The five-year demonstration project, beginning Jan. 1, 2018, aims to strengthen substance use disorder care for state Medicaid beneficiaries.

The Centers for Medicare & Medicaid Services' frequently asked questions document clarifies aspects of the Mental Health and Substance Use Disorder Parity final rule for Medicaid and the Children’s Health Insurance Program.

The document explains hospital payment adjustments under the Medicare Electronic Health Record Incentive Program; adjustments are applied as a reduction to the hospital Inpatient Prospective Payment System percentage increase for FY 2018.

America's Essential Hospitals opposed the proposed payment model, which would have reduced Medicare payments to providers for Part B drugs.

Hospitals have until Oct. 31 to preview their quality data; CMS hospital-specific preview reports for overall quality star ratings will be available to hospitals in mid-October.

Hospitals use the worksheet S-10 to submit uncompensated care data to the Centers for Medicare & Medicaid Services; the agency will begin using the worksheet to calculate Medicare disproportionate share hospital payments in fiscal year 2018.

The Centers for Medicare & Medicaid Services did not receive any letters of intent for the 2018 start date of the Medicare-Medicaid accountable care organization model.

The Centers for Medicare & Medicaid Services will conduct field testing from Oct. 16 to Nov. 15 of eight episode-based cost measures for the Merit-based Incentive Payment System.

The harmful payment reduction was included in the 2018 Outpatient Prospective Payment System proposed rule, expected to be finalized this fall.

Clinicians can participate in the first year of the Merit-based Incentive Payment System and avoid a negative payment adjustment if they begin collecting data by Dec. 31.

America's Essential Hospitals was among those urging the agency to suspend overall star ratings and examine concerns with the methodology.

CMS is seeking broad feedback on a new direction for the Centers for Medicare & Medicaid Innovation, with increased emphasis on patient-centered care and market-based reforms.

Affected providers will be exempt from reporting provisions of the Medicare Hospital Outpatient Quality Reporting Program, Hospital Inpatient Quality Reporting Program, and Ambulatory Surgical Center Quality Reporting Program.

A push is underway on Capitol Hill to delay Medicaid disproportionate share hospital cuts and withdraw proposed 340B policy. Please urge your member of Congress to sign both letters.

The proposed rule would further cut payments to non-excepted provider-based departments to 25 percent of the Medicare Outpatient Prospective Payment System rate and change certain quality reporting requirements.

The Centers for Medicare & Medicaid Services, the Centers for Disease Control and Prevention, and other federal agencies have released several resources to help health care providers prepare for and respond to disasters.

The online course provides an overview of disaster preparedness and skills to gauge compliance with emergency preparedness requirements that go into effect on Nov. 15.

By cutting reimbursement rates for Part B drugs to 340B hospitals, the Centers for Medicare & Medicaid Services would harm essential hospitals, which care for the nation’s poorest, most complex, and costliest patients.

The Centers for Medicare & Medicaid Services is granting exceptions under certain Medicare quality reporting and value-based purchasing programs to hospitals and health care facilities in Federal Emergency Management Agency–designated major disaster counties.

The changes include optimizing the assignment of star categories, eliminating the removal of outliers, and ensuring only hospitals meeting public reporting thresholds are assigned star ratings.

The proposed reductions are set to take effect Oct. 1; the association recommended the Centers for Medicare & Medicaid Services protect state disproportionate share hospital payment allotments from total elimination, among other suggestions.

In response to a proposed annual update to the Quality Payment Program, America’s Essential Hospitals offered recommendations related to the merit-based incentive payment system.

The newly released set of frequently asked questions relates to potential payment issues for Medicaid managed care patients in institutions for mental disease.

The first performance year was set to begin Jan. 1, 2018; America’s Essential Hospitals previously expressed concern about the scope and pace of the models.

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

The decision extends by five years the state's demonstration of a capitated Medicaid managed care program and a low-income pool to provide support for the safety net.

The announcement to allow revisions to fiscal year (FY) 2014 worksheets is important because the agency will use FY 2014 data to calculate FY 2018 Medicare disproportionate share hospital compensation.

