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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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state-action

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

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policy

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

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state-action

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

The rule from the Centers for Medicare & Medicaid Services includes numerous policy and payment changes important to essential hospitals, including a 4.3 percent increase in inpatient payment rates for fiscal year 2023.

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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state-action

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

The proposed rule includes numerous policy and payment changes for Medicare’s Inpatient Prospective Payment System for fiscal year 2023, including a 3.2 percent increase in inpatient payment rates.

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policy

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

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webinar

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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cms, gme
policy

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

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policy

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

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policy

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

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policy

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

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state-action

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

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policy

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

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policy

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

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policy

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

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policy

A final rule with comment period from the Centers for Medicare & Medicaid Services addresses the distribution of 1,000 new graduate medical education slots and other policies.

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policy

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

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policy

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

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policy

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

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policy

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

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policy

A letter to state Medicaid directors defines supplemental payments and designates a system to submit required supplemental payment reports. CMS also notes a lack of data to determine the application of an exception to new rules on Medicaid disproportionate share hospital uncompensated care limits.

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webinar

2022 Advocacy Outlook

Dec. 16, 2021 || Staff

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

Final rules for Medicare’s OPPS and PFS for CY 2022 continue Medicare Part B drug payment cuts to hospitals in the 340B Drug Pricing Program; continue site-neutral payment policies; and halt elimination of the inpatient-only (IPO) list.

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policy

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

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policy

CMS recently announced vaccination requirements for providers as a condition of participating in Medicare and Medicaid. Simultaneously, the Department of Labor’s Occupational Safety and Health Administration released an emergency temporary standard for employers with at least 100 employees.

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policy

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

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policy

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

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

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policy

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

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

America's Essential Hospitals sent CMS recommendations for implementing the new Medicaid supplemental payment reporting system under the Consolidated Appropriations Act of 2020. The association noted the importance of accuracy and avoiding duplicate data collection.

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policy

The rule includes numerous policy and payment changes for Medicare’s Inpatient Prospective Payment System for fiscal year 2022, including a 2.5 percent increase in inpatient payment rates.

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policy

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

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policy

CMS released an advisory alerting certain qualifying participants in alternative payment models that the agency does not have billing information needed to disburse incentive payments. Participants who anticipated but have not received an incentive payment should submit the necessary form by Nov. 1.

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policy

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

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policy

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

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policy

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

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policy

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

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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

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cms
policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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state-action

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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Essential Insights

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

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policy

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

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policy

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

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policy

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

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policy

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

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

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policy

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

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policy

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

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policy

The Office of Inspector General (OIG) and the Centers for Medicare & Medicaid Services (CMS) finalized rules in conjunction with HHS' regulatory sprint to coordinated care. The OIG rule modifies safe harbor protections; CMS’ rule targets undue burden of the physician self-referral law, or Stark law.

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policy

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

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policy

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

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policy

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

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policy

In its fourth interim final rule during the COVID-19 public health emergency, the Centers for Medicare & Medicaid Services implements several measures to ensure timely access to a vaccine.

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policy

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

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policy

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

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cms
quality

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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

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policy

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

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policy

In the interim final rule, the Centers for Medicare & Medicaid Services establishes that hospitals and critical access hospitals must report certain information, at a frequency and in a standardized format, as specified by the Department of Health and Human Services during the COVID-19 public health emergency.

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

The Centers for Medicare & Medicaid Services and Office of the National Coordinator for Health Information Technology have released final rules intended to advance interoperability of health information technology and improve patients’ access to their health information.

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

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policy

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

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policy

The Centers for Medicare & Medicaid Services on April 30 issued a second round of waivers and rule changes to provide flexibility to hospitals and improve access to testing for beneficiaries. These changes update waivers issued March 30 to address patient surge.

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policy

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

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policy

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

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policy

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

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policy

The agency provides recommendations for resuming non-essential care for services that cannot be virtually delivered and for health care systems and facilities in regions with low incidence of COVID-19.

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policy

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

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policy

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

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policy

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

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policy

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

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state-action

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

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policy

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

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

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policy

The frequently asked questions document provides guidance on how states can leverage Medicaid flexibilities in response to the novel coronavirus. Key issues for essential hospitals are detailed in our latest Action Update.

