Effective Oct. 5, the State Department’s regulations will revert to the narrower definition of public charge in a 1997 State Department rule.

In a recent letter to House leaders, America's Essential Hospitals voiced its support of a legislative proposal that would avert $16 billion in cuts to Medicaid disproportionate share hospital funding but cautioned against other onerous policies, including for site-neutral payment.

CMS urges states to review their Medicaid renewal processes to ensure eligible individuals are not disenrolled erroneously through ex parte renewals at the household level.

CMS has developed a three-step guide for state Medicaid programs to develop a claiming methodology for the differential match rate.

The letters review the state's May 2023 Medicaid unwinding metrics and compliance with federal requirements in three categories.

The toolkit aims to help states increase postpartum care access, quality, and equity by maximizing existing Medicaid authorities.

CMS will release state Medicaid and Children's Health Insurance Program renewal data on a monthly, two-part basis due to data availability. 

CMS outlines three strategies to improve treatment and support for Medicaid and CHIP enrollees with mental health and substance use disorder conditions.

An August webinar series will provide strategies for reaching out to diverse communities to share information about Medicaid and CHIP renewals.

The states will implement mitigation strategies before starting procedural terminations for Medicaid beneficiaries who have not renewed.

In California and Kentucky, mobile teams can provide Medicaid services to individuals experiencing a behavioral health or substance use crisis.

CMS is publishing all approved state directed payment preprints on its website, along with preprint addendum tables in Excel workbook format.

The FAQ clarify the new enforcement authority in the Consolidated Appropriations Act, 2023 related to states' federal medical assistance percentage.

The association urged CMS to ensure sufficient payment rates in the Medicaid managed care and fee-for-service programs for providers in hospital settings.

The Medicaid and CHIP Payment and Access Commission's June report to Congress includes recommendations on countercyclical disproportionate share hospital policy and explores health care challenges faced by adults leaving incarceration.

HHS offers flexible options states can adopt to ensure smooth transitions of coverage during the Medicaid redetermination process.

The new group, comprising two divisions from existing groups, will monitor and provide technical assistance to state and territory managed care programs.

CMS says the withdrawal of the mandate, effective immediately, aligns with the agency's approach to other infectious diseases.

The proposed rule targets drug misclassification, along with drug pricing and product data misreporting, by manufacturers.

The proposed rules are part of CMS’ response to executive orders directing federal agencies to review existing guidance for opportunities to strengthen and improve access to health care coverage, including through Medicaid.

The FAQ guide state Medicaid and Children's Health Insurance Program agencies as they begin terminating enrollment for those who no longer qualify.

The proposed rule changes directed payment policy; access standards and monitoring; in lieu of service and setting requirements; medical loss ratio policy and reporting; and quality strategies, improvements, and reviews.

America's Essential Hospitals calls on Senate leaders to reject a House proposal to impose work requirements for Medicaid as part of negotiations to raise the nation's debt limit, saying the plan would jeopardize access to care and harm communities.

If CMS finalizes the proposed rule, DACA recipients would be eligible to apply for coverage through the health care marketplaces, Basic Health Programs, and some Medicaid and Children’s Health Insurance Programs.

The six new members will review Medicaid and CHIP access and payment policies and make recommendations to Congress, the administration, and states.

Two proposed rules establish access standards and standardize review and assessment of Medicaid payment rates across states; comments are due to CMS July 3.

House panels last week heard testimony on a variety of issues important to essential hospitals, including looming cuts to Medicaid disproportionate share hospital funding, workforce shortages and training, and the 340B Drug Pricing Program.

The agency encourages states to leverage a new Section 1115 demonstration to implement a service delivery system that facilitates reentry transitions for Medicaid-eligible individuals leaving prisons and jails.

The rule updates essential community provider requirements for qualified health plans and adds a special enrollment period for those losing Medicaid or CHIP coverage.

The rule would allow DACA recipients to be eligible for health care coverage through the Affordable Care Act marketplace, Medicaid, and the Children's Health Insurance Program.

The association urged CMS to work with Congress to avoid unintended cuts to Medicaid disproportionate share hospital payments imposed by Section 203.