The Hospital Compare refresh includes data on new measures; hospitals can preview their overall star ratings through Aug. 13.

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

A publicly released set of slides describes dramatic restrictions to CMS' budget neutrality policy for Section 1115 waivers.

The Centers for Medicare & Medicaid Services will allow hospitals to submit revisions to Worksheet S-10 of their Medicare cost report for fiscal year 2015 by Sept. 30.

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

Aids provided by the Centers for Medicare & Medicaid Services include fact sheets and overview documents, lists of alternative payment models, webinars and other educational tools, and support contacts.

The proposed rule would increase outpatient payment rates by 1.75 percent and drastically reduce Medicare Part B reimbursement for drugs purchased through the 340B Drug Pricing Program.

Courts in Minnesota, Tennessee, and Virginia have ruled in favor of hospitals challenging the Center for Medicare & Medicaid Services' inclusion of Medicare and commercial payments in the calculation of disproportionate-share hospital payment limits.

This is the second Section 1332 State Innovation Waiver to receive approval; Alaska is pursuing the waiver to stabilize the state's individual health care market.

In the bulletin on the Medicaid managed care final rule, the Centers for Medicare & Medicaid Services said it will use enforcement discretion based on state-specific facts.

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

CMS proposes changes related to participation in the merit-based incentive payment system or Advanced Alternative Payment Models tracks.

New Medicare cards will include a randomly generated Medicare beneficiary identifier instead of the Social Security-based health insurance claim number.

The fact sheet gives a general overview of the Medicare Shared Savings Program and Quality Payment Program and explains how the programs work together.

America’s Essential Hospitals encourages CMS to improve transparency, risk adjust, and reduce regulatory burden for essential hospitals.

CMS aims to eliminate or change outdated, costly, or inconsistent regulations for marketplaces established under the Affordable Care Act.

The webinar on June 28 will focus on the Medicaid Innovation Accelerator Program's Reducing Substance Use Disorders program area.

States have until June 12 to complete an expression of interest form for the Medicaid Innovation Accelerator Program track.

The Vital Signs report notes ways to prevent the bacterial lung infection, which is fatal in 25 percent of people who contract it at a health care facility.

The deadline for Medicare- and Medicaid-providers and suppliers to meet applicable requirements of the rule, including training and testing, is Nov. 15.

Overall star ratings now will be released in October because of issues with data on three measures; hospitals can preview the ratings in July.

CMS predicts nearly all clinicians in advanced alternative payment models in 2016 would qualify for a 2019 incentive payment for participating in 2017.

A new Centers for Medicare & Medicaid Services guide highlights technical resources for clinicians participating in the Quality Payment Program under MACRA.

The nine-month program will link up to eight state Medicaid agencies with local housing systems to aid Medicaid beneficiaries.

The first performance year for new cardiac episode payment models and the effective date of joint replacement regulation amendments now starts Jan. 1, 2018.

The new checklist tool helps states compile the necessary documents to apply to waive ACA provisions and pursue alternative reforms.

Clinicians enter their national provider identifier into the tool to determine whether they must submit data to the merit-based incentive payment system.

The update for the 2018 performance year aligns electronic clinical quality measure specifications with current clinical guidelines and code systems.

A vote on the bipartisan bill could come Wednesday in the House, followed by Senate consideration before continuing resolution appropriations expire Friday.

CMS updated the Hospital Compare website with new data, including health care–associated infections and HCAHPS survey data.

America’s Essential Hospitals expressed support of the delay of episode payment models to allow selected hospitals more time to prepare for participation.

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

The rule contains provisions on the Hospital Readmissions Reduction Program, Medicare DSH, the Inpatient Quality Reporting program, and more.

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

Over a five-year period, CMS will test the three-track AHC model, which aims to support health-related social needs of Medicare and Medicaid beneficiaries.

Hospitals have until May 5 to review overall Hospital Compare star rating and until May 10 to review value-based purchasing hospital-specific reports.

