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policy

Hospitals no longer are required to report COVID-19 data to HHS, and a program providing no-cost vaccines will end in August.

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policy

The Increasing Organ Transplant Access Model aims to increase access to and quality of kidney transplants for individuals with end-stage renal disease.

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policy

CMS reviews ways to leverage Medicaid and CHIP to improve mental health and substance use disorder treatment services for individuals experiencing homelessness.

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policy

Two informational bulletins provide guidance on Medicaid eligibility determinations and the extension of unwinding-related waivers.

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webinar

Join our new policy director, Rob Nelb, MPH, and experts from the Center for Medicaid and CHIP Services for an in-depth discussion about key provisions in the rule and its impact on essential hospitals.

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policy

The Medicaid and CHIP Managed Care Access, Finance, and Quality and Ensuring Access to Medicaid Services final rules modify existing Medicaid managed care regulations and seek to ensure access to care across fee-for-service and managed care delivery systems.

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policy

The proposed rule includes numerous policy and payment changes to Medicare’s Inpatient Prospective Payment System for fiscal year 2025, including a 2.6 percent increase in inpatient payment rates. CMS will accept comments on the proposed rule through June 10.

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policy

Together, these rules establish access standards and standardize review and assessment of Medicaid payment policies across states.

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policy

The final rule incorporates feedback from the association and coalition partners on the administrative dispute resolution process.

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policy

Hospitals at or above the 97th percentile of one of two metrics are subject to exceptions when calculating Medicaid DSH funding limits.

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policy

This year, CMS added several proposals governing state-based marketplaces, including network adequacy requirements and provisions that will impact state Medicaid programs. The agency also aims to align open enrollment periods across marketplaces.

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policy

The rule aims to align state marketplace requirements with federal marketplace requirements, including by standardizing open enrollment dates.

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policy

The guidance requires hospitals to set clear guidelines to obtain informed consent before conducting sensitive examinations.

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policy

A CMS final rule removes administrative barriers, automates the renewal process, and updates outdated record-keeping regulations for Medicaid and the Children's Health Insurance Program.

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policy

CMS extended the special enrollment period for individuals who lost Medicaid and CHIP coverage at the end of continuous enrollment to Nov. 30.

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policy

A new letter and toolkit outline the administration's response to the Change Healthcare cyberattack and provide resources for health care providers.

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policy

Federal agencies report health insurance enrollment to mark the 10th anniversary of the Affordable Care Act marketplaces.

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policy

Lack of payment to health care providers due to the Change Healthcare cyberattack is causing significant cash flow problems for providers and suppliers. CMS is monitoring the situation and has distributed guidance related to advance payments for services provided to Medicaid beneficiaries.

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policy

CMS encourages all states to review their renewal processes and to test the renewal logic in eligibility systems.

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policy

The Government Accountability Office recommends that CMS require states to report on the outcomes of Medicaid managed care appeals.

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policy

This policy brief discusses how HHS has leveraged its authority under Medicaid and Medicare to advance policies aimed at addressing social determinants of health and health-related social needs.

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state-action

Utah becomes the 45th state, along with Washington, D.C., and the U.S. Virgin Islands, to extend Medicaid and Children's Health Insurance Program eligibility for 12 months postpartum.

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policy

Medicare Part A providers and Part B suppliers affected by the Change Healthcare cyberattack may apply for accelerated and advance payments.

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policy

The final rule for Section 203 of the Consolidated Appropriations Act, 2021, changes how the calculation of a hospital’s Medicaid disproportionate share hospital uncompensated care limit accounts for costs and payments related to Medicare and other dually eligible patients.

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policy

The collaborative will bring together providers, community partners, and other experts to explore challenges facing postpartum populations and solutions to improve postpartum mortality.

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policy

The rule finalizes a 2021 statutory requirement that hospitals, when calculating a Medicaid DSH cap, include only the costs and payments for patients for whom Medicaid is the primary payer or who are uninsured.

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policy

The agency proposes to increase oversight of organizations that accredit Medicare facilities, reduce conflicts of interest, and make surveys more consistent.

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policy

The FAQ clarify what constitutes full benefits for states extending Medicaid and Children's Health Insurance Program coverage for 12 months postpartum.

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policy

The FAQ include guidance for hospitals, long term care facilities, and critical access hospitals on enforcing and communicating visitation policies.

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policy

HHS and CMS will share training materials, convene hospital and provider associations to discuss best practices and challenges, and establish a team of experts to support hospitals.

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policy

Hospitals have until March 31 to apply for the third round of Section 126 awards, which will implement 200 new Medicare-funded residency slots.

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policy

The rule requires payers to create application programming interfaces to facilitate payer-to-provider data sharing.

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policy

Comments on the Federal Independent Dispute Resolution Operations proposed rule now are due Feb. 5.

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policy

CMS will select eight organizations to test the eight-year behavioral health care integration model; applications will open in spring 2024.

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policy

The website provides tailored outreach and engagement resources for partners helping people with Medicaid and Children's Health Insurance Program renewals.

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state-action

The waiver funds health-related social needs services, workforce development, and matching funds for Medicare beneficiaries with substance use disorder.

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policy

Comments on the rule, aims to improve the independent dispute resolution process for surprise medical bills, originally were due Jan. 2.

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webinar

Join America’s Essential Hospitals association senior staff as they share highlights from the 2023 legislative and regulatory landscape and preview potential action relevant to essential hospitals in 2024.

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policy

The association supports provisions that will expand coverage for non–modified adjusted gross income populations and align open enrollment periods across all marketplaces.

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policy

The Transforming Maternal Health Model supports a whole-person approach to pregnancy, childbirth, and postpartum care for Medicaid and Children's Health Insurance Program patients.

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policy

CMS shares strategies to ensure continuity of coverage amid a decline in Medicaid and CHIP enrollment among youth after the end of continuous enrollment.

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policy

GAO identifies weaknesses in CMS' policies and procedures for approving payments and makes recommendations to improve fiscal guardrails and transparency.

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policy

Effective Jan. 1, 2024, Medicare will cover marriage and family therapists, mental health counselors, and intensive outpatient services.

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policy

States that fail to meet reporting requirements must submit a corrective action plan that reinstates coverage for those affected or suspends procedural disenrollments.

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policy

In its annual proposed changes to benefit and payment parameters, CMS added several proposals governing state-based marketplaces, including network adequacy requirements, as well as provisions that will impact state Medicaid programs.

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policy

CMS released guidance outlining opportunities under Medicaid and CHIP for supporting efforts to address health-related social needs.

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policy

The proposed rule aligns state and federal marketplace requirements and includes several Medicaid provisions.

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policy

The rules 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.

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policy

CMS outlines tools for states to monitor Medicaid and CHIP managed care, along with new submission requirements for Medicaid managed care contracts.

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policy

CMS advises state Medicaid programs on adding questions about sexual orientation and gender identity to Medicaid and CHIP applications.

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policy

The rule covers Part B payment to 340B hospitals, site-neutral payment policies, price transparency requirements, and outpatient quality reporting.

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policy

The agency outlines its plan to remedy nearly five years of unlawful Medicare Part B cuts to hospitals in the 340B Drug Pricing Program with $9 billion in lump-sum Outpatient Prospective Payment System payments.

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policy

CMS answers FAQ about separate CHIP programs, enrollment fees, and unpaid premiums related to a Consolidated Appropriations Act, 2023 provision requiring continuous enrollment for children in Medicaid and CHIP.

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policy

The Center for Medicaid & CHIP Services seeks information on assessing mental health and addiction equity parity compliance in Medicaid and CHIP; comments are due Dec. 4.

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policy

Effective Jan. 1, 2024, states must provide 12 months of continuous eligibility for children younger than age 19 in Medicaid and CHIP.

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policy

The guide covers federal and state policies and includes updated guidance on nonemergency medical transportation.

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policy

The Department of Health and Human Services published a contingency staffing plan for operations in the absence of enacted annual appropriations for fiscal year 2024.

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policy

CMS requires 29 states and Washington, D.C. to pause procedural renewals after system issues improperly disenrolled eligible beneficiaries from Medicaid.

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policy

America's Essential Hospitals called on CMS to provide an adequate annual payment update to cover the effects of inflation and rising workforce costs.

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policy

In its response to the Centers for Medicare & Medicaid Services, America's Essential Hospitals comments on policies for telehealth services, advanced diagnostic imaging, social determinants of health, and other Physician Fee Schedule proposals.

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policy

The President’s Council of Advisors on Science and Technology outlines strategies to improve patient safety and reduce health care–associated injuries.

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policy

The association supports changes to the definition and duration of short-term, limited-duration insurance and requests clarification in application notices.

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Essential Insights

The Ohio State University Wexner Medical Center promotes sustainability through energy conservation, construction of efficient buildings, and intentional partnerships.

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policy

The States Advancing All-Payer Health Equity Approaches and Development Model focuses on chronic condition treatment and behavioral health.

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policy

CMS urges states to review their Medicaid renewal processes to ensure eligible individuals are not disenrolled erroneously through ex parte renewals at the household level.

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policy

America’s Essential Hospitals urged CMS to swiftly finalize a remedy to repay 340B hospitals for five years of Medicare Part B drug payment cuts.

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policy

HHS will host the Aug. 24 webinar to gather input from a variety of health care stakeholders on hospital preparedness before, during, and after emergencies.

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cdc, cms, hhs
policy

The administrative fee returns from $350 to $50 after an Aug. 3 court decision, but the independent dispute resolution portal remains closed to new disputes.

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policy

CMS has developed a three-step guide for state Medicaid programs to develop a claiming methodology for the differential match rate.

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policy

The letters review the state's May 2023 Medicaid unwinding metrics and compliance with federal requirements in three categories.

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policy

The toolkit aims to help states increase postpartum care access, quality, and equity by maximizing existing Medicaid authorities.

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policy

CMS suspended the independent dispute resolution process for certain surprise billing disputes due to an Aug. 3 court decision.

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policy

The rule includes changes to the calculation of Medicare disproportionate share hospital payments and payment and quality reporting provisions.

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The final rule for the fiscal year 2024 Inpatient Prospective Payment System will undermine the nation’s essential hospitals and safety net care for low-income and marginalized patients with its harmful policies on disproportionate share hospital funding.

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policy

CMS will release state Medicaid and Children's Health Insurance Program renewal data on a monthly, two-part basis due to data availability. 

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policy

CMS outlines three strategies to improve treatment and support for Medicaid and CHIP enrollees with mental health and substance use disorder conditions.

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policy

An August webinar series will provide strategies for reaching out to diverse communities to share information about Medicaid and CHIP renewals.

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policy

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.