Responding to association advocacy, four House lawmakers introduced legislation to eliminate $16 billion in Medicaid disproportionate share hospital (DSH) cuts in fiscal years 2024 and 2025. In a statement, America's Essential Hospitals called on all House members to support the bill.

The proposal includes numerous policy and payment changes to Medicare’s Inpatient Prospective Payment System for fiscal year 2024, including a 2.8 percent increase in inpatient payment rates.

A new Section 1115 demonstration will support service delivery systems that facilitate reentry transitions for Medicaid-eligible individuals leaving prisons and jails.

The House Committee on Energy and Commerce Health Subcommittee will hear testimony on legislation to address the nation's health care workforce shortage. Meanwhile, two House lawmakers circulate a sign-on letter to build support for a bill to bolster physician training.

In the House and Senate, lawmakers discuss the need for 340B Drug Pricing Program reforms and how pharmacy benefit manager practices affect the program's value to marginalized patients.and communities.

The state has extended postpartum coverage from 60 days to 12 months through the state plan authority established by the American Rescue Plan Act in 2021.

At two Senate hearings, Health and Human Services Secretary Xavier Becerra presented the Biden administration's health care budget. In a joint statement, America's Essential Hospitals and other organizations raised concerns about a new alliance between drug companies and community health centers.

The report reviews how COVID-19 public health emergency policies affected hospital finances and includes state-specific projections for the Medicaid disproportionate share hospital funding cuts scheduled to take effect Oct. 1.

America's Essential Hospitals and other groups, in a letter to congressional leaders, urge lawmakers to avert an $8 billion cut Oct. 1 to Medicaid disproportionate share hospital funding. President Biden's proposed budget includes measures to protect Medicare.

Key health committees in the House and Senate issue requests for information — one on reauthorizing the Pandemic and All Hazards Preparedness Act and another to examine health care workforce shortages.

States may start initiating Medicaid renewals between February and April and terminating enrollment for individuals who no longer qualify as early as April 1.

Our proposal would codify a designation of essential hospitals in statute, allowing lawmakers to better target support to improve access to care and public health.

The proposed rule implements Section 203, which alters the process for calculating the Medicaid disproportionate share hospital uncompensated care limit.

The bulletin advises that arrangements among providers to redistribute Medicaid payments violate the hold harmless provisions of the law.

The roadmap outlines which policies implemented under the COVID-19 public health emergency (PHE) will be affected when the PHE ends May 11.

The updated fact sheets share when specific waivers will end and whether they will continue after the public health emergency's end on May 11.

The guidance informs states how to maintain the temporary increased federal medical assistance percentage while returning to normal Medicaid operations.

Qualified individuals and their families who lose Medicaid or CHIP eligibility once the continuous enrollment requirement ends can apply for marketplace coverage between March 31, 2023, and July 31, 2024.

In a new podcast series by a physician at association member NYC Health + Hospitals, Beth Feldpush, DrPH, the association's senior vice president of policy and advocacy, unpacks the complex patchwork of payments that keep essential hospitals afloat. 

A CMS letter to state Medicaid directors clarifies how in lieu of services (ILOS) can be used to mitigate health disparities, limits ILOS expenditures, and adopts documentation and review requirements.

The association supports CMS' work to simplify enrollment and asks the agency to ensure equitable access to beneficiaries’ preferred health care providers.

After the omnibus bill decoupled Medicaid redeterminations from the end of the COVID-19 public health emergency, CMS updates key redetermination dates.

Medicaid and CHIP coverage of interprofessional consultation is permissible as long as the consultation is for the beneficiary's direct benefit.

The report summarizes responses to a 2022 request for information, which focus on eligibility and enrollment, access to hospital services, and payment.

The $1.66 trillion package would extend funding for government operations through Sept. 30, 2023, including $120.7 billion for the Department of Health and Human Services, $9.9 billion more than the FY 2022 enacted level, and numerous provisions important to essential hospitals.

The proposed rule updates essential community provider requirements for qualified health plans and adds a special enrollment period for those disenrolled from Medicaid or CHIP.

The bill includes funding to bolster the health care workforce and extends flexible telehealth policies, including the hospital at home waiver.

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

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

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

Lawmakers return to their states and districts for August recess following last week's passage of the Inflation Reduction Act. The bill includes provisions of note for essential hospitals, including those to extend Affordable Care Act subsidies and fight climate change.