CMS finalizes the agency's interpretation that, in determining hospital-specific DSH payment limits, the total costs of care for Medicaid inpatient and outpatient services must account for all third-party payments.

The delay, which applies to certain hospital outreach labs, comes after stakeholders expressed concerns about the March 31, 2017, deadline.

The webinar and listening session, on April 4 and 5, will focus on MIPS' advancing care information performance category and cost measure development.

The deadline for meeting all applicable requirements of the rule is Nov. 15; CMS will host a provider conference call on April 27 to review the rule.

The rule affects the Advancing Care Through Episode Payment Models, the Cardiac Rehabilitation Payment model, and changes to the CJR model.

Health care professionals who provide chronic care management services often are not aware they are eligible for separate payments under Medicare Part B.

The letter affirms their desire to improve the Medicaid program and the vulnerable people it serves and to ensure the program provides value to taxpayers.

The FAQs outline how hospitals should complete the form's free-text field and clarify that the form must be issued to Medicare Advantage enrollees.

America’s Essential Hospitals expressed concerns about proposed changes that could harm the integrity of qualified health plan networks.

A series of forums will provide information on the Next Generation ACO Model; a separate CMS webinar will outline the Medicare ACO Track 1+ Model.

The March 22 webinar will outline the agencies' roles in the expansion of the program model, next steps for organization considering offering it & more.

Draft GOP text for legislation to repeal and replace the ACA leaks; a Senate committee is poised to vote on the administration's CMS administrator nominee.

In a request for information, CMS seeks input on how to improve the quality and reduce the cost of care for children enrolled in Medicaid and CHIP.

Hospitals will be required to provide the form and accompanying instructions to applicable Medicare patients starting March 8.

CMS has pushed back by seven weeks, to June 21, the deadline for qualified health plans to apply to participate in the ACA health insurance marketplaces in 2018.

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

The delay is in accordance with a “regulatory freeze” set forth in a recent White House memorandum.

CMS has extended the deadline for submitting certain hospital quality data after receiving reports of system issues and inaccessibility with QualityNet.

Former Rep. Tom Price was confirmed as secretary of HHS; the Senate Committee on Finance will consider the nomination of Seema Verma as CMS administrator.

Eligible hospitals and professionals now have until March 13 to attest to the Medicare Electronic Health Record (EHR) Incentive Program.

The new guidance outlines how and when hospitals must deliver the notice, retention requirements, and how the notices intersect with state laws.

The 60-minute webinar on new episode payment models for cardiac care and surgical treatment for hip and femur fractures will begin at noon ET on Feb. 9.

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

Hospitals now have until March 13 — instead of Feb. 28 — to submit electronic clinical quality measure data from 2016 to CMS.

Along with renewing ACOs, the 99 new organizations bring the total number of ACOs nationally to 480 in 2017.

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

The new Center for Medicare and Medicaid Innovation model aims to boost participation from small rural hospitals and other smaller health care practices.

Hawaii is the first state to receive approval for a Section 1332 waiver, and will be allowed to close its Small Business Health Options Program for five years.

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

The changes, which reflect stakeholder feedback and the large volume of changes to ICD-10 in FY 2017, will be available on the National Library of Medicine’s Value Set Authority Center this month.

New guidance describes how off-campus hospital provider-based departments can maintain their grandfathered status when relocating due to extraordinary circumstances.

These new EPMs and the updated CJR model will give clinicians more opportunities to earn incentive payments through advanced alternative payment models.

Of particular interest to essential hospitals, CMS revised the Worksheet S-10, which hospitals use to report uncompensated care data.

A CMS spokesperson said the project was pulled after the agency reviewed public comments — there were more than 1,300 comments submitted, mostly negative.

CMS will partner with up to six states on the new Medicare-Medicaid ACO Model, which was designed by the CMS Innovation Center.

The BBA’s “site neutral” policy creates serious, unintended consequences for vulnerable people, and CMS rules do not provide enough flexibility.

All hospitals and critical access hospitals will be required to provide the MOON to applicable patients beginning March 8, 2017.

