Qualified individuals and their families who lose Medicaid or CHIP eligibility once the continuous enrollment requirement ends can apply for marketplace coverage between March 31, 2023, and July 31, 2024.
view more »New Requirements for Managed Care Coverage of In Lieu of Services
Jan. 13, 2023 ||A CMS letter to state Medicaid directors clarifies how in lieu of services (ILOS) can be used to mitigate health disparities, limits ILOS expenditures, and adopts documentation and review requirements.
view more »CMS Awards 200 New Residency Slots to Strengthen Workforce
Jan. 12, 2023 ||Prioritizing hospitals in health professional shortage areas, CMS awarded residency slots to 100 hospitals, including 27 essential hospitals.
view more »CMS Updates Key Dates for Medicaid Redeterminations
Jan. 10, 2023 ||After the omnibus bill decoupled Medicaid redeterminations from the end of the COVID-19 public health emergency, CMS updates key redetermination dates.
view more »Medicaid and CHIP coverage of interprofessional consultation is permissible as long as the consultation is for the beneficiary's direct benefit.
view more »Million Hearts Initiative to Host Webinars on Climate Change and Cardiovascular Health
Jan. 4, 2023 ||Registration is open now for the two Climate Change and Cardiovascular Disease Collaborative webinars on Jan. 12, at noon ET, and Feb. 9, at noon ET.
view more »CMS Report on Access to Coverage and Care in Medicaid and CHIP
Jan. 3, 2023 ||The report summarizes responses to a 2022 request for information, which focus on eligibility and enrollment, access to hospital services, and payment.
view more »CMS Proposes 2024 Notice of Benefit and Payment Parameters
Dec. 21, 2022 ||The proposed rule updates essential community provider requirements for qualified health plans and adds a special enrollment period for those disenrolled from Medicaid or CHIP.
view more »CMS Proposes Rule to Streamline Prior Authorization
Dec. 13, 2022 ||The proposed rule leverages application programming interfaces to exchange health information and automate the provider prior authorization process.
view more »The agency will not enforce a surprise billing requirement that requires good faith estimates to include cost estimates from co-providers and co-facilities.
view more »CMS Releases Hospital Workplace Violence Memo
Nov. 29, 2022 ||The memo reviews regulatory obligations to care for patients in a safe environment, including the need to identify patients at risk for intentional harm to themselves or others.
view more »New CMS Resources for Hospital Price Transparency Requirements
Nov. 18, 2022 ||The agency shared three sample formats to help hospital staff build machine readable files to comply with the Hospital Price Transparency Rule.
view more »CMS Innovation Center Shares Progress Report, Specialty Care Plans
Nov. 10, 2022 ||The CMS Innovation Center shares a progress report on its 10-year strategy and a blog post announcing plans to improve integrated specialty care.
view more »Association Comments on Proposed Updates to Medicaid Eligibility, Enrollment Policies
Nov. 8, 2022 ||The association urges CMS to educate and provide funding for essential hospital staff to conduct Medicaid and CHIP eligibility and enrollment activities.
view more »CY 2023 OPPS Final Rule Reverses 340B Cuts
Nov. 4, 2022 ||The Medicare Outpatient Prospective Payment System final rule for calendar year 2023 reverses cuts to hospitals in the 340B Drug Pricing Program and delays developing a remedy for cuts to 340B hospitals that have been in place since 2018.
view more »CMS Issues CY 2023 Physician Fee Schedule Final Rule
Nov. 4, 2022 ||The rule finalizes the conversion factor and includes reimbursement provisions for telehealth and behavioral health services, the Quality Payment Program, and the Medicare Shared Savings Program.
view more »COVID-19: Administration Launches Updated Vaccine Outreach
Nov. 1, 2022 ||President Joe Biden urges Americans to get their updated COVID-19 vaccine, which protects against the original SARS-CoV-2 variant and BA.4 and BA.5 subvariants.
view more »Currently, 26 states have extended Medicaid and Children's Health Insurance Program coverage from 60 days to 12 months postpartum.
view more »COVID-19: CDC Recommends Immunization Schedule Update, Administration Launches Biodefense Strategy
Oct. 25, 2022 ||A CDC committee recommends the inclusion of COVID-19 vaccines in the 2023 immunization schedule; the administration releases a biodefense strategy.
view more »CMS Extends Arizona Section 1115 Waiver with Housing Focus
Oct. 25, 2022 ||The waiver provides temporary housing to Medicaid beneficiaries experiencing or at risk of homelessness who have a significant health need or are enrolled in long-term care.
view more »CMS to Pay 340B Hospitals at Full OPPS Rate for Remainder of 2022
Oct. 17, 2022 ||The decision to revert to the full payment rate is in compliance with a recent federal district court decision in favor of America’s Essential Hospitals.
view more »CMS Extends Two Section 1115 Waivers
Oct. 17, 2022 ||Section 1115 waivers in Massachusetts and Oregon aim to test improvements in coverage, access, and quality and target unmet health-related social needs.
view more »CMS Extends, Changes Bundled Payments Model
Oct. 17, 2022 ||CMS extends for two years the Bundled Payments for Care Improvement Advanced Model and alters the accounting process for beneficiaries with COVID-19.
view more »Association Comments on CY 2023 OPPS Proposed Rule
Sept. 20, 2022 ||America's Essential Hospitals urges CMS to swiftly restore full Medicare Part B drug payment rates for hospitals in the 340B Drug Pricing Program and define a select group of hospitals with a safety net mission.
view more »COVID-19: Biden Administration Announces Fall Strategy
Sept. 13, 2022 ||The Biden administration's fall plan to manage the COVID-19 pandemic includes securing millions of updated vaccines and additional at-home, rapid tests; ensuring vaccine access for higher-risk Americans; and fostering community conversations about updated vaccines.
view more »CMS Seeks Input on Health Equity, Program Efficiency
Sept. 12, 2022 ||The agency requests information on health care access and equity, provider experiences, and the effect of policies introduced in response to COVID-19.
view more »Association Comments on CY 2023 Physician Fee Schedule Proposed Rule
Sept. 12, 2022 ||The association urged CMS to adequately reimburse off-campus, provider-based departments; refine physician quality reporting; and codify a definition of essential hospitals.
view more »Proposed Rule Streamlines Medicaid, CHIP Enrollment
Sept. 1, 2022 ||An Aug. 31 CMS proposed rule aims to streamline Medicaid and CHIP enrollment and ensure continuous coverage throughout the renewal process.
view more »CMS Delays Indefinitely Radiation Oncology Model
Aug. 30, 2022 ||CMS on Aug. 29 finalized its decision to delay indefinitely implementation of the Radiation Oncology Model, which was scheduled to start Jan. 1, 2023.
view more »Pfizer applies for emergency use authorization for its omicron-specific booster vaccine, the National Healthcare Safety Network will take over hospital data reporting, and CMS tells hospitals to brace for the public health emergency's end.
view more »Administration Publishes No Surprises Act Final Rule
Aug. 23, 2022 ||The rule finalizes disclosure requirements for the qualifying payment amount and select provisions for the related independent dispute resolution process.
view more »The rule from the Centers for Medicare & Medicaid Services includes numerous policy and payment changes important to essential hospitals, including a 4.3 percent increase in inpatient payment rates for fiscal year 2023.
view more »Care Compare October 2022 Preview Reports Available
Aug. 8, 2022 ||Health care providers have until Aug. 30 to download their preview reports before CMS shares quality data publicly in October.
view more »CMS Releases July 2022 Overall Hospital Star Ratings
Aug. 2, 2022 ||This is the second star ratings update since the agency updated its methodology in 2020 to include the use of peer grouping.
view more »CMS to Hold Listening Session on End of APM Incentive Payments
July 19, 2022 ||CMS seeks feedback at a July 21 listening session on the 5 percent lump sum Alternative Payment Model Incentive Payment, set to expire at the end of 2022.
view more »FDA approves the Novavax COVID-19 vaccine for those 18 and older as the Biden-Harris administration releases an action plan to take on the BA.5 subvariant.
view more »CMS Issues CY 2023 OPPS Proposed Rule, Plans to Reverse 340B Cuts
July 19, 2022 ||The Medicare Outpatient Prospective Payment System proposed rule for calendar year 2023 reverses cuts to 340B Drug Pricing Program hospitals and seeks comment on remedying existing cuts to 340B hospitals.
view more »CMS Issues CY 2023 Physician Fee Schedule Proposed Rule
July 12, 2022 ||CMS proposes to decrease the conversion factor determining physician payment rates for specific services by $1.53. The proposed rule also includes provisions related to Medicare reimbursement of telehealth services, vaccine administration, and the Medicare Shared Savings Program.
view more »CMS Approves Colorado Option
June 28, 2022 ||CMS approved Colorado's Section 1332 waiver application to create a state-based standard health benefit plan.
view more »CMS Releases New Medicaid Tool: Top 10 Ways to Unwind
June 14, 2022 ||The tool compiles existing guidance to help states prepare to return to regular Medicaid operations after the COVID-19 public health emergency ends.
view more »Hospitals have until June 16 to preview their Overall Hospital Quality Star Rating, measure group score, and individual measure results, along with peer grouping.
view more »CMS Outlines Behavioral Health Care Strategy
June 7, 2022 ||The agency's strategy to strengthen behavioral health care focuses on improving access, equity, quality, and data integration.
view more »Four States Expand Postpartum Medicaid Coverage
May 27, 2022 ||CMS on May 25 approved proposals in four states to extend postpartum Medicaid coverage from 60 days to one year after birth.
view more »CMS Launches New Medicaid, CHIP Renewal Webpage
May 24, 2022 ||The webpage includes renewal instructions for eligible beneficiaries and guidance for ineligible beneficiaries to secure insurance through the marketplaces.
view more »A new CMS resource highlights federal requirements for program renewals, verifications, applications, and oversight amid the anticipated COVID-19 public health emergency unwinding.
view more »COVID-19: Post-PHE Planning; Pediatric Booster Authorized
May 17, 2022 ||HHS urges governors to start planning for the end of the COVID-19 public health emergency; FDA authorizes a Pfizer booster vaccine for children ages 5 to 11.
view more »The proposed rule includes numerous policy and payment changes for Medicare’s Inpatient Prospective Payment System for fiscal year 2023, including a 3.2 percent increase in inpatient payment rates.
view more »2023 Marketplace Benefit and Payment Parameters Finalized
May 3, 2022 ||The final rule raises the essential community provider threshold from 20 to 35 percent and uses wait time standards to evaluate qualified health plans for network adequacy.
view more »Learn about equity proposals in the fiscal year 2023 Inpatient Prospective Payment System proposed rule that focuses on social determinants of health, climate, maternal health care, and more.
view more »Leveraging Section 1115 Demonstrations to Drive Equity in Medicaid
April 29, 2022 ||In a white paper, the association encourages CMS to develop policies that reduce disparities and incorporate equity into waiver approval and evaluation processes.
view more »CMS Releases Health Equity Action Plan
April 22, 2022 ||The action plan includes goals to close gaps in health care access, quality, and outcomes through data collection, outreach, and community engagement.
view more »CMS Releases FY 2023 IPPS Proposed Rule
April 19, 2022 ||The proposed fiscal year 2023 Inpatient Prospective Payment System rule would increase operating payment rates by 3.2 percent and make other changes to Medicare payment and quality reporting policies. CMS is accepting comments on the proposed rule until June 17.
view more »CMS Opens Federal IDR Portal
April 19, 2022 ||The independent dispute resolution process can be initiated to resolve payment disputes between health care providers and issuers.
view more »Association Comments on Medicaid Access
April 19, 2022 ||The association made recommendations on payment rates, workforce development, eligibility and enrollment policies, and measuring access to hospital services.
view more »Essential Hospitals Advance Equity through Hospital-At-Home Model
April 19, 2022 ||The ability to provide hospital-level care at home has been essential to managing case surges during the COVID-19 pandemic and can improve access and equity outside of a public health crisis.
view more »COVID-19: Long COVID-19 Initiative; Sotrovimab Authorization Limited
April 11, 2022 ||President Joe Biden announces a national research plan on prolonged illness developed after COVID-19; FDA limits authorization of sotrovimab to treat COVID-19.
view more »CMS Issues FAQs on Surprise Billing, Good Faith Estimates
April 11, 2022 ||Two new documents provide guidance for health care providers on No Surprises Act compliance and good faith estimates for uninsured or self-pay patients.