The bill, which passed by a 51-50 margin, would extend Affordable Care Act subsidies through 2025, allow Medicare to negotiate drug prices, invest in measures to mitigate climate change, and make other changes of interest to essential hospitals.

The GAO reviewed recent and planned actions to enhance oversight of state directed payments and found the effectiveness of these actions is unknown and information gaps remain.

The committee released a discussion draft of policies to improve youth mental health, the second of an expected five discussion drafts from the committee in advance of their full mental health legislative proposal.

In its June report to Congress, the Medicaid and CHIP Payment and Access Commission considers oversight of managed care directed payments and examines Medicaid's role in advancing health equity.

The Supreme Court’s dismissal of the appeal does not touch on the legality of the public charge rule but only on the ability of the 13 states to intervene in defense of the rule.

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

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

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

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

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

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.

The association thanked the administration for taking steps to reverse the damaging 2019 broadened definition of public charge and made recommendations for developing and implementing a new definition.

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

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

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.

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

Congressional panels will review President Joe Biden's fiscal year 2023 budget request. Sens. Robert Casey Jr. (D-Pa.) and Ron Wyden (D-Ore.) have asked the Government Accountability Office to investigate low vaccination rates among Medicaid beneficiaries.

In its March report to Congress, the Medicaid and CHIP Payment and Access Commission examines the relationship between Medicaid disproportionate share hospital (DSH) allotments, uncompensated care costs, and services for low-income, uninsured populations.

The proposed rule limits the types of benefits considered in public charge determinations to exclude nonemergency Medicaid and other in-kind benefits that were in the 2019 final rule.

The House-passed bill does not allocate additional COVID-19 relief for providers on the front lines of the pandemic. An initial version of the legislation included $15.6 billion in COVID-19 related spending — a scaled-back version of the $22.5 billion requested by the Biden administration.

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.

The Department of Homeland Security proposed rule is a step toward withdrawing and replacing the controversial public charge regulation issued by the Trump administration. The new definition would include only cash benefits and long-term institutionalization. Comments are due April 25.

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.

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.

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.

The House passed the $1 trillion bipartisan physical infrastructure bill after agreeing on a path forward for the $1.75 trillion "human infrastructure" bill. New language in the human infrastructure measure calls for Medicare to negotiate certain drug prices and retains Medicaid DSH cuts.

America's Essential Hospitals submitted comments on the Department of Homeland Security advanced notice of proposed rulemaking on the public charge ground of inadmissibility. Following feedback, the agency plans to engage in the rulemaking process to issue an updated public charge regulation.

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.

The Senate voted Oct. 7 to temporarily increase the debt ceiling by $480 billion; the government likely will remain below the new ceiling through year's end.

In this first white paper of a new series, America's Essential Hospitals discusses the chronic underfunding of Medicaid as a form of structural racism and provides recommendations to ensure the program is an effective tool to improve equity.

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.

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.

In an Aug. 13 letter to state health officials, the Centers for Medicare & Medicaid Services updates its guidance regarding the resumption of normal state Medicaid, Children’s Health Insurance Program, and Basic Health Program operations when the COVID-19 public health emergency ends.

A bulletin from the Center for Medicaid and CHIP Services notes the withdrawal of the 2019 public charge rule and addresses states' role in safeguarding applicant and beneficiary information. The public charge rule was vacated and is no longer in effect, retroactive to March 2, 2021.

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

America's Essential Hospitals and 11 additional national groups sent a letter to the Centers for Medicare & Medicaid Services urging the agency to partner with stakeholders who can offer technical expertise and context in developing the supplemental payment reporting system.

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.

In response to an executive order, a new issue brief reviews four policy areas under Section 1115 demonstrations and their impact on Medicaid coverage and access to care. The brief notes all examined areas create barriers to enrollment and reduce coverage, leading to adverse health effects.

The association will convene its virtual spring Policy Assembly March 16. Whether or not you join us, these resources are available to encourage your legislators to protect access to care.

Effective March 9, the Department of Homeland Security reverted to enforcing the narrower 1999 definition of public charge, which excludes many of the benefits added by the 2019 rule. Our latest Action Update details the changes and next steps.