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webinar

Join America’s Essential Hospitals Policy Manager Shahid Zaman Esq. to examine CMS’ proposed remedy for unlawful 340B cuts and next steps for essential hospital advocacy.

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state-action

Washington's renewed Section 1115 waiver introduces prerelease services for incarcerated individuals, social needs services, and continuous coverage.

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policy

The states will implement mitigation strategies before starting procedural terminations for Medicaid beneficiaries who have not renewed.

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policy

In California and Kentucky, mobile teams can provide Medicaid services to individuals experiencing a behavioral health or substance use crisis.

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policy

CMS released a request for information to aid the design of a future episode-based payment model to be implemented no later than 2026.

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cms
policy

The rule revises site-neutral payment policies, updates price transparency requirements, and changes outpatient quality reporting, among other provisions.

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policy

The proposed rule includes provisions for Medicare reimbursement of telehealth services, quality programs, and social determinants of health data collection.

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policy

The FAQ respond to concerns about the definition of cost sharing and facility fees in the No Surprises Act and Affordable Care Act.

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policy

CMS proposes to remedy five years of unlawful cuts to Medicare Part B reimbursement for separately payable drugs with lump-sum payments expected in late 2023 or early 2024.

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policy

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.

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We are pleased the administration proposes lump-sum reimbursements to hospitals in the 340B Drug Pricing Program to remedy years of unlawful cuts to Medicare outpatient drug payments.

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policy

CMS is publishing all approved state directed payment preprints on its website, along with preprint addendum tables in Excel workbook format.

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policy

The FAQ clarify the new enforcement authority in the Consolidated Appropriations Act, 2023 related to states' federal medical assistance percentage.

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policy

Starting Oct. 1, Medicaid and the Children’s Health Insurance Program will cover only COVID-19 vaccines that have been fully approved by the Food and Drug and Administration.

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policy

The association urged CMS to ensure sufficient payment rates in the Medicaid managed care and fee-for-service programs for providers in hospital settings.

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policy

Hospitals face a 25 percent reduction in Medicare payments if they fail to meet the new equity standards or regulations mandated by the Centers for Medicare & Medicaid Services under the Inpatient Quality Reporting Program.

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policy

The Medicaid and CHIP Payment and Access Commission's June report to Congress includes recommendations on countercyclical disproportionate share hospital policy and explores health care challenges faced by adults leaving incarceration.

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state-action

New York becomes the 35th state to offer Medicaid and CHIP for 12 months after pregnancy after extending postpartum coverage through a state plan amendment.

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policy

HHS offers flexible options states can adopt to ensure smooth transitions of coverage during the Medicaid redetermination process.

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policy

From July 2024 through 2034, CMMI will pilot in eight states the Making Care Primary Model, which will support value-based primary care.

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policy

The final rule retroactively affects the calculation of Medicare disproportionate share hospital payments from fiscal years 2005 to 2013.

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policy

The association urged CMS to increase the proposed annual hospital payment update and adopt a safety net hospital definition and related payment policies.

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policy

The new group, comprising two divisions from existing groups, will monitor and provide technical assistance to state and territory managed care programs.

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policy

CMS says the withdrawal of the mandate, effective immediately, aligns with the agency's approach to other infectious diseases.

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Essential Insights

California is the first state to receive approval for a Section 1115 waiver that seeks to improve access to care for formerly incarcerated populations.

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policy

The proposed rule targets drug misclassification, along with drug pricing and product data misreporting, by manufacturers.

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policy

The proposed rules are part of CMS’ response to executive orders directing federal agencies to review existing guidance for opportunities to strengthen and improve access to health care coverage, including through Medicaid.

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policy

The FAQ guide state Medicaid and Children's Health Insurance Program agencies as they begin terminating enrollment for those who no longer qualify.

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policy

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.

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policy

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.

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policy

Hospitals have until June 1 to preview their Overall Hospital Quality Star Rating, measure group score, individual measure results, and peer grouping.

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policy

FDA amends the Pfizer vaccine authorization for immunocompromised children aged 6 months to 4 years old, while the Biden administration ends its vaccine requirement for federal employees.

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policy

The May 5 webinar will feature CMS experts sharing how the end of the PHE will affect current health care waivers and flexible policies.

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policy

Two proposed rules establish access standards and standardize review and assessment of Medicaid payment rates across states; comments are due to CMS July 3.

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policy

To increase compliance with the hospital price transparency rule, CMS has set new compliance timelines and no longer will issue warning notices.

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policy

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.

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Essential Insights

Corporate affiliate member Guidehouse shares strategies for essential hospital leaders to prepare for the end of the COVID-19 public health emergency.

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policy

The rule updates essential community provider requirements for qualified health plans and adds a special enrollment period for those losing Medicaid or CHIP coverage.

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webinar

America’s Essential Hospitals, the American Hospital Association, the Association of American Medical Colleges, and the Federation of American Hospitals are pleased to invite you to a call with the Centers for Medicare & Medicaid Services.

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policy

The association urged CMS to work with Congress to avoid unintended cuts to Medicaid disproportionate share hospital payments imposed by Section 203.

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policy

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.

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policy

A new Section 1115 demonstration will support service delivery systems that facilitate reentry transitions for Medicaid-eligible individuals leaving prisons and jails.

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policy

In honor of Black Maternal Health Week, CMS shares recent work and resources focused on advancing equity in obstetric outcomes.

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policy

The proposed fiscal year 2024 Inpatient Prospective Payment System rule includes a request for feedback on defining safety net hospitals; CMS will accept comments until June 9.

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policy

A new categorical waiver allows health care facilities to use alternate power sources other than a generator or battery system.

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policy

The upcoming end of the COVID-19 national emergency will not affect policies enacted during the public health emergency issued under a separate declaration.

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state-action

On April 1, CMS began decreasing the temporary federal medical assistance percentage increase, and five states began disenrolling Medicaid beneficiaries.

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policy

The state has extended postpartum coverage from 60 days to 12 months through the state plan authority established by the American Rescue Plan Act in 2021.

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policy

To exclude 340B drugs from Medicare Part B inflation rebates required by the Inflation Reduction Act, providers must identify 340B drugs on Medicare claims. 

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policy

Per the Inflation Reduction Act, drug manufacturers that increase prices faster than the inflation rate will be required to pay rebates to Medicare.

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policy

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.

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policy

The updated guidance highlights the importance of sustaining a QAPI program over time and increasing engagement by the hospital’s governing body.

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institute

The April 13 webinar will highlight how health care institutions can advance climate-informed patient care, climate mitigation, and community climate resilience.

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policy

States may start initiating Medicaid renewals between February and April and terminating enrollment for individuals who no longer qualify as early as April 1.

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policy

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.

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policy

Applications close May 31 for the two-year extension of the Bundled Payments for Care Improvement Advanced voluntary payment model.

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policy

The proposed rule implements Section 203, which alters the process for calculating the Medicaid disproportionate share hospital uncompensated care limit.

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policy

The bulletin advises that arrangements among providers to redistribute Medicaid payments violate the hold harmless provisions of the law.

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policy

The association asked that CMS swiftly make 340B hospitals whole for reduced Medicare Part B reimbursement from 2018 to fall 2022, plus applicable interest.

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policy

Drug manufacturers that increase prices faster than the inflation rate must pay rebates to Medicare; comments on this policy are due to CMS March 11.

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policy

The updated fact sheets share when specific waivers will end and whether they will continue after the public health emergency's end on May 11.

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policy

The guidance informs states how to maintain the temporary increased federal medical assistance percentage while returning to normal Medicaid operations.

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policy

Qualified individuals and their families who lose Medicaid or CHIP eligibility once the continuous enrollment requirement ends can apply for marketplace coverage between March 31, 2023, and July 31, 2024.

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policy

A CMS letter to state Medicaid directors clarifies how in lieu of services (ILOS) can be used to mitigate health disparities, limits ILOS expenditures, and adopts documentation and review requirements.

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policy

Prioritizing hospitals in health professional shortage areas, CMS awarded residency slots to 100 hospitals, including 27 essential hospitals.

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policy

After the omnibus bill decoupled Medicaid redeterminations from the end of the COVID-19 public health emergency, CMS updates key redetermination dates.

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policy

Medicaid and CHIP coverage of interprofessional consultation is permissible as long as the consultation is for the beneficiary's direct benefit.

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policy

Registration is open now for the two Climate Change and Cardiovascular Disease Collaborative webinars on Jan. 12, at noon ET, and Feb. 9, at noon ET.

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policy

The report summarizes responses to a 2022 request for information, which focus on eligibility and enrollment, access to hospital services, and payment.

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policy

The proposed rule updates essential community provider requirements for qualified health plans and adds a special enrollment period for those disenrolled from Medicaid or CHIP.

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policy

The proposed rule leverages application programming interfaces to exchange health information and automate the provider prior authorization process.

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policy

The agency will not enforce a surprise billing requirement that requires good faith estimates to include cost estimates from co-providers and co-facilities.

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policy

The memo reviews regulatory obligations to care for patients in a safe environment, including the need to identify patients at risk for intentional harm to themselves or others.

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policy

The agency shared three sample formats to help hospital staff build machine readable files to comply with the Hospital Price Transparency Rule.

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policy

The CMS Innovation Center shares a progress report on its 10-year strategy and a blog post announcing plans to improve integrated specialty care.

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policy

The association urges CMS to educate and provide funding for essential hospital staff to conduct Medicaid and CHIP eligibility and enrollment activities.

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policy

The Medicare Outpatient Prospective Payment System final rule for calendar year 2023 reverses cuts to hospitals in the 340B Drug Pricing Program and delays developing a remedy for cuts to 340B hospitals that have been in place since 2018.

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policy

The rule finalizes the conversion factor and includes reimbursement provisions for telehealth and behavioral health services, the Quality Payment Program, and the Medicare Shared Savings Program.

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policy

President Joe Biden urges Americans to get their updated COVID-19 vaccine, which protects against the original SARS-CoV-2 variant and BA.4 and BA.5 subvariants.

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policy

Currently, 26 states have extended Medicaid and Children's Health Insurance Program coverage from 60 days to 12 months postpartum.

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policy

A CDC committee recommends the inclusion of COVID-19 vaccines in the 2023 immunization schedule; the administration releases a biodefense strategy.

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state-action

The waiver provides temporary housing to Medicaid beneficiaries experiencing or at risk of homelessness who have a significant health need or are enrolled in long-term care.

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policy

The decision to revert to the full payment rate is in compliance with a recent federal district court decision in favor of America’s Essential Hospitals.

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state-action

Section 1115 waivers in Massachusetts and Oregon aim to test improvements in coverage, access, and quality and target unmet health-related social needs.

