential Hospitals and other hospital groups urge CMS to continue to delay the public release of overall hospital quality star ratings, arguing that the rating methodology is opaque and flawed.

America's Essential Hospitals denounces the Centers for Medicare & Medicaid Services decision to limit flexibility and withhold hospital payments for new, off-campus hospital outpatient departments.

The updates aim to reduce incidence of infections, inappropriate use of antibiotics, and discriminatory behavior by health care providers.

The proposed rule includes key provisions for carrying out a new physician payment system to replace Medicare's sustainable growth rate updates.

CMS stands by its decision to prohibit states from directing payments under managed care, but responds to association concerns by adding flexibility to the policy.

A new proposed rule for Medicare’s Inpatient Prospective Payment System would reverse the controversial two-midnight policy payment cut and make numerous other policy and payment changes, including to quality reporting programs.

Responding to hospital and other stakeholder concerns, CMS says the delay will allow a greater opportunity to fully understand the impact of the final star ratings methodology.

Aggregate data collected by the association will help inform advocacy on disproportionate share hospital payments and other funding support.

A 2015 budget law that creates site-neutral payment for off-campus hospital outpatient departments does not directly affect 340B Drug Pricing Program eligibility, but changes to how hospitals report Medicare costs does raise concerns.

Material note association concerns about, and help members prepare for, April 21 public release of Hospital Compare star ratings.

In comments to CMS, America's Essential Hospitals argues for a delay to re-evaluate ratings methodology changes and the potential to disproportionately disadvantage essential hospitals.

March 8 proposed rule details two approaches agency will test to encourage prescribing of lower-cost medications: reimbursement rate adjustments and value-based purchasing.

Guidance builds on 2012 final regulations that outline the process for submission and review of section 1332 waivers, which may begin as early as Jan. 1, 2017.

Proposals would make required and recommended changes to how qualified health plans operate in Affordable Care Act marketplaces.

Hospitals paid under IPPS in 67 metropolitan statistical areas will be required to participate in new payment model starting in April 2016

Rule for Medicaid FFS omits hospitals from the list of services for which a state must evaluate access. Comments on rule due Jan. 4.

Changes include reducing OPPS payment by 0.3 percent, relaxing two-midnight policy requirements, and updating OQR measures.

Changes for hospitals participating in Medicare and Medicaid intended to improve patient communication, outcomes; comments due Jan. 4.

Key provisions in the final rule include calendar year reporting, 90-day reporting period in 2015, and details for stage 3 meaningful use requirements.

Proposed changes could significantly narrow the scope of patients for whom 340B pricing may be utilized and reduce potential savings from program

If made final, U.S. Department of Labor rule would shift as many as 4.7 million workers nationally from exempt to nonexempt status.

Omnibus guidance proposes an expanded list of six requirements for an individual to be considered a patient of a 340B covered entity.

Rule includes a net increase in IPPS payment rates of 0.9 percent, Medicare DSH cuts of $1.2 billion in FY 2016, and updates to the HAC Reduction, Hospital VBP, IQR, and EHR Incentive programs.

Proposed CCJR model would bundle Medicare payments to acute care hospitals for hip and knee replacement surgery in 75 metropolitan statistical areas; hospitals would be held financially accountable for meeting quality and cost targets for entire episode of care.

Agency proposes to reduce slightly payment rates for hospital outpatient services, relax some provisions of the two-midnight policy, and update quality reporting measures.

The association will use the information gathered to advocate to policymakers the need to continue to support essential hospitals’ mission and service to their communities. This survey focuses on the first quarter of calendar year 2015. We will use aggregate information only.

The Supreme Court ruled in King v. Burwell that the Affordable Care Act makes federal subsidies available to individuals in states that use the federally facilitated marketplace, not just those with a state-based marketplace.

Six justices ruled in favor of the Obama administration, arguing that the overall structure and purpose of the ACA supports the interpretation that Congress intended subsidies to be available in both federally facilitated and state-based marketplaces.

New law replaces sustainable growth rate with new update schedule and creates quality reporting and merit-based payment systems

Proposed rule would better align regulations with those for commercial, health insurance marketplace, and Medicare Advantage plans

We are pleased to see that this amendment was not included in the Cures package and look forward to working with lawmakers to strengthen the 340B program in the future.

It remains unclear what 340B Drug Pricing Program provisions could be included in the legislation.

America's Essential Hospitals is pleased that the House Committee on Energy and Commerce is working collaboratively with stakeholders on the proposal.

America's Essential Hospitals is conducting this member survey to capture the impact of the ACA coverage expansion on essential hospitals.

The rule includes provisions on several topics, including a payment update, Medicare disproportionate share hospital cuts, Medicare payment for short inpatient hospital stays, and the Readmissions Reduction Program.

The law also delays Medicaid DSH payment cuts for an additional year - until fiscal year 2018 - and extends CHIP funding for two years.

CMS suggested changes to the Medicare and Medicaid EHR Incentive Programs for 2015 through 2017 reporting, including reporting on a calendar year schedule, 90 day reporting periods, and uniform meaningful use objectives in 2015.

The survey focuses on uncompensated care and utilization during the last two quarters of CYs 2013 and 2014. It aims to capture the impact of ACA coverage expansion on essential hospitals.

The rules detail requirements for the Medicare and Medicaid EHR Incentive Programs, including a requirement for all providers to transition to stage 3 by 2018.

