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policy

This policy brief discusses how HHS has leveraged its authority under Medicaid and Medicare to advance policies aimed at addressing social determinants of health and health-related social needs.

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policy

Medicare Part A providers and Part B suppliers affected by the Change Healthcare cyberattack may apply for accelerated and advance payments.

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policy

The final rule for Section 203 of the Consolidated Appropriations Act, 2021, changes how the calculation of a hospital’s Medicaid disproportionate share hospital uncompensated care limit accounts for costs and payments related to Medicare and other dually eligible patients.

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policy

The document details payment features of Medicare fee-for-service Hospital Global Budgets under the States Advancing All-Payer Health Equity Approaches and Development Model (AHEAD).

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policy

The agency proposes to increase oversight of organizations that accredit Medicare facilities, reduce conflicts of interest, and make surveys more consistent.

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policy

Hospitals have until March 31 to apply for the third round of Section 126 awards, which will implement 200 new Medicare-funded residency slots.

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policy

The rule requires payers to create application programming interfaces to facilitate payer-to-provider data sharing.

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policy

CMS will select eight organizations to test the eight-year behavioral health care integration model; applications will open in spring 2024.

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policy

America’s Essential Hospitals urged HHS to withdraw its proposed information blocking disincentives for health care providers.

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policy

Effective Jan. 1, 2024, Medicare will cover marriage and family therapists, mental health counselors, and intensive outpatient services.

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policy

The final rule will decrease physician payments, expand access to telehealth for Medicare beneficiaries, target social determinants of health, and make other payment and quality reporting changes important to essential hospitals.

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policy

The race for a House speaker resumes after Rep. Jim Jordan's (R-Ohio)'s Oct. 20 exit; site-neutral policies surface in a House subcommittee hearing.

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policy

The Republicans' House speaker nominee, Rep. Jim Jordan, of Ohio, failed to secure the votes needed on a first ballot, with 20 fellow GOP lawmakers voting against him. It was unclear whether he could win a majority to gain the speakership.

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policy

America’s Essential Hospitals urged CMS to swiftly finalize a remedy to repay 340B hospitals for five years of Medicare Part B drug payment cuts.

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policy

The Centers for Medicare & Medicaid Services is exploring a new model to promote health equity, with the goal of enhancing access to patient-centered care for underserved groups and including them in value-based care systems.

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policy

The rule includes changes to the calculation of Medicare disproportionate share hospital payments and payment and quality reporting provisions.

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policy

Proposed rules for Medicare’s OPPS and PFS for calendar year 2024 would maintain full Medicare Part B drug payment to hospitals in the 340B Drug Pricing Program, revise site-neutral payment policies, and amend price transparency policies, among other changes.

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policy

The proposed rule includes provisions for Medicare reimbursement of telehealth services, quality programs, and social determinants of health data collection.

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policy

Hospitals face a 25 percent reduction in Medicare payments if they fail to meet the new equity standards or regulations mandated by the Centers for Medicare & Medicaid Services under the Inpatient Quality Reporting Program.

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policy

The association urged CMS to increase the proposed annual hospital payment update and adopt a safety net hospital definition and related payment policies.

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policy

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

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policy

The letter expressed concern with reports that HRSA no longer will allow hospitals to administer 340B drugs in offsite outpatient locations that have not yet appeared on a filed Medicare cost report.

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policy

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

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policy

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.

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policy

To exclude 340B drugs from Medicare Part B inflation rebates required by the Inflation Reduction Act, providers must identify 340B drugs on Medicare claims. 

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policy

Per the Inflation Reduction Act, drug manufacturers that increase prices faster than the inflation rate will be required to pay rebates to Medicare.

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The commission’s Medicare safety net index methodology fails to account for all the nation’s safety net hospitals by overlooking uncompensated care and care provided to non-Medicare, low-income patients — especially Medicaid beneficiaries.

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policy

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.

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policy

The proposed rule implements Section 203 of the 2021 Consolidated Appropriations Act, altering the rules for considering the costs and payments associated with Medicare and commercial dually eligible patients when calculating a hospital’s Medicaid DSH uncompensated care limit.