view more »New Tools for Medicaid Fair Hearings, PHE Unwinding
April 8, 2022 ||CMS shares tools to mitigate an anticipated increase in Medicaid fair hearing requests and resume normal operations after the COVID-19 public health emergency ends.
view more »Association Makes Equity Measurement Recommendations to CMS
April 4, 2022 ||Recommendations for Medicare and Medicaid equity measures under development focus on standardized data collection and opportunities for testing and feedback.
view more »COVID-19: Second Booster Authorized for Older, Immunocompromised People
March 29, 2022 ||FDA authorizes a second vaccine booster for older and immunocompromised individuals; OSHA reopens the comment period for its emergency temporary standard.
view more »CMS Releases PHE Unwinding Guidance for Medicaid Renewals
March 8, 2022 ||A State Health Official letter includes guidance for states to prepare for the COVID-19 public health emergency unwinding and return to regular Medicaid program operations.
view more »Federal Judge Strikes Down Key Portion of Surprise Billing Rule
March 8, 2022 ||The court ruled the qualifying payment amount should not be the main factor in determining payment for out-of-network services in independent dispute resolution.
view more »CMS Issues FAQs on New GME Slots
March 1, 2022 ||The Centers for Medicare & Medicaid Services outlines the application process for 1,000 new graduate medical education slots created by the Consolidated Appropriations Act of 2021. Applications for the first round of slots are due March 31, 2022, and CMS intends to award slots July 1, 2023.
view more »CMS Announces ACO Model With Health Equity Focus
March 1, 2022 ||The Center for Medicare & Medicaid Innovation will release a request for applications for the Realizing Equity, Access, and Community Health accountable care organization model, which will focus on promoting health equity and mitigating health disparities for underserved communities.
view more »COVID-19: National Emergency Extended; Post-Infection Conditions
Feb. 22, 2022 ||National emergency extended; new study highlights conditions and symptoms developed after COVID-19 infection; CDC updates vaccine guidance with clarifications for immunocompromised people.
view more »CMS Seeks Information on Medicaid, CHIP Access to Care and Coverage
Feb. 18, 2022 ||Through a request for information, the Centers for Medicare & Medicaid Services hopes to better understand enrollees' barriers to coverage and access to care to inform future policies and regulatory actions. A 60-day public comment period began Feb. 17.
view more »Pfizer and BioNTech apply for emergency use authorization for their pediatric COVID-19 vaccine; CDC recommends the Moderna COVID-19 vaccine; Medicare will cover over-the-counter COVID-19 tests.
view more »In a letter to CMS, Republican Govs. Glenn Youngkin of Virginia and Jim Justice of West Virginia cite strained health care workforce and staffing crises as reasons for requesting relief. They ask for broader conscience exemptions, flexibility on enforcement, or simply a six-month delay of the rule.
view more »14.5M Americans Enroll in Marketplace Coverage
Jan. 31, 2022 ||An estimated 5.8 million people newly gained coverage during this open enrollment period; 32 percent of consumers using the federal marketplace selected a plan that costs them $10 or less per month. Enrollment remains open through Jan. 31 in five states and the District of Columbia.
view more »CMS to Award $49M to Increase CHIP, Medicaid Enrollment
Jan. 31, 2022 ||Each awardee will receive up to $1.5 million for a three-year period to reduce the number of uninsured children by advancing Medicaid and Children's Health Insurance Program enrollment and retention. Grant applications are due March 28.
view more »COVID-19: Vaccine Mandate Ruling; Testing and Therapeutics Access
Jan. 18, 2022 ||The U.S. Supreme Court upheld CMS' vaccine mandate but struck down the Occupational Safety and Health Administration's mandate; President Joe Biden announced new initiatives to expand testing access.
view more »A final rule with comment period from the Centers for Medicare & Medicaid Services addresses the distribution of 1,000 new graduate medical education slots and other policies.
view more »CDC shortens the time between primary vaccine series and booster shot and recommends a Pfizer booster for adolescents; the Supreme Court hears oral arguments on two vaccine mandates; HHS requires coverage of at-home COVID-19 tests, effective Jan. 15.
view more »COVID-19: Guidance Updates, Authorization of Antiviral Pills
Jan. 4, 2022 ||FDA expands authorization for the Pfizer COVID-19 booster; FDA authorizes two antiviral pills; CMS updates guidance on vaccine mandate compliance.
view more »The new document explains various provisions under part II surprise billing regulations, including that all financial assistance should be reflected in the good faith estimate regardless of the amount or type of discount. The new regulations take effect Jan. 1, 2022.
view more »Association Comments on CMS Vaccination Rule
Dec. 23, 2021 ||The association asked that CMS provide additional time for hospitals to comply with the requirements, especially given the uncertain outcome of pending litigation regarding the administration's vaccine mandate.
view more »A letter to state Medicaid directors defines supplemental payments and designates a system to submit required supplemental payment reports. CMS also notes a lack of data to determine the application of an exception to new rules on Medicaid disproportionate share hospital uncompensated care limits.
view more »Recap highlights from 2021 and preview the agenda for regulatory and legislative priorities in 2022.
view more »A Centers for Medicare & Medicaid Services letter to state Medicaid directors outlines new supplemental payment reporting and Medicaid disproportionate share hospital requirements under the Consolidated Appropriations Act.
view more »COVID-19: Omicron Variant Reaches U.S.; Vaccine Mandate on Hold
Dec. 7, 2021 ||As the omicron SARS-CoV-2 variant reaches the United States, President Joe Biden releases a new plan to combat COVID-19; CMS will not enforce its health care worker vaccine mandate amid legal challenges.
view more »CMS released guidance to help states maintain Medicaid and Children's Health Insurance Program coverage as they return to normal operations when the COVID-19 public health emergency ends. Many strategies in the documents require support from outside organizations that work with beneficiaries.
view more »COVID-19: Vaccine Booster Eligibility, Oral Antiviral Medication
Nov. 19, 2021 ||FDA and CDC endorse expanded eligibility for Pfizer and Moderna COVID-19 booster vaccine doses; Pfizer seeks authorization for its COVID-19 antiviral pill.
view more »Final rules for Medicare’s OPPS and PFS for CY 2022 continue Medicare Part B drug payment cuts to hospitals in the 340B Drug Pricing Program; continue site-neutral payment policies; and halt elimination of the inpatient-only (IPO) list.
view more »CMS Releases Hospital Co-Location Guidance
Nov. 16, 2021 ||CMS released final guidance for compliance with Medicare conditions of participation related to co-location, which occurs when two Medicare-certified hospitals or a Medicare-certified hospital and another health care entity are on the same campus or in the same building and share resources.
view more »CMS recently announced vaccination requirements for providers as a condition of participating in Medicare and Medicaid. Simultaneously, the Department of Labor’s Occupational Safety and Health Administration released an emergency temporary standard for employers with at least 100 employees.
view more »COVID-19: CDC Recommends Pfizer Vaccine for Children
Nov. 9, 2021 ||CDC recommends the Pfizer COVID-19 vaccine for children ages 5 to 11; CMS holds a stakeholder call on its vaccine mandate for health care workers. Pfizer says its investigational novel COVID-19 oral antiviral candidate significantly reduces hospitalization and death.
view more »CMS, OSHA Issue New Vaccination Requirements
Nov. 5, 2021 ||CMS announced phased vaccination requirements as a condition of participating in Medicare and Medicaid; vaccination must be completed by Jan. 4, 2022. A new Occupational Safety and Health Administration emergency temporary standard promotes vaccination for businesses with 100 or more employees.
view more »Statement on Vaccination Requirements for Health Care Workers
Nov. 4, 2021 ||We support the Biden administration’s vaccination goals, including for health care workers as they lead our nation’s response to COVID-19. The interim final rule from CMS aligns with our commitment to vaccination as the best way to protect patients and keep caregivers safe.
view more »CMS Issues CY 2022 Physician Fee Schedule Final Rule
Nov. 3, 2021 ||The rule adjusts the conversion factor used to determine physician payment rates and includes provisions related to appropriate use criteria, Medicare reimbursement for telehealth services, vaccine payment rates, the Quality Payment Program, and the Medicare Shared Savings Program.
view more »2022 OPPS Final Rule Perpetuates Threats to Nation’s Safety Net
Nov. 2, 2021 ||By maintaining harmful cuts to outpatient drug payments for hospitals in the 340B Drug Pricing Program and for services at hospital outpatient clinics, the 2022 Outpatient Prospective Payment System final rule jeopardizes safety net care.
view more »Preview Healthcare.gov Plans Before Open Enrollment
Oct. 26, 2021 ||Consumers now can preview health plans and prices on healthcare.gov ahead of open enrollment, which runs Nov. 1, 2020, through Jan. 15, 2021.
view more »CMS Innovation Center Outlines Strategy for Next Decade
Oct. 25, 2021 ||A new Center for Medicare and Medicaid Innovation white paper outlines a strategy to advance health system transformation. The goal is to achieve equitable outcomes by driving accountable care, advancing health equity, supporting innovation, addressing affordability, and creating partnerships.
view more »Medicaid Required to Cover COVID-19 Treatment
Oct. 25, 2021 ||CMS will require states to cover COVID-19 treatment with no cost-sharing for Medicaid and Children's Health Insurance Program beneficiaries. Further, states in some circumstances must cover treatments for conditions that might seriously complicate the treatment of COVID-19.
view more »CMS Study Shows Slight Increase in Z Code Use
Oct. 12, 2021 ||The use of Z codes to document social determinants of health in Medicare fee-for-service beneficiaries increased slightly from 2017 to 2019 but remains low.
view more »COVID-19: FDA, CDC Recommend Pfizer Booster Shot
Sept. 28, 2021 ||FDA on Sept. 22 authorized a third booster dose of the Pfizer-BioNTech COVID-19 vaccine for select groups. A CDC panel subsequently recommended the booster shots, and CMS announced coverage for all Medicare beneficiaries and nearly all Medicaid and Children's Health Insurance Program beneficiaries.
view more »COVID-19: President’s Plan, Infection Control Guidance
Sept. 14, 2021 ||The president's newly announced "Path out of the Pandemic" plan includes action steps for increasing vaccinations, further protecting those who are vaccinated, keeping schools safely open, testing and mask requirements, and economic recovery. CDC updates its infection control guidance.
view more »Association Comments on New Supplemental Payment Reporting System
Aug. 24, 2021 ||America's Essential Hospitals sent CMS recommendations for implementing the new Medicaid supplemental payment reporting system under the Consolidated Appropriations Act of 2020. The association noted the importance of accuracy and avoiding duplicate data collection.
view more »The rule includes numerous policy and payment changes for Medicare’s Inpatient Prospective Payment System for fiscal year 2022, including a 2.5 percent increase in inpatient payment rates.
view more »CMS Proposes to Withdraw Part B Drug Model
Aug. 9, 2021 ||CMS proposes to rescind the Trump administration’s Most Favored Nation model interim final rule, which aimed to reduce payment for 50 Medicare Part B drugs. America’s Essential Hospitals previously urged the agency to withdraw the model due to substantive and procedural issues.
view more »CMS Requests Billing Data to Disburse APM Incentive Payments
July 27, 2021 ||CMS released an advisory alerting certain qualifying participants in alternative payment models that the agency does not have billing information needed to disburse incentive payments. Participants who anticipated but have not received an incentive payment should submit the necessary form by Nov. 1.
view more »The OPPS proposed rule would continue cuts to hospitals in the 340B Drug Pricing Program and off-campus provider-based departments, pause the elimination of the inpatient-only list, and increase penalties for failing to report standard charges.
view more »CMS Grant Opportunity for Crisis Care
July 20, 2021 ||CMS announces $15 million for state Medicaid agencies to launch mobile crisis intervention services, as authorized by the American Rescue Plan.
view more »CMS Issues CY 2022 Physician Fee Schedule Proposed Rule
July 19, 2021 ||The rule includes provisions related to telehealth, vaccine payment rates, the Quality Payment Program, and the Medicare Shared Savings Program; comments are due to CMS by Sept. 13.
view more »On the Hill: Senate Confirms CMS Administrator
May 25, 2021 ||The Senate confirmed Chiquita Brooks-LaSure as head of the Centers for Medicare & Medicaid Services. Several Senate committees last week examined issues of importance to essential hospitals, including telehealth, hospital consolidation, and the medical supply chain.