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policy

CMS extends for two years the Bundled Payments for Care Improvement Advanced Model and alters the accounting process for beneficiaries with COVID-19.

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policy

America's Essential Hospitals urges CMS to swiftly restore full Medicare Part B drug payment rates for hospitals in the 340B Drug Pricing Program and define a select group of hospitals with a safety net mission.

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policy

The Biden administration's fall plan to manage the COVID-19 pandemic includes securing millions of updated vaccines and additional at-home, rapid tests; ensuring vaccine access for higher-risk Americans; and fostering community conversations about updated vaccines.

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policy

The agency requests information on health care access and equity, provider experiences, and the effect of policies introduced in response to COVID-19.

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policy

The association urged CMS to adequately reimburse off-campus, provider-based departments; refine physician quality reporting; and codify a definition of essential hospitals.

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policy

An Aug. 31 CMS proposed rule aims to streamline Medicaid and CHIP enrollment and ensure continuous coverage throughout the renewal process.

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policy

CMS on Aug. 29 finalized its decision to delay indefinitely implementation of the Radiation Oncology Model, which was scheduled to start Jan. 1, 2023.

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policy

Pfizer applies for emergency use authorization for its omicron-specific booster vaccine, the National Healthcare Safety Network will take over hospital data reporting, and CMS tells hospitals to brace for the public health emergency's end.

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policy

The rule finalizes disclosure requirements for the qualifying payment amount and select provisions for the related independent dispute resolution process.

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policy

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.

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policy

Health care providers have until Aug. 30 to download their preview reports before CMS shares quality data publicly in October.

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policy

This is the second star ratings update since the agency updated its methodology in 2020 to include the use of peer grouping.

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policy

CMS seeks feedback at a July 21 listening session on the 5 percent lump sum Alternative Payment Model Incentive Payment, set to expire at the end of 2022. 

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policy

FDA approves the Novavax COVID-19 vaccine for those 18 and older as the Biden-Harris administration releases an action plan to take on the BA.5 subvariant.

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policy

The Medicare Outpatient Prospective Payment System proposed rule for calendar year 2023 reverses cuts to 340B Drug Pricing Program hospitals and seeks comment on remedying existing cuts to 340B hospitals.

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policy

CMS proposes to decrease the conversion factor determining physician payment rates for specific services by $1.53. The proposed rule also includes provisions related to Medicare reimbursement of telehealth services, vaccine administration, and the Medicare Shared Savings Program.

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state-action

CMS approved Colorado's Section 1332 waiver application to create a state-based standard health benefit plan.

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policy

The tool compiles existing guidance to help states prepare to return to regular Medicaid operations after the COVID-19 public health emergency ends.

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policy

Hospitals have until June 16 to preview their Overall Hospital Quality Star Rating, measure group score, and individual measure results, along with peer grouping.

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policy

The agency's strategy to strengthen behavioral health care focuses on improving access, equity, quality, and data integration.

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policy

CMS on May 25 approved proposals in four states to extend postpartum Medicaid coverage from 60 days to one year after birth.

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policy

The webpage includes renewal instructions for eligible beneficiaries and guidance for ineligible beneficiaries to secure insurance through the marketplaces.

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policy

A new CMS resource highlights federal requirements for program renewals, verifications, applications, and oversight amid the anticipated COVID-19 public health emergency unwinding.

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policy

HHS urges governors to start planning for the end of the COVID-19 public health emergency; FDA authorizes a Pfizer booster vaccine for children ages 5 to 11.

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policy

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.

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policy

The final rule raises the essential community provider threshold from 20 to 35 percent and uses wait time standards to evaluate qualified health plans for network adequacy.

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webinar

Learn about equity proposals in the fiscal year 2023 Inpatient Prospective Payment System proposed rule that focuses on social determinants of health, climate, maternal health care, and more.

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policy

In a white paper, the association encourages CMS to develop policies that reduce disparities and incorporate equity into waiver approval and evaluation processes.

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policy

The action plan includes goals to close gaps in health care access, quality, and outcomes through data collection, outreach, and community engagement.

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policy

The proposed fiscal year 2023 Inpatient Prospective Payment System rule would increase operating payment rates by 3.2 percent and make other changes to Medicare payment and quality reporting policies. CMS is accepting comments on the proposed rule until June 17.

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policy

The independent dispute resolution process can be initiated to resolve payment disputes between health care providers and issuers.

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policy

The association made recommendations on payment rates, workforce development, eligibility and enrollment policies, and measuring access to hospital services.

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policy

The ability to provide hospital-level care at home has been essential to managing case surges during the COVID-19 pandemic and can improve access and equity outside of a public health crisis.

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policy

President Joe Biden announces a national research plan on prolonged illness developed after COVID-19; FDA limits authorization of sotrovimab to treat COVID-19.

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policy

Two new documents provide guidance for health care providers on No Surprises Act compliance and good faith estimates for uninsured or self-pay patients.

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policy

CMS shares tools to mitigate an anticipated increase in Medicaid fair hearing requests and resume normal operations after the COVID-19 public health emergency ends.

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policy

Recommendations for Medicare and Medicaid equity measures under development focus on standardized data collection and opportunities for testing and feedback.

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policy

FDA authorizes a second vaccine booster for older and immunocompromised individuals; OSHA reopens the comment period for its emergency temporary standard.

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policy

A State Health Official letter includes guidance for states to prepare for the COVID-19 public health emergency unwinding and return to regular Medicaid program operations.

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policy

The court ruled the qualifying payment amount should not be the main factor in determining payment for out-of-network services in independent dispute resolution.

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policy

The Centers for Medicare & Medicaid Services outlines the application process for 1,000 new graduate medical education slots created by the Consolidated Appropriations Act of 2021. Applications for the first round of slots are due March 31, 2022, and CMS intends to award slots July 1, 2023.

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cms, gme
policy

The Center for Medicare & Medicaid Innovation will release a request for applications for the Realizing Equity, Access, and Community Health accountable care organization model, which will focus on promoting health equity and mitigating health disparities for underserved communities.

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policy

National emergency extended; new study highlights conditions and symptoms developed after COVID-19 infection; CDC updates vaccine guidance with clarifications for immunocompromised people.

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policy

Through a request for information, the Centers for Medicare & Medicaid Services hopes to better understand enrollees' barriers to coverage and access to care to inform future policies and regulatory actions. A 60-day public comment period began Feb. 17.

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policy

Pfizer and BioNTech apply for emergency use authorization for their pediatric COVID-19 vaccine; CDC recommends the Moderna COVID-19 vaccine; Medicare will cover over-the-counter COVID-19 tests.

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state-action

In a letter to CMS, Republican Govs. Glenn Youngkin of Virginia and Jim Justice of West Virginia cite strained health care workforce and staffing crises as reasons for requesting relief. They ask for broader conscience exemptions, flexibility on enforcement, or simply a six-month delay of the rule.

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policy

An estimated 5.8 million people newly gained coverage during this open enrollment period; 32 percent of consumers using the federal marketplace selected a plan that costs them $10 or less per month. Enrollment remains open through Jan. 31 in five states and the District of Columbia.

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policy

Each awardee will receive up to $1.5 million for a three-year period to reduce the number of uninsured children by advancing Medicaid and Children's Health Insurance Program enrollment and retention. Grant applications are due March 28.

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policy

The U.S. Supreme Court upheld CMS' vaccine mandate but struck down the Occupational Safety and Health Administration's mandate; President Joe Biden announced new initiatives to expand testing access.

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policy

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.

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policy

CDC shortens the time between primary vaccine series and booster shot and recommends a Pfizer booster for adolescents; the Supreme Court hears oral arguments on two vaccine mandates; HHS requires coverage of at-home COVID-19 tests, effective Jan. 15.

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policy

FDA expands authorization for the Pfizer COVID-19 booster; FDA authorizes two antiviral pills; CMS updates guidance on vaccine mandate compliance.

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policy

The new document explains various provisions under part II surprise billing regulations, including that all financial assistance should be reflected in the good faith estimate regardless of the amount or type of discount. The new regulations take effect Jan. 1, 2022.

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policy

The association asked that CMS provide additional time for hospitals to comply with the requirements, especially given the uncertain outcome of pending litigation regarding the administration's vaccine mandate.

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policy

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.

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webinar

2022 Advocacy Outlook

Dec. 16, 2021 || Staff

Recap highlights from 2021 and preview the agenda for regulatory and legislative priorities in 2022.

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policy

A Centers for Medicare & Medicaid Services letter to state Medicaid directors outlines new supplemental payment reporting and Medicaid disproportionate share hospital requirements under the Consolidated Appropriations Act.

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policy

As the omicron SARS-CoV-2 variant reaches the United States, President Joe Biden releases a new plan to combat COVID-19; CMS will not enforce its health care worker vaccine mandate amid legal challenges.

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policy

CMS released guidance to help states maintain Medicaid and Children's Health Insurance Program coverage as they return to normal operations when the COVID-19 public health emergency ends. Many strategies in the documents require support from outside organizations that work with beneficiaries.

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policy

FDA and CDC endorse expanded eligibility for Pfizer and Moderna COVID-19 booster vaccine doses; Pfizer seeks authorization for its COVID-19 antiviral pill.

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policy

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.

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policy

CMS released final guidance for compliance with Medicare conditions of participation related to co-location, which occurs when two Medicare-certified hospitals or a Medicare-certified hospital and another health care entity are on the same campus or in the same building and share resources.

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policy

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.

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policy

CDC recommends the Pfizer COVID-19 vaccine for children ages 5 to 11; CMS holds a stakeholder call on its vaccine mandate for health care workers. Pfizer says its investigational novel COVID-19 oral antiviral candidate significantly reduces hospitalization and death.

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policy

CMS announced phased vaccination requirements as a condition of participating in Medicare and Medicaid; vaccination must be completed by Jan. 4, 2022. A new Occupational Safety and Health Administration emergency temporary standard promotes vaccination for businesses with 100 or more employees.

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We support the Biden administration’s vaccination goals, including for health care workers as they lead our nation’s response to COVID-19. The interim final rule from CMS aligns with our commitment to vaccination as the best way to protect patients and keep caregivers safe.

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policy

The rule adjusts the conversion factor used to determine physician payment rates and includes provisions related to appropriate use criteria, Medicare reimbursement for telehealth services, vaccine payment rates, the Quality Payment Program, and the Medicare Shared Savings Program.

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By maintaining harmful cuts to outpatient drug payments for hospitals in the 340B Drug Pricing Program and for services at hospital outpatient clinics, the 2022 Outpatient Prospective Payment System final rule jeopardizes safety net care.