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policy

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

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policy

The Centers for Medicare & Medicaid Services issued various waivers to increase hospital capacity, expand the health care workforce, eliminate certain paperwork requirements, and further promote telehealth.

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policy

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

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policy

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

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policy

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

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state-action

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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state-action

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

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state-action

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

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policy

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

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policy

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

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policy

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

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policy

The rules, intended to increase interoperability and improve patients’ access to their health information, finalize provisions related to the MyHealthEData initiative and implement provisions of the 21st Century Cures Act.

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

The “Healthy Adult Opportunity” Medicaid Section 1115 demonstration waiver allows states to provide coverage for select Medicaid populations under aggregate or per-capita caps and assume increased accountability in exchange for greater flexibility to test alternative implementation approaches.

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policy

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

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policy

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

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policy

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

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

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policy

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

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policy

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

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

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policy

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

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policy

CMS issued a request for information seeking input on coordinating care from out-of-state providers for medically complex children who are eligible for Medicaid coverage. The agency will use the information collected to produce guidance to state Medicaid directors.

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policy

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.

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institute

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

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Essential Insights

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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webinar

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

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policy

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

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policy

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

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

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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

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policy

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

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policy

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

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policy

The Department of Health and Human Services on Oct. 9 proposed two rules that seek to eliminate barriers to care coordination and undue burden under current fraud and abuse laws.

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cms
policy

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

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institute

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

The final rule, implementing disproportionate share hospital payment cuts for fiscal years 2020–2025 should they take effect, includes revisions to the methodology for determining each state's allotment reduction for each fiscal year.

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policy

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

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policy

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

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cms, ehr
policy

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

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policy

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

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policy

A U.S. District Court judge has invalidated a Centers for Medicare & Medicaid Services policy that made a $380 million payment cut this year to off-campus, provider-based departments previously exempt from site-neutral reductions.

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

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cms, hhs
policy

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

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policy

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

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webinar

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

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policy

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

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policy

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

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Essential Insights

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

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state-action

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

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policy

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

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policy

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

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policy

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

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cms, dsh
policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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Essential Insights

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

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policy

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

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policy

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

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policy

A proposed rule from the Department of Health and Human Services would overhaul parts of Section 1557 of the Affordable Care Act, removing some nondiscrimination protections for transgender individuals and requirements for covered entities treating people with limited English proficiency.

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aca, cms, hhs
policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

The agency released a request for applications on the Emergency Triage, Treat, and Transport model for emergency ambulance services. The new model encourages treatment for Medicare beneficiaries outside the emergency department.

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Essential Insights

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

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policy

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

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policy

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

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webinar

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

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policy

A new proposed rule for Medicare’s Inpatient Prospective Payment System for fiscal year 2020 would increase net inpatient payment rates by 3.2 percent in addition to numerous other policy and payment changes.

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policy

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

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policy

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

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policy

The Centers for Medicare & Medicaid Services will accept applications for its second cohort of participants in the Bundled Payments for Care Improvement Advanced Model; second cohort participants will start model year three, beginning on Jan. 1, 2020.

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policy

The Primary Cares Initiative comprises five new voluntary payment model options under two paths. The new models build on the experience of the Medicare Shared Savings Program and Next Generation Accountable Care Organization model.

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policy

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

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policy

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

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policy

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

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quality

The new Care Coordination Toolkit showcases the work of accountable care organizations (ACOs) participating in the Medicare Shared Savings Program and Next Generation ACO Model. The agency also released a set of case studies describing innovation ACO initiatives.

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policy

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

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policy

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

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policy

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

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policy

The recently released 2017 Quality Payment Program Experience Report includes participation and performance statistics for the Merit-based Incentive Payment System and Advanced Alternative Payment Model tracks.

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policy

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

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policy

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

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policy

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

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policy

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

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policy

The lawsuit asserts that the policy adopted by the Centers for Medicare & Medicaid Services is unlawful and unenforceable because it conflicts with federal statutes and violates congressional intent.

