CMS Proposes Rule to Streamline Prior Authorization
Dec. 13, 2022 ||The proposed rule leverages application programming interfaces to exchange health information and automate the provider prior authorization process.
view more »The proposed rule leverages application programming interfaces to exchange health information and automate the provider prior authorization process.
view more »In a letter to the HHS Office of Civil Rights (OCR), America's Essential Hospitals responds to proposed changes to privacy rules under the Health Insurance Portability and Accountability Act. OCR outlined the changes in a Jan. 21 proposed rule aiming to improve the transition to value-based care.
view more »In a new HHS Office of Inspector General report, hospitals highlight challenges associated with the public health emergency — including barriers to care delivery and vaccination, staff burnout, supply shortages, and declining revenue — that have strained the nation's health care delivery system.
view more »The Department of Health and Human Services’ Office of Civil Rights proposed modifications to the Health Insurance Portability and Accountability Act privacy rule as part of the agency's regulatory sprint to coordinated care.
view more »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 »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 »The final rule modifies several provisions to facilitate better care coordination and information sharing between providers treating patients with substance use disorder.
view more »The changes aim to remove barriers to care coordination and allow additional information sharing for providers treating patients with substance use disorder.
view more »The report, requested by Republican representatives, details challenges states face in administering Medicaid programs, including with coverage exclusions and care coordination, coverage benefits and eligibility, and Medicare and Medicaid alignment.
view more »The agency provides recommendations for resuming non-essential care for services that cannot be virtually delivered and for health care systems and facilities in regions with low incidence of COVID-19.
view more »The rules, intended to increase interoperability and improve patients’ access to their health information, finalize provisions related to the MyHealthEData initiative and implement provisions of the 21st Century Cures Act.
view more »CMS issued a request for information seeking input on coordinating care from out-of-state providers for medically complex children who are eligible for Medicaid coverage. The agency will use the information collected to produce guidance to state Medicaid directors.
view more »The new Care Coordination Toolkit showcases the work of accountable care organizations (ACOs) participating in the Medicare Shared Savings Program and Next Generation ACO Model. The agency also released a set of case studies describing innovation ACO initiatives.
view more »The Medical Leaders Interest Group gives clinical leaders an opportunity to share work, discuss common topics, and learn from essential hospital peers.
view more »The proposals aim to increase interoperability and improve patients’ access to their health information, while reducing regulatory burden on hospitals.
view more »In response to a request for information, America's Essential Hospitals urges the Department of Health and Human Services to ensure enforcement of the Health Insurance Portability and Accountability Act encourages care coordination and reduces regulatory burden on essential hospitals.
view more »The Department of Health and Human Services released a request for information on ways to modify the Health Insurance Portability and Accountability Act to improve care coordination, promote value-based care, and reduce regulatory burden on providers.
view more »Essential Hospitals Institute is committed to advancing the field of complex care, especially for hospitals serving a safety-net role. Institute Director Kalpana Ramiah, DrPH, MSc, took part in a recent conference where a new Blueprint for Complex Care was unveiled.
view more »The new rule is intended to improve care coordination and better align current rules with the Health Insurance Portability and Accountability Act.
view more »Explore Whole Person Care, a pilot initiative through California’s Section 1115 Medicaid waiver that works to improve care for people with complex issues by tackling medical, behavioral, and socioeconomic needs.
view more »The webinar on June 28 will focus on the Medicaid Innovation Accelerator Program's Reducing Substance Use Disorders program area.
view more »Hospitals and other providers generated more than $466 million in savings in 2015 through participation in Medicare accountable care organizations (ACOs).
view more »With support from Kaiser Permanente and East Bay Community Foundation, America's Essential Hospitals collaborates with NACHC and GW to help providers navigate and adapt to the systemwide policy changes and accountability standards mandated by the ACA.
view more »The new rule aims to help more accountable care organizations successfully participate in the Medicare Shared Savings Program.
view more »Hospitals and other providers now have until May 20 to submit a letter of intent for the Next Generation ACO model, which carries greater risk but also offers greater rewards; applications are due May 25.
view more »The Comprehensive Primary Care Plus model will encourage primary care practices to transform care delivery, including by increasing care management and coordination.