view more »Essential Hospitals Applaud Brooks-LaSure Confirmation
May 25, 2021 ||Brooks-LaSure takes the reins at CMS at a critical juncture for our nation, as COVID-19 and its lingering economic effects make access to health care coverage more important than ever. Her knowledge of, and experience with, Medicaid and Medicare make her well suited to meet these challenges.
view more »CMS Releases Guidance on Interoperability Rule
May 18, 2021 ||The interpretive guidance includes information on hospital admission, discharge, and transfer notification requirements outlined in CMS' May 2020 interoperability and patient access final rule.
view more »The Senate voted to advance the nomination of Chiquita Brooks-LaSure as Centers for Medicare & Medicaid Services administrator; a full Senate vote could take place this week. America's Essential Hospitals hosted a virtual Capitol Hill briefing in recognition of the association's 40th anniversary.
view more »COVID-19: Mask Guidance for Vaccinated People
May 18, 2021 ||New CDC recommendations no longer require people who are fully vaccinated against COVID-19 to wear a mask or physically distance.
view more »A CDC brief updates transmission methods; Pfizer applies for FDA approval of its vaccine; CMS increases the Medicare payment for monoclonal antibodies.
view more »CMS Changes Wage Index Reclassification Rules
May 11, 2021 ||In a new interim final rule with comment period, the Centers for Medicare & Medicaid Services revises the rules for certain hospitals seeking a wage index reclassification with the Medicare Geographic Classification Review Board.
view more »Overall Hospital Star Ratings Updated on Care Compare
May 3, 2021 ||The Centers for Medicare & Medicaid Services published updated overall hospital quality star ratings on its Care Compare website; the ratings were last updated in January 2020. America's Essential Hospitals has expressed continued concern about the fairness and reliability of the ratings.
view more »Senate Republicans release a $568 billion infrastructure framework to kickstart negotiations. House Democrats and Republicans reintroduce opposing prescription drug pricing bills. A CMS decision delays advancement of Chiquita Brooks-LaSure's nomination for CMS administrator.
view more »On the Hill: Infrastructure Talks Continue; CMS, HHS Nominee Hearings
April 20, 2021 ||The president met with a group of bipartisan lawmakers to discuss his $2 trillion American Jobs Plan infrastructure proposal; other lawmakers have expressed interest in a less costly, more targeted package. The Senate Committee on Finance is expected to advance two Biden administration nominees.
view more »On the Hill: Congress Focuses on Medicare Cut, Infrastructure Funding
April 13, 2021 ||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.
view more »CMS Issues Interpretive Guidance for Emergency Preparedness
March 30, 2021 ||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.
view more »Special ACA Enrollment Period Extended to Aug. 15
March 26, 2021 ||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.
view more »COVID-19: OSHA Guidance, Infection Control
March 16, 2021 ||The Occupational Safety and Health Administration updated its COVID-19 enforcement plan; CDC updates infection control guidance for vaccinated people in health care facilities.
view more »COVID-19: Guidelines for Vaccinated People; New CMS Learning Series
March 9, 2021 ||CDC releases public health guidelines for fully vaccinated people; CMS invites hospitals to pilot a COVID-19 learning series.
view more »COVID-19: Janssen Vaccine EUA, Coverage FAQs
March 2, 2021 ||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.
view more »Essential Hospitals Support Brooks-LaSure for CMS Administrator
Feb. 20, 2021 ||The nominee’s deep policy expertise in Medicaid and Medicare and her role in advancing coverage under the Affordable Care Act would bring valuable skills and leadership to CMS.
view more »Special Enrollment for ACA Coverage Began Feb. 15
Feb. 16, 2021 ||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.
view more »CMS Releases Hospital Star Rating April Preview Reports
Feb. 2, 2021 ||Hospitals have 30 days to review their reports before public reporting to Care Compare.
view more »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.
view more »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.
view more »Biden Administration Freezes Pending Regulations
Jan. 26, 2021 ||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.
view more »FAQs for Reporting Median Payer-Specific Negotiated Charges
Jan. 26, 2021 ||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.
view more »CMS to Reprocess 2019 OPPS Claims at Site Neutral Rates
Jan. 15, 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.
view more »CMS Approves Tenn. Medicaid Block Grant
Jan. 15, 2021 ||This is the first approval of its kind and will allow the state to have more control over financing its Medicaid program.
view more »CMS Announces New Direct Contracting Model for Dual Eligibles
Jan. 12, 2021 ||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.
view more »CMS Finalizes Rule on Value-Based Payments for Medicaid Drugs
Jan. 12, 2021 ||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.
view more »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.
view more »Courts Pause Most Favored Nation Drug Model Rule
Jan. 5, 2021 ||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.
view more »COVID-19: Moderna Vaccine, At-Home Test
Dec. 22, 2020 ||FDA issues an emergency use authorization for the Moderna vaccine and an at-home antigen test; a CDC committee votes on allocation recommendations.
view more »Association member UVA Health System is one of seven finalists in the CMS Artificial Intelligence Health Outcomes Challenge, which encourages applicants to use artificial intelligence to predict and prevent unplanned admissions and adverse events.
view more »COVID-19: Pfizer Vaccine EUA, Hospital Reporting Requirements
Dec. 15, 2020 ||FDA authorizes the Pfizer COVID-19 vaccine for emergency use; HHS expands hospital COVID-19 data reporting requirements to include therapeutic data.
view more »The two rules, finalized Nov. 20, aim to eliminate barriers to care coordination and undue burden under current fraud and abuse laws. One provides exceptions to the physician anti-referral law, and one modifies existing safe harbor protections under the anti-kickback statute.
view more »The 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.
view more »CMS Proposes Changes to Medicare Cost Reports
Dec. 3, 2020 ||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.
view more »Statement on OPPS, Physician Fee Schedule Final Rules
Dec. 2, 2020 ||The final rule takes critical resources away from hospitals and is especially harmful now as they strain under the heavy financial burden of COVID-19.
view more »CMS Announces Acute Hospital Care At Home Program
Dec. 1, 2020 ||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.
view more »CMS Hosts Hospital Price Transparency Webcast
Dec. 1, 2020 ||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.
view more »HHS Finalizes Changes to Stark Law and Anti-Kickback Statute
Nov. 23, 2020 ||The Office of Inspector General (OIG) and the Centers for Medicare & Medicaid Services (CMS) finalized rules in conjunction with HHS' regulatory sprint to coordinated care. The OIG rule modifies safe harbor protections; CMS’ rule targets undue burden of the physician self-referral law, or Stark law.
view more »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.
view more »CMS Finalizes Most Favored Nation Medicare Drug Model
Nov. 23, 2020 ||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.
view more »CMS Retires Hospital Compare; No Star Ratings Update in Jan.
Nov. 20, 2020 ||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.
view more »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.
view more »HHS Finalizes Coverage Transparency Rule
Nov. 6, 2020 ||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.
view more »Association Comments on Hospital COVID-19 Data Reporting
Nov. 3, 2020 ||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.
view more »CMS to Remove Historical Reports from HQR System
Nov. 2, 2020 ||CMS encourages hospitals to download and save historical reports from the Hospital Quality Reporting system before the reports are removed on Dec. 15.
view more »CMS Issues Rule on COVID-19 Vaccine and Therapeutic Coverage
Oct. 30, 2020 ||The interim final rule targets future vaccine costs, price transparency for COVID-19 tests, and enhanced Medicare payments for new COVID-19 treatments.
view more »HHS, CMS Taking Email Questions on Data Collection, Enforcement
Oct. 29, 2020 ||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.
view more »CMS Expands List of Reimbursable Telehealth Services
Oct. 20, 2020 ||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.
view more »COVID-19: CDC Vaccine Resources, CMS Testing Payment Changes
Oct. 20, 2020 ||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.
view more »HHS Webinar Series on Hospital COVID-19 Data Reporting
Oct. 20, 2020 ||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.
view more »COVID-19: Testing Advancements, Vaccine Development
Oct. 13, 2020 ||NIH will study experimental COVID-19 treatments and support the development of six new testing technologies; FDA's vaccine committee will meet Oct. 22.
view more »CMS Announces New Repayment Terms for Medicare Loans
Oct. 12, 2020 ||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.
view more »Guidance for Hospital Reporting of COVID-19 Data
Oct. 9, 2020 ||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.
view more »CMS Launches Price Transparency Rule Webpage
Oct. 6, 2020 ||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.
view more »COVID-19: Testing Tools, Health Care Personnel Cases
Sept. 29, 2020 ||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.
view more »New Guidance on Advancing Value-Based Care
Sept. 21, 2020 ||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.
view more »Essential Hospitals Praise Decision to Withdraw MFAR
Sept. 14, 2020 ||America's Essential Hospitals thanks the Centers for Medicare & Medicaid Services for recognizing the potential for unintended consequences of its proposed Medicaid Fiscal Accountability Regulation and withdrawing this potentially damaging rule.
view more »CMS Merges Health Care Compare Tools
Sept. 8, 2020 ||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.
view more »Interim Final Rule Establishes COVID-19 Data Reporting as Medicare Condition of Participation
Aug. 31, 2020 ||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.
view more »Data Collection as a Medicare Condition of Participation
Aug. 28, 2020 ||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.
view more »CMS to Require Positive Test for COVID-19 Add-on Payment
Aug. 25, 2020 ||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.
view more »HHS announces $6.5 million in testing investments; CDC issues antigen testing guidance; HHS partners with Moderna to manufacture and deliver its vaccine.
view more »CMS Rule Addresses Medicare DSH Payment Calculation
Aug. 18, 2020 ||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.
view more »CMS Issues Temporary Policy For Marketplace Premium Reductions
Aug. 11, 2020 ||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.
view more »Association, Other National Groups Urge CMS to Withdraw MFAR
Aug. 11, 2020 ||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.
view more »COVID-19: Public Data Hub Launch; Transmission-Based Precautions
July 21, 2020 ||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.
view more »Proposed Rule Supports Value-Based Payments for Medicaid Drugs
June 23, 2020 ||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.
view more »COVID-19: Recovery, Contact Tracing, Telehealth
June 16, 2020 ||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.
view more »New CMMI Model Options for COVID-19
June 4, 2020 ||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.
view more »CMS Clarifies Use of COVID-19 Modifier, Condition Code
June 2, 2020 ||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.
view more »COVID-19: Surveys Resume, Remdesivir Donation, Antibody Testing
June 2, 2020 ||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.
view more »COVID-19: Medicare Payment for Testing; Recovery Resources
May 26, 2020 ||CMS updates Medicare payment information to capture two new testing codes; FDA updates testing FAQs; CDC issues resources for reopening businesses and organizations.
view more »Association Urges CMS to Withdraw 340B Cost Survey
May 11, 2020 ||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.
view more »Association Urges CMS to Reopen MFAR Comment Period
May 11, 2020 ||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.
view more »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.
view more »Essential Hospitals Urge CMS to Withdraw 340B Cost Survey
May 6, 2020 ||America’s Essential Hospitals today called on the Centers for Medicare & Medicaid Services to immediately withdraw the agency’s survey on 340B Drug Pricing Program acquisition costs, saying it imposes an unnecessary and costly burden on hospitals as they battle COVID-19.
view more »COVID-19: Racial Inequity; Testing and Isolation Guidance
May 5, 2020 ||A new study highlights racial disparities among COVID-19 patients; CDC updates testing and isolation guidelines and releases National Healthcare Safety Network data.
view more »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.
view more »COVID-19: New Symptoms; Workforce, Telehealth Toolkits
April 28, 2020 ||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.
view more »CMS Launches Survey to Collect 340B Drug Acquisition Costs
April 28, 2020 ||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.
view more »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.
view more »CMS Guidance on Non-emergent Care Unrelated to COVID-19
April 21, 2020 ||The agency provides recommendations for resuming non-essential care for services that cannot be virtually delivered and for health care systems and facilities in regions with low incidence of COVID-19.
view more »COVID-19: New CMS Waivers; Increased Medicare Payments
April 21, 2020 ||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.
view more »CMS Releases Additional COVID-19 Medicaid FAQs
April 20, 2020 ||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.
view more »COVID-19: Infection Control Guidance, Reporting FAQs
April 14, 2020 ||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.
view more »The fund, authorized by the CARES Act, intends to support providers incurring health care–related expenses and lost revenue from COVID-19 pandemic response.
