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Action Updates

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.

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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.

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

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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.

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

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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.

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Proposed rules would affect outpatient payment rates, reduce Medicare Part B payments to hospitals in the 340B Program, and revise site-neutral policies.

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

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

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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.

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

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

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

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

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

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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.

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

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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.

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

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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.

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

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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).

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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.

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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.

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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.

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

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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.

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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.

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

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

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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.

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

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

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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.

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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.

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

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

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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.

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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.

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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.

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

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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.

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

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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.

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

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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.

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Action Updates

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

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

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

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

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

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

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

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

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

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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.

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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.

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

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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.

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Action Updates

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.

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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.

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

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

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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.

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

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

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

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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.

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

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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.

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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.

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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.

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

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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.

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

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

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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.

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

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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

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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.

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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

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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.

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

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

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

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

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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.

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

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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.

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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.

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

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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.

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

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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.

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Action Updates

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

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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.

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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.

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

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Rule finalizes several Outpatient Prospective Payment System provisions

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

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

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Action Updates

Senate reached a deal to end the federal government shutdown

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

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Rule finalizes several inpatient prospective payment system provisions

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Rule proposes several outpatient prospective payment system provisions

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

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Rule proposes several inpatient prospective payment system provisions

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

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

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

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

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

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

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

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

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About America’s Essential Hospitals

America’s Essential Hospitals is the leading association and champion for hospitals and health systems dedicated to high-quality care for all, including the most vulnerable. Since 1981, America’s Essential Hospitals has initiated, advanced, and preserved programs and policies that help these hospitals ensure access to care. We support members with advocacy, policy development, research, and education.