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policy

Applications close May 31 for the two-year extension of the Bundled Payments for Care Improvement Advanced voluntary payment model.

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policy

The association asked that CMS swiftly make 340B hospitals whole for reduced Medicare Part B reimbursement from 2018 to fall 2022, plus applicable interest.

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policy

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

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policy

Drug manufacturers that increase prices faster than the inflation rate must pay rebates to Medicare; comments on this policy are due to CMS March 11.

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policy

The president vowed to veto attempts to roll back Inflation Reduction Act measures to reduce prescription drug prices. He also voiced his plan to make permanent pandemic-related increases to Affordable Care Act premium subsidies.

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policy

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.

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policy

The Senate announced rosters for the Finance and Health, Education, Labor, and Pensions (HELP) committees, as well as for the Finance Committee's Subcommittee on Health Care. HELP Committee Chair Sen. Bernie Sanders (I-Vt.) signaled his intention to act on prescription drug prices.

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policy

House leaders fill seats on committees and subcommittees with jurisdiction over health care issues of particular importance to essential hospitals and their patients.

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policy

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. 

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policy

House and Senate lawmakers returned to Capitol Hill this week to find regular legislative business overshadowed by a growing partisan debate about the nation's debt limit and spending on Medicare, Social Security, and other federal programs.

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policy

America's Essential Hospitals and other plaintiffs had asked the judge to order an immediate repayment in full for five years of underpayments to 340B hospitals.

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policy

Prioritizing hospitals in health professional shortage areas, CMS awarded residency slots to 100 hospitals, including 27 essential hospitals.

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policy

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.

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policy

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

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policy

The memo reviews regulatory obligations to care for patients in a safe environment, including the need to identify patients at risk for intentional harm to themselves or others.

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policy

The final rule for calendar year 2023 continues certain flexible telehealth policies, overhauls the Medicare Shared Savings Program, and revises the Quality Payment Program.

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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

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

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.

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policy

Notable for essential hospitals, the bill contains an extension of Affordable Care Act advance premium tax credits, and historic drug pricing provisions that give the federal government power to negotiate drug prices on behalf of Medicare beneficiaries.

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policy

President Joe Biden signed the legislation Aug. 16 after the House sent it to his desk with a 220-207, party-line vote. It extends Affordable Care Act subsidies through 2025 and makes other changes of interest to essential hospitals.

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policy

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.

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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

The $433 billion Inflation Reduction Act would allow Medicare to negotiate prescription drug prices and would extend expanded Affordable Care Act subsidies for three years. It also includes tax provisions and new investments related to energy and climate change.

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policy

Work continues on a bill to advance through the reconciliation process by a Sept. 30 deadline. America's Essential Hospitals is pressing lawmakers to include more support for essential hospitals in the final package.

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policy

A proposed rule for Medicare’s Outpatient Prospective Payment System for calendar year 2023 would reverse Medicare Part B drug payment cuts to hospitals in the 340B Drug Pricing Program, continue site-neutral payment policies, and revise the inpatient-only list, among other proposed changes.

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policy

A proposed rule for the Medicare Physician Fee Schedule for calendar year 2023 would extend telehealth regulatory flexibility, make changes to the Medicare Shared Savings Program, and revise the Quality Payment Program.

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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

Senate Democrats work to pass a revived human infrastructure bill before the end of the fiscal year, Sept. 30. The updated legislative language includes a Medicare prescription drug pricing proposal approved by all 50 Senate Democrats.

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policy

The Bipartisan Safer Communities Act seeks to close gaps in current gun safety laws and bolster mental health care, including through new support for hospitals and other providers.

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policy

The commission's June report to Congress includes illustrative policies about defining and supporting Medicare safety net providers and aligning payments across outpatient settings, among other topics of interest to essential hospitals.

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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

Congress last week passed aid for the Ukraine war effort but remains stalled on a $10 billion COVID-19 funding bill. A group of three House caucuses of Black, Hispanic, and Asian Pacific American lawmakers have introduced health equity legislation.

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policy

FDA limits authorized use of the Janssen COVID-19 vaccine after reports of thrombosis with thrombocytopenia syndrome following vaccination; a new analysis estimates vaccines are associated with $2.6 million in savings due to a reduction in Medicare hospitalizations.