view more »CMS Approves State Plans to Mitigate COVID-19
April 10, 2020 ||Newly approved state plan amendments in Alabama, Arizona, Minnesota, Washington, and Wyoming aim to increase flexibility to respond to the COVID-19 pandemic.
view more »HHS Disburses First $30B of COVID-19 Provider Relief
April 10, 2020 ||Providers will receive direct deposits of their share of the $30 billion based on 2019 Medicare fee-for-service payments.
view more »America's Essential Hospitals is eager for the administration to distribute $30 billion in COVID-19 relief for hospitals but concerned by the allocation methodology, which could put some essential hospitals at a disadvantage.
view more »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.
view more »CMS Guidance on Telehealth for Rural Health, Substance Use Treatment
April 7, 2020 ||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.
view more »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.
view more »FAQ: COVID-19 FMAP Increase and Essential Hospitals
April 3, 2020 ||America's Essential Hospitals distills recent CMS guidance on enhanced Medicaid funding for essential hospitals during the COVID-19 pandemic.
view more »Quality Program Reporting Exemptions, COVID-19 Testing Guidance
March 31, 2020 ||CMS releases guidance for hospitals in quality reporting programs; CDC updates guidelines for testing and handling COVID-19 specimens.
view more »CMS Issues Waivers, New Rules Amid COVID-19 Patient Surge
March 31, 2020 ||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.
view more »States Respond to COVID-19: Reporting Requirements, 1135 Waivers
March 31, 2020 ||States are expanding requirements for hospitals to report their bed capacity and supply inventory, and readying facilities to expand capacity to treat patients with COVID-19. CMS has approved Section 1135 waivers for 38 states.
view more »The administration has issued guidance making policy changes related to Medicare payment, mandated paid leave, and hospital reporting requirements related to COVID-19.
view more »CMS Guidance on COVID-19 FMAP Increase
March 25, 2020 ||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.
view more »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.
view more »COVID-19: Elective Surgeries, Quality Programs, Targeted Inspections
March 24, 2020 ||CMS issues elective surgery guidance, telehealth toolkits, and information on quality reporting flexibility amid the COVID-19 pandemic; The Joint Commission suspends regular surveys.
view more »Medicaid, CHIP Resources for COVID-19 Response
March 23, 2020 ||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.
view more »Wash. Receives 1135 Waiver Approval
March 23, 2020 ||Washington state received approval for a Section 1135 waiver, targeted at removing additional Medicare and Medicaid regulatory barriers for providers to respond to the COVID-19 outbreak.
view more »Okla. Releases Application for Medicaid Block Grants
March 22, 2020 ||Under the proposed Section 1115 waiver, Oklahoma would accept a per-capita cap on federal funds for the Medicaid expansion population and incorporate other market-based reforms.
view more »The law increases the Federal Medical Assistance Percentage to states, allows states to extend Medicaid eligibility, and requires diagnostic test coverage.
view more »COVID-19 Update: National Emergency, Community Guidance, Coverage
March 17, 2020 ||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.
view more »Association Comments on Proposed 340B Acquisition Cost Survey
March 13, 2020 ||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.
view more »CMS, ONC Finalize Rules on Interoperability
March 13, 2020 ||The rules, intended to increase interoperability and improve patients’ access to their health information, finalize provisions related to the MyHealthEData initiative and implement provisions of the 21st Century Cures Act.
view more »On the Hill: COVID-19 Response, Star Ratings Letter
March 10, 2020 ||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.
view more »CMS Releases New COVID-19 Lab Test Code, Coverage Guidance
March 9, 2020 ||The new code applies to tests conducted outside CDC laboratories; CMS also issued frequently asked questions and fact sheets about COVID-19–related billing.
view more »CMS to Focus Inspections on Infection Control Amid COVID-19 Outbreak
March 9, 2020 ||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.
view more »Court Vacates Mich. Medicaid Work Requirements
March 9, 2020 ||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.
view more »CMS Proposes Extension, Changes to Joint Model
Feb. 25, 2020 ||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.
view more »Appeals Court Strikes Down Ark. Medicaid Work Requirements
Feb. 20, 2020 ||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.
view more »CMS Administrator Blogs About MFAR
Feb. 18, 2020 ||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.
view more »CMS Proposes New 340B Hospital Acquisition Cost Survey
Feb. 15, 2020 ||Comments on a proposed acquisition cost survey to inform Outpatient Prospective Payment System payment rates for 340B drugs are due March 9.
view more »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.
view more »CMS Outlines Medicaid Block Grant Option for States
Feb. 3, 2020 ||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.
view more »Association Comments on Health Plan Transparency Proposals
Feb. 3, 2020 ||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.
view more »Association Urges CMS to Withdraw the MFAR
Jan. 31, 2020 ||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.
view more »The proposal would "cut at the very core of the Medicaid program by introducing unprecedented restrictions on states’ ability to fund their share of the Medicaid program," America's Essential Hospitals says.
view more »CMS Plans to Combine Quality Compare Tools
Jan. 31, 2020 ||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.
view more »Quality Data, Hospital Star Ratings Refreshed
Jan. 31, 2020 ||This month’s data refresh is based on the existing, flawed methodology used during the last update of star ratings in February 2019.
view more »CMS Disappoints with Decision to Publish Flawed Star Ratings
Jan. 29, 2020 ||Health care consumers need accurate, relevant information to make the best care decisions; the current star ratings do not meet this need. The ratings rely on a methodology that fails to account for differences among hospitals and, therefore, could mislead rather than inform consumers.
view more »Study Reviews Use of Z Codes for Social Determinants of Health
Jan. 27, 2020 ||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.
view more »CMS Seeks Input on Out-of-State Care for Medically Complex Children
Jan. 27, 2020 ||CMS issued a request for information seeking input on coordinating care from out-of-state providers for medically complex children who are eligible for Medicaid coverage. The agency will use the information collected to produce guidance to state Medicaid directors.
view more »The 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.
view more »Researchers studied 3,608 hospitals nationwide, examining the associations between neighborhood social risk factors and seven CMS quality domains.
view more »Hospital Overall Star Ratings: Meaningful or Full of Confusion?
Jan. 16, 2020 ||Essential hospitals are committed to transparent, accurate quality measurement, but a single hospital star rating oversimplifies a complex and personal decision.
view more »CMS Updates Interpretive Guidance for Surveyors
Jan. 7, 2020 ||The new guidelines reflect revised conditions of participation in the September 2019 discharge planning and burden reduction final rules.
view more »Medicaid Fiscal Accountability Regulation Comment Period Extended
Dec. 26, 2019 ||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.
view more »Association Comments on Fraud and Abuse Proposals
Dec. 20, 2019 ||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.
view more »CMS Awards Funds for Maternal, Child Health Models
Dec. 20, 2019 ||The agency announced awardees for two new models that seek to improve care coordination for children and for mothers with opioid use disorder.
view more »CMS Releases Report on Improving Hospital Star Ratings
Dec. 17, 2019 ||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.
view more »CMS Approves Medicaid Work Requirements in S.C.
Dec. 16, 2019 ||Through this newly approved Section 1115 demonstration waiver, South Carolina becomes the first state to apply work requirements primarily to parents and caregivers.
view more »America’s Essential Hospitals expressed concern that a proposed drug acquisition cost survey would impose excessive burden on hospitals and raise many operational challenges.
view more »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.
view more »Learn about the threat this proposed rule poses to essential hospitals, and gain strategies for commenting on and advocating against the proposal.
view more »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.
view more »CMS Issues Medicaid Supplemental Payment Proposed Rule
Nov. 18, 2019 ||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.
view more »Administration Rule on Price Transparency a Threat to Access
Nov. 15, 2019 ||Rather than empower consumers with meaningful information, the administration's plan only would give health plans an unfair advantage in negotiations with providers and put access to care at risk.
view more »Transparency Proposal Would Undermine Care, State Flexibility
Nov. 12, 2019 ||The proposed regulation would undermine the financial stability of state Medicaid programs by restricting the flexibility states have to meet their commitment to vulnerable patients and avoid spending cutbacks that threaten access to care.
view more »CMS Updates Medicaid and CHIP Scorecard
Nov. 8, 2019 ||This year’s update contains new quality and accountability measures and new national context data.
view more »NQF Panel Urges Transparency, Clarity in Hospital Star Ratings
Nov. 8, 2019 ||A new brief summarizes program recommendations from an expert panel, which included America's Essential Hospitals staff.
view more »CMS Increases Public Access to Medicaid, CHIP Data
Nov. 8, 2019 ||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.
view more »New Guidance for Substance Use Disorder Patients in IMDs
Nov. 8, 2019 ||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.
view more »Hospital Compare January Preview Reports Include Star Ratings
Nov. 5, 2019 ||Health care providers have until Dec. 3 to download their preview reports, which include overall hospital quality star ratings.
view more »OPPS Final Rule Continues 340B, Site-Neutral Cuts
Nov. 4, 2019 ||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.
view more »2020 OPPS Rule Threatens Access to Care for Vulnerable
Nov. 1, 2019 ||The final rule jeopardizes access to care in underserved communities and flouts court rulings on unlawful federal policies regarding payments to hospitals in the 340B Drug Pricing Program and to provider-based outpatient departments.
view more »CMS Refreshes Hospital Compare Data
Nov. 1, 2019 ||The October refresh does not include an update of overall star ratings, which were last updated in February.
view more »Application Period Opens for Kidney Care, Primary Care Models
Oct. 28, 2019 ||Applications for the new payment models are due to the Centers for Medicare & Medicaid Services Jan. 22, 2020.
view more »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.
view more »CMS Shares New QPP Resources
Oct. 18, 2019 ||The updated resource library includes new fact sheets and guides for the Merit-based Incentive Payment System and Advanced Alternative Payment Models.
view more »Patient Experience and HCAHPS at Essential Hospitals
Oct. 15, 2019 ||This new brief can help hospitals identify changes that might improve patient experience scores, as well as help policymakers understand how structural factors influence scores and design incentives accordingly.
view more »GAO Report Analyzes Medicaid Work Requirement Waiver Costs
Oct. 11, 2019 ||The report includes recommendations to the Centers for Medicare & Medicaid Services for improved oversight of these waivers.
view more »CMS, OIG Propose to Modify Fraud and Abuse Laws
Oct. 10, 2019 ||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.
view more »Of interest to essential hospitals, the rule targets emergency preparedness, hospital quality program requirements, infection control, and physical examinations.
view more »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.
view more »Association Comments on CY 2020 OPPS, PFS Proposed Rules
Oct. 1, 2019 ||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.
view more »CMS Seeks Comments on Collecting 340B Hospital Acquisition Costs
Oct. 1, 2019 ||The agency seeks comments until Nov. 29 on a proposal to collect acquisition cost data from hospitals participating in the 340B Drug Pricing Program.
view more »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.
view more »CMS Finalizes Burden Reduction Rule
Sept. 26, 2019 ||The final rule revises conditions of participation and conditions for coverage and also targets emergency preparedness, quality reporting, infection control, and physical examination requirements.
view more »CMS Finalizes Discharge Planning Rule
Sept. 26, 2019 ||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.
view more »CMS Awards Planning Grants for Substance Use Disorder Treatment
Sept. 24, 2019 ||The 18-month grants, awarded to 15 state Medicaid agencies, seek to increase the ability of providers to deliver substance use disorder treatment and recovery services.
view more »CMS Finalizes Methodology for Oct. 1 Medicaid DSH Cuts
Sept. 24, 2019 ||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.
view more »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.
view more »Essential Hospitals Applaud Court Ruling on Outpatient Payments
Sept. 18, 2019 ||The U.S. District Court’s ruling that the government overstepped its authority by cutting payments to hospital outpatient clinics is a victory for vulnerable patients and an important step toward protecting access to care in underserved communities.
view more »CMS Delays Exact Match Requirement Implementation
Sept. 17, 2019 ||Beginning in April 2020, hospitals with multiple service locations must accurately enter the address of their off-campus, provider-based departments.
view more »Quality Reporting Exceptions to Providers Affected by Hurricane Barry
Sept. 17, 2019 ||Facilities located in areas designated as emergency or major disaster areas will be exempt from provisions of Medicare quality reporting programs.
view more »Learn about proposals for damaging Medicare payment cuts and price transparency requirements in 2020 and next steps for association advocacy to protect hospitals.
view more »CMS Responds to Hurricane Dorian Public Health Emergencies
Sept. 10, 2019 ||The agency is waiving program requirements and suspending enforcement activities in Florida, Georgia, North Carolina, South Carolina, and Puerto Rico.