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policy

Consumers now can preview health plans and prices on healthcare.gov ahead of open enrollment, which runs Nov. 1, 2020, through Jan. 15, 2021.

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policy

A new Center for Medicare and Medicaid Innovation white paper outlines a strategy to advance health system transformation. The goal is to achieve equitable outcomes by driving accountable care, advancing health equity, supporting innovation, addressing affordability, and creating partnerships.

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policy

CMS will require states to cover COVID-19 treatment with no cost-sharing for Medicaid and Children's Health Insurance Program beneficiaries. Further, states in some circumstances must cover treatments for conditions that might seriously complicate the treatment of COVID-19.

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policy

The use of Z codes to document social determinants of health in Medicare fee-for-service beneficiaries increased slightly from 2017 to 2019 but remains low.

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policy

FDA on Sept. 22 authorized a third booster dose of the Pfizer-BioNTech COVID-19 vaccine for select groups. A CDC panel subsequently recommended the booster shots, and CMS announced coverage for all Medicare beneficiaries and nearly all Medicaid and Children's Health Insurance Program beneficiaries.

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policy

The president's newly announced "Path out of the Pandemic" plan includes action steps for increasing vaccinations, further protecting those who are vaccinated, keeping schools safely open, testing and mask requirements, and economic recovery. CDC updates its infection control guidance.

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policy

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.

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policy

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.

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policy

CMS proposes to rescind the Trump administration’s Most Favored Nation model interim final rule, which aimed to reduce payment for 50 Medicare Part B drugs. America’s Essential Hospitals previously urged the agency to withdraw the model due to substantive and procedural issues.

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policy

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.

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policy

The OPPS proposed rule would continue cuts to hospitals in the 340B Drug Pricing Program and off-campus provider-based departments, pause the elimination of the inpatient-only list, and increase penalties for failing to report standard charges.

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policy

CMS announces $15 million for state Medicaid agencies to launch mobile crisis intervention services, as authorized by the American Rescue Plan.

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policy

The rule includes provisions related to telehealth, vaccine payment rates, the Quality Payment Program, and the Medicare Shared Savings Program; comments are due to CMS by Sept. 13.

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policy

The Senate confirmed Chiquita Brooks-LaSure as head of the Centers for Medicare & Medicaid Services. Several Senate committees last week examined issues of importance to essential hospitals, including telehealth, hospital consolidation, and the medical supply chain.

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Brooks-LaSure takes the reins at CMS at a critical juncture for our nation, as COVID-19 and its lingering economic effects make access to health care coverage more important than ever. Her knowledge of, and experience with, Medicaid and Medicare make her well suited to meet these challenges.

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policy

The interpretive guidance includes information on hospital admission, discharge, and transfer notification requirements outlined in CMS' May 2020 interoperability and patient access final rule.

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policy

The Senate voted to advance the nomination of Chiquita Brooks-LaSure as Centers for Medicare & Medicaid Services administrator; a full Senate vote could take place this week. America's Essential Hospitals hosted a virtual Capitol Hill briefing in recognition of the association's 40th anniversary.

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policy

New CDC recommendations no longer require people who are fully vaccinated against COVID-19 to wear a mask or physically distance.

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policy

A CDC brief updates transmission methods; Pfizer applies for FDA approval of its vaccine; CMS increases the Medicare payment for monoclonal antibodies.

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policy

In a new interim final rule with comment period, the Centers for Medicare & Medicaid Services revises the rules for certain hospitals seeking a wage index reclassification with the Medicare Geographic Classification Review Board.

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policy

The Centers for Medicare & Medicaid Services published updated overall hospital quality star ratings on its Care Compare website; the ratings were last updated in January 2020. America's Essential Hospitals has expressed continued concern about the fairness and reliability of the ratings.

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policy

Senate Republicans release a $568 billion infrastructure framework to kickstart negotiations. House Democrats and Republicans reintroduce opposing prescription drug pricing bills. A CMS decision delays advancement of Chiquita Brooks-LaSure's nomination for CMS administrator.

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policy

The president met with a group of bipartisan lawmakers to discuss his $2 trillion American Jobs Plan infrastructure proposal; other lawmakers have expressed interest in a less costly, more targeted package. The Senate Committee on Finance is expected to advance two Biden administration nominees.

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policy

The House will vote as early as tonight to extend the moratorium on the 2 percent Medicare sequester cut; CMS has held provider claims in anticipation of this bill passing. Meanwhile, lawmakers continue conversations on infrastructure funding and workplace violence prevention.

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policy

In light of the COVID-19 public health emergency, CMS updated its guidance document to expand on best practices, lessons, and planning considerations for emerging infectious diseases. 

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policy

The Centers for Medicare & Medicaid Services is extending until Aug. 15 the special enrollment period for 36 states using the federal health insurance marketplace, giving consumers more time to view new options under the American Rescue Plan, including lower premiums and plan upgrades.

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policy

The Occupational Safety and Health Administration updated its COVID-19 enforcement plan; CDC updates infection control guidance for vaccinated people in health care facilities.

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policy

CDC releases public health guidelines for fully vaccinated people; CMS invites hospitals to pilot a COVID-19 learning series.

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policy

FDA granted an emergency use authorization for the one-dose Janssen COVID-19 vaccine and an at-home COVID test; a multi-agency FAQ document addresses COVID-19 health coverage.

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The nominee’s deep policy expertise in Medicaid and Medicare and her role in advancing coverage under the Affordable Care Act would bring valuable skills and leadership to CMS.

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cms
policy

The special enrollment period, intended to ensure access to health coverage amid the the COVID-19 pandemic, will continue through May 15. The enrollment period applies to consumers in the 36 states that use the federal marketplace platform.

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policy

Hospitals have 30 days to review their reports before public reporting to Care Compare.

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policy

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.

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policy

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. 

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policy

The regulatory freeze could affect rules directing health clinics to pass certain drug discounts on to patients, establishing minimum standards in Medicaid state drug utilization review, and modifying Health Insurance Portability and Accountability Act privacy arrangements.

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policy

The document outlines acceptable approaches to calculate and report median payer-specific negotiated charges by Medicare Severity Diagnosis Related Group for reporting periods ending on or after Jan. 1, 2021.

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policy

The Centers for Medicare & Medicaid Services will begin reprocessing outpatient claims to excepted off-campus provider-based departments at the lower site neutral payment rate it established in the calendar year 2019 Outpatient Prospective Payment System final rule.

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state-action

This is the first approval of its kind and will allow the state to have more control over financing its Medicaid program.

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policy

Managed care organizations can participate in direct contracting for their populations dually eligible for Medicare and Medicaid. The model builds on direct contracting opportunities that test risk-sharing arrangements to reduce Medicare expenditures while preserving or enhancing quality of care.

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policy

A new Centers for Medicare & Medicaid Services final rule addresses minimum standards in Medicaid State Drug Utilization Review, creates value-based purchasing arrangements with manufacturers, and outlines minimum standards to reduce opioid prescribing–related fraud and abuse.

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policy

The proposed rule builds on a CMS final rule on interoperability and patient access; it would leverage application programming interfaces to improve patients’ access to their electronic health information and reduce burden on providers related to prior authorization.

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policy

Two federal courts halted implementation of the Centers for Medicare & Medicaid Services' most favored nation model interim final rule. The seven-year model was set to begin Jan. 1, 2021, phasing in a reduced payment rate for 50 Medicare Part B drugs.

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policy

FDA issues an emergency use authorization for the Moderna vaccine and an at-home antigen test; a CDC committee votes on allocation recommendations.

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Essential Insights

Association member UVA Health System is one of seven finalists in the CMS Artificial Intelligence Health Outcomes Challenge, which encourages applicants to use artificial intelligence to predict and prevent unplanned admissions and adverse events.

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policy

FDA authorizes the Pfizer COVID-19 vaccine for emergency use; HHS expands hospital COVID-19 data reporting requirements to include therapeutic data.

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policy

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.

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policy

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.

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policy

In a notice of proposed information collection, the Centers for Medicare & Medicaid Services announced its intention to make changes to the Medicare cost report and accompanying instructions.

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The final rule takes critical resources away from hospitals and is especially harmful now as they strain under the heavy financial burden of COVID-19.

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policy

The Centers for Medicare & Medicaid Services announced the Acute Hospital Care at Home program to further increase hospital capacity during the COVID-19 crisis, in response to a rising number of hospitalizations nationwide. The program builds on the Hospitals Without Walls initiative.

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policy

The Dec. 8 webcast will offer hospitals information and resources to prepare for publishing standard charges, including negotiated rates, for all services in a machine-readable format and display prices of shoppable services in a consumer-friendly format.

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policy

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.

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policy

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.

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policy

In an interim final rule with comment period, CMS announces a seven-year mandatory payment model set to go into effect Jan. 1. The Most Favored Nation rule builds on an International Pricing Index model; by issuing an interim final rule, the agency bypasses releasing a proposed rule.

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policy

The Centers for Medicare & Medicaid Services (CMS) on Dec. 1 will retire its original Hospital Compare tools, encouraging users to visit Medicare.gov’s new Care Compare tool to find and compare health care providers. CMS will not update the overall hospital quality star ratings in January 2021.

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policy

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.

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policy

The rule sets content elements a plan or issuer must disclose for a covered item or service. The rule also finalizes changes to the medical loss ratio program to allow issuers offering group or individual health coverage to receive credit for certain savings they share with enrollees.

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policy

In Nov. 2 comments on the interim final rule, America's Essential Hospitals strongly opposed new hospital conditions of participation related to reporting COVID-19 data and urged the Centers for Medicare & Medicaid Services to withdraw these requirements.

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cms
quality

CMS encourages hospitals to download and save historical reports from the Hospital Quality Reporting system before the reports are removed on Dec. 15.

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policy

The interim final rule targets future vaccine costs, price transparency for COVID-19 tests, and enhanced Medicare payments for new COVID-19 treatments.

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policy

New email inboxes set up by the Department of Health and Human Services (HHS) and Centers for Medicare & Medicaid Services (CMS) will take questions about the updated guidance for hospital COVID-19 data reporting requirements as part of Medicare conditions of participation.

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policy

The Centers for Medicare & Medicaid Services added 11 new telehealth services to the list of Medicare services reimbursable during the COVID-19 public health emergency. The agency also published resources on Medicaid and Children’s Health Insurance Program coverage of telehealth services.

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policy

The Centers for Disease Control and Prevention created a vaccines web resource with helpful COVID-19 information. The Centers for Medicare & Medicaid Services announced new actions to pay for expedited COVID-19 test results.

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policy

The webinar series for hospitals and other stakeholders will review new requirements for reporting COVID-19 data as a Medicare condition of participation and feature administration subject matter experts.