The guidance clarifies how hospitals receiving Medicaid disproportionate share hospital payments can use Provider Relief Fund general and targeted distribution payments.

America's Essential Hospitals sent a letter to President Joe Biden and his administration detailing key priorities for essential hospitals, including issues related to structural racism, COVID-19, Medicaid, the 340B Drug Pricing Program, site-neutral payment policies, immigration, and other topics.

President Biden released an executive order to strengthen Medicaid and the Affordable Care Act. The order calls for a special enrollment period on the federally facilitated exchange for uninsured or underinsured individuals — particularly those hardest hit by the COVID-19 pandemic.

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

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

A new notice encourages states to improve health outcomes, reduce disparities, and lower costs within Medicaid and the Children's Health Insurance Program. It describes how states might address social determinants of health using flexibility available under current law.

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

The next phase of the Maternal and Infant Health Initiative (MIHI) includes a new focus on postpartum care visits, well-child visits, and decreasing rates of cesarean-section births in low-risk pregnancies. A work group developed a set of recommendations and a report on next steps for the MIHI.

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.

The Medicaid and Children's Health Insurance Plan managed care final rule includes provisions to help reach Medicaid goals, increase network adequacy for managed care plans, and align quality rating approaches.

The decision of the U.S. District Court for the Northern District of Illinois marks the first time a court ruled in favor of the plaintiffs on the merits of the legal challenges to the public charge rule. DHS immediately appealed the case, allowing continued enforcement while the appeal is pending.

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

The 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.

Following the Supreme Court's denial of hospitals’ appeal petition, the D.C. Circuit’s decision upholding CMS' third-party payer final rule will stand. This allows CMS to require the offset of third-party payments in calculating the hospital-specific disproportionate share hospital payment limit.

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.

CMS issued an information bulletin outlining two approaches for states to reflect third-party payer payments in calculations of uncompensated care costs used to determine hospital-specific Medicaid disproportionate share hospital limits.

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.

In a letter to Senate leaders, America's Essential Hospitals outlines key legislative priorities to assist essential hospitals in the ongoing response to the COVID-19 public health emergency as Congress considers another supplemental bill.

The Department of Health and Human Services June 9 announced additional, targeted allocations from the Provider Relief Fund for hospitals filling a safety-net role and sole Medicaid and Children’s Health Insurance Program providers.

New guidance provides details on COVID-19 lab test data reporting and flexible options for states implementing a Medicaid group for testing the uninsured.

Early survey results from the Kaiser Family Foundation show implications of the unexpected pandemic upended previous budget projections as Medicaid enrollment is shown to grow rapidly during economic downturns and uncertainty.

In a new informational bulletin, CMS details temporary flexibility for states to modify provider payment methodologies and capitation rates that direct expenditures under managed care contracts to address impacts of COVID-19.

CMS has updated its Medicaid and CHIP COVID-19 frequently asked questions (FAQ) document, which has been reorganized for greater usability. The new FAQs offer guidance on adjusting upper payment limit demonstrations, supplemental payments, and more to reflect pandemic response.

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

The rule requiring hospital-specific Medicaid DSH limit calculations to include payments from Medicare and commercial payers now is valid nationwide, with lower courts determining the effective date. Plaintiff hospitals filed a petition to appeal the decision to the United States Supreme Court.

HHS announced additional detail on how the agency intends to distribute the COVID-19 relief fund to hospitals and other providers. HHS will allocate funds through a general approach and use a targeted approach for certain hospitals, rural providers, and Indian Health Services.

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. 

Congress should increase emergency funding for hospitals on the front lines of the COVID-19 epidemic, target hospitals in greatest need, adjust Medicaid to help essential hospitals, and provide other financial and regulatory relief.

In an April 10 letter, America's Essential Hospitals urged the agency to target critical relief to essential hospitals, expressed concern about disbursements based on Medicare payments, and offered general metrics to identify and support providers serving Medicaid and low-income patients.

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

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

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

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

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

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

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

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.

The Department of Homeland Security will implement its expanded definition of public charge nationwide until five district courts decide on the lawfulness of change. Meanwhile, the Department of State also will begin using the expanded definition for those seeking visas.