view more »Targeted Review of 2018 MIPS Scores Available
Sept. 3, 2019 ||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.
view more »Medicaid Policy in 2019: Eligibility
Aug. 29, 2019 ||Essential hospitals are an important resource to help patients determine their eligibility for Medicaid and other assistance programs.
view more »States Restrategize to Enroll Children in Medicaid, CHIP
Aug. 27, 2019 ||For the first time since 2007, the number of children enrolled in Medicaid and the Children’s Health Insurance Program declined in 2018.
view more »CMS Issues Guidance on Enforcement of Immigrant Benefit Rules
Aug. 26, 2019 ||The guidance follows a May 23 presidential memorandum calling for increased enforcement of laws related to individuals sponsoring immigration applicants.
view more »An NEJM Catalyst article assesses four public hospital quality reporting programs' ability to classify hospital performance.
view more »Appeals Court Reinstates Medicaid Third-Party Payer Final Rule
Aug. 20, 2019 ||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.
view more »CMS Announces Star Ratings Listening Session, 2020 Data Refresh
Aug. 19, 2019 ||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.
view more »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.
view more »Association Provides Feedback on Reducing Burden
Aug. 12, 2019 ||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.
view more »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.
view more »CMS Announces Medicare Will Cover CAR T Cancer Treatment
Aug. 9, 2019 ||The agency will reimburse hospitals at least 65 percent of the cost for this innovative cancer treatment.
view more »Court Rejects New Hampshire Work Requirements
Aug. 5, 2019 ||The court ruled that the Secretary of Health and Human Services failed to adequately consider the effect of the work requirements on Medicaid coverage.
view more »CMS Publishes Final Rule for FY 2020 Medicare IPPS
Aug. 4, 2019 ||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.
view more »CMS Refreshes Hospital Compare Data
Aug. 1, 2019 ||The refresh includes results from the Hospital Consumer Assessment of Healthcare Providers and Systems but does not include overall star ratings.
view more »OPPS Proposed Rule Continues 340B, Site-Neutral Cuts
July 30, 2019 ||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.
view more »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.
view more »Hospital Compare Fall Preview Reports Available
July 19, 2019 ||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.
view more »New Chronic Kidney Disease Payment Models
July 16, 2019 ||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.
view more »The two mandatory payment models will test prospective episode-based payments for radiation oncology therapy and end-stage renal disease treatment.
view more »CMS Delays OPPS Address Match Requirements
July 8, 2019 ||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.
view more »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.
view more »Funding Opportunity for Substance Use Disorder Treatment
June 27, 2019 ||The Centers for Medicare & Medicaid Services announced a $50 million funding opportunity for up to 10 states to aid in treatment and recovery services for individuals with substance use disorder, including opioid use disorder.
view more »CMS Approves La. Value-based Arrangement
June 27, 2019 ||Louisiana is the fifth state cleared to pursue value-based purchasing agreements for supplemental rebates with manufacturers through a state plan amendment.
view more »Medicaid Policy in 2019: Social Determinants of Health
June 25, 2019 ||As essential hospitals target social determinants of health in their communities, it is crucial that the Medicaid program continues to evolve to ensure this vital work can continue.
view more »Association Comments on FY 2020 IPPS Proposed Rule
June 25, 2019 ||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.
view more »CMS Approves Wash. Value-based Arrangement
June 14, 2019 ||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.
view more »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.
view more »Supreme Court Issues Ruling in Medicare DSH Allina Case
June 10, 2019 ||The decision does not impact ongoing litigation challenging Medicare Outpatient Prospective Payment System policies or Medicaid disproportionate share hospital third-party payer policy.
view more »CMS Seeks Further Input on Reducing Regulatory Burden
June 7, 2019 ||The agency requests feedback as part of its Patients Over Paperwork initiative to update or eliminate administratively burdensome regulations.
view more »CMS Sets Implementation Date for Exact Match Requirement
June 4, 2019 ||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.
view more »Association Comments on Interoperability Proposed Rules
June 4, 2019 ||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.
view more »June 24 Deadline to Review Proposed Medicare DSH Amounts
May 28, 2019 ||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.
view more »CMS Provides Details on Ambulance Service Model Application
May 28, 2019 ||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.
view more »Directed Payments: The Future of Accountable Medicaid Financing?
May 24, 2019 ||Directed payments through Medicaid managed care plans have avoided much of the confusion — even suspicion — that surrounds other supplemental support to providers. But as policy evolves, will the accountability and transparency built into this payment mechanism be sufficient in the long run?
view more »CMS Requests Letters of Intent for Direct Contracting Models
May 21, 2019 ||Providers interested in the professional or global options under the new Primary Cares Initiative must submit a nonbinding letter of intent by Aug. 2.
view more »CMS Seeks Feedback on Section 1332 Waivers
May 6, 2019 ||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.
view more »Join us for a deep dive into Medicaid managed care directed payments and what they mean for essential hospitals.
view more »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.
view more »CMS Revises Ligature Risk Guidance
April 29, 2019 ||Revised guidance clarifies what constitutes a ligature risk and outlines a ligature risk extension process for deficient hospitals; comments are due June 17.
view more »CMS Promotes Innovation for Dual-Eligible Beneficiaries
April 29, 2019 ||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.
view more »CMS Accepting BPCI Advanced Applications
April 29, 2019 ||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.
view more »CMMI Announces New Primary Care Models
April 25, 2019 ||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.
view more »Hospital Compare July Preview Reports Available
April 23, 2019 ||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.
view more »CMS, ONC Extend Comment Deadlines for Interoperability Rules
April 22, 2019 ||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.
view more »CMS Finalizes ACA Marketplace Benefit, Payment Notice
April 19, 2019 ||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.
view more »CMS Toolkit Highlights ACO Care Coordination Work
April 16, 2019 ||The new Care Coordination Toolkit showcases the work of accountable care organizations (ACOs) participating in the Medicare Shared Savings Program and Next Generation ACO Model. The agency also released a set of case studies describing innovation ACO initiatives.
view more »CMS Approves Medicaid Work Requirements, Spending Cap in Utah
April 8, 2019 ||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.
view more »CMS Launches HIPAA Administrative Simplification Compliance Program
April 1, 2019 ||The agency in April will randomly select nine Health Insurance Portability and Accountability Act–covered entities, including health plans and clearinghouses, for compliance reviews.
view more »Court Rejects Arkansas, Kentucky Work Requirements
April 1, 2019 ||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
view more »Most MIPS-Eligible Clinicians Earned Positive Payment Adjustment in 2017
March 26, 2019 ||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.
view more »CMS Releases Guidance on Waiver Monitoring, Evaluation
March 18, 2019 ||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.
view more »CMS Approves Medicaid Work Requirements in Ohio
March 18, 2019 ||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.
view more »President Releases FY 2020 Budget Proposal
March 12, 2019 ||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.
view more »CMS Revises Immediate Jeopardy Policies
March 11, 2019 ||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.
view more »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.
view more »CMS Updates Overall Hospital Star Ratings, Proposes Future Changes
Feb. 28, 2019 ||The agency posted potential changes to the star ratings program for public comment, including potential hospital peer grouping.
view more »Statement on February Hospital Star Ratings Release
Feb. 28, 2019 ||We find it unfortunate that the Centers for Medicare & Medicaid Services decided to publish hospital star ratings today even as the agency proposed changes that recognize ongoing flaws in the ratings methodology.
view more »CMS Announces New Interoperability Resources
Feb. 26, 2019 ||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.
view more »New Payment Model For Emergency Ambulance Services
Feb. 19, 2019 ||The Emergency Triage, Treat, and Transport model for emergency ambulance services encourages treatment for Medicare beneficiaries outside the emergency department.
view more »CMS, ONC Release Proposed Rules on Interoperability
Feb. 13, 2019 ||The proposals aim to increase interoperability and improve patients’ access to their health information, while reducing regulatory burden on hospitals.
view more »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.
view more »CMS Approves Medicaid Work Requirements in Arizona
Jan. 22, 2019 ||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.
view more »Proposed provisions aim to further the Trump administration’s goals to lower premiums, increase market stability, reduce regulatory burden, and protect taxpayers.
view more »CMS Updates QPP Participation Status Tool
Jan. 22, 2019 ||The tool includes 2018 Qualifying Alternative Payment Model (APM) Participant and Merit-based Incentive Payment System APM status.
view more »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.
view more »Association Comments on Medicaid Managed Care Proposed Rule
Jan. 15, 2019 ||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.
view more »CMS Approves Medicaid Work Requirements in Maine, Michigan
Jan. 7, 2019 ||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.
view more »CMS Highlights Opportunities for Dual-Eligible Beneficiaries
Dec. 21, 2018 ||In a letter to state Medicaid directors, the agency shared 10 opportunities to improve service to individuals dually eligible for Medicare and Medicaid.
view more »CMS Approves N.M. IMD Exclusion Waiver
Dec. 21, 2018 ||The waiver permits federal reimbursement for short-term stays in institutions for mental disease for individuals with substance use disorders.
view more »CMS Reapproves N.H. Work Requirements
Dec. 10, 2018 ||The state’s waiver initially was approved in May, but required a second approval to extend beyond Dec. 31.
view more »CMS Releases Additional Price Transparency FAQs
Dec. 10, 2018 ||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.
view more »Hospital Compare February Preview Reports Now Available
Dec. 6, 2018 ||Hospitals have until Dec. 30 to preview their quality data before it is published on the Hospital Compare website in February 2019.
view more »CMS Reapproves Kentucky Medicaid Work Requirements
Dec. 4, 2018 ||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.
view more »Association Submits Feedback on Disparity Methods
Dec. 3, 2018 ||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.
view more »Most MIPS-Eligible Clinicians See Positive Payment Adjustment
Nov. 27, 2018 ||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.
view more »CMS Launches New Hospital Quality Reporting Platform
Nov. 26, 2018 ||The agency will hold educational webinars to help health care providers understand the new user interface for Hospital Compare preview reports.
view more »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.
view more »Association Comments on Burden Reduction Proposed Rule
Nov. 21, 2018 ||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.
view more »Medicaid Demonstration Targets Serious Mental Illness Treatment
Nov. 15, 2018 ||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.
view more »The Outpatient Prospective Payment System and Physician Fee Schedule final rules for calendar year 2019 expand damaging site-neutral payment policies and continue Medicare Part B drug payment cuts to hospitals in the 340B Drug Pricing Program.
view more »CMS Proposes to Streamline Medicaid Managed Care Regulations
Nov. 13, 2018 ||The proposed rule reflects the agency’s broader strategy to relieve regulatory burden, support state flexibility, and promote transparency and innovation in the delivery of care.
view more »CMS Approves Wisconsin Medicaid Work Requirements
Nov. 5, 2018 ||Wisconsin is the fifth state to receive approval to incorporate work and community engagement requirements as a condition of Medicaid eligibility.
view more »OPPS Final Rule Extends Site Neutral, 340B Cuts
Nov. 2, 2018 ||The Medicare Outpatient Prospective Payment System final rule for calendar year 2019 broadens the scope of cuts to hospitals in the 340B Drug Pricing Program and to off-campus provider-based departments; in a statement, the association strongly objected to these additional payment cuts.
view more »The rule undermines stability and choice for vulnerable patients by continuing to cut critical funding to hospitals serving people who face barriers to care.
view more »Statement on 340B Drug Pricing Program Proposed Rule on Ceiling Price and Civil Monetary Penalties
Oct. 31, 2018 ||We are pleased that the Department of Health and Human Services has responded to our lawsuit with other national organizations by proposing a Jan. 1, 2019, effective and compliance date for 340B Drug Pricing Program enforcement.
view more »CMS Seeks Feedback on Disparity Methods
Oct. 30, 2018 ||The agency seeks stakeholder feedback on two disparity methods measuring patient outcomes based on social risk factors; comments are due Dec. 14.
view more »CMS Announces Maternal Opioid Misuse Model
Oct. 29, 2018 ||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.
view more »CMS Releases Guidance on Section 1332 Waivers
Oct. 23, 2018 ||The guidance allows states additional flexibility to waive certain provisions of the Affordable Care Act while preserving access to affordable, comprehensive coverage.
view more »CMS Approves Virginia Medicaid Expansion
Oct. 23, 2018 ||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.
view more »Association Comments on Proposed MSSP Changes
Oct. 22, 2018 ||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.