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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 Accreditation Council for Graduate Medical Education introduced two rural track program designations to accredited residency programs and seeks members for an advisory group on health care access for medically underserved areas and populations.

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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

President Joe Biden signed a $1.5 trillion fiscal year 2022 spending package; he already signed a four-day continuing resolution to provide time for the omnibus spending measure to move forward. 

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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

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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policy

The Medicare Part B drug model, also known as the most favored nation model, would have phased-in reduced payment rates for 50 Part B drugs over four years. America's Essential Hospitals previously called on CMS to withdraw the model.

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policy

The legislation delays looming Medicare payment cuts and creates an expedited pathway for debt limit relief; Senate Democrats this week are expected to release legislative text for a $2 trillion debt limit increase — sufficient to last through the 2022 midterm election.

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policy

Congress passed a continuing resolution to maintain government funding through Feb. 18, 2022. The bill does not further suspend Medicare cuts slated to take effect in the new year. Meanwhile, the Senate continues work on the Build Back Better Act, debt limit legislation, and defense appropriations.

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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

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.

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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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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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policy

President Joe Biden last week announced a $1.75 trillion framework for "human infrastructure" reconciliation legislation; the House subsequently released updated legislative text for its human infrastructure bill that aims to close the Medicaid coverage gap.

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policy

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.

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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

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

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

As a bipartisan group of senators crafts infrastructure legislation, Senate Democrats work to develop a human infrastructure package.

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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 Supreme Court’s decision to review the case marks a significant step in the association’s efforts to overturn harmful Medicare Part B cuts to hospitals in the 340B Drug Pricing Program. The Supreme Court will hear oral arguments in the case in its next term, with a decision likely in 2022.

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policy

In its June report to Congress, the Medicare Payment Advisory Commission issues recommendations on issues of importance to essential hospitals, including payment for Part B drugs, alternative payment models, indirect medical education payments, and Medicare coverage of vaccines, among other topics.

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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

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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The association is pleased to see policy proposals to improve health care equity in graduate medical education and value-based payment programs and to withdraw burdensome Medicare Advantage data collection requirements.

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Extending the Medicare sequester moratorium through the end of this year provides much-needed relief for essential hospitals, which continue to face heavy financial pressure from their front-line response to COVID-19, the association says.

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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

The Senate advanced legislation extending the moratorium on a 2 percent Medicare sequester cut; however, it is unlikely the House will take up the measure before April 1, when the cut is scheduled to take effect. The association submitted a letter of support for the LIFT America Act.

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policy

The House voted to extend the moratorium on a 2 percent Medicare sequester cut, but the bill lacks support from Senate Republicans. The Senate confirms Xavier Becerra. A reintroduced bipartisan bill would ensure 340B hospitals can maintain program eligibility while responding to COVID-19.

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policy

In its March report to Congress, the Medicare Payment Advisory Commission recommends payment updates in fee-for-service payment systems, including for hospital inpatient and outpatient services. The panel also outlines Medicare coverage of telehealth services during the pandemic and beyond.

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policy

The House this week will vote on legislation to extend the moratorium on a 2 percent Medicare sequester cut. House Democrats unveil an infrastructure package that prioritizes funding for construction and modernization activities to bolster public health preparedness and cyberattack prevention.

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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

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

The $2.3 trillion package to fund the government, provide new COVID-19 relief, and stimulate the economy would eliminate a $4 billion cut to Medicaid disproportionate share hospital payments and add $3 billion to the Provider Relief Fund, among numerous other changes.

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policy

Final rules for Medicare’s Outpatient Prospective Payment System and Physician Fee Schedule for calendar year 2021 continue Medicare Part B drug payment cuts to hospitals in the 340B Drug Pricing Program and site-neutral payment policies.

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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 Medicare Outpatient Prospective Payment System final rule for calendar year 2021 continues cuts to hospitals in the 340B Drug Pricing Program and off-campus provider-based departments, and updates the overall hospital star ratings methodology.