Hospitals can request an exemption from the electronic clinical quality measure reporting requirement in the Hospital Inpatient Quality Reporting Program.

The CMS FAQ answers questions about new regulatory requirements to ensure health care facilities are ready for disasters and public health emergencies.

America's Essential Hospitals expressed continued concerns about qualified health plan network adequacy in federally facilitated marketplaces.

Rep. Tom Price has been nominated to head HHS and Seema Verma, who graduated from the association's Fellows Program in 2001, has been nominated to lead CMS.

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

The agency released software that will help developers build applications for clinicians and their practices and make it easier for organizations to retrieve and maintain QPP measures using the Explore Measures section of the QPP website.

The FAQ provides clarification on managed care contracts, rating periods, and external quality reviews, among other things.

These long-term HCBS services and supports are critical to ensure people can remain in their homes and communities as they receive treatment.

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

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

In the rule, CMS revised its earlier position not to direct any physician fee schedule payments to non-grandfathered, off-campus hospital clinics in 2017 and, instead, established a 50 percent interim rate.

With the opportunities, clinicians potentially could earn a 5 percent incentive payment for a growing list of alternative payment models in 2017 and 2018.

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

The rule establishes a "transition year," as well as flexibility for providers to choose their participation pace.

CMS says it miscalculated some hospitals' uncompensated care share and provided the incorrect wage index reclassification status of four hospitals.

CMS will use social video platform Twitch, improve the HealthCare.gov mobile interface, and use #HealthyAdulting to encourage young adults to sign up.

The Medicare Access and CHIP Reauthorization Act of 2015 requires CMS to remove Social Security numbers from beneficiaries’ Medicare cards by April 2019.

The webinar will focus on the Advancing Care Coordination through Episode Payment Models proposed rule.

A new policy brief by America's Essential Hospitals notes that managed care pathways might be a potential complement, or alternative, to waiver-based delivery system reform.

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

While details are still being finalized, a continuing resolution to fund the government through early December likely will include funding to combat Zika.

The Accountable Health Communities Model aims to close a gap in the health care delivery system between clinical care and community services.

The grants to support marketplace navigators come as exchanges gear up for the Nov. 1 start of open enrollment for coverage beginning in 2017.

In a FAQ document, CMS states that the required JW modifier and patient documentation policy applies to separately payable Part B drugs.

CMS is concerned that some providers might steer Medicare- and Medicaid-eligible patients into individual market plans to get higher payments.

Review contractors will be able to use coding specificity as the reason for an audit or a denial of a claim to the extent that they did before Oct. 1, 2015.

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

The rule includes the annual payment update to inpatient payment rates and changes to the Medicare disproportionate share hospital payment methodology.

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

CMS will issue future rulemaking to further restrict new or increased pass-through payments under Medicaid managed care plan contracts.

The release comes after America’s Essential Hospitals and other hospital groups urged CMS to delay the ratings due to serious concerns with the methodology.

Under the models, hospitals would be financially accountable beginning July 1, 2017, for meeting quality and cost measures for the entire episode of care.

The actions build on the National Pain Strategy, a federally coordinated plan for reducing and better treating chronic pain.

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

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

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

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

The agency says the proposed changes are intended to reduce a backlog of Medicare payment and coverage determination appeals.

The new CMS rate development guide outlines various provisions of the recent Medicaid managed care final rule that affect the rate-setting process.

This year’s release includes some changes in both the information released and its classification.

Failure to follow the public notice and process for Medicaid payment changes can result in delay or disapproval of state plan amendments.

The Senate rejected a $1.1 billion Zika funding package, and Patrick Conway, with CMS, testified about the proposed Medicare Part B demonstration project.

By forming strategic partnerships and using social media, CMS aims to “reach young adults where they are” to facilitate engagement during open enrollment.

Providers have until July 1 to apply for a hardship exception to avoid a penalty for the Medicare EHR Incentive Program.

CMS has delayed the effective date of a new claims coding and patient documentation policy for unused Medicare Part B drugs from July 1 to Jan. 1, 2017.