view more »CMS Responds to Hurricane Michael Public Health Emergency
Oct. 15, 2018 ||The Centers for Medicare & Medicaid Services is waiving program requirements and suspending enforcement activities in Florida and Georgia.
view more »Nearly 1,300 Sign Up for New BPCI Advanced Model
Oct. 15, 2018 ||Participating entities, including 832 acute-care hospitals, will receive bundled payments for certain episodes of care to promote value in care delivery.
view more »The agency will publish accrediting organization (AO) performance data, redesign AO validation surveys, and share its annual report to Congress.
view more »CMS Will Host Cost Report Webcast on MCReF System
Oct. 4, 2018 ||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.
view more »CMS Revises Medicare DSH Payment Amounts for FY 2019
Oct. 2, 2018 ||A new notice makes technical and typographical corrections to the fiscal year 2019 Inpatient Prospective Payment System final rule.
view more »CMS Releases Price Transparency FAQs
Oct. 1, 2018 ||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.
view more »CMS Announces Funding for Quality Measure Development
Sept. 25, 2018 ||Cooperative agreements with seven organizations aim to develop, improve, update, or expand quality measures for Medicare’s Quality Payment Program.
view more »Association Comments on 2019 Medicare OPPS Proposed Rule
Sept. 25, 2018 ||America’s Essential Hospitals urged the Centers for Medicare & Medicaid Services to reverse policies that will result in significant funding cuts to essential hospitals and hinder access to care.
view more »CMS to Host Webinar on Aligning Medicaid with MACRA
Sept. 25, 2018 ||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.
view more »Elements of the proposal of interest to essential hospitals include targeting emergency preparedness, hospital quality program requirements, infection control, and physical examinations.
view more »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.
view more »HHS Responds to Hurricane Florence State of Emergency
Sept. 18, 2018 ||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.
view more »Association Comments on 2019 Physician Fee Schedule Proposed Rule
Sept. 12, 2018 ||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.
view more »CMS: ACOs Saved Medicare $314M in 2017
Sept. 10, 2018 ||New data show 472 accountable care organizations in the Medicare Shared Savings Program cared for 9 million program beneficiaries in 2017.
view more »CMS Provides Confidential Reports to Highlight Disparity Gaps
Aug. 30, 2018 ||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.
view more »CMS Releases Disaster Response Toolkit
Aug. 29, 2018 ||The toolkit includes strategies and examples to help Medicaid agencies prepare for and respond to natural and man-made disasters.
view more »Association Responds to Physician Self-Referral RFI
Aug. 27, 2018 ||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.
view more »CMS to Fund New Child Behavioral Health Model
Aug. 27, 2018 ||The Integrated Care for Kids (InCK) Model seeks to target physical and behavioral health needs through prevention, early identification, and treatment.
view more »CMS Issues Guidance on 1115 Waiver Budget Neutrality
Aug. 27, 2018 ||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.
view more »CMS Updates Work to Streamline SPAs, Section 1915 Waivers
Aug. 21, 2018 ||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.
view more »A proposed rule for the Medicare Shared Savings Program would overhaul participation tracks to create a "glide path" along which accountable care organizations could transition from a rewards-only model to a two-sided model with risk and the potential for greater rewards.
view more »The Centers for Medicare & Medicaid Services final rule for Medicare’s Inpatient Prospective Payment System for FY 2019 increases inpatient operating payment rates and Medicare disproportionate share hospital payments.
view more »CMS to Update Ligature Risk Guidance
Aug. 13, 2018 ||The agency will not convene a proposed task force to reduce environmental risks associated with the care of psychiatric inpatients, opting instead to use findings from The Joint Commission special report on suicide prevention in health care settings.
view more »The confidential reports, available Aug. 24, will allow hospitals to review two disparity methods that assess performance for patients with social risk factors.
view more »CMS To Host Aug. 15 Forum on Opioids
Aug. 6, 2018 ||The special open-door forum aims to educate prescribers on federal resources and strategies to combat the opioid epidemic.
view more »CMS Issues FY 2019 IPPS Final Rule
Aug. 6, 2018 ||The final rule increases Medicare inpatient payment rates to acute care hospitals by 1.85 percent, revises electronic health record requirements, and changes the payment adjustment methodology for the Hospital Readmissions Reduction Program.
view more »The Centers for Medicare & Medicaid Services has released Outpatient Prospective Payment System and Physician Fee Schedule proposed rules for calendar year 2019 that would expand site-neutral payment policies and continue Medicare Part B drug payment cuts to 304B hospitals.
view more »Hospital Compare October Preview Reports Available
July 31, 2018 ||Hospitals have until Aug. 25 to preview their quality data before publication on the Hospital Compare website in October.
view more »CY 2019 OPPS Proposed Rule Extends Site Neutral, 340B Cuts
July 26, 2018 ||A new proposed rule for Medicare’s Outpatient Prospective Payment System would broaden the scope of cuts to hospitals in the 340B Drug Pricing Program and to off-campus provider-based departments; it also contains provisions related to quality reporting and transparency.
view more »The rule would make bad policies worse, impose draconian new cuts that jeopardize access to care, and undermine the foundation of the nation's health care safety net.
view more »CMS Extends BPCI Advanced Model Deadline
July 16, 2018 ||The Centers for Medicare & Medicaid Services extended to Aug. 8 the participation agreement deadline for the Bundled Payments for Care Improvement Advanced model and announced that participants can retroactively withdraw from the program in March 2019.
view more »CMS Demonstration Would Waive MIPS Requirements
July 10, 2018 ||The project would waive Merit-based Incentive Payment System requirements for clinicians who participate in certain Medicare Advantage plans that involve taking on risk to better align such plans with fee-for-service Medicare.
view more »MIPS Participants May Request Targeted Review of 2017 Scores
July 9, 2018 ||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.
view more »Court Rejects Kentucky Medicaid Waiver
July 5, 2018 ||The decision strikes down the state's overall Section 1115 waiver, which included community engagement and work requirements, but it upholds as a separate waiver a portion allowing Medicaid reimbursement for substance use disorder treatment in institutions for mental disease.
view more »New, Enhanced Initiatives Target Medicaid Program Integrity
June 29, 2018 ||Several new or enhanced Centers for Medicare & Medicaid Services initiatives are designed to improve Medicaid program integrity and sustainability through greater transparency and accountability, strengthened data, and innovative analytical tools.
view more »CMS approved Oklahoma's proposal to advance Medicaid value-based arrangements with drugmakers in negotiating supplemental rebate agreements; The agency rejected Massachusetts' request to institute a closed formulary for Medicaid outpatient prescription drugs.
view more »Association Comments on Annual Medicare Inpatient Payment Rule
June 29, 2018 ||America's Essential Hospitals urged the Centers for Medicare & Medicaid Services to implement its Medicare disproportionate share hospital payment methodology and quality measurement programs in a way that accounts for the unique needs and patient populations served by essential hospitals.
view more »CMS Outlines Expanded Access for Children in Psychiatric Care
June 28, 2018 ||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.
view more »EHR Incentive Program Hardship Exception Deadline Approaching
June 25, 2018 ||Medicare-eligible hospitals have until July 1 to apply for exception—and avoid a negative payment adjustment—for the 2019 payment adjustment year.
view more »Joint Model Policies for Extreme Circumstances Finalized
June 15, 2018 ||This finalized rule provides flexibility in determining episode spending for Comprehensive Care for Joint Replacement model participating hospitals affected by a major disaster, such as a hurricane or wildfire.
view more »CMS Releases Opioid Crisis Road Map
June 15, 2018 ||A blog post and road map highlight the agency's approach to the crisis, including prevention of new opioid use disorder cases and use of data to target prevention and treatment.
view more »Responding to concerns raised by America’s Essential Hospitals and other stakeholders, the Centers for Medicare & Medicaid Services has announced it will postpone the July public release of overall hospital star ratings.
view more »Statement on CMS Decision to Postpone Hospital Star Ratings
June 12, 2018 ||The agency says postponing the July release will allow additional time to analyze the impact of changes to some measures.
view more »CMS Leverages Medicaid Program to Combat Opioid Crisis
June 12, 2018 ||An informational bulletin outlines the role of Medicaid in the care of infants born with neonatal abstinence syndrome, while a letter to state Medicaid directors offers guidance on funding Medicaid technology to combat the opioid crisis.
view more »CMS to Host Emergency Preparedness Webinar
June 12, 2018 ||The June 19 webinar will explore the 2016 final rule on emergency preparedness requirements for Medicare- and Medicaid-participating health care providers, along with 1135 waivers.
view more »CMS Releases New Medicaid and CHIP Scorecard
June 4, 2018 ||The first Medicaid and Children’s Health Insurance Program scorecard is intended to increase public transparency and accountability in the two programs.
view more »Association Comments on Medicaid Access Exemptions Proposal
May 23, 2018 ||To ensure Medicaid beneficiaries' access to quality care, America's Essential Hospitals urges CMS not to issue access monitoring review exemptions to states with high managed care penetration.
view more »CMS Unveils Enhanced Drug Dashboards
May 22, 2018 ||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.
view more »CMS Announces First Rural Health Strategy
May 14, 2018 ||The interagency effort targets obstacles to health care, including a fragmented delivery system and lack of specialty service access, faced by many rural communities.
view more »CMS Approves N.H. Medicaid Work Requirements
May 14, 2018 ||New Hampshire is the fourth state to receive approval to incorporate work and community engagement requirements as a condition of Medicaid eligibility.
view more »Hospital Compare July Preview Reports Available
May 8, 2018 ||Hospitals have until June 2 to preview their quality data before it is published on the Hospital Compare website in July.
view more »HCAHPS Podcast Helps Participants Improve Response Rates
May 7, 2018 ||The podcast provides updates to survey vendors, self-administering hospitals, and client hospitals participating in the national patient experience survey.
view more »The new proposed IPPS rule for FY 2019 contains numerous policy and payment changes, including increasing net inpatient payment rates by 1.75 percent.
view more »CMS Refreshes Hospital Compare Data
May 1, 2018 ||The refresh includes data for the Hospital Inpatient Quality Reporting, Prospective Payment System–Exempt Cancer Hospital Quality Reporting, and Hospital Outpatient Quality Reporting programs.
view more »HHS Releases Parity Action Plan
May 1, 2018 ||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.
view more »CMS Issues FY 2019 IPPS Proposed Rule
April 25, 2018 ||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.
view more »CMS Requests Feedback on Direct Provider Contracting
April 25, 2018 ||The new model would allow providers to contract directly with patients, rather than contracting with Medicare or private insurers; comments are due May 25.
view more »Receive MIPS Credit for Participating in Reporting Burden Survey
April 23, 2018 ||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.
view more »CMS Webinar on New Medicare Cost Report e-Filing System
April 23, 2018 ||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.
view more »CMS Updates Market Saturation, Utilization Data Tool
April 17, 2018 ||Unlike previous data releases, this version of the tool allows users to view trend lines of the available metrics and health services areas.
view more »CMS Hosts Forum on Opioid Epidemic in Minority Communities
April 17, 2018 ||The event, for National Minority Health Month, will discuss how the opioid crisis affects minority communities and how organizations partner to combat the crisis and improve behavioral health.
view more »Webinar Focuses on 30-Day Readmission Measure
April 16, 2018 ||The April 18 webinar will explain the benefits of voluntary submission in calendar year 2018, share reporting resources, and answer attendee questions.
view more »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.
view more »Updated Guidance on OPPS Modifiers for 340B Drugs
April 9, 2018 ||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.
view more »New Research Highlights Evolving Role of DSRIPs
April 2, 2018 ||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.
view more »Work Requirements in Medicaid Waivers
March 29, 2018 ||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.
view more »CMS Publishes 2019 Essential Community Providers List
March 28, 2018 ||Hospitals have until Aug. 22 to petition the Centers for Medicare & Medicaid Services for inclusion on the list for the 2020 plan year.
view more »Analysis: Specialty Hospitals Have Disproportionately High Star Ratings
March 27, 2018 ||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.
view more »CMS Proposes Exemptions to Medicaid Access Reviews
March 27, 2018 ||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.
view more »Another Court Rules Against DSH Third-Party Payer Final Rule
March 12, 2018 ||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.
view more »Resources Help with EHR Incentive Program Attestation
March 9, 2018 ||The new resources for Medicare-eligible hospitals and critical access hospitals include details about submitting data through QualityNet and information on clinical quality measures.