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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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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

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

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 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

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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Essential hospitals thank House lawmakers for responding to the heavy financial burden of COVID-19 on hospitals with bipartisan action to ease repayment terms for Medicare loans and further delay Medicaid disproportionate share hospital payment cuts.

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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

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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The Medicare Outpatient Prospective Payment System proposed rule takes a bad policy on Part B drug payments and makes it worse by digging an even deeper financial hole for essential hospitals and their vulnerable patients.

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policy

The executive orders aim to end retrospective rebates to Medicare Part D pharmacy benefit managers; allow patients of federally qualified health centers to purchase certain drugs at 340B discounted prices; and tie Medicare Part B payment to international drug prices, among other provisions.

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policy

CMS announces the end of the blanket Extraordinary Circumstances Exception for quality reporting and value-based purchasing programs. HHS issues a remdesivir allocation fact sheet, and FDA approves a third influenza and COVID-19 combination diagnostic test.

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state-action

The report, requested by Republican representatives, details challenges states face in administering Medicaid programs, including with coverage exclusions and care coordination, coverage benefits and eligibility, and Medicare and Medicaid alignment.

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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

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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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

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.

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policy

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.

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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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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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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

President Trump has signed a $2 trillion package of COVID-19 aid that provides $100 billion to hospitals and other providers, averts cuts to Medicaid disproportionate share hospital (DSH) payments, suspends Medicare sequester cuts, and includes numerous other relief measures.

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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

After two failed votes, senators continue negotiations on a $1.6 trillion funding package to boost the economy and improve access to care during the COVID-19 pandemic. Meanwhile, House Democratic leadership unveiled competing legislation to provide relief.

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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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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

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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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

After delaying Medicaid DSH cuts and extending funding for other health care programs by five additional months, congressional leaders are expected to leverage the new May 22 expiration date to advance bills to lower drug prices and protect patients from surprise medical bills.

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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

Beginning Jan. 1, 2020, CMS will start to adjust claims that were paid at the reduced rate. The agency also filed a notice appealing its case to the U.S. Court of Appeals for the District of Columbia Circuit.

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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

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

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policy

The final rule includes provisions related to the Quality Payment Program, evaluation and management services, telehealth services, and the Medicare Shared Savings Program.

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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 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.

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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

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.

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policy

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

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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

The order directs the Department of Health and Human Services to alter the Medicare Advantage program, increase cost and quality transparency, and continue site-neutral payment policies.

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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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Essential Insights

Presenters from the University of Texas Health Science Center at Tyler and Germane Solutions discussed strategies to improve graduate medical education economics.

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state-action

The rate of Americans without health insurance was 8.5 percent in 2018, up from 7.9 percent the previous year.

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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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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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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

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 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 calendar year 2020 proposed rule includes updates to the Quality Payment Program, a request for information on the creation of Merit-based Incentive Payment System Value Pathways, and other topics of interest to essential hospitals.

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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 final judgement, in favor of America's Essential Hospitals, does not indicate how the Department of Health and Human Services should remedy unlawful payment reductions to hospitals in the 340B Drug Pricing Program in 2018 and 2019.

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policy

The administration issued a June 24 executive order addressing hospital price disclosure, quality measurement, data sharing, and the expanded use of health savings accounts.

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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 Medicare Payment Advisory Commission outlines issues of importance to essential hospitals, including Medicare payment strategies for Part B drugs, the Medicare Shared Savings Program,and Medicare fee-for-service spending for emergency department services.

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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

A draft plan from the Senate Health, Education, Labor, and Pensions Committee aims to end surprise medical bills for out-of-network emergency services, reduce prescription drug prices, and improve transparency in health care costs, among other priorities.

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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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policy

A federal judge found the Department of Health and Human Services’ Medicare outpatient payment cuts in 2019 to hospitals in the 340B Drug Pricing Program were unlawful, extending a similar decision regarding 2018 cuts. The case was sent back to the agency to determine the appropriate remedy.

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America’s 340B hospitals are pleased with the District Court’s decision and urge the Department of Health and Human Services to follow the judge’s directive to promptly resolve the harm caused by its unlawful cuts to Medicare reimbursement.