DSH cuts would be eliminated in FY 2017, and DSH would be "rebased," extending cuts by one year, to 2025.

Contact your lawmakers on the House Energy and Commerce and Senate Health, Education, Labor, and Pensions committees to underscore the critical need for the 340B program. An update on the SGR package will be provided as more information is available.

New association materials include messaging on Medicaid DSH, Medicare, risk adjustment for sociodemographic status, 340B, and more.

Feb. 20 final rule and letter to issuers outline benefit and payment parameters for 2016 health insurance marketplace plans

The budget would extend Medicaid DSH cuts another year and reduce Medicare payments for outpatient services, medical education, and bad debt, among other threats to essential hospitals.

Changes to the rule will include shortening the reporting period for eligible hospitals and professionals to 90 days

Document, developed by association's policy advisory committee, demonstrates essential hospitals' commitment to and promotion of care equity, and supports risk adjustment for sociodemographic status in certain quality improvement measures

IRS issued a final rule for all 501(c)(3) certified charitable hospital organizations, detailing requirements for CHNAs, financial assistance policies, charge limitations, and collection practices.

Agency reverts to position recommended by America's Essential Hospitals to define uninsured status at the service level for purposes of calculating DSH payments; sets Dec. 31 as start of new policy

CMS, NAIC documents contain important health insurance marketplace provisions, including cost-sharing requirements. Comments due to CMS Dec. 22, to NAIC by Jan. 12, 2015.

Legislation includes provisions on Ebola response funding, 340B Drug Pricing Program, children's hospital GME, and Health Centers Program

The association extended the survey deadline to continue to gather information on members' uncompensated care post-ACA.

The association launched this survey Nov. 10 to capture the impact of the ACA coverage expansion on essential hospitals.

CMS returns to a pre-2008 definition of uninsured that includes whether a patient is covered for a particular service, among other changes.

Previously, HRSA submitted a comprehensive proposed rule to OMB on 340B issues, but a subsequent court ruling called into question the agency's authority to issue a rule.

Topics of member interest include payment updates, the OQR Program, and the MSSP.

After eight years in the Senate minority, Republicans will take control of the chamber in 2015, with at least 52 seats. The elections also resulted in at least 61 new members being elected to Congress, providing a valuable opportunity for essential hospitals to educate new lawmakers.

OPA webinar will cover recent changes to 340B audit process. The office is also working to standardize the process for self-disclosing a 340B requirement breach and notes successful recertification process.

The final rule updates Medicare payment policies, rates for inpatient stays at general acute care hospitals, and provisions related to quality improvement programs.

The agency proposes to increase payment rates by an outpatient department fee schedule increase factor of 2.1 percent for CY 2015. CMS also proposes to collect data on services provided in off-campus provider-based departments by requiring hospitals and physicians to identify these services using a modifier on hospital and physician claims.

The letter addresses the unintended consequences for essential hospitals of the current readmissions penalty methodology and asks federal agencies to work with Congress.

On April 30, CMS issued the IPPS proposed rule for fiscal year 2015. The rule updates Medicare payment policies, rates for inpatient stays at general acute care hospitals, and provisions related to quality improvement programs. CMS will accept comments on the proposed rule through June 30.

In a major victory for essential hospitals, a House committee late last night posted physician payment legislation that includes an additional year delay in Medicaid disproportionate share hospital (DSH) cuts and requires an annual DSH report sought by America’s Essential Hospitals. The changes come in a House Rules Committee bill to extend the current patch

NQF makes eight recommendations to enhance the ability of policymakers and consumers to make accurate conclusions about the quality of care and prevent unintended consequences, such as a worsening of care disparities. Members are encouraged to submit comments by April 16.

Of particular interest to members of America's Essential Hospitals, we are pleased to see CCIIO account for the concerns raised by our member hospitals and enhance its essential community provider standard.

Bill would fund the government through fiscal year 2014

Guides can help providers troubleshoot enrollment problems

Budget bill eliminates FY 2014 Medicaid DSH cuts, delays FY 2015 cuts

Rule finalizes several Outpatient Prospective Payment System provisions

CMS updates earlier guidance, CCIIO addresses third-party payments of premiums for individuals covered by QHPs

In the Loop is a private, secure community for people working to help health insurance enrollment

Senate reached a deal to end the federal government shutdown

Rule implements the Affordable Care Act's Medicaid DSH cuts for fiscal years 2014 and 2015

Rule finalizes several inpatient prospective payment system provisions

Rule proposes several outpatient prospective payment system provisions

Rule proposes implementation of the Affordable Care Act's Medicaid DSH cuts

Rule proposes several inpatient prospective payment system provisions

Association summary of rules, guidance

Includes important changes to Medicaid and Medicare of interest to association members

Deadline extended after significant pressure from America's Essential Hospitals and association members

Most health care spending outside of Medicare and Medicaid was subject to cuts

Rule continues agency's 2012 efforts to reform hospital conditions of participation

Administration official announced that the president would not include Medicaid cuts in 2014 budget

Legislation did not cut Medicaid provider taxes, Medicare E&M, but targeted hospitals in other ways

Senate passed legislation by a vote of 89-9, sent for vote in the House of Representatives

Association develops entitlement reform principles to guide possible future discussions around changes to the Medicare and Medicaid programs.