CMS has released a no-cost resource to help patients access care after signing up for coverage on the health insurance marketplaces.

Delay of patient status reviews will continue until further notice. The agency will work with Quality Improvement Organizations to ensure the two-midnight policy is enforced consistently for all hospitals.

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

The new provisions include updated sprinkler requirements and increased flexibility to allow for facility modernization. Hospitals and other health care facilities must comply with the regulations by July 3.

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

The rule maintains a prohibition against direct payments by states to providers for services delivered under managed care contracts and explicitly prohibits states from directing plan expenditures.

The proposal would reverse the cut starting in FY 2017, in addition to a temporary adjustment to retroactively pay for reduced payments from fiscal years 2014 to 2016.

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

Changes will more accurately reflect cost of care for dual eligibles and adjust Medicare Advantage star ratings for enrollees' socioeconomic and disability statuses.

States now have until Oct. 1 to submit plans. Agency continues to omit hospital services from the list of core services subject to review.

In letter to CMS, association raises issues of payment, definition of off-campus outpatient department of a provider, and 340B eligibility.

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

Proposed Medicaid managed care regulations effectively would end supplemental payments that have been in effect for at least a generation to many essential hospitals.

HHS finalizes 2017 Notice of Payment and Benefit Parameters rule and letter to issuers offering qualified health plans on the federally facilitated marketplace.

Hospitals, providers can claim exclusions for public health meaningful use measures to avoid inadvertent penalties from the 2015 EHR Incentive Program final rule.

Final rule and implementation as described in the guidance could significantly reduce Medicaid payments for 340B-covered outpatient drugs in some states.

Agency's decision to extend deadline to July 1 gives eligible hospitals an additional three months to file for an exception.

Eligible hospitals now have until March 11 to show meaningful use of EHR technology or face a Medicare payment adjustment in 2017.

Providers now must report and return a Medicare Part A or B overpayment to CMS by the later date of 60 days since identification or the corresponding cost report due date. The final rule also establishes a six-year lookback period.

The new FAQ clarify that site neutral law won't impact PO modifier requirements. PO modifiers must be included on claims as of Jan. 1 for all services and items furnished in off-campus, provider-based departments.

New, streamlined process requires less information from hospitals for application; deadline to apply is April 1.

CMS now able to grant categorical exceptions to essential providers and hospitals that did not meet 2015 requirements; hospital applications due April 1.

America's Essential Hospitals urges CMS to include hospital services among those subject to triennial state reviews to determine whether payments ensure adequate access.

Agency to give hospitals opportunity to comment on law's requirements for notifying Medicare beneficiaries when outpatient observation services last longer than 24 hours.

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

CMS website includes information on changes to Medicare and Medicaid EHR Incentive Programs in recent final rule.

Court-ordered justification provides additional insight for 0.2 percent inpatient payment rates cut agency linked to policy

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

Fourth cycle of grants through the Connecting Kids to Coverage program supports work to link eligible children with Medicaid, CHIP coverage; proposals due Jan. 20, 2016.

In three FAQs, agency provides guidance on how to attest to health information exchange and patient electronic access measures, as well as objectives that require patient action.

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

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

Tool gives physicians, nurses, and other health care professionals access to geographic comparisons of opioid prescribing habits and use.

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

Federal grants to 24 states will promote better integration of behavioral health and primary care services and improve quality and data reporting systems. The grants are the first phase of a Section 223 Demonstration Program for Certified Community Behavioral Health Clinics.

Feedback due Nov. 17 on provisions to implement MIPS and APM participation incentives; MIPS quality measures of particular interest to hospitals

Just added: CMS contacts for provider questions. Explore fact sheets, videos, other information available to help ease Oct. 1 transition to new coding system

Updates cover exclusions for submitting electronic immunization data and applicability of submitting summary of care documents for transferring patients.

Recent narrowing of provider networks in Medicare Advantage (MA) organizations, which privately offer one or more health benefit plans to Medicare beneficiaries, has caused concerns over whether MA enrollees can adequately access care.