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policy

The House this week will take up legislation to protect people with pre-existing conditions and help generic drug and biosimilar manufacturers bring their products to market. A House letter calling for a delay of Medicaid DSH payment cuts has 286 bipartisan signatures; the deadline to sign is May 8.

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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

A House letter calling for a delay of Medicaid disproportionate share hospital payment cuts has 178 bipartisan signatures; the deadline to sign is May 3. A House committee holds the first congressional hearing on the Medicare for All Act.

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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

A new proposed rule would increase inpatient 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 24.

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policy

Hospitals with the greatest proportion of Medicare patients dually eligible for Medicaid had decreased readmissions penalties, according to a study in JAMA Internal Medicine.

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policy

The Centers for Medicare & Medicaid Services announced notice of intent to apply and application deadlines for a Jan. 1, 2020, start date for the Medicare Shared Savings Program.

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policy

The report includes recommendations on several issues of importance to essential hospitals, including hospital inpatient and outpatient services, hospital quality incentive programs, and alternatives to opioids.

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policy

Adjusting for social risk factors in Medicare's Hospital Readmissions Reduction Program results in decreased penalties for hospitals serving a safety-net role.

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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

Long-expected "Medicare-for-all" bill formally introduced; Congressional hearings continue to focus on rising health care costs and prescription drug prices.

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policy

Hospitals now have until March 14 to submit data for the Medicare Promoting Interoperability and Hospital Inpatient Quality Reporting (IQR) programs.

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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 president signs a multibillion-dollar funding package and declares a national emergency, which now faces multiple court challenges. Two House Democrats announce plans to introduce Medicare-for-all legislation.

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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

As the partial government shutdown continues, the House this week will consider the Pandemic and All-Hazards Preparedness and Advancing Innovations Act and a bill to extend funding for the "Money Follows the Person" demonstration program.

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policy

The association urged the agency to consider the interplay of new policies with existing government programs, such as the 340B Drug Pricing Program.

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policy

The Medicare Shared Savings Program final rule creates a pathway for accountable care organizations to transition more rapidly to performance-based risk.

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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 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.

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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

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.

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policy

The five-year demonstration, beginning in 2020, would be open to hospitals and physicians in selected geographic areas representing 50 percent of Medicare Part B spending on separately payable drugs.

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policy

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.

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policy

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.

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policy

The association strongly encourages essential hospitals to submit individual comments with specific examples of how your institution addresses social risk factors among Medicare beneficiaries; comments are due Nov. 16.

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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

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.

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policy

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

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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

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

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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webinar

Learn more about the Essential Hospitals Value-Based Care Collaborative and hear how Premier helped NewYork-Presbyterian Queens in the 1115 DSRIP Waiver program to bring additional value to the community.

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America’s Essential Hospitals, the American Hospital Association, and the Association of American Medical Colleges, along with three hospital plaintiffs, refiled our lawsuit against the U.S. Department of Health and Human Services to reverse Medicare cuts to 340B hospitals.

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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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webinar

Learn about the recently proposed Medicare rules that will broaden the scope of cuts to hospitals in the 340B Drug Pricing Program and to off-campus hospital outpatient departments.

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policy

A new proposed rule would create a pathway for accountable care organizations to more rapidly transition to performance-based risk.

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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

Bills to repeal the medical device tax and expand health savings accounts go to a House floor vote; a House committee advanced legislation that would fund the Hospital Preparedness Program at about $265 billion annually.

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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

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

The report provides updates on the Hospital Readmissions Reduction Program, off-campus emergency department access, the physician fee schedule, population-based quality measures and incentives, and Medicare accountable care organizations, among other topics.

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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

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.

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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 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 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.

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policy

Four House hearings this week examine the opioid crisis, as lawmakers work to craft bipartisan legislation; A Senate hearing focuses on oversight reports on the 340B Drug Pricing Program.

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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

On May 4, America’s Essential Hospitals and fellow plaintiffs will make oral arguments in a legal battle to reverse damaging Medicare cuts to hospitals in the 340B Drug Pricing Program; The public can watch via livestream.

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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

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

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.

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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

In its annual report to Congress, the commission also recommends curbing Medicare Advantage plan consolidation and evaluating telehealth services before including them in coverage.