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policy

NIH will study experimental COVID-19 treatments and support the development of six new testing technologies; FDA's vaccine committee will meet Oct. 22.

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policy

Providers will have one year from the issuance date of their Medicare Accelerated and Advance Payment Program funds before they must begin to repay their loans. Providers may apply for an extended repayment schedule and may not use Provider Relief Fund dollars to pay back the Medicare loans.

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policy

CMS shares new guidance and FAQs on implementation of an interim final rule requiring COVID-19 data reporting as a Medicare condition of participation. The agency on Oct. 7 began sending letters regarding compliance status; hospitals that do not comply face termination from the Medicare program.

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policy

The webpage includes checklists, step-by-step instructions, and FAQs to help hospitals comply with the Hospital Price Transparency Rule, effective Jan. 1, 2021. It also offers information to help consumers use the data.

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policy

CMS released a guide and online payment option for laboratories seeking approval to test for COVID-19; CDC studies COVID-19 in health care workers.

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policy

In a letter to state Medicaid directors, CMS outlines lessons learned from previous initiatives, offers a comprehensive toolkit and examples of value-based care models, and highlights changes to existing flexibility.

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America's Essential Hospitals thanks the Centers for Medicare & Medicaid Services for recognizing the potential for unintended consequences of its proposed Medicaid Fiscal Accountability Regulation and withdrawing this potentially damaging rule.

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policy

Care Compare merges the agency's eight health care provider comparison tools into one interface; price and provider data are now available through an application programming interface.

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policy

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.

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policy

The Centers for Medicare & Medicaid Services in an interim final rule announced new Medicare condition of participation requirements for hospitals to report COVID-19 cases and related data to the Department of Health and Human Services.

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policy

Positive tests must be demonstrated using only the results of viral testing (i.e., molecular or antigen), consistent with CDC guidelines. The test may be performed either during or prior to the hospital admission.

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policy

HHS announces $6.5 million in testing investments; CDC issues antigen testing guidance; HHS partners with Moderna to manufacture and deliver its vaccine.

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policy

The agency announced that Medicare Part C enrollee days, otherwise known as Medicare Advantage days, would be included in the calculation of the Medicare fraction used to determine Medicare disproportionate share hospital payments for years prior to fiscal year 2014.

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policy

The agency is using its discretion to allow premium credits to support continuity of coverage for individuals and families impacted by the COVID-19 public health emergency and facing difficulties paying premiums.

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policy

America's Essential Hospitals, along with five other national associations, calls for withdrawal of the proposed Medicaid Fiscal Accountability Regulation. In a letter, the groups note that the rule, if finalized, would exacerbate public health and economic uncertainty resulting from the pandemic.

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policy

The HHS Coronavirus Data Hub goes live; CDC guidance recommends a symptom-based strategy for COVID-19 patients. CMS data show an increase in telehealth use among Medicare beneficiaries. The IRS extends the deadline for tax-exempt hospitals to conduct a community health needs assessment.

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policy

The proposed rule, issued by CMS, aims to advance Medicaid prescription drug value-based purchasing arrangements between states and manufacturers, set standards to promote safe opioid prescribing, and amend regulations related to the Medicaid drug rebate program.

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policy

New CDC guidance offers best practices to safely venture outside and begin to resume daily activities amid the COVID-19 pandemic, as well as information on using telehealth to expand access. CMS releases recommendations for non-emergent care in areas that are in Phase II of recovery.

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policy

The new options are detailed in a comprehensive table for each payment model. Notably, CMS will extend the Next Generation Accountable Care Organization model through December 2021.

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policy

CMS has issued blanket waivers and flexible options to increase hospital capacity, expand access to COVID-19 testing, promote telehealth, and augment the health care workforce. CMS is clarifying what requires usage of modifier “CR” or condition code “DR” when submitting claims to Medicare.

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policy

The Joint Commission will resume regular surveys of health care facilities; Gilead Sciences Inc. donates a second round of remdesivir to treat severe COVID-19 cases; CDC issues antibody testing guidelines.

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policy

CMS updates Medicare payment information to capture two new testing codes; FDA updates testing FAQs; CDC issues resources for reopening businesses and organizations.

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policy

America's Essential Hospitals expressed deep concern with the agency's ill-timed launch of the 340B Drug Pricing Program acquisition cost survey during this public health emergency.

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policy

In a letter, America's Essential Hospitals urged the agency to reopen the comment period for the Medicaid Fiscal Accountability Regulation to allow stakeholders to address the proposed rule's impact, as the COVID-19 pandemic has fundamentally altered the health care and economic landscapes.

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policy

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.

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America’s Essential Hospitals today called on the Centers for Medicare & Medicaid Services to immediately withdraw the agency’s survey on 340B Drug Pricing Program acquisition costs, saying it imposes an unnecessary and costly burden on hospitals as they battle COVID-19.

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policy

A new study highlights racial disparities among COVID-19 patients; CDC updates testing and isolation guidelines and releases National Healthcare Safety Network data.

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policy

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.

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policy

CDC revised its testing guidance to reflect six new COVID-19 symptoms: chills, repeated shaking with chills, muscle pain, headache, sore throat, and new loss of taste or smell. HHS released a Workforce Virtual Toolkit, and CMS released a State Medicaid and CHIP Telehealth Toolkit.

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policy

The survey will run April 24 to May 15 and requests drug acquisition costs from all hospitals participating in the 340B Drug Pricing Program, except critical access hospitals. CMS might use data collected through the survey to determine Medicare Part B drug reimbursement rates.

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policy

The Department of Health and Human Services announced April 22 how it will allocate more than $70 billion in COVID-19 provider relief under the CARES Act, including targeted aid for hospitals and other providers on the front lines of the pandemic.

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policy

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.

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policy

CMS announced waivers for IPPS and long-term care hospitals; Medicare will nearly double payment for select COVID-19 tests; CDC developed a new National Healthcare Safety Network COVID-19 module.

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policy

CMS released new COVID-19 FAQs for state Medicaid and CHIP agencies, providing additional guidance on Medicaid provisions in the Families First Coronavirus Response Act and the Coronavirus Aid, Relief, and Economic Security (CARES) Act. 

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policy

New CDC guidance requires face coverings for all who enter a health care facility. HHS Secretary Azar issues FAQs on testing and reporting requirements. Federal agencies warn about scams related to COVID-19.

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policy

The fund, authorized by the CARES Act, intends to support providers incurring health care–related expenses and lost revenue from COVID-19 pandemic response.

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state-action

Newly approved state plan amendments in Alabama, Arizona, Minnesota, Washington, and Wyoming aim to increase flexibility to respond to the COVID-19 pandemic.

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policy

Providers will receive direct deposits of their share of the $30 billion based on 2019 Medicare fee-for-service payments.

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America's Essential Hospitals is eager for the administration to distribute $30 billion in COVID-19 relief for hospitals but concerned by the allocation methodology, which could put some essential hospitals at a disadvantage.

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policy

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.

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policy

In a two-part bulletin, the Center for Medicaid and CHIP Services details leveraging telehealth for rural health care and fulfills federal requirements to provide guidance on using telehealth for substance use disorder treatment.

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policy

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.

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policy

America's Essential Hospitals distills recent CMS guidance on enhanced Medicaid funding for essential hospitals during the COVID-19 pandemic.

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policy

CMS releases guidance for hospitals in quality reporting programs; CDC updates guidelines for testing and handling COVID-19 specimens.

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policy

The new waivers and flexible options are designed to increase hospital capacity, rapidly expand the health care workforce, temporarily eliminate certain paperwork requirements, and promote telehealth in Medicare.

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state-action

States are expanding requirements for hospitals to report their bed capacity and supply inventory, and readying facilities to expand capacity to treat patients with COVID-19. CMS has approved Section 1135 waivers for 38 states.

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policy

The administration has issued guidance making policy changes related to Medicare payment, mandated paid leave, and hospital reporting requirements related to COVID-19.

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policy

CMS issued a frequently asked questions document on how the agency will implement enhanced Medicaid funding to states to support COVID-19 response. The 6.2 percent increase in the Federal Medical Assistance Percentage was included in the Families First Coronavirus Response Act, made law on March 19.

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policy

The March 20 letter details additional action needed to support essential hospitals as they respond to the pandemic. The letter also explains how essential hospitals face significant financial challenges as they work on the front lines of public health threats.

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policy

CMS issues elective surgery guidance, telehealth toolkits, and information on quality reporting flexibility amid the COVID-19 pandemic; The Joint Commission suspends regular surveys.

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policy

CMS issued several checklists and templates for state Medicaid and the Children's Health Insurance Program agencies to request regulatory relief and flexibility to respond to the COVID-19 outbreak.

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state-action

Washington state received approval for a Section 1135 waiver, targeted at removing additional Medicare and Medicaid regulatory barriers for providers to respond to the COVID-19 outbreak.

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state-action

Under the proposed Section 1115 waiver, Oklahoma would accept a per-capita cap on federal funds for the Medicaid expansion population and incorporate other market-based reforms.

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policy

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

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policy

President Trump declared a national emergency as the number of confirmed COVID-19 cases in the U.S. nears 3,500. CMS responds to concerns about complying with Emergency Medical Treatment and Labor Act requirements and CDC released updated infection control guidance for health care providers.

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policy

America's Essential Hospitals expressed concern that a proposed drug acquisition cost survey exceeds CMS authority under Medicare statute and would impose excessive burden on hospitals in the 340B Drug Pricing Program.

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policy

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.

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policy

Both chambers passed a bill providing more than $8 billion to combat the new coronavirus; House leaders now are discussing legislation to mitigate economic impacts associated with the virus. A Senate letter calling to incorporate social determinants into hospital star ratings closes tomorrow.

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policy

The new code applies to tests conducted outside CDC laboratories; CMS also issued frequently asked questions and fact sheets about COVID-19–related billing.

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policy

In a memo to state survey agencies and accrediting organizations, CMS announced it will focus survey activities solely on infection control until further notice and provided guidance for patient triage and nursing homes.

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policy

This decision is the latest of several court cases invalidating work requirements policies in Medicaid; Utah now is the only state with these requirements in effect. It is unknown at this time if Michigan or the Department of Health and Human Services will appeal the decision.

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policy

A new proposed rule would extend the Comprehensive Care for Joint Replacement (CJR) model by three years and add outpatient knee and hip replacement to the definition of a CJR episode. Comments are due to CMS by April 24.

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policy

In the unanimous decision, the United States Court of Appeals for the District of Columbia Circuit found that the Department of Health and Human Services failed to adequately assess the potential impact of work requirements on coverage under Arkansas' Section 1115 demonstration waiver.