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policy

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

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

A final rule for the Medicare Shared Savings Program overhauls the program and creates a pathway for accountable care organizations to more rapidly transition to performance-based risk models with the potential for greater shared savings.

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

The proposed rule reflects the agency’s broader strategy to relieve regulatory burden, support state flexibility, and promote transparency and innovation in the delivery of care. We encourage all members to review the proposed rule, give us feedback, and submit your own comments to CMS.

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policy

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

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policy

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

view more »
policy

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

view more »
policy

The proposed rule reflects the agency’s broader strategy to relieve regulatory burden, support state flexibility, and promote transparency and innovation in the delivery of care.

view more »
policy

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

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policy

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

view more »

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

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

The Centers for Medicare & Medicaid Services has released Outpatient Prospective Payment System and Physician Fee Schedule proposed rules for calendar year 2019 that would expand site-neutral payment policies and continue Medicare Part B drug payment cuts to 304B hospitals.

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policy

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

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policy

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

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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.

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

Responding to concerns raised by America’s Essential Hospitals and other stakeholders, the Centers for Medicare & Medicaid Services has announced it will postpone the July public release of overall hospital star ratings.

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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quality

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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cms
quality

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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webinar

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

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policy

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

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policy

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

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policy

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.

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policy

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

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policy

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.

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policy

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.

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webinar

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.

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policy

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

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policy

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

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policy

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.

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policy

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

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policy

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.

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policy

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.

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policy

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

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policy

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.

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policy

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

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policy

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.

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quality

During the Dec. 13 webinar, association member Boston Medical Center will discuss the hospital's substance use disorder treatment initiatives.

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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.

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policy

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

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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.

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policy

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

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policy

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

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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.

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policy

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.

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webinar

Dive into the policy details of the CMS rule that cuts 340B program savings, and hear how America’s Essential Hospitals plans to respond.

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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.

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policy

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

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The final rule puts expansion of services further out of reach for underserved communities and threatens access to care where access is needed most.

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policy

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.

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policy

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

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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.

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policy

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

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quality

Shifting from condition-specific to hospitalwide measures in the Hospital Readmissions Reduction Program would significantly increase penalties for hospitals with many vulnerable patients.

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policy

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.

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policy

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

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policy

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.

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policy

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.

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policy

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

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policy

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.

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policy

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.

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policy

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.

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policy

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.

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policy

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

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policy

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.

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policy

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

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policy

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.

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policy

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.

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policy

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.

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policy

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.

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policy

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.

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policy

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.

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policy

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.

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policy

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.

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policy

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.

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policy

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

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policy

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.

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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.

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policy

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

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webinar

An in-depth discussion on proposed Medicaid DSH reduction methodology and the association’s efforts to combat the impending cuts.

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cms, dsh
policy

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.

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policy

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.

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policy

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

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policy

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.

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webinar

The latest from experts on the CMS proposed policy rules that cut 340B savings and support for outpatient services in underserved areas.

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policy

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

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policy

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.

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policy

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.

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policy

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.

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policy

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.

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policy

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.

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webinar

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.

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policy

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.

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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.

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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policy

The study found that the penalty burden was greater in hospitals treating a high share of patients with socioeconomic disadvantages.

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quality

Barriers to communication can be especially harmful for Medicare beneficiaries, who are more likely to have comorbidities and complex health needs.

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policy

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

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policy

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

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policy

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

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policy

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

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policy

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

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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.

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policy

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

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policy

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.

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policy

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

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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.

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

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

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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.

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

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

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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.

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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.

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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.

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

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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.

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

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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.

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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.

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

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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.

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

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

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

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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.

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

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

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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.

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

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

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

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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.

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

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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.

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

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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.

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

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

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

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

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

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CMS on Dec. 19 refreshed its Hospital Compare site, including data on the Ambulatory Surgical Center Program, Hospital Readmission Reduction Program & more.

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

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

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

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

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

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America’s Essential Hospitals is pleased President-Elect Trump has made health care experience a priority in his choices for Secretary of Health and Human Services and administrator of the Centers for Medicare & Medicaid Services.

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

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

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

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

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

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webinar

Hosted by the Financial Interest Group, this webinar will help prepare your hospital to implement provisions of the MACRA final rule.

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