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webinar

Hear a cost report expert explain the recent changes to worksheet S-10 of the Medicare cost report and share best practices for accurate completion to capture all of your uncompensated care.

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policy

Republicans from both chambers work on a marketplace stabilization package; Senate Finance Committee Republicans plan to review the Internal Revenue Service's process for designating nonprofit hospitals.

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policy

The budget plan for fiscal years 2018 and 2019 proposes changes to the distribution of 340B Drug Pricing Program savings and increased funding to fight the opioid crisis.

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policy

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.

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policy

The live session, on Feb. 8, will provide information on the upcoming transition to the QualityNet Secure Portal for hospitals participating in the Medicare Electronic Health Record Incentive Program.

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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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The groups called for swift action on seven programs and policies lawmakers left out of a Jan. 19 continuing resolution that funds the government through Feb. 8 and that extended the Children’s Health Insurance Program by six years.

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policy

This year, there are 124 new participants, including 55 that will take part in the risk-baring Medicare Shared Savings Program Track 1+ model; Accountable care organizations now serve 10.5 million Medicare patients, up 1.5 million from 2017.

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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

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

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 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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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 CHAMPIONING HEALTHY KIDS Act extends Children's Health Insurance Program funding for five years and delays cuts to Medicaid disproportionate share hospital payments for two years.

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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

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

The meeting came a day after the association submitted comments to the agency in response to the proposed annual update of the Hospital Outpatient Prospective Payment System.

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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 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 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 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

The Medicare Physician Fee Schedule proposed rule for calendar year 2018 includes physician payment and quality program changes.

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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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institute

A study finds hospitals penalized more often in the Hospital Readmissions Reduction Program's first years — including safety-net hospitals — were more likely to be penalized all five years.

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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 Medicare Payment Advisory Commission's annual report examines various issues in the Medicare payment system and offers recommendations to Congress.

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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 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

Senate Republicans stay focused on a strategy to repeal and replace the ACA; committees hold hearings on public health, Medicare, and chronic conditions.

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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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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

Hospital participation in Medicare value-based programs in 2015, including ACOs and bundled payments, was associated with 2,377 fewer readmissions and $32.7 million in savings.

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policy

The agency estimates that MA organization payment rates will increase by 0.45 percent on average in 2018, with an expected average revenue increase of 2.95 percent when accounting for coding changes.

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policy

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

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policy

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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policy

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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policy

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

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policy

CMS projects that Medicare Advantage organization payment rates will increase by 0.25 percent in 2018.

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policy

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

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policy

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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policy

The report is the last in a series of five by an ad hoc committee focused on social risk factors that affect the health outcomes of Medicare beneficiaries.

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policy

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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policy

OIG found that the federal portion of spending on catastrophic coverage reached $33.2 billion in 2015, compared with $10.8 billion in 2010.

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policy

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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quality

The report finds that dual enrollment status was “the most powerful predictor of poor outcomes” on many quality measures.

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policy

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

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policy

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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policy

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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policy

It outlines factors stakeholders should focus on when designing alternative payment models, including type to propose, how to measure improvements, and more.

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policy

An Oct. 14 final rule establishes a new approach to physician payment required by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA): the Quality Payment Program.

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policy

The rule establishes a "transition year," as well as flexibility for providers to choose their participation pace.

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policy

This is the fourth of five reports from an ad hoc committee to identify social risk factors affecting health outcomes of Medicare beneficiaries.

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policy

CMS says it miscalculated some hospitals' uncompensated care share and provided the incorrect wage index reclassification status of four hospitals.

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policy

The Medicare Access and CHIP Reauthorization Act of 2015 requires CMS to remove Social Security numbers from beneficiaries’ Medicare cards by April 2019.

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policy

In May, CMS paused initial patient status reviews to ensure reviews are performed consistently and the two-midnight policy is properly applied.

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policy

The webinar will focus on the Advancing Care Coordination through Episode Payment Models proposed rule.

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policy

Congress seems likely to pass a continuing resolution to fund the government beyond Sept. 30. Lawmakers also are expected to approve funding to combat Zika.

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policy

In a FAQ document, CMS states that the required JW modifier and patient documentation policy applies to separately payable Part B drugs.