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policy

Administrator Verma writes that provisions of the Medicaid Fiscal Accountability Regulation are meant to ensure transparent and lawful use of taxpayer resources to fund Medicaid. She contends that nothing in the proposal is meant to reduce Medicaid funding or prohibit supplemental payments.

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policy

Comments on a proposed acquisition cost survey to inform Outpatient Prospective Payment System payment rates for 340B drugs are due March 9.

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policy

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.

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policy

CMS issued guidance outlining how states can receive a block grant or per-capita cap in exchange for additional administrative flexibility. Through a Section 1115 demonstration waiver, these new financing arrangements would apply to coverage of optional Medicaid patient populations.

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policy

In response to a joint proposal, America’s Essential Hospitals expressed concern about mandating the public posting of payer-specific negotiated rates and urged the departments of Labor, Treasury, and Health and Human Services to seek alternatives that better serve consumers.

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policy

In its submitted comments, the association outlines overarching and specific problems that necessitate withdrawal of the rule to protect the stability and viability of the Medicaid program.

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The proposal would "cut at the very core of the Medicaid program by introducing unprecedented restrictions on states’ ability to fund their share of the Medicaid program," America's Essential Hospitals says.

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policy

CMS plans to transition to a unified Medicare Care Compare portal this spring that will combine and standardize the eight existing tools and allow a single point of entry for quality information.

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policy

This month’s data refresh is based on the existing, flawed methodology used during the last update of star ratings in February 2019.

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Health care consumers need accurate, relevant information to make the best care decisions; the current star ratings do not meet this need. The ratings rely on a methodology that fails to account for differences among hospitals and, therefore, could mislead rather than inform consumers.

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policy

Despite a growing awareness of the impact of social determinants of health on patient health outcomes, the CMS study found challenges to consistent data collection, including a lack of standardized screening tools and inconsistent use of electronic health record codes.

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policy

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.

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institute

Researchers studied 3,608 hospitals nationwide, examining the associations between neighborhood social risk factors and seven CMS quality domains.

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Essential Insights

Essential hospitals are committed to transparent, accurate quality measurement, but a single hospital star rating oversimplifies a complex and personal decision.

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policy

The new guidelines reflect revised conditions of participation in the September 2019 discharge planning and burden reduction final rules.

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policy

CMS granted a 15-day comment period extension for the Medicaid Fiscal Accountability Regulation. Comments are now due to the agency on Feb. 1, 2020.

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policy

America’s Essential Hospitals said the federal Anti-Kickback Statute and Physician Self-Referral Law should be modified to remove barriers to coordinating care for the complex patients essential hospitals serve.

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policy

The agency announced awardees for two new models that seek to improve care coordination for children and for mothers with opioid use disorder.

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policy

The report is based on feedback gathered during a September listening session, in which more than 300 stakeholders shared recommendations for improving predictability, stability, and relevance of star ratings.

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policy

Through this newly approved Section 1115 demonstration waiver, South Carolina becomes the first state to apply work requirements primarily to parents and caregivers.

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policy

America’s Essential Hospitals expressed concern that a proposed drug acquisition cost survey would impose excessive burden on hospitals and raise many operational challenges.

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policy

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.

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webinar

Learn about the threat this proposed rule poses to essential hospitals, and gain strategies for commenting on and advocating against the proposal.

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policy

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.

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policy

The agency proposes to increase transparency in Medicaid supplemental payments and impose more stringent requirements on those payments and their financing for states and providers.

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Rather than empower consumers with meaningful information, the administration's plan only would give health plans an unfair advantage in negotiations with providers and put access to care at risk.

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The proposed regulation would undermine the financial stability of state Medicaid programs by restricting the flexibility states have to meet their commitment to vulnerable patients and avoid spending cutbacks that threaten access to care.

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policy

This year’s update contains new quality and accountability measures and new national context data.

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policy

A new brief summarizes program recommendations from an expert panel, which included America's Essential Hospitals staff.

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policy

The move aims to give researchers a better understanding of key Medicaid and Children's Health Insurance Program information, including on utilization and spending under Medicaid managed care.

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policy

CMS also approved a unique behavioral health transformation waiver for the District of Columbia that targets beneficiaries with serious mental illness or serious emotional disturbance.

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policy

Health care providers have until Dec. 3 to download their preview reports, which include overall hospital quality star ratings.

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policy

In a separate, forthcoming final rule, the Centers for Medicare & Medicaid Services will summarize and respond to the more than 1,400 public comments it received about proposed requirements for hospitals to make public their standard charges.

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The final rule jeopardizes access to care in underserved communities and flouts court rulings on unlawful federal policies regarding payments to hospitals in the 340B Drug Pricing Program and to provider-based outpatient departments.

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policy

The October refresh does not include an update of overall star ratings, which were last updated in February.

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policy

Applications for the new payment models are due to the Centers for Medicare & Medicaid Services Jan. 22, 2020.

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policy

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.

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cms
policy

The updated resource library includes new fact sheets and guides for the Merit-based Incentive Payment System and Advanced Alternative Payment Models.

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institute

This new brief can help hospitals identify changes that might improve patient experience scores, as well as help policymakers understand how structural factors influence scores and design incentives accordingly.

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policy

The report includes recommendations to the Centers for Medicare & Medicaid Services for improved oversight of these waivers.

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policy

The proposed rules seek to eliminate barriers to promoting care coordination under current fraud and abuse laws; comments are due to the agencies Dec. 31.

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policy

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

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policy

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.

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policy

The association urged the Centers for Medicare & Medicaid Services to reverse policies that will result in significant funding cuts to essential hospitals and hinder access to care.

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policy

The agency seeks comments until Nov. 29 on a proposal to collect acquisition cost data from hospitals participating in the 340B Drug Pricing Program.

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policy

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.

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policy

The final rule revises conditions of participation and conditions for coverage and also targets emergency preparedness, quality reporting, infection control, and physical examination requirements.

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policy

The final rule requires hospitals to create discharge plans for all inpatients and some outpatients and excludes several burdensome requirements that were included in the proposed rule.

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cms, ehr
policy

The 18-month grants, awarded to 15 state Medicaid agencies, seek to increase the ability of providers to deliver substance use disorder treatment and recovery services.

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policy

The methodology outlines how the agency will calculate states’ Medicaid disproportionate share hospital payment reductions and encourages states to target remaining payments to hospitals caring for the most low-income patients.

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policy

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.

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The U.S. District Court’s ruling that the government overstepped its authority by cutting payments to hospital outpatient clinics is a victory for vulnerable patients and an important step toward protecting access to care in underserved communities.

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cms, hhs
policy

Beginning in April 2020, hospitals with multiple service locations must accurately enter the address of their off-campus, provider-based departments.

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policy

Facilities located in areas designated as emergency or major disaster areas will be exempt from provisions of Medicare quality reporting programs.

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webinar

Learn about proposals for damaging Medicare payment cuts and price transparency requirements in 2020 and next steps for association advocacy to protect hospitals.

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policy

The agency is waiving program requirements and suspending enforcement activities in Florida, Georgia, North Carolina, South Carolina, and Puerto Rico.

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policy

Merit-based Incentive Payment System participants can request a targeted review of their performance feedback and final score if they find an error in their 2020 payment adjustment calculation.

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Essential Insights

Essential hospitals are an important resource to help patients determine their eligibility for Medicaid and other assistance programs.

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state-action

For the first time since 2007, the number of children enrolled in Medicaid and the Children’s Health Insurance Program declined in 2018.

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policy

The guidance follows a May 23 presidential memorandum calling for increased enforcement of laws related to individuals sponsoring immigration applicants.

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policy

An NEJM Catalyst article assesses four public hospital quality reporting programs' ability to classify hospital performance.

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policy

The ruling reinstates a 2017 final rule requiring that audits include payments from Medicare and commercial payers when calculating the hospital-specific disproportionate share hospital funding limit.

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cms, dsh
policy

The agency plans to update the Overall Hospital Quality Star Ratings methodology in 2021 and will host a Sept. 19 listening session to seek stakeholder feedback.

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policy

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.

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policy

America’s Essential Hospitals urged the Centers for Medicare & Medicaid Services to reduce administrative burden regarding clinical documentation, health information technology, and public health reporting.

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policy

To facilitate multi-payer alignment for ambulance services, the Center for Medicare and Medicaid Innovation will provide an interactive learning system with targeted learning opportunities for state Medicaid programs.

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policy

The agency will reimburse hospitals at least 65 percent of the cost for this innovative cancer treatment.

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policy

The court ruled that the Secretary of Health and Human Services failed to adequately consider the effect of the work requirements on Medicaid coverage.

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policy

The rule increases inpatient operating payment rates by 3.1 percent, makes other payment and quality reporting policy changes, and estimates a $140 million increase in Medicare disproportionate share hospital payments.

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policy

The refresh includes results from the Hospital Consumer Assessment of Healthcare Providers and Systems but does not include overall star ratings.

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policy

The Medicare Outpatient Prospective Payment System proposed rule for calendar year 2020 would continue cuts to hospitals in the 340B Drug Pricing Program and to off-campus provider-based departments and introduce new transparency requirements.

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policy

A Centers for Medicare & Medicaid Services report to Congress details an action plan to assist states in providing housing-related support for Medicaid beneficiaries with substance use disorders.

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policy

Hospitals in the Inpatient Quality Reporting, Prospective Payment System–Exempt Cancer Hospital Quality Reporting, and Hospital Outpatient Quality Reporting programs can view their preview reports through Aug. 14.

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policy

The Centers for Medicare & Medicaid Services announced new payment models through the Center for Medicare and Medicaid Innovation to promote high-quality, coordinated care for patients with chronic kidney disease.

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policy

The two mandatory payment models will test prospective episode-based payments for radiation oncology therapy and end-stage renal disease treatment.

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policy

Under the requirement, delayed until October, the address a hospital lists on a claim will have to exactly match agency enrollment records for the hospital to receive payment through the Outpatient Prospective Payment System.

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policy

Under five-year demonstration projects, these states are approved to receive Medicaid matching funds for treatment in facilities that qualify as institutions for mental diseases.

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policy

The Centers for Medicare & Medicaid Services announced a $50 million funding opportunity for up to 10 states to aid in treatment and recovery services for individuals with substance use disorder, including opioid use disorder.

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policy

Louisiana is the fifth state cleared to pursue value-based purchasing agreements for supplemental rebates with manufacturers through a state plan amendment.

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Essential Insights

As essential hospitals target social determinants of health in their communities, it is crucial that the Medicaid program continues to evolve to ensure this vital work can continue.