The CMS Equity Plan aims to reduce disparities in health care over the next four years for populations including racial and ethnic minorities, sexual and gender minorities, people with disabilities, and people living in rural areas.

In comments on the CY 2016 OPPS proposed rule, the association calls on CMS to consider the unique challenges of caring for the most vulnerable, including in relation to the two-midnight policy and ambulatory payment classification.

Agency resource, in preparation for Oct. 1 transition to ICD-10, can help providers determine how to accurately report codes.

Updated guidance clarifies what codes will be accepted by CMS during one-year grace period, including examples of a code family.

Plans must be budget-neutral and cover as many people as traditional ACA reforms. With these waivers, states may forgo certain ACA provisions including the marketplaces and individual mandate.

Agency says that for one year it will not deny inaccurate claims as long as the code listed is from the correct code family.

In comments to CMS, America's Essential Hospitals also urged the agency to finalize a 90-day reporting period for all providers in 2015 and lower the threshold of the patient electronic access measure.

In comments on the agency’s proposals for stage 3 of the EHR Incentive Programs, the association called on CMS to delay finalizing the proposed rule and to provide much-needed flexibility for providers in the program.

The funding opportunity will support navigators for up to three years in federally facilitated and state partnership health insurance marketplaces.

CMS proposes to extend an enhanced matching rate to states to help modernize and update their Medicaid eligibility and enrollment systems.

The Oncology Care Model is a multipayer payment and care delivery model designed to encourage high quality cancer care.

A district court has granted a preliminary injunction restricting HHS and CMS from altering the hospital-specific DSH limit without following notice-and-comment procedures.

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

Applications are due by Jan. 6, 2015.

The association advocates for a modification of the direct pay prohibition to allow states to pursue public policy goals while implementing Medicaid Managed Care

Hospitals will be chosen for pre and postpayment audits at random or through a risk profile. CMS encourages hospitals to keep data for six years.

OIG finds state standards for access to care for Medicaid managed care beneficiaries vary widely. OIG recommends stronger CMS oversight and more state accountability.

Hear members of our policy team discuss the association's recently released brief on innovative alternative payment models. These models focus on ways to replace or augment existing fee-for-service and managed care models, while also increasing efficiency, coordination, and quality of care.

Hospitals willing to resolve pending appeals will receive a timely, partial payment equal to 68 percent of the net payable amount. Provider call scheduled for Sept. 9.

Data collection for a chart-abstracted sepsis measure is delayed until further notice based on an NQF recommendation.

CMS is compiling three TEPs to provide technical input to CMS contractors on the development, selection, and maintenance of quality measures. Nominations are due Sept. 12 and Sept. 19.

Models should use evidence-based social and behavioral insights to increase engagement in health outcomes for Medicare beneficiaries, Medicaid beneficiaries, dual-eligible patients, and/or Children’s Health Insurance Program (CHIP) beneficiaries.

GAO released a report recommending that CMS increase oversight of the Medicare claims review process and release additional guidance for contractors to increase efficiency and reduce duplicative claim reviews.

The House and Senate head into August recess after voting to clear a VA assistance bill, sending it to the president on Friday. The Senate couldn't pass border emergency supplemental legislation, while the House passed a less expensive version. CMS faced tough criticism from Republicans about HealthCare.gov contractors.

CMS issued a final rule establishing Oct. 1, 2015 as the transition date to International Classification of Diseases, 10th Edition (ICD-10) diagnosis and procedure codes. The Protecting Access to Medicare Act of 2014 required at least a one-year delay of this transition date, previously set for Oct. 1, 2014.

The guidance could subject certain assessments on Medicaid managed care organizations to provider tax rules. CMS will allow a state until the end of its next regular legislative session to make changes that comply with the guidance.

CMS awarded contracts to 14 organizations as part of the restructuring of the Quality Improvement Organization (QIO) Program. These organizations will work with providers to increase quality of care.

Thirteen states received letters stating that enrollment and eligibility issues must be addressed.

CMS seeks perspectives on strengths and weaknesses of the program and processes surrounding data accuracy.