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policy

Review contractors will be able to use coding specificity as the reason for an audit or a denial of a claim to the extent that they did before Oct. 1, 2015.

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policy

Medicare Part D spending increased 17 percent, outpacing overall prescription drug spending increases, according to CMS data.

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policy

The rule addresses the controversial two-midnight policy, Medicare DSH, the Hospital-Acquired Condition Reduction Program, Value-Based Purchasing, and more.

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policy

The rule includes the annual payment update to inpatient payment rates and changes to the Medicare disproportionate share hospital payment methodology.

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policy

Model will test new episode payment models for acute myocardial infarction and coronary artery bypass graft, as well as expansion of the current CJR model.

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quality

Several members of America’s Essential Hospitals are among the participants selected for the Million Hearts Cardiovascular Disease Risk Reduction Model.

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quality

The report aims to identify social risk factors that affect beneficiaries' health outcomes and methods to account for these factors in payment programs.

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policy

The rule, released July 7, updates physician payment rates for Medicare services and makes changes to physician quality programs.

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policy

The agency says the proposed changes are intended to reduce a backlog of Medicare payment and coverage determination appeals.

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policy

This year’s release includes some changes in both the information released and its classification.

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policy

The Senate rejected a $1.1 billion Zika funding package, and Patrick Conway, with CMS, testified about the proposed Medicare Part B demonstration project.

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policy

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

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policy

America's Essential Hospitals gave feedback on Medicare DSH payments, payments associated with the two-midnight policy, and quality reporting programs.

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policy

Senate appropriators pass HHS spending bill that includes 340B Drug Pricing Program user fee and instructions to HRSA to consider stakeholder input in final mega-guidance.

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policy

CMS has delayed the effective date of a new claims coding and patient documentation policy for unused Medicare Part B drugs from July 1 to Jan. 1, 2017.

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Association supports bill, which would add needed risk adjustment to the Medicare Hospital Readmissions Reduction Program and provide some relief for recent cuts to off-campus hospital outpatient department payments.

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policy

Delay of patient status reviews will continue until further notice. The agency will work with Quality Improvement Organizations to ensure the two-midnight policy is enforced consistently for all hospitals.

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policy

The House and Senate are expected to vote on Zika spending. In other activity, opioid measure are set to go to conference and committees review Part B payment model and tax-related health proposals.

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policy

The proposed rule includes key provisions for carrying out a new physician payment system to replace Medicare's sustainable growth rate updates.

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policy

The House is expected to vote on several opioid-related measures, and 19 House Democrats sent CMS a letter of support for the Medicare Part B demonstration to reduce drug costs.

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policy

The Comprehensive Primary Care Plus model will encourage primary care practices to transform care delivery, including by increasing care management and coordination.

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policy

The proposal would reverse the cut starting in FY 2017, in addition to a temporary adjustment to retroactively pay for reduced payments from fiscal years 2014 to 2016.

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policy

Changes will more accurately reflect cost of care for dual eligibles and adjust Medicare Advantage star ratings for enrollees' socioeconomic and disability statuses.

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policy

A 2015 budget law that creates site-neutral payment for off-campus hospital outpatient departments does not directly affect 340B Drug Pricing Program eligibility, but changes to how hospitals report Medicare costs does raise concerns.

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quality

Special Innovation Project grants will be awarded to 28 partnerships with QIN-QIOs to support and scale quality improvement projects. Projects should aim to provide Medicare beneficiaries with better care, better health, and greater value.

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policy

In letter to CMS, association raises issues of payment, definition of off-campus outpatient department of a provider, and 340B eligibility.

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policy

In comments to CMS, America's Essential Hospitals argues for a delay to re-evaluate ratings methodology changes and the potential to disproportionately disadvantage essential hospitals.

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quality

Tool, developed by association member University of Chicago, shows geographic disparities in health outcomes, health care use, and health care spending.

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quality

Department calls for interagency approach that employs alternative payment models and better communication between patients and providers.

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policy

March 8 proposed rule details two approaches agency will test to encourage prescribing of lower-cost medications: reimbursement rate adjustments and value-based purchasing.