view more »Hospitals that perform well in quality programs—despite serving high levels of vulnerable patients—invest in health equity, data, collaborative partnerships, patient engagement, and more.
view more »Department calls for interagency approach that employs alternative payment models and better communication between patients and providers.
view more »Under new model, providers will screen Medicare and Medicaid beneficiaries for unmet social needs and connect patients to community services. Applications are due May 18.
view more »Changes allow IHS and tribal facilities to enter into care coordination agreements with non-IHS/tribal providers to furnish certain services for AI/AN Medicaid beneficiaries.
view more »New ACOs are eligible for risk-bearing tracks with increased savings for positive patient outcomes and penalties for negative outcomes. A total of 477 ACOs will care for almost 8.9 million beneficiaries in 2016.
view more »Educational surveys to help CMS determine best ways to assess infection control regulations for hospitals, nursing homes, and care transitions. Surveys to begin in FY 2016 for nursing homes and in FY 2017 for hospitals.
view more »National HIV/AIDS Strategy Federal Action Plan directs HHS to issue best practices for hospitals to ensure access to services for patients with HIV. CMS also will provide states with information on program flexibility to ensure access to testing, coordinated care.
view more »Week-long annual event will engage stakeholders in discussion and education about antibiotic stewardship in inpatient, outpatient, and animal health settings.
view more »Report on National Strategy for Quality Improvement in Health Care details progress made toward better care, lower costs, and improved health.
view more »Federal grants to 24 states will promote better integration of behavioral health and primary care services and improve quality and data reporting systems. The grants are the first phase of a Section 223 Demonstration Program for Certified Community Behavioral Health Clinics.
view more »Pioneer and MSSP ACOs showed improvement in at least 27 of 33 quality measures in last reporting period. More than 420 Medicare ACOs have been established, coordinating care for more than 7.8 million patients.
view more »Event, open to all providers, will focus on coordinating efforts in the fight against the increasing number of potentially life-threatening germs that resist drugs created to treat them.
view more »Vital Signs report recommends collaboration between public health departments and health care facilities to stop antibiotic resistance, promote infection control.
view more »Multidisciplinary teams at Truman Medical Centers developed two care transitions assessments and reduced hospital admissions, ED visits, costs.
view more »The new website provides health care providers and policymakers with further information about the National Partnership as well as access to resources for collaboration and tackling health policy issues.
view more »Research shows how Medicaid coverage improves health and health care outcomes, and saves money.
view more »Upfront and ongoing savings aim to encourage providers to form ACOs in rural and underserved areas and promote participation in models with greater financial risk. Applications accepted July 1 to July 31.
view more »Nominations are due June 19. The work group will define terms related to alternative payment models and a strategy to track progress of APM implementation.
view more »Roughly 48 percent of participating ACOs produced $121 million in total shared savings in 2013, with a net shared savings of $99 million
view more »The model saved $384 million over a two-year time period and is the first alternative payment pilot to meet criteria for expansion to additional sites.
view more »The agency will grant funding to 10 community organizations, government agencies, or community groups to spread health information to community partners.
view more »Learn more about the content and tone of recent conversations about DSRIP efforts.
view more »Learn how to use a team-based approach and the IMPACT model to integrate care in an ambulatory setting
view more »Learn more about what essential hospitals can do to improve care for homeless patients.
view more »The plan serves as a guide for federal departments and agencies to combat the spread of antibiotic-resistant bacteria. Funding is included in the president's proposed FY 2016 budget.
view more »This new model will allow ACOs to take greater performance risks for greater financial reward, calls start March 31.
view more »CMS will host a national provider call for ACOs interested in the 2016 program year.
view more »Through CMS' new model, ACOs can take greater performance risk and receive a greater portion of savings through coordinated, high-quality care.
view more »The Network will support the transition toward alternative payment models, using efforts in the Medicare Program as a guide.
view more »Two videos provide overview and benefits, and expand previous ICD-10 resources from the agency
view more »There is particular interest in mechanisms for greater comprehensiveness in care delivery, care for complex patients, care coordination, and value-driven reimbursement.