CMS outlines three methods for reviewing enrollee coverage eligibility for insurance purchased through the federally facilitated marketplace.

GAO released a report on the integrity of Medicaid managed care programs, detailing recommendations for CMS. The report identified potential gaps and duplication of program integrity efforts and listed recommendations, including additional oversight.

HHS announced recipients of Health Care Innovation Awards and a call for applications for the State Innovation Models Initiative. These programs were created through the Affordable Care Act to give stakeholders and states tools and flexibility to transform health care delivery system models.

CMS finalized its proposal to rescind the requirement that a hospital's governing body include a member of the medical staff and revised its position that each hospital, including those in a multihospital system, have a separate and distinct medical staff. America's Essential Hospitals urged CMS to take both of these actions.

America’s Essential Hospitals would like to hear from its members on their experiences and difficulties with stages 1 and 2 so that we can convey any concerns to CMS and the HIT Policy Committee as they finalize stage 3 recommendations.

CMS will release an interim final rule requiring the use of ICD-10 beginning Oct. 1, 2015. The rule will require the continued use of ICD-9, Clinical Modification, through Sept. 30, 2015. The Protecting Access to Medicare Act of 2014 forbade CMS from adopting ICD-10 prior to Oct. 1, 2015, which is one year after CMS originally planned to implement it.

CMS released the final rule with comment period regarding the new Medicare FQHC prospective payment system. The payment system could increase Medicare payments to FQHCs by as much as 32 percent.

It provides information to help states prepare for the end of the transition period established in 2008. CMS specifically outlines the requirements independent auditors must follow when conducting annual DSH audits, as well as information to help states calculate uncompensated care costs.

CMS is allowing consumers to enroll in the federally facilitated marketplace under a special enrollment period if they experienced life changes, exceptional circumstances, or technical problems with healthcare.gov. Coverage will be effective for 2014. HHS reported that 7.1 million people enrolled in health insurance through the marketplaces before the March 31 open enrollment deadline.

A new FAQ is available on the patient electronic access objective. Updated FAQs provide information on the summary of care objective and AIU attestation.

Providers interested in participating in an ACO through the MSSP must submit a notice of intent to CMS by May 30 and a final application to CMS by July 31.

This week the longest serving member of Congress, Rep. John Dingell, announced he will retire. Dingell served for 29 terms and through 11 different presidents. The House Energy and Commerce Committee will look at the changes CMS is making to Medicare Part D, and House Majority Leader Eric Cantor announced that the chamber would vote on the ACA's 30-hour work week definition.

Inpatient population and sampling data for chart-abstracted quality measures for the third quarter of 2013 (discharges from July 1 through Sept. 30, 2013) will be due Feb. 8 for the IQR Program. Outpatient population and sampling data and outpatient chart-abstracted measures will be due Feb. 8 for the OQR Program.

The Centers for Medicare & Medicaid Services (CMS) hosted today a follow-up Special Open Door Forum on the two-midnight policy. The call discussed physician order and physician certification, inpatient hospital admission, and medical review criteria.

Bill would fund the government through fiscal year 2014

ACOs allow hospitals, health care providers to improve quality, slow cost growth through coordinated care while sharing in savings

Codes provide data that help improve care, can be exchanged with health care systems across the world

The report found that all states varied Medicaid provider payment rates for some services

The new office will take over several functions of the abolished Office of Public Engagement

Letter underscores necessity for more time for CMS to assess policy's impact on patients, hospitals

Call will cover inpatient hospital admission, medical review criteria and offer case scenarios

Fact sheets, database available through healthcare.gov

Rule proposes national emergency preparedness requirements for health care facilities

Will provide high-quality, coordinated care to about 1.5 million Medicare beneficiaries

MACPAC commissioners voted to increase standardization and transparency around UPL payments.