view more »CMS Approves Arkansas Medicaid Work Requirements
March 6, 2018 ||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.
view more »BPCI Advanced Model Deadline Approaching
March 5, 2018 ||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.
view more »CMS Hosts Webinar on Physical, Mental Health Integration
March 1, 2018 ||The Innovation Accelerator Program's March 26 webinar will focus on administrative and regulatory barriers to physical and mental health integration in the Medicaid program.
view more »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.
view more »MIPS Quality Reporting Data Due in March
Feb. 13, 2018 ||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.
view more »Grants Aim to Increase Flexibility in Health Insurance Markets
Feb. 8, 2018 ||The Centers for Medicare & Medicaid Services is awarding $8.1 million in targeted funding to assess and potentially alter states’ essential health benefits packages.
view more »CMS Publishes List of Alternative Payment Models
Feb. 8, 2018 ||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.
view more »CMS Approves Indiana Medicaid Work Requirements
Feb. 5, 2018 ||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.
view more »CMS Resources Prepare Providers for New Medicare Cards
Feb. 5, 2018 ||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.
view more »Hospital Compare Preview Reports Now Available
Feb. 5, 2018 ||Hospitals have until March 2 to preview their quality data before it is published on the Hospital Compare website in April.
view more »Take a deep dive into the new Bundled Payment for Care Improvement (BPCI) model, “BPCI Advanced,” with experts from Premier Inc.
view more »CMS Clarifies Ligature Risk Policy
Jan. 22, 2018 ||The agency expects to release comprehensive ligature risk interpretive guidance later this year for psychiatric units of acute-care hospitals and psychiatric hospitals.
view more »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.
view more »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.
view more »FAQs Issued on Site Neutral Mid-Build Attestation
Jan. 12, 2018 ||The Centers for Medicare & Medicaid Services will audit mid-build certifications this year and should complete all audits by December 2018.
view more »CMS To Host Call on 1115 Community Engagement Initiative
Jan. 12, 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.
view more »CMS Events Focus on Innovation Accelerator Program
Jan. 12, 2018 ||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.
view more »America’s Essential Hospitals continues to fight to protect the 340B Drug Pricing Program, a crucial source of support for essential hospitals. Participants heard an overview of our recent advocacy activities and an update on our next steps.
view more »CMS Launches New QPP Data Submission System
Jan. 4, 2018 ||The new system streamlines quality reporting through one portal; the data submission period runs from Jan. 2 to March 31.
view more »CMS Releases Q&A Document on Worksheet S-10
Jan. 3, 2018 ||The guidance defines courtesy discounts, defines when a bad debt is "written off," provides clarity about unpaid coinsurance and deductibles, and more.
view more »CMS Approves Waiver Extensions for Texas, Mississippi
Jan. 2, 2018 ||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.
view more »Association Comments on Finalized Quality Payment Program Updates
Dec. 22, 2017 ||In response to an annual update to the Quality Payment Program, the association called for increased flexibility and risk adjustment for socioeconomic factors.
view more »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.
view more »Final 2019 ECP Petitions Due Dec. 22
Dec. 15, 2017 ||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.
view more »The cancellation of three episode payment models and an incentive payment model comes in response to stakeholder feedback about the burden of these models.
view more »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.
view more »CCIIO Calls for State Flexibility in Letter to Issuers
Nov. 30, 2017 ||The calendar year 2019 draft letter to plans offered through federally facilitated marketplaces also provides deadlines for qualified health plan certification.
view more »Association Comments on 2019 Marketplace Plan Standards
Nov. 29, 2017 ||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.
view more »Webinar to Explore Innovative Substance Use Treatment in EDs
Nov. 27, 2017 ||During the Dec. 13 webinar, association member Boston Medical Center will discuss the hospital's substance use disorder treatment initiatives.
view more »CMS Proposes Rule on Medicare Advantage Plans, Part D
Nov. 27, 2017 ||The proposed rule increases flexibility for Medicare Advantage plans and implements the Comprehensive Addiction and Recovery Act of 2016.
view more »CMS Issues Medicaid Access to Care Guidance
Nov. 21, 2017 ||The guidance specifies rate reductions in Medicaid fee-for-service that will not require access reviews by the Center for Medicare & Medicaid Services.
view more »Association Submits Response to Innovation Center New Direction
Nov. 20, 2017 ||In response to the request for information, the association encouraged flexibility and a focus on hospitals treating high numbers of complex patients.
view more »CMS, SAMHSA Release Behavioral Health Roadmap
Nov. 17, 2017 ||The new guide will help patients understand their mental and behavioral health, navigate treatment options, and find appropriate services.
view more »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.
view more »Hospital Compare Overall Hospital Star Ratings Reports Released
Nov. 16, 2017 ||The Centers for Medicare & Medicaid Services will review December 2017 methodology enhancements and their impact on star ratings in a Nov. 30 webinar.
view more »Statement on Bipartisan Legislation to Stop Cuts to 340B Hospitals
Nov. 15, 2017 ||America's Essential Hospitals thanks Reps. David McKinley (R-WV) and Mike Thompson (D-CA) for legislation that would place a permanent moratorium on the Centers for Medicare & Medicaid Services policy to cut $1.6 billion in Medicare Part B drug reimbursement from 340B hospitals.
view more »Joint Commission Updates Emergency Management Requirements
Nov. 14, 2017 ||The updated standards focus on collaboration between health care providers and emergency management officials in the community.
view more »CMS to Streamline Medicaid Demonstration, Waiver Policies
Nov. 14, 2017 ||In a speech to the National Association of Medicaid Directors, Administrator Verma also announced an initiative to create scorecards for Medicaid and CHIP outcomes.
view more »The lawsuit argues that the 340B provisions of the Centers for Medicare & Medicaid Services’ outpatient prospective payment system rule violate the Social Security Act and should be set aside under the Administrative Procedure Act as unlawful and in excess of the HHS Secretary’s statutory authority.
view more »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.
view more »Dive into the policy details of the CMS rule that cuts 340B program savings, and hear how America’s Essential Hospitals plans to respond.
view more »CMS Finalizes CY 2018 Updates to Quality Payment Program
Nov. 3, 2017 ||The Quality Payment Program combines and replaces three separate clinician quality programs with a single system for clinicians that bill Medicare Part B.
view more »2018 Physician Fee Schedule Cuts Outpatient Payments
Nov. 3, 2017 ||The rule includes additional cuts to new off-campus, provider-based departments (PBDs), as well as physician payment and quality program changes.
view more »CMS Advises States on Directed Provider Payments in Managed Care
Nov. 3, 2017 ||An agency bulletin instructs states on how to seek approval for state-directed payment arrangements and distinguishes directed payments from other payment models.
view more »CMS Proposes Notice of Benefit and Payment Parameters for 2019 Health Insurance Marketplaces
Nov. 3, 2017 ||The proposed rule would expand the role of states in administering marketplace plans and give states additional flexibility to define essential health benefits.
view more »CMS Releases Preliminary FY 2017 Medicaid DSH Allotments
Nov. 3, 2017 ||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.
view more »CMS Announces New Opioid Policy, Approves State Demonstrations
Nov. 3, 2017 ||CMS announced a new streamlined process to encourage state innovation through demonstrations and approved new demonstrations for New Jersey and Utah.
view more »Statement on 2018 Physician Fee Schedule Final Rule
Nov. 2, 2017 ||The final rule puts expansion of services further out of reach for underserved communities and threatens access to care where access is needed most.
view more »CMS Finalizes 340B Cuts in CY 2018 OPPS Rule
Nov. 2, 2017 ||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.
view more »CMS Extends Worksheet S-10 Deadline to Jan. 2
Nov. 2, 2017 ||The Centers for Medicare & Medicaid Services previously had extended the revision deadline to Oct. 31, following numerous changes to the worksheet S-10.
view more »The final rule's cuts to Medicare Part B drug payments to 340B hospitals jeopardizes health care access for millions of low-income individuals and families nationwide and weakens the ability of essential hospitals to provide vital services to communities.
view more »Hospital Compare Refreshed, Overall Star Ratings Coming This Week
Oct. 31, 2017 ||The quality measure data update excludes Hospital Compare overall star ratings, which will refresh beginning Nov. 3.
view more »Study: Hospitalwide Readmission Measure Harder on Safety Net
Oct. 23, 2017 ||Shifting from condition-specific to hospitalwide measures in the Hospital Readmissions Reduction Program would significantly increase penalties for hospitals with many vulnerable patients.
view more »Association Comments on Proposal to Cancel Episode Payment Models
Oct. 17, 2017 ||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.
view more »CMS Approves West Virginia Medicaid Waiver
Oct. 16, 2017 ||The five-year demonstration project, beginning Jan. 1, 2018, aims to strengthen substance use disorder care for state Medicaid beneficiaries.
view more »FAQs Clarify Effect of Parity Rule on Medicaid, CHIP
Oct. 16, 2017 ||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.
view more »CMS Releases Fact Sheet on EHR Penalties
Oct. 16, 2017 ||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.
view more »CMS Officially Withdraws Medicare Part B Drug Payment Model
Oct. 6, 2017 ||America's Essential Hospitals opposed the proposed payment model, which would have reduced Medicare payments to providers for Part B drugs.
view more »Hospital Compare Preview Reports Now Available
Oct. 6, 2017 ||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.
view more »CMS Revises Worksheet S-10, Extends Revision Deadline
Oct. 6, 2017 ||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.
view more »CMS Cancels New ACO Model for Dual Eligibles
Oct. 6, 2017 ||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.
view more »CMS to Test MIPS Episode-Based Cost Measures
Oct. 5, 2017 ||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.
view more »Senators Urge CMS to Stop Harmful 340B Cuts
Oct. 3, 2017 ||The harmful payment reduction was included in the 2018 Outpatient Prospective Payment System proposed rule, expected to be finalized this fall.
view more »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.
view more »CMS Will Not Update Overall Star Ratings Data in October
Oct. 2, 2017 ||America's Essential Hospitals was among those urging the agency to suspend overall star ratings and examine concerns with the methodology.
view more »CMS Seeks New Direction for Innovation Center
Sept. 22, 2017 ||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.
view more »Reporting Exceptions Granted to Providers Affected by Hurricane Irma
Sept. 22, 2017 ||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.
view more »Association Comments on Proposed 2018 Physician Fee Schedule
Sept. 12, 2017 ||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.
view more »Federal Agencies Offer Hurricane Resources, Guidance
Sept. 8, 2017 ||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.
view more »CMS Offers Emergency Preparedness Training Course
Sept. 8, 2017 ||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.
view more »CMS Exceptions Granted To Hospitals Affected by Hurricane Harvey
Sept. 5, 2017 ||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.
view more »CMS Proposes Enhancements to Hospital Star Ratings Methodology
Sept. 5, 2017 ||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.
view more »Association Comments on Proposed DSH Allotment Reductions
Aug. 30, 2017 ||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.
view more »Association Comments on Proposed QPP Updates
Aug. 22, 2017 ||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.
view more »CMS Releases New Medicaid Managed Care Rule FAQs
Aug. 21, 2017 ||The newly released set of frequently asked questions relates to potential payment issues for Medicaid managed care patients in institutions for mental disease.
view more »CMS Proposes to Cancel Mandatory Episode Payment Models
Aug. 16, 2017 ||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.
view more »Statement on CMS Decision to Cancel Cardiac Episode Payment Models
Aug. 15, 2017 ||The association says providers selected for the Comprehensive Care for Joint Replacement (CJR) demonstration are only just now adapting to the new payment and delivery approaches and need more time before facing another demonstration.
view more »The new rule would affect inpatient operating payments, Medicare disproportionate share hospital payments, and the Hospital Readmissions Reduction Program.
view more »An in-depth discussion on proposed Medicaid DSH reduction methodology and the association’s efforts to combat the impending cuts.
view more »CMS Approves Extension of Florida Medicaid Waiver
Aug. 4, 2017 ||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.
view more »CMS To Accept Additional Year of Revised S-10 Worksheets
Aug. 4, 2017 ||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.
view more »Hospital Compare Site Refreshed, Star Ratings Previews Released
July 31, 2017 ||The Hospital Compare refresh includes data on new measures; hospitals can preview their overall star ratings through Aug. 13.
view more »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.
view more »The latest from experts on the CMS proposed policy rules that cut 340B savings and support for outpatient services in underserved areas.
