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.

This is the latest of several delays of a rule that provides guidance on the calculation of ceiling prices and imposes civil monetary penalties on manufacturers who knowingly exceed them.

In a March 6 comment letter, America's Essential Hospitals urged federal officials to ensure association health plans have proper oversight and cover all necessary services for beneficiaries.

The association emphasized access to essential community providers within qualified health plan networks in its comments on the 2019 draft letter to issuers.

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

In comments to HRSA, the association says the proposal would harm care for the vulnerable by restricting the definition of a patient, adding requirements for hospital outpatient facility eligibility, and narrowing which drugs qualify for discounts.

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

America's Essential Hospitals joins other associations in calling for final action on a 90-day reporting period for 2015, but warns that the delay in a final rule has made other requirements impossible to achieve.

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

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

The association urged CMS to revise its C-APC proposal and opposed its proposal to add a claims-based modifier for every outpatient service provided in off-campus provider-based departments.

Comments cover topics such as Medicare disproportionate share hospital payment cuts and risk adjustment for socioeconomic status.

Comments include requests to allow provider-supplemented premium assistance and cost-sharing for individuals obtaining marketplace coverage and to clarify that QHPs should accept premium and cost-sharing assistance from private, nonprofit foundations.

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

The association said that CMS should implement the QRS in a way that protects consumer access to ECPs in the marketplaces. It also urged CMS to ensure the measures used in the QRS are endorsed by the National Quality Forum and risk adjusted for socioeconomic factors.

Standards, implementation specifications, and certification criteria for stage 1

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

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

The Affordable Care Act establishes state-based and regional health insurance exchanges

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

Under EMTALA, hospitals are required to provide stabilizing medical services for patients

OPPS is used by CMS for hospital outpatient services under Medicare

Eligibility notices, benefits in alternative benefit plans, appeals process among rule's provisions

Section 1115 projects give states additional authority to design, improve Medicaid and CHIP programs

The Affordable Care Act expanded the RAC program to Medicaid

Measures are intended for voluntary use by state Medicaid agencies

Rule implements proposed provisions in the Affordable Care Act

Proposed rule clarifies costs, payments associated with programs are not federally reimbursable under Medicaid

Clarifies the Outpatient Clinic and Hospital Facility Services definition, Upper Payment Limit.

Rule proposes standardized, transparent process for assured access to Medicaid services in states

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

The final rule implements the Affordable Care Act's primary care payment bump

The rule outlines reporting and cost parameters for states and individual hospitals