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

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

The Ways and Means legislation would preserve the ability of providers and health plans to negotiate payment rates through independent dispute resolution, while the Education and Labor plan would impose federal benchmark rates for charges of more than $750.

In its bipartisan proposal on surprise medical bills, the House Committee on Ways and Means would preserve the ability of providers and health plans to negotiate the payment rate for out-of-network care. Also, the president releases his FY 2021 budget plan, including $920 billion in Medicaid cuts.

The proposal calls for $920 billion in cuts to Medicaid funding, including a call to finalize the Medicaid Fiscal Accountability Regulation.

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.

GAO found that state Medicaid programs did not always have written procedures to identify 340B drugs and prevent duplicate discounts. Even when states have written policies and procedures, GAO found they were not always adequate to prevent duplicate discounts.

The Department of Homeland Security will evaluate applications for immigration benefits postmarked or submitted electronically on or after Feb. 24. The agency will not consider any newly added public benefit categories that the applicant received before Feb. 24.

America's Essential Hospitals this week is closely following congressional health care committee efforts to develop a robust legislative package to stop impending cuts to Medicaid disproportionate share hospital funding and extend funding for several expiring health care programs.

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.

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

Congressional leaders have delayed for five months a $4 billion cut to Medicaid disproportionate share hospital payments under comprehensive legislation to fund federal operations for the remainder of fiscal year 2020, which started Oct. 1.

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

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.

In a letter to the Department of State, America’s Essential Hospitals expressed concern that broadening the definition of public charge would harm the nation’s health care system, vulnerable patients, and state and local economies.

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

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

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

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

The agency seeks comment on a questionnaire to enforce its revised public charge standard for visa applicants. Separately, the department sought comment and emergency review of information collection to enforce the presidential proclamation suspending the entry of immigrants without health coverage.

A House vote on the Lower Drug Costs Now Act of 2019, scheduled for this week, has been postponed to allot more time for the Congressional Budget Office (CBO) to score the bill.

One report focuses on available treatment services for pregnant women and children, while the other analyzes states' medication-assisted treatment policies. The reports were mandated by the SUPPORT Act.

The rule intends to align the State Department’s public charge definition with the Department of Homeland Security public charge final rule.

America’s Essential Hospitals applauded the decision, noting that the rule threatens the health of millions and the stability of essential hospitals.

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

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

The 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.

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

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

The Department of Homeland Security finalized a proposed rule that expands the definition of “public charge” in immigration application determinations to include additional types of public benefits and new immigration applicant categories.

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

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.

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.

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

A House-passed bill to extend funding for Medicaid programs heads to the Senate; the Senate Committee on Health, Education, Labor, and Pensions introduced the Lower Health Care Costs Act.

In a letter to the Office of Management and Budget, America’s Essential Hospitals expressed concern that changes to the consumer inflation index would negatively impact vulnerable populations’ access to Medicaid coverage.

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.

Under current law, most individuals applying to enter the country on a visa or applying for a green card must submit an affidavit of support from a sponsor residing in the United States who meets certain criteria. The memo claims these requirements are not adequately enforced.

The new chair is Melanie Bella, head of partnerships and policy at Cityblock Health and former founding director of the Centers for Medicare & Medicaid Services' Medicare-Medicaid Coordination Office. The Government Accountability Office also appointed a new vice chair and two new members.

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.

America’s Essential Hospitals, in coalition with other national hospital associations, has filed an amicus brief urging the Fifth Circuit to uphold the Affordable Care Act and overturn a Texas district court’s decision declaring the individual mandate and, in turn, the entire law unconstitutional.

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

The 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

Lawmakers have introduced bipartisan legislation to give states additional support for combating the opioid crisis by extending Medicaid's certified community behavioral health clinic demonstration program. Committees remain focused on prescription drug prices.

The report proposes three recommendations responding to Medicaid disproportionate share hospital allotment reductions and responds to concerns about the accuracy and completeness of available upper payment limit data.

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

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

The 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.

A Centers for Medicare & Medicaid Services bulletin notes that states can cover non-opioid pain management therapies using several Medicaid authorities, including Section 1945 health home benefits, 1915(i) state plan amendments, Section 1115 demonstrations, and managed care strategies.

