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.

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. 

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.

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

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

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.

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.

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

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

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

The 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.

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.

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.

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.

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.

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.

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.

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

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

The two rules, finalized Nov. 20, aim to eliminate barriers to care coordination and undue burden under current fraud and abuse laws. One provides exceptions to the physician anti-referral law, and one modifies existing safe harbor protections under the anti-kickback statute.

The rule builds on an International Pricing Index model CMS first outlined in an advance notice of proposed rulemaking in late 2018. The mandatory model will include most providers and suppliers who purchase and receive reimbursement for Medicare Part B drugs.

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.

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.

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.

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.

On Nov. 9, CMS issued a final rule largely adopting policies overhauled by the Obama administration in 2016. The final rule reflects the agency’s broader strategy to relieve regulatory burden, support state flexibility, and promote transparency and innovation in the delivery of care.

In 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.

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.

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.

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.

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.

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

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.

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.

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.

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.

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

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.

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.

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.

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.

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.

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.

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.

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.

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.

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

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.

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.

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.

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.

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.

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.

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.

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.

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.

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

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.

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.

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.

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

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.

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.

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.

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.

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.

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.

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. 

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.

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

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

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.

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.

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.

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

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

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.

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

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.

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.

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

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.

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

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.

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.

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.

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.

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

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.

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.

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.

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.

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.

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

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.

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.

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.

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.

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.

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

America’s Essential Hospitals encourages members to submit by Feb. 1 comments to CMS detailing the devastating impact of the MFAR’s proposed provisions and to urge House and Senate members to weigh in with the administration.

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.

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.

The proposed Medicaid Fiscal Accountability Regulation would sharply curtail flexibility states now have to finance and structure Medicaid to serve vulnerable people. Congress must step in immediately and demand that CMS withdraw this damaging rule in its entirety.

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

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.

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.

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

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.

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

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

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

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

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

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

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

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.

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.

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

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.

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

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

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.

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

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

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.

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

The final rule gives patients and their families access to information that encourages active participation in post-acute care planning and that might reduce their chances of being rehospitalized.

The 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.

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

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.

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

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.

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.

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.

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

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

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

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.

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

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

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.

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.

An Aug. 2 final rule for Medicare’s Inpatient Prospective Payment System for fiscal year 2020 will increase inpatient operating payments and Medicare disproportionate share hospital funding and make changes to electronic health records use and quality reporting programs.

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

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.

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

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

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.

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

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.

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.

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.

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.

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

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.

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.

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

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.

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.

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.

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

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

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.

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.

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.

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.

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

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.

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.

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

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.

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.

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.

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.

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.

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.

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.

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

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

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.

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.

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.

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.

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.

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.

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

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.

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

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

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

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.

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

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

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.

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.

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.

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

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

Recent policy changes have drained vital funding and threaten a financial crisis at essential hospitals. Without action by Congress, communities nationwide will lose access to care and vital support services.

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

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.

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

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.

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.

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.

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

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.

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.

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.

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

The 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.

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

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.

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

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.

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

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.

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.

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

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

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

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.

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

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.

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

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.

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.

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

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.

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.

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.

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

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.

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

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.

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

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.

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.

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

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

The 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.

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

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

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.

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.

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

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.

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.

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.

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.

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.

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.

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.

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.

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.

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

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.

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.

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.

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.

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.

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

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.

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.

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

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

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

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

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

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.

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.

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

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.

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.

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

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

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

The 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.

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.

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.

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

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.

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.

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.

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

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.

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.

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.

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.

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

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.

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.

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.

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

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

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

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

The Centers for Medicare & Medicaid Services will audit mid-build certifications this year and should complete all audits by December 2018.

The Centers for Medicare & Medicaid Services announced the community engagement initiative, often referred to as work requirements, in a Jan. 11 letter and a frequently asked questions document.

The Centers for Medicare & Medicaid Services will host an information session and a series of four webinars in the coming weeks to provide information on new opportunities for states.

The new system streamlines quality reporting through one portal; the data submission period runs from Jan. 2 to March 31.

The guidance defines courtesy discounts, defines when a bad debt is "written off," provides clarity about unpaid coinsurance and deductibles, and more.

The waiver extensions fund Texas' uncompensated care pool and delivery system reform incentive payment program and provide family planning services for low-income individuals in Mississippi for 10 years.

In response to an annual update to the Quality Payment Program, the association called for increased flexibility and risk adjustment for socioeconomic factors.

Hospital staff participating in the Medicare Electronic Health Record Incentive Program will learn how to register, attest, and submit measures using the QualityNet Secure Portal.

Hospitals serving low-income, underserved patients have until Dec. 22 to submit a petition for inclusion on the Centers for Medicare & Medicaid Services’ final 2019 essential community provider list.

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

Tax reform legislation heads to a House-Senate conference committee. Meanwhile, a bill to delay Medicaid disproportionate share hospital payment cuts could be included in year-end legislation.

The calendar year 2019 draft letter to plans offered through federally facilitated marketplaces also provides deadlines for qualified health plan certification.

The association encouraged the Centers for Medicare & Medicaid Services to ensure that state plans cover essential health benefits and include sufficient access to essential community providers.

The proposed rule increases flexibility for Medicare Advantage plans and implements the Comprehensive Addiction and Recovery Act of 2016.

The guidance specifies rate reductions in Medicaid fee-for-service that will not require access reviews by the Center for Medicare & Medicaid Services.

In response to the request for information, the association encouraged flexibility and a focus on hospitals treating high numbers of complex patients.

The new guide will help patients understand their mental and behavioral health, navigate treatment options, and find appropriate services.

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

The Centers for Medicare & Medicaid Services will review December 2017 methodology enhancements and their impact on star ratings in a Nov. 30 webinar.

The updated standards focus on collaboration between health care providers and emergency management officials in the community.

In a speech to the National Association of Medicaid Directors, Administrator Verma also announced an initiative to create scorecards for Medicaid and CHIP outcomes.

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

The Quality Payment Program combines and replaces three separate clinician quality programs with a single system for clinicians that bill Medicare Part B.

The rule includes additional cuts to new off-campus, provider-based departments (PBDs), as well as physician payment and quality program changes.

An agency bulletin instructs states on how to seek approval for state-directed payment arrangements and distinguishes directed payments from other payment models.

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

In a Nov. 2 Federal Register notice, the Centers for Medicare & Medicaid Services posted final DSH allotments for FY 2015 and preliminary allotments for FY 2017.

CMS announced a new streamlined process to encourage state innovation through demonstrations and approved new demonstrations for New Jersey and Utah.

The rule cuts 340B Drug Pricing Program payments by $1.6 billion and requires hospitals to use modifiers to identify 340B drugs in Medicare claims.

The Centers for Medicare & Medicaid Services previously had extended the revision deadline to Oct. 31, following numerous changes to the worksheet S-10.

The quality measure data update excludes Hospital Compare overall star ratings, which will refresh beginning Nov. 3.

In its comments, America’s Essential Hospitals recommended that CMS finalize the cancellation of the mandatory episode payment models, work with stakeholders to develop voluntary models, and more.

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.

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.