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policy

America’s Essential Hospitals encouraged the Centers for Medicare & Medicaid Services to consider the disproportionately negative financial effect on essential hospitals of certain quality reporting requirements and administrative burden in the Promoting Interoperability Programs.

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policy

The state plan amendment is specifically designed to allow the state to negotiate under a “subscription” model with manufacturers of prescription drugs that treat patients with hepatitis C. Washington is the fourth state cleared to pursue value-based purchasing agreements for supplemental rebates.

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policy

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.

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aca, cms, hhs
policy

The decision does not impact ongoing litigation challenging Medicare Outpatient Prospective Payment System policies or Medicaid disproportionate share hospital third-party payer policy.

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policy

The agency requests feedback as part of its Patients Over Paperwork initiative to update or eliminate administratively burdensome regulations.

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policy

In July, the Centers for Medicare & Medicaid Services will require hospitals with multiple service locations to accurately enter the address of their off-campus, provider-based departments to receive payment through the Outpatient Prospective Payment System.

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policy

In June 3 letters, America's Essential Hospitals encouraged the Centers for Medicare & Medicaid Services and the Office of the National Coordinator for Health Information Technology to consider the regulatory burden that new interoperability requirements would place on essential hospitals.

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policy

An America's Essential Hospitals analysis identified more than 300 hospitals with mismatching fiscal year 2015 uncompensated care values compared with the Centers for Medicare & Medicaid Services' provided Factor 3 values.

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policy

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.

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Essential Insights

Directed payments through Medicaid managed care plans have avoided much of the confusion — even suspicion — that surrounds other supplemental support to providers. But as policy evolves, will the accountability and transparency built into this payment mechanism be sufficient in the long run?

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policy

Providers interested in the professional or global options under the new Primary Cares Initiative must submit a nonbinding letter of intent by Aug. 2.

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policy

In a new request for information, the agency seeks ideas for innovative programs and waiver concepts states could consider in developing Section 1332 waivers. The request follows October 2018 guidance aimed at increasing state flexibility.

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webinar

Join us for a deep dive into Medicaid managed care directed payments and what they mean for essential hospitals.

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policy

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.

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policy

Revised guidance clarifies what constitutes a ligature risk and outlines a ligature risk extension process for deficient hospitals; comments are due June 17.

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policy

In a letter to state Medicaid directors, the Centers for Medicare & Medicaid Services encouraged states to partner with the agency to test innovative approaches to better serve beneficiaries who are dually eligible for Medicare and Medicaid.

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policy

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.

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policy

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.

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policy

Hospitals in the Inpatient Quality Reporting, Prospective Payment System–Exempt Cancer Hospital Quality Reporting, and Hospital Outpatient Quality Reporting programs can view their preview reports through May 21.

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policy

The Centers for Medicare & Medicaid Services and the Office of the National Coordinator for Health Information Technology extended to June 3 the deadlines for commenting on two proposed rules related to interoperability, patient access to health information, and information blocking.

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policy

CMS finalized the Notice of Benefit and Payment Parameters for the Affordable Care Act’s health insurance marketplace and the annual letter to issuers offering plans on the federally facilitated marketplaces for plan years beginning on or after Jan. 1, 2020.

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quality

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.

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policy

Utah joins a growing list of states with approval to implement Medicaid work requirements, but it is the first state to limit enrollment to individuals below the federal poverty level and implement a spending cap.

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policy

The agency in April will randomly select nine Health Insurance Portability and Accountability Act–covered entities, including health plans and clearinghouses, for compliance reviews.

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policy

The court ruled that the Department of Health and Human Services overstepped its authority and failed to show that work requirements would help promote the purpose of the Medicaid program

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policy

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.

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policy

The tools and guidance aim to help states monitor and evaluate the effects of Section 1115 waiver demonstrations, including those with work and community engagement requirements and those that combat substance use disorder.

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policy

Ohio’s waiver requires beneficiaries ages 18 to 49 who are eligible through Medicaid expansion to work or participate in other community engagement activities for at least 80 hours a month.

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policy

The budget plan proposes to overhaul the Medicaid program, as well as significantly change the 340B Drug Pricing Program and expand site-neutral payment policies in hospital outpatient departments.

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policy

The revised Appendix Q to the State Operations Manuals includes key changes to the immediate jeopardy definition. CMS also released updated online training and a template to assist surveyors.

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policy

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.

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policy

The agency posted potential changes to the star ratings program for public comment, including potential hospital peer grouping.

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We find it unfortunate that the Centers for Medicare & Medicaid Services decided to publish hospital star ratings today even as the agency proposed changes that recognize ongoing flaws in the ratings methodology.

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policy

The Centers for Medicare & Medicaid Services updated the Promoting Interoperability Programs website with new resources for the 2019 program year. The agency also announced two calls on the recently released interoperability and patient access proposed rule.

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policy

The Emergency Triage, Treat, and Transport model for emergency ambulance services encourages treatment for Medicare beneficiaries outside the emergency department.

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policy

The proposals aim to increase interoperability and improve patients’ access to their health information, while reducing regulatory burden on hospitals.

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policy

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.

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policy

The waiver requires beneficiaries ages 19 to 49 who are eligible through Medicaid expansion to work or participate in community engagement activities for at least 80 hours a month.

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policy

Proposed provisions aim to further the Trump administration’s goals to lower premiums, increase market stability, reduce regulatory burden, and protect taxpayers.

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policy

The tool includes 2018 Qualifying Alternative Payment Model (APM) Participant and Merit-based Incentive Payment System APM status.

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policy

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.

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policy

America's Essential Hospitals praised the administration’s efforts to streamline managed care regulations for Medicaid and the Children's Health Insurance Program, reduce regulatory burden, and increase state flexibility.

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policy

Maine and Michigan join five other states to receive approval for Medicaid work requirements; unlike most other states, Maine's work requirements will apply to both existing beneficiaries and those newly eligible through expansion.

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policy

In a letter to state Medicaid directors, the agency shared 10 opportunities to improve service to individuals dually eligible for Medicare and Medicaid.

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policy

The waiver permits federal reimbursement for short-term stays in institutions for mental disease for individuals with substance use disorders.

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policy

The state’s waiver initially was approved in May, but required a second approval to extend beyond Dec. 31.

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policy

The frequently asked questions are about a new requirement, under the fiscal year 2019 Hospital Inpatient Prospective Payment System final rule, that hospitals make public a list of their standard charges via the internet.

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policy

Hospitals have until Dec. 30 to preview their quality data before it is published on the Hospital Compare website in February 2019.

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policy

The U.S. District Court for the District of Columbia vacated the previous approval, saying the administration failed to adequately assess the waiver's impact on Medicaid’s core objective: to provide health care coverage for beneficiaries.

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policy

The association expressed concerns about two disparity methods developed to report readmission rates among patients with social risk factors; the deadline for comments has been extended to Dec. 14.

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policy

More than 1 million eligible clinicians received a neutral or better payment adjustment in the first year of the Merit-based Incentive Payment System, one of two tracks in the Quality Payment Program.

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policy

The agency will hold educational webinars to help health care providers understand the new user interface for Hospital Compare preview reports.

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policy

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.

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policy

America’s Essential Hospitals encouraged the agency to continue its efforts to reduce regulatory burden at essential hospitals, including through refining Medicare and Medicaid conditions of participation.

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policy

A new demonstration opportunity, which can be carried out through Section 1115 waivers, would allow states to receive reimbursement for services at institutions for mental disease for individuals with serious mental illness or serious emotional disturbance.

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policy

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.

view more »
policy

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.

view more »
policy

Wisconsin is the fifth state to receive approval to incorporate work and community engagement requirements as a condition of Medicaid eligibility.

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policy

The Medicare Outpatient Prospective Payment System final rule for calendar year 2019 broadens the scope of cuts to hospitals in the 340B Drug Pricing Program and to off-campus provider-based departments; in a statement, the association strongly objected to these additional payment cuts.

view more »

The rule undermines stability and choice for vulnerable patients by continuing to cut critical funding to hospitals serving people who face barriers to care.

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We are pleased that the Department of Health and Human Services has responded to our lawsuit with other national organizations by proposing a Jan. 1, 2019, effective and compliance date for 340B Drug Pricing Program enforcement.

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policy

The agency seeks stakeholder feedback on two disparity methods measuring patient outcomes based on social risk factors; comments are due Dec. 14.

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policy

The Maternal Opioid Misuse model will last five years and support the integration of clinical care with other services critical for health, well-being, and recovery for pregnant and postpartum Medicaid beneficiaries.

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policy

The guidance allows states additional flexibility to waive certain provisions of the Affordable Care Act while preserving access to affordable, comprehensive coverage.

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policy

The expansion is expected to give up to 400,000 additional Virginians access to the program; the Centers for Medicare & Medicaid Services has not announced a decision on the state's Section 1115 waiver, which includes work requirements.

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policy

America's Essential Hospitals encouraged the Centers for Medicare & Medicaid Services to promote stability in the Medicare Shared Savings Program and allow essential hospitals more time to stay in savings-only tracks.

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policy

The Centers for Medicare & Medicaid Services is waiving program requirements and suspending enforcement activities in Florida and Georgia.

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policy

Participating entities, including 832 acute-care hospitals, will receive bundled payments for certain episodes of care to promote value in care delivery.

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policy

The agency will publish accrediting organization (AO) performance data, redesign AO validation surveys, and share its annual report to Congress.

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policy

The Oct. 15 webinar will review how to use the new Medicare Cost Report e-Filing system to submit cost reports for fiscal years ending on or after Dec. 31, 2017.

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policy

A new notice makes technical and typographical corrections to the fiscal year 2019 Inpatient Prospective Payment System final rule.

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policy

The frequently asked questions clarify the type and format of information that hospitals must post under new requirements finalized in the fiscal year 2019 Inpatient Prospective Payment System rule.

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policy

Cooperative agreements with seven organizations aim to develop, improve, update, or expand quality measures for Medicare’s Quality Payment Program.

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policy

America’s Essential Hospitals urged the Centers for Medicare & Medicaid Services to reverse policies that will result in significant funding cuts to essential hospitals and hinder access to care.

view more »
policy

The Sept. 26 webinar will review requirements for submitting value-based payment approaches as an Other Payer Advanced Alternative Payment Model under the Medicare Access and CHIP Reauthorization Act of 2015.

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policy

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

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policy

Essential hospital staff are invited to provide feedback on overall hospital quality star rating methodology during an Oct. 4 listening session; the Centers for Medicare & Medicaid Services will use the feedback to inform future methodology updates.

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policy

The Centers for Medicare & Medicaid Services waived program requirements in Virginia, North Carolina, and South Carolina; the Centers for Disease Control & Prevention issued guidance for treating carbon monoxide poisoning in hurricane victims.