The Medicaid Extenders Act of 2019 heads to President Trump for approval. Meanwhile, a new bill would limit the use of Medicaid to care for undocumented immigrants.

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.

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

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

The 116th session of Congress convenes as leaders seek a deal to end a partial government shutdown, while health care legislation hangs in the balance.

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

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

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

The association urged the Department of Homeland Security to exclude nonemergency Medicaid benefits and low-income subsidies for Medicare Part D beneficiaries from the list of programs considered in public charge determinations.

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.

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.

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

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

The new law, which represents the federal government’s first comprehensive policy response to the nation’s opioid crisis, aims to advance treatment and recovery initiatives, improve prevention, protect communities, and bolster efforts to fight deadly illicit synthetic drugs.

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

America’s Essential Hospitals and six other hospital groups urged Health and Human Services Secretary Alex Azar to refrain from adding health information exchange requirements to the Medicare and Medicaid Conditions of Participation.

America’s Essential Hospitals is closely reviewing the proposed rule from the Department of Homeland Security and evaluating its potential impact on our members. We encourage all members to review the provisions of the proposed rule, provide us feedback, and submit your own comments to the agency.

The proposal differs from a previously leaked version and expands the list of public programs for consideration in a public charge determination.

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.

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

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

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

The waivers allow each state to create a reinsurance program to lower premiums in the individual market; the waivers will take effect in 2019 and are approved through 2023.

What comes next after the June 29 court ruling that vacated the U.S. Department of Health and Human Services approval of a Section 1115 waiver that allowed Kentucky to impose community engagement and work requirements on Medicaid beneficiaries.

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

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

The brief reviews each type of Medicaid hospital payment, information on payment goals, and state-level data on fiscal year 2016 supplemental payments to hospitals.

This year's Medicaid and CHIP Payment and Access Commission report focuses on the high cost of prescription drugs and the opioid epidemic.

Modeled on a program developed at essential hospital St. Joseph's Regional Medical Center, in Paterson, N.J., the Alternatives to Opioids bill is one of 25 opioid-related bills the House passed last week.

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

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

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

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

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

The plan cites and builds on proposed changes to the 340B Drug Pricing Program in the president’s fiscal year 2019 budget, as well as damaging cuts implemented through the calendar year 2018 Outpatient Prospective Payment System final rule.

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

Senate and House panels hold hearings on opioid and substance use disorder treatment among Medicare and Medicaid beneficiaries and how distributors might contribute to the crisis.

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

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

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.

The three-pronged approach aims to reduce drug demand, cut off the flow of illicit drugs domestically and internationally, and expand opportunities for proven addiction treatments.

This year's report includes the commission’s statutorily required annual analysis of Medicaid disproportionate share hospital payments, as well as chapters on Medicaid managed care and telehealth.

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

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

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.

Senate Finance Committee leadership sent a letter to stakeholders requesting information on Medicare and Medicaid policy options that could be used to combat the opioid epidemic.

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

The designation allows federal health agencies to allocate resources and hire specialists to combat the opioid crisis. The original declaration was set to expire on Jan. 23.

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.

As Congress focuses on Jan. 19 funding deadline, America's Essential Hospitals continues pressure to delay Medicaid disproportionate share hospital cuts. The Trump administration releases guidance on work requirements for Medicaid recipients.

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

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

The 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.

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.

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

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

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

The emergency declaration expands telemedicine services to treat addiction and opens up the Public Health Emergency Fund, among other actions to combat the opioid crisis.

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

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

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.

The bill would replace Medicaid expansion funding and private insurance subsidies with $1.2 trillion in block grants to states; the Congressional Budget Office is expected to release a score early next week.

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.

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.

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.

A revised draft of the Senate bill was released to address some Republicans' concerns, but it made no meaningful changes to the bill’s Medicaid provisions.

The brief projects Medicaid disproportionate share hospital payment reductions under the Affordable Care Act and the House-passed American Health Care Act.

In a report to Congress, the commission details state solutions for improving care delivery, increasing treatment availability, and reducing opioid misuse.

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

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

Senate Republican leadership recently indicated the possibility of a vote by the end of July, before the month-long August recess.

The plan would reduce funding for social and entitlement programs for low-income Americans by $1.7 trillion, including a $610 billion cut to Medicaid.