Hospitals will have through FY 2016 to meet Stage 2 requirements

States expanding their Medicaid programs saw a 15.5 percent increase in applications

The rule replaces outpatient visit codes with a single code describing all clinic visits

The rule reduces Medicare rates by 20.1 percent

Revised policy presumes inpatient admissions fewer than two midnights are inappropriate for inpatient reimbursement

Standards, implementation specifications, and certification criteria for stage 1

The final rule modifies stage 1 meaningful use criteria for hospitals and eligible professionals

The ONC policy committee requested comments regarding stage 3 Meaningful Use criteria

The CoP set standards for health and safety, aim to improve health care quality and the safety of beneficiaries

The Affordable Care Act expanded the RAC program to Medicaid

This rule clarifies several provisions related to the cost limit for public providers

Expressed concern that several provisions could challenge the ability of FQHCs to integrate care and address patient needs

Congress holds healthcare.gov hearings, planned vote on "Keep Your Health Plan" Act

Guidance extends the existing enforcement delay by three months

Hospitals were urged to attest that they have meaningfully used certified EHR technology

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

Offered direction on how to select hospital claims during inpatient probe and educate program

Senate Democrats pressured Obama administration to fix healthcare.gov, SGR agreement gained support

Congress holds healthcare.gov hearings, committee met on budget agreement

The final rule was delayed due to the partial government shutdown

The rule finalizes a number of provisions regarding health insurance marketplaces

Guidance focuses on CAC organizations in federally facilitated marketplaces

Rule establishes presumption of medical need for Medicare hospital inpatient admissions that span two midnights

Cited concerns that hospitals may be undercompensated for providing necessary services that do not meet new criteria

Proposed rule establishes framework for several program elements

House abandoned plans to vote on a bill to extend the continuing resolution

Rule outlines CMS' methodology for annual reductions to DSH payments

Suggests CMS convene hospital industry work group to better understand off-campus outpatient care

Talk focused on insurance coverage expansion activities and impact on essential hospitals

Office urges action to ensure contractors identify, report improper payments and potential fraud

Documents provide answers on coverage and enrollment

Agency provides methodological considerations, questions for states to address in program proposals

Report evaluates differences among four types of postpayment review contractors CMS uses

Programs will replace payment error rate measurement reviews, eligibility quality control program

Extension applies to data submitted to Medicare inpatient quality reporting program

Will take comment on physician order and certification, medical review criteria, and other issues

Tool uses 2011 Medicare cost data aggregated by demographic, spending, utilization, quality indicators

Effort will seek to increase understanding of low-income and minority populations’ experiences with exchanges

Document, released as frequently asked questions, indicates exchanges will use tax filings and Social Security data

Hospital inpatient quality reporting program intended to provide consumers with quality of care information

Rule finalizes several inpatient prospective payment system provisions

Rule also finalizes use of Medicaid and low-income Medicare inpatient days as uncompensated care proxy

Responds to CMS concern that Medicare and beneficiaries might pay more for outpatient care

Hospitals may review and request correction of performance scores

Document explores care delivery and payment models that help states care for challenging patients

CMS says all 32 pioneer ACOs improved quality, performed better than published rates in fee-for-service Medicare

Rule proposes several outpatient prospective payment system provisions

Agency seeks to understand type and frequency of, and payment for, services furnished in off-campus outpatient departments

Association urges CMS to accurately capture uncompensated care data to implement Medicare DSH cuts

Will support demonstration ombudsman programs to provide Medicare-Medicaid enrollees with more person-centered, coordinated care

Agency accepts applications for Model 1 bundled payment initiative

Calculation will determine reduction to each state's DSH allotment for FYs 2014 and 2015

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

Rule includes proposed formula to make Medicare DSH reductions under ACA

Rule proposes several inpatient prospective payment system provisions

Letter offers issuers operational and technical guidance on how to successfully participate

Association summary of rules, guidance

Agency also releases FAQ on state-supplied premium assistance option

Letter to state Medicaid directors details federal-state efforts to strengthen program integrity

Lawmakers turn back governor's plan to accept expansion for three years

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

Document addresses questions about federal medical assistance percentages

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

Urges CMS to keep nation's safety net in mind as agency fine tunes marketplace framework