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policy

The association urged the Centers for Medicare & Medicaid Services to adequately reimburse off-campus, provider-based departments and refine physician quality reporting to account for costs of care and the unique needs and patient populations served by essential hospitals.

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policy

New data show 472 accountable care organizations in the Medicare Shared Savings Program cared for 9 million program beneficiaries in 2017.

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policy

The hospital-specific reports, available for download through Sept. 24, use dual eligibility as the social risk factor for stratification of readmission rates within a hospital and enable comparison of differences across hospitals.

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policy

The toolkit includes strategies and examples to help Medicaid agencies prepare for and respond to natural and man-made disasters.

view more »
policy

In its response, the association encouraged federal regulators to revisit the Stark law with an eye toward easing barriers to care coordination and reducing regulatory burden.

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policy

The Integrated Care for Kids (InCK) Model seeks to target physical and behavioral health needs through prevention, early identification, and treatment.

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policy

The letter marks the first time the Centers for Medicare & Medicaid Services has clearly described its budget neutrality calculation and represents its attempts to streamline the waiver process and control costs.

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policy

In an Aug. 16 bulletin, the agency announced it has decreased approval times for state plan amendments and Section 1915 waivers through a process improvement strategy and will continue efforts to streamline the waiver approval process.

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policy

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.

view more »
policy

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.

view more »
policy

The agency will not convene a proposed task force to reduce environmental risks associated with the care of psychiatric inpatients, opting instead to use findings from The Joint Commission special report on suicide prevention in health care settings.

view more »
policy

The confidential reports, available Aug. 24, will allow hospitals to review two disparity methods that assess performance for patients with social risk factors.

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policy

The special open-door forum aims to educate prescribers on federal resources and strategies to combat the opioid epidemic.

view more »
policy

The final rule increases Medicare inpatient payment rates to acute care hospitals by 1.85 percent, revises electronic health record requirements, and changes the payment adjustment methodology for the Hospital Readmissions Reduction Program.

view more »
policy

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.

view more »
policy

Hospitals have until Aug. 25 to preview their quality data before publication on the Hospital Compare website in October.

view more »
policy

A new proposed rule for Medicare’s Outpatient Prospective Payment System would broaden the scope of cuts to hospitals in the 340B Drug Pricing Program and to off-campus provider-based departments; it also contains provisions related to quality reporting and transparency.

view more »

The rule would make bad policies worse, impose draconian new cuts that jeopardize access to care, and undermine the foundation of the nation's health care safety net.

view more »
policy

The Centers for Medicare & Medicaid Services extended to Aug. 8 the participation agreement deadline for the Bundled Payments for Care Improvement Advanced model and announced that participants can retroactively withdraw from the program in March 2019.

view more »
policy

The project would waive Merit-based Incentive Payment System requirements for clinicians who participate in certain Medicare Advantage plans that involve taking on risk to better align such plans with fee-for-service Medicare.

view more »
policy

Merit-based Incentive Payment System participants can request a targeted review of their performance feedback and final score if they find an error in their 2019 payment adjustment calculation.

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policy

The decision strikes down the state's overall Section 1115 waiver, which included community engagement and work requirements, but it upholds as a separate waiver a portion allowing Medicaid reimbursement for substance use disorder treatment in institutions for mental disease.

view more »
policy

Several new or enhanced Centers for Medicare & Medicaid Services initiatives are designed to improve Medicaid program integrity and sustainability through greater transparency and accountability, strengthened data, and innovative analytical tools.

view more »
policy

CMS approved Oklahoma's proposal to advance Medicaid value-based arrangements with drugmakers in negotiating supplemental rebate agreements; The agency rejected Massachusetts' request to institute a closed formulary for Medicaid outpatient prescription drugs.

view more »
policy

America's Essential Hospitals urged the Centers for Medicare & Medicaid Services to implement its Medicare disproportionate share hospital payment methodology and quality measurement programs in a way that accounts for the unique needs and patient populations served by essential hospitals.

view more »
policy

A change brought by passage of the 21st Century Cures Act will ensure coverage for early and periodic screening, diagnostic, and treatment services for children under age 21 receiving inpatient psychiatric hospital services.

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policy

Medicare-eligible hospitals have until July 1 to apply for exception—and avoid a negative payment adjustment—for the 2019 payment adjustment year.

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policy

This finalized rule provides flexibility in determining episode spending for Comprehensive Care for Joint Replacement model participating hospitals affected by a major disaster, such as a hurricane or wildfire.

view more »
policy

A blog post and road map highlight the agency's approach to the crisis, including prevention of new opioid use disorder cases and use of data to target prevention and treatment.

view more »
policy

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.

view more »

The agency says postponing the July release will allow additional time to analyze the impact of changes to some measures.

view more »
policy

An informational bulletin outlines the role of Medicaid in the care of infants born with neonatal abstinence syndrome, while a letter to state Medicaid directors offers guidance on funding Medicaid technology to combat the opioid crisis.

view more »
policy

The June 19 webinar will explore the 2016 final rule on emergency preparedness requirements for Medicare- and Medicaid-participating health care providers, along with 1135 waivers.

view more »
policy

The first Medicaid and Children’s Health Insurance Program scorecard is intended to increase public transparency and accountability in the two programs.

view more »
policy

To ensure Medicaid beneficiaries' access to quality care, America's Essential Hospitals urges CMS not to issue access monitoring review exemptions to states with high managed care penetration.

view more »
policy

The dashboards, which show spending for drugs purchased in Medicaid and Medicare Parts B and D, for the first time include data on year-over-year price increases for individual drugs.

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policy

The interagency effort targets obstacles to health care, including a fragmented delivery system and lack of specialty service access, faced by many rural communities.

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policy

New Hampshire is the fourth state to receive approval to incorporate work and community engagement requirements as a condition of Medicaid eligibility.

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policy

Hospitals have until June 2 to preview their quality data before it is published on the Hospital Compare website in July.

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quality

The podcast provides updates to survey vendors, self-administering hospitals, and client hospitals participating in the national patient experience survey.

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policy

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

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policy

The refresh includes data for the Hospital Inpatient Quality Reporting, Prospective Payment System–Exempt Cancer Hospital Quality Reporting, and Hospital Outpatient Quality Reporting programs.

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policy

The plan is required by the 21st Century Cures Act and is meant to improve federal and state coordination around the enforcement of parity laws.

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policy

A new proposed rule for Medicare’s Inpatient Prospective Payment System for fiscal year 2019 would increase inpatient operating payment rates by 1.75 percent.

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policy

The new model would allow providers to contract directly with patients, rather than contracting with Medicare or private insurers; comments are due May 25.

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policy

Clinicians eligible for the Merit-based Incentive Payment System can receive Improvement Activity credit for participating in a study on quality reporting burdens; applications are due April 30.

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policy

The webinar, intended for Medicare Part A providers, will include a presentation on the new Medicare Cost Report e-Filing system followed by a question-and-answer session.

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policy

Unlike previous data releases, this version of the tool allows users to view trend lines of the available metrics and health services areas.

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cms
quality

The event, for National Minority Health Month, will discuss how the opioid crisis affects minority communities and how organizations partner to combat the crisis and improve behavioral health.

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policy

The April 18 webinar will explain the benefits of voluntary submission in calendar year 2018, share reporting resources, and answer attendee questions.

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policy

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.

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policy

The Centers for Medicare & Medicaid Services offers details on how Medicare Advantage plans might be affected by reimbursement reductions in the calendar year 2018 Outpatient Prospective Payment System final rule.

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policy

Reports by the National Academy of State Health Policy and the Medicaid and CHIP Payment and Access Commission point to new trends, including increased focus on reform, new financing mechanisms, and standardized evaluation.

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policy

A new policy brief examines Centers for Medicare & Medicaid Services guidance on work and community engagement requirements for Medicaid eligibility and outlines recently approved section 1115 waivers in Kentucky, Indiana, and Arkansas.

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policy

Hospitals have until Aug. 22 to petition the Centers for Medicare & Medicaid Services for inclusion on the list for the 2020 plan year.

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policy

A new analysis suggests specialty hospitals receive higher star ratings from the Centers for Medicare & Medicaid Services than major teaching hospitals by reporting fewer quality measures.

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policy

The proposed rule would exempt states with high Medicaid managed care penetration from Medicaid access to care guidelines; 17 states currently meet the proposal's exemption requirements. America’s Essential Hospitals is analyzing the proposed rule and will provide written comment to CMS.

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policy

A federal court in Washington, D.C., vacated a final rule requiring Medicaid disproportionate share hospital limit calculations to include Medicare and commercial insurance payments; the court explicitly issued a decision with nationwide impact.

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policy

The new resources for Medicare-eligible hospitals and critical access hospitals include details about submitting data through QualityNet and information on clinical quality measures.

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policy

Under the approved waiver, Arkansas Medicaid beneficiaries ages 19 to 49 beginning June 1 must work or participate in community engagement activities for 80 hours per month to maintain their eligibility.

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policy

The Centers for Medicare & Medicaid Services has issued a frequently asked questions document about the new voluntary bundled payment model ahead of the March 12 deadline for applications.

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policy

The Innovation Accelerator Program's March 26 webinar will focus on administrative and regulatory barriers to physical and mental health integration in the Medicaid program.

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policy

The Centers for Medicare & Medicaid Services is giving up to 10 states the opportunity to participate in the program to design, develop, and implement value-based payment approaches.

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policy

Group reporting through the Centers for Medicare & Medicaid Services web interface must be completed by March 16; all other Merit-based Incentive Payment System data must be submitted by March 31.

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policy

The Centers for Medicare & Medicaid Services is awarding $8.1 million in targeted funding to assess and potentially alter states’ essential health benefits packages.

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policy

The table identifies which alternative payment models (APMs) are designated as Advanced APMs under the Quality Payment Program or the Merit-based Incentive Payment System.

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policy

The Centers for Medicare & Medicaid Services approved Indiana's request to incorporate work requirements in their Section 1115 Medicaid expansion waiver. This is the second waiver with work requirements approved by CMS.

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policy

The new cards will have a Medicare beneficiary identifier to replace the existing health insurance claim number, which was based on the beneficiary’s Social Security number.

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policy

Hospitals have until March 2 to preview their quality data before it is published on the Hospital Compare website in April.

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webinar

Take a deep dive into the new Bundled Payment for Care Improvement (BPCI) model, “BPCI Advanced,” with experts from Premier Inc.

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policy

The agency expects to release comprehensive ligature risk interpretive guidance later this year for psychiatric units of acute-care hospitals and psychiatric hospitals.

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policy

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.

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policy