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

In this new policy brief, America's Essential Hospitals examines Section 1115 waivers that use a market-based approach to expanding Medicaid.

Penny Thompson, principal at Penny Thompson Consulting and former deputy director of CMS' Center for Medicaid and CHIP Services, was named MACPAC chair.

Rep. MacArthur (R-NJ) proposed an amendment to the AHCA that would have allowed states to opt out of several important insurance regulations.

The replacement plan would make steep cuts to Medicaid and leave an estimated 24 million more people uninsured, compared with current law under the ACA.

Whether you join us or support the fight from home, urge lawmakers to ensure continued coverage access and stable, equitable, sustainable Medicaid funding.

The House plan to repeal and replace the Affordable Care Act would rescind Medicaid disproportionate share hospital cuts and impose per-capita caps on Medicaid funding.

On February 16, a policy brief by House Republicans on how they would repeal and replace the Affordable Care Act (ACA) was leaked in Washington. Learn more about what was included.

A House subcommittee marked up two bills focused on income eligibility for Medicaid. The association weighed in on a hearing about the individual mandate.

The Feb. 7 letter offers recommendations on proposed executive orders, regulations, and legislation that could affect essential hospitals, patients.

No agreements have been reached about a repeal/replacement plan for the ACA and it appears Republicans in both chambers are far from making final decisions.

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.

MACPAC's recommendation is part of a larger package of suggestions meant to improve coverage for children in low- and moderate-income families.

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

The notice contains state-specific FMAPs, used to determine the amount of federal matching funds for state Medicaid programs; and enhanced FMAPs, used to calculate federal funding for the Children’s Health Insurance Program.

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

The guide gives states information they need to develop actuarial rate certifications, such as benefit cost projections, pass-through payments, and risk mitigation strategies.

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

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

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

The updates aim to reduce incidence of infections, inappropriate use of antibiotics, and discriminatory behavior by health care providers.

The plan would convert Medicaid to a program managed entirely by states through block grants or per-capita allotments from the federal government.

A review of 61 studies found that expansion under the ACA has improved health coverage, access to care, and economic outcomes.

A CMS bulletin reminds states that Medicaid funds can be used for prevention, diagnosis, and treatment of the Zika virus.

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

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

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

Regulation provides more robust mental health, substance use care options for those in Medicaid alternative benefit plans, CHIP, and Medicaid managed care.

House Committee on Energy and Commerce approves legislation that would cut provider taxes, repeal enhanced FMAP for prisoners and CHIP, and end ACA Prevention and Public Health Fund.

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

Changes allow IHS and tribal facilities to enter into care coordination agreements with non-IHS/tribal providers to furnish certain services for AI/AN Medicaid beneficiaries.

The House will consider a bill to prevent payments to providers ineligible for Medicaid and CHIP. The Senate will consider measures to fund opioid abuse and respond to the Flint water crisis.

Partisan politics follow Scalia death; House speaker to table entitlement reform until next year; congressional panels to hold hearings on HHS budget, opiod abuse, Zika virus.

Senate Judiciary examines heroin and prescription drug abuse; Winter Storm Jonas delays scheduled House Energy and Commerce Health Subcommittee hearing on Medicaid FMAP

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

Letter from Senate Finance Committee leaders asks America's Essential Hospitals, other stakeholders, for comment on Medicaid transparency, quality, accountability

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

Senate plans to expand House reconciliation bill with full ACA repeal; Rep. Brady named Ways and Means chair; Republicans establish Medicaid task force.

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

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

President signs budget deal that reduces payment to new hospital outpatient facilities; Ryan becomes House speaker; Energy and Commerce Committee considers Medicaid supplemental payment oversight bills

Medicaid managed care payment rates must be certified by an actuary, appropriate for the covered population and services, and developed in accordance with generally accepted actuarial practices and principles.

Planned Parenthood controversy continues to influence federal funding negotiations. Health insurer and hospital mergers are reviewed. Plus, committees consider abortion, Medicaid, HIT, and biosimilar drugs.

Planned Parenthood remains an issue in government funding. Congress considers hospital bills, Medicare Part B premiums, medical innovation, health care competition, and Medicaid fraud and abuse, vows to focus on mental health.