view more »The Oncology Care Model is a multipayer payment and care delivery model designed to encourage high quality cancer care.
view more »In recent journal articles from the New England Journal of Medicine and Medical Care, researchers explore issues related to Medicare accountable care organizations and patient-centered medical homes.
view more »Learn how two essential hospitals prepared and cared for Ebola patients.
view more »Learn how the Nurse-Family Partnership has improved outcomes for moms and babies across the country
view more »The funding will be allocated to up to 75 ACOs participating in the Medicare Shared Savings Program to bring better care coordination to rural and underserved areas.
view more »Learn how human capital management and retention strategies can support quality care initiatives
view more »Innovations in health care require evaluation to determine impact and success. But what is the difference between conducting an evaluation and researching a program? At Olive View-UCLA Medical Center, staff learned this distinction is important to consider.
view more »Hear members of our policy team discuss the association's recently released brief on innovative alternative payment models. These models focus on ways to replace or augment existing fee-for-service and managed care models, while also increasing efficiency, coordination, and quality of care.
view more »Take a deep dive of our latest policy brief on waiver-based Medicaid programs, which details how essential providers work with their state and the federal government to carry out sustainable, systemic delivery system changes.
view more »Recent articles from Health Affairs, the Joint Commission Journal on Quality and Patient Safety, the Journal for Healthcare Quality, and The New England Journal of Medicine explore efforts to reduce readmissions and infection rates, improve patient safety, and more.
view more »Zuckerberg San Francisco General Hospital recognized an opportunity to lead the way by developing a comprehensive, systems-based care transitions program to give patients proper care and the tools they need to stay out of the hospital.
view more »Virginia Coordinated Care Program for the Uninsured's Complex Care Clinic manages population health by addressing all patient needs in one location with multidisciplinary care teams.
view more »Journal articles from the March and April editions of the New England Journal of Medicine explore issues including the usefulness of surgical safety checklists, the importance of promoting financial stewardship, and the impact of Medicaid cost sharing.
view more »Safety-net organizations face numerous problems, each with many potential solutions. When thinking about solutions, it is helpful to have a framework of innovation. This installment of the blog discusses how to choose between solutions and how to operationalize them.
view more »HHS announced recipients of Health Care Innovation Awards and a call for applications for the State Innovation Models Initiative. These programs were created through the Affordable Care Act to give stakeholders and states tools and flexibility to transform health care delivery system models.
view more »The final webinar of the Better Together: Partnership with Families Program
view more »The third of four webinars from the Better Together: Partnership with Families Program
view more »The second of four webinars from the Better Together: Partnership with Families Program
view more »Members learned about the fundamental challenges driving industry workforce shortages
view more »In health care, patients discharged from rescue care – either the emergency department or inpatient settings – are frequently lost and lack information about their conditions, future studies, and appointments. If you could design the ideal toolkit to assist recently discharged patients navigate their post-discharge care, what would you include? First, you would want to
view more »Webinar #1 of 4 in the Better Together: Partnership with Families Program
view more »Reduce patient harm using 15-minute safety huddles, which convene representatives from across the organization to address potential safety concerns.
view more »ACOs allow hospitals, health care providers to improve quality, slow cost growth through coordinated care while sharing in savings
view more »Will provide high-quality, coordinated care to about 1.5 million Medicare beneficiaries
view more »Measures are intended for voluntary use by state Medicaid agencies
view more »Association urged committees to ensure payment system solution does not come at the expense of hospitals
view more »Agency provides methodological considerations, questions for states to address in program proposals
view more »Innovative, team-based programs to keep patients from coming back to the hospital
view more »Project to help essential providers prepare for ACA coverage expansion
view more »SFGH's Care Management Program offers focused care coordination and health coaching
view more »CMS says all 32 pioneer ACOs improved quality, performed better than published rates in fee-for-service Medicare
view more »Will support demonstration ombudsman programs to provide Medicare-Medicaid enrollees with more person-centered, coordinated care
view more »Winners recognized for successful, creative programs that boost patient care and meet community needs
view more »Truman Medical Centers employed a strategy that integrated diabetes care across all inpatient and outpatient departments, designated physician champions, and used data to identify high-risk patients.
view more »