view more »CMS Outlines Section 1115 Budget Neutrality Methodology Changes
July 24, 2017 ||A publicly released set of slides describes dramatic restrictions to CMS' budget neutrality policy for Section 1115 waivers.
view more »CMS To Accept Revised Uncompensated Care Worksheets
July 24, 2017 ||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.
view more »MACRA Physician Payment Resources for Essential Hospitals
July 19, 2017 ||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.
view more »CY 2018 OPPS Proposed Rule Includes 340B Cuts
July 14, 2017 ||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.
view more »Courts Rule in Favor of Hospitals on DSH Limits
July 13, 2017 ||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.
view more »CMS Approves Alaska’s Section 1332 Waiver
July 12, 2017 ||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.
view more »Attendees gained a comprehensive view of legislative and regulatory action in Washington, D.C, a preview of action in the fall, and our recommendations for messaging and strategy during Congress’ August recess.
view more »CMS Issues Bulletin on Managed Care Regulations
July 5, 2017 ||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.
view more »America's Essential Hospitals provides a detailed analysis of the Quality Payment Program proposed rule for calendar year 2018.
view more »CMS Proposes CY 2018 Updates to Quality Payment Program
June 22, 2017 ||CMS proposes changes related to participation in the merit-based incentive payment system or Advanced Alternative Payment Models tracks.
view more »CMS Urges Providers To Prepare for New Medicare Cards
June 21, 2017 ||New Medicare cards will include a randomly generated Medicare beneficiary identifier instead of the Social Security-based health insurance claim number.
view more »CMS Publishes Quality Payment Program Fact Sheet
June 19, 2017 ||The fact sheet gives a general overview of the Medicare Shared Savings Program and Quality Payment Program and explains how the programs work together.
view more »Association Comments on 2018 Medicare Inpatient Payment Proposals
June 13, 2017 ||America’s Essential Hospitals encourages CMS to improve transparency, risk adjust, and reduce regulatory burden for essential hospitals.
view more »CMS Seeks Input on Reducing Regulatory Burden of ACA
June 9, 2017 ||CMS aims to eliminate or change outdated, costly, or inconsistent regulations for marketplaces established under the Affordable Care Act.
view more »CMS To Host Webinar on Substance Use Disorder Treatment
June 9, 2017 ||The webinar on June 28 will focus on the Medicaid Innovation Accelerator Program's Reducing Substance Use Disorders program area.
view more »CMS Extends Deadline for Medicaid Housing Program
June 8, 2017 ||States have until June 12 to complete an expression of interest form for the Medicaid Innovation Accelerator Program track.
view more »CDC Releases Report on Legionnaires’ Disease
June 6, 2017 ||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.
view more »CMS Issues Guidance for Emergency Preparedness Final Rule
June 6, 2017 ||The deadline for Medicare- and Medicaid-providers and suppliers to meet applicable requirements of the rule, including training and testing, is Nov. 15.
view more »CMS Cancels July Update of Overall Star Ratings
June 6, 2017 ||Overall star ratings now will be released in October because of issues with data on three measures; hospitals can preview the ratings in July.
view more »CMS Predicts Advanced APM Participants’ Qualifying Status
June 6, 2017 ||CMS predicts nearly all clinicians in advanced alternative payment models in 2016 would qualify for a 2019 incentive payment for participating in 2017.
view more »CMS Publishes Quality Payment Program Resource Guide
May 30, 2017 ||A new Centers for Medicare & Medicaid Services guide highlights technical resources for clinicians participating in the Quality Payment Program under MACRA.
view more »CMS Seeks Participants for Medicaid Housing Program
May 22, 2017 ||The nine-month program will link up to eight state Medicaid agencies with local housing systems to aid Medicaid beneficiaries.
view more »CMS Further Delays Mandatory Bundled Payment Models
May 18, 2017 ||The first performance year for new cardiac episode payment models and the effective date of joint replacement regulation amendments now starts Jan. 1, 2018.
view more »CMS Checklist Helps States Apply for Section 1332 Waivers
May 18, 2017 ||The new checklist tool helps states compile the necessary documents to apply to waive ACA provisions and pursue alternative reforms.
view more »CMS Tool Identifies Clinicians’ MIPS Participation Status
May 11, 2017 ||Clinicians enter their national provider identifier into the tool to determine whether they must submit data to the merit-based incentive payment system.
view more »CMS Posts eCQM Annual Update
May 9, 2017 ||The update for the 2018 performance year aligns electronic clinical quality measure specifications with current clinical guidelines and code systems.
view more »Study: Some Hospitals Face Repeat Penalties Under HRRP
May 8, 2017 ||The study found that the penalty burden was greater in hospitals treating a high share of patients with socioeconomic disadvantages.
view more »Barriers to communication can be especially harmful for Medicare beneficiaries, who are more likely to have comorbidities and complex health needs.
view more »$1T Omnibus Spending Bill Unveiled for FY 2017
May 2, 2017 ||A vote on the bipartisan bill could come Wednesday in the House, followed by Senate consideration before continuing resolution appropriations expire Friday.
view more »CMS Refreshes Hospital Compare Data
May 2, 2017 ||CMS updated the Hospital Compare website with new data, including health care–associated infections and HCAHPS survey data.
view more »Association Responds to Final Rule Delaying Cardiac, Joint Models
April 20, 2017 ||America’s Essential Hospitals expressed support of the delay of episode payment models to allow selected hospitals more time to prepare for participation.
view more »The rule would raise inpatient operating payment rates, revise Medicare DSH payment methodology, and apply a transitional methodology for HRRP penalties.
view more »CMS Issues FY 2018 IPPS Proposed Rule
April 17, 2017 ||The rule contains provisions on the Hospital Readmissions Reduction Program, Medicare DSH, the Inpatient Quality Reporting program, and more.
view more »Statement on FY 2018 Inpatient Prospective Payment System Proposed Rule
April 14, 2017 ||Association calls the fiscal year 2018 Inpatient Prospective Payment System proposed rule a welcome first step toward broader recognition in federal health policy of challenges that affect the health of vulnerable patients.
view more »It requires Medicare payments for beneficiaries dually eligible for Medicaid, and other third-party payments be included in uncompensated care calculations.
view more »CMS Selects Participants for Accountable Health Communities Model
April 11, 2017 ||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.
view more »Review Periods Open for Quality, Value-Based Purchasing Reports
April 11, 2017 ||Hospitals have until May 5 to review overall Hospital Compare star rating and until May 10 to review value-based purchasing hospital-specific reports.
view more »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.
view more »CMS Delays New Lab Reporting Requirements 60 Days
April 4, 2017 ||The delay, which applies to certain hospital outreach labs, comes after stakeholders expressed concerns about the March 31, 2017, deadline.
view more »Merit-Based Incentive Payments Focus of CMS Presentations
April 3, 2017 ||The webinar and listening session, on April 4 and 5, will focus on MIPS' advancing care information performance category and cost measure development.
view more »CMS Issues Information on Emergency Preparedness Final Rule
March 28, 2017 ||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.
view more »CMS Delays Mandatory Bundled Payment Models
March 21, 2017 ||The rule affects the Advancing Care Through Episode Payment Models, the Cardiac Rehabilitation Payment model, and changes to the CJR model.
view more »CMS, HRSA Announce Chronic Care Educational Initiative
March 17, 2017 ||Health care professionals who provide chronic care management services often are not aware they are eligible for separate payments under Medicare Part B.
view more »Price, Verma Outline Medicaid Priorities
March 17, 2017 ||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.
view more »CMS Publishes Medicare Outpatient Observation Notice FAQs
March 14, 2017 ||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.
view more »Statement on Confirmation of Seema Verma as CMS Administrator
March 14, 2017 ||America's Essential Hospitals recognizes the new CMS administrator for her experience with health care for low-income and other vulnerable people and helping states tailor Medicaid to meet specific program and policy goals.
view more »Association Letter Responds to Market Stabilization Proposed Rule
March 7, 2017 ||America’s Essential Hospitals expressed concerns about proposed changes that could harm the integrity of qualified health plan networks.
view more »Next Generation ACO Application Portal Open
March 7, 2017 ||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.
view more »CMS, CDC Co-Host Webinar on Medicare Diabetes Prevention Program
March 2, 2017 ||The March 22 webinar will outline the agencies' roles in the expansion of the program model, next steps for organization considering offering it & more.
view more »On the Hill: Leaked GOP Plan; Verma CMS Nomination
Feb. 28, 2017 ||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.
view more »CMS Seeks New Approaches to Improve Pediatric Care
Feb. 27, 2017 ||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.
view more »Medicare Outpatient Observation Notice Required Starting March 8
Feb. 27, 2017 ||Hospitals will be required to provide the form and accompanying instructions to applicable Medicare patients starting March 8.
view more »CMS Extends Deadline for 2018 QHP Applications
Feb. 21, 2017 ||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.
view more »The proposed rule aims to provide flexibility by targeting network adequacy reviews & inclusion of essential community providers in qualified health plans.
view more »CMS Delays Effective Date of Joint Replacement Model Provisions
Feb. 21, 2017 ||The delay is in accordance with a “regulatory freeze” set forth in a recent White House memorandum.
view more »CMS Extends Quality Reporting Deadline after Technical Issues
Feb. 13, 2017 ||CMS has extended the deadline for submitting certain hospital quality data after receiving reports of system issues and inaccessibility with QualityNet.
view more »On the Hill: HHS Confirmations, ACA Repeal
Feb. 13, 2017 ||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.
view more »CMS Extends Meaningful Use Attestation Deadline
Feb. 7, 2017 ||Eligible hospitals and professionals now have until March 13 to attest to the Medicare Electronic Health Record (EHR) Incentive Program.
view more »CMS Offers Medicare Outpatient Observation Notice Guidance
Jan. 31, 2017 ||The new guidance outlines how and when hospitals must deliver the notice, retention requirements, and how the notices intersect with state laws.
view more »CMS To Host Webinar on Bundled Payments Final Rule
Jan. 24, 2017 ||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.
view more »A memo instructs all executive departments and agencies to temporarily halt pending regulations until incoming department or agency heads can review them.
view more »CMS Extends eCQM Reporting Deadline for Hospitals
Jan. 23, 2017 ||Hospitals now have until March 13 — instead of Feb. 28 — to submit electronic clinical quality measure data from 2016 to CMS.
view more »CMS Announces Nearly 100 New Medicare ACOs
Jan. 23, 2017 ||Along with renewing ACOs, the 99 new organizations bring the total number of ACOs nationally to 480 in 2017.
view more »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.
view more »CMS Announces New Medicare ACO Track 1+ Model
Jan. 10, 2017 ||The new Center for Medicare and Medicaid Innovation model aims to boost participation from small rural hospitals and other smaller health care practices.
view more »CMS Approves First Section 1332 Waiver
Jan. 6, 2017 ||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.
view more »CMS also expanded the Comprehensive Care for Joint Replacement (CJR) model to include surgical hip/femur fracture treatment.
view more »eCQM Value Sets To Be Updated for Performance Year 2017
Jan. 3, 2017 ||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.
view more »New guidance describes how off-campus hospital provider-based departments can maintain their grandfathered status when relocating due to extraordinary circumstances.
view more »CMS Finalizes Bundled Payments for Cardiac Care, Hip Fracture
Dec. 21, 2016 ||These new EPMs and the updated CJR model will give clinicians more opportunities to earn incentive payments through advanced alternative payment models.
view more »CMS Revises Uncompensated Care Worksheet
Dec. 20, 2016 ||Of particular interest to essential hospitals, CMS revised the Worksheet S-10, which hospitals use to report uncompensated care data.
view more »Medicare Part B Drug Payment Model Canceled
Dec. 20, 2016 ||A CMS spokesperson said the project was pulled after the agency reviewed public comments — there were more than 1,300 comments submitted, mostly negative.
view more »CMS Announces New ACO Model for Dual Eligibles
Dec. 20, 2016 ||CMS will partner with up to six states on the new Medicare-Medicaid ACO Model, which was designed by the CMS Innovation Center.
view more »CMS Updates Hospital Compare Data
Dec. 20, 2016 ||CMS on Dec. 19 refreshed its Hospital Compare site, including data on the Ambulatory Surgical Center Program, Hospital Readmission Reduction Program & more.
view more »Medicare Outpatient Observation Notice Form Finalized
Dec. 9, 2016 ||All hospitals and critical access hospitals will be required to provide the MOON to applicable patients beginning March 8, 2017.
view more »