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policy

Conservative Freedom Caucus opposes GOP budget plan; Senate-passed bill would combat opioid abuse; health committees work on mental health, Medicare improvement.

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policy

Association responds to House lawmakers' request for comment on Medicare's new payment policy for off-campus hospital outpatient departments. Congress works on FY 2017 budget, holds hearings on Zika virus and opiod abuse.

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policy

Providers now must report and return a Medicare Part A or B overpayment to CMS by the later date of 60 days since identification or the corresponding cost report due date. The final rule also establishes a six-year lookback period.

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policy

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.

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America's Essential Hospitals welcomes proposals on Medicaid access and coverage, mental health, and others, but says proposed funding cuts would undermine work of essential hospitals.

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policy

State hospital association says risk adjusting CMS readmissions methodology results in significantly less variation in measured quality differences among hospitals.

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policy

The new FAQ clarify that site neutral law won't impact PO modifier requirements. PO modifiers must be included on claims as of Jan. 1 for all services and items furnished in off-campus, provider-based departments.

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quality

Now-voluntary OAS CAHPS will measure patient experience of care in Medicare-certified hospital outpatient departments and ASCs. The first public reporting of data is not expected until 2018.

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quality

The guide focuses on reducing readmissions for racial and ethnic minority groups and is part of the CMS Equity Plan for Improving Quality in Medicare.

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policy

First of five consensus reports from National Academy of Medicine (NAM) ad hoc committee identifies social risk factors for Medicare payment and quality programs, and the measures they can impact.

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Association expresses deep disappointment with Medicare Payment Advisory Commission (MedPAC) recommendation to cut Medicare Part B reimbursement to hospitals in the 340B Drug Pricing Program.

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policy

House and Senate lawmakers negotiate omnibus appropriations bill and two-year extension of tax cuts, but fail to provide relief on new Medicare site-neutral payment policy for hospital outpatient departments.

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policy

Agency to give hospitals opportunity to comment on law's requirements for notifying Medicare beneficiaries when outpatient observation services last longer than 24 hours.

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policy

Eligible hospitals have until Dec. 31 to submit data through QualityNet for the Inpatient Quality Reporting and Medicare Electronic Health Record Incentive programs.

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policy

Court-ordered justification provides additional insight for 0.2 percent inpatient payment rates cut agency linked to policy

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institute

Essential hospitals 2.67 times more likely than other hospitals to receive penalties under Medicare readmissions program in FY 2016

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policy

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

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policy

Feedback due Nov. 17 on provisions to implement MIPS and APM participation incentives; MIPS quality measures of particular interest to hospitals

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policy

CMS released a new resource clarifying when ICD-9 and ICD-10 codes are required. Claims submitted on Oct. 1 or later but with dates of service prior to Oct. 1 require ICD-9 codes, not ICD-10.

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policy

The rule finalizes proposals from the stage 3 proposed rule and the proposed rule modifying the programs from 2015 to 2017. Changes include a 90-day reporting period, fewer hospital objectives, and a lower threshold for patient electronic access.

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quality

These findings come from GAO, which also found that essential hospitals narrowed this gap over the study, overall performance during VBP's initial years didn't change, and bonuses and penalties were less than 0.5 percent of Medicare payments per year.

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policy

Recent narrowing of provider networks in Medicare Advantage (MA) organizations, which privately offer one or more health benefit plans to Medicare beneficiaries, has caused concerns over whether MA enrollees can adequately access care.

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policy

CMS requests feedback on a range of provisions relating to MIPS and incentives for participation in APMs, including whether to stratify quality measure data by demographic factors.

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policy

CMS has tested its systems and is prepared to assist providers as problems arise. Providers should first contact their MAC for Medicare claims questions or subsequently email the ICD-10 Coordination Center or the ICD-10 ombudsman.

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policy

In a legal victory for hospitals, a district court said CMS did not meet legal requirements for rulemaking when it cut hospital inpatient payments by 0.2 percent in FY 2014. The court ordered CMS to reissue the FY 2014 IPPS rule.

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quality

The webinars will feature representatives from CMS answering questions about the model. Instructions on how to submit questions will be included in the registration confirmation email.

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quality

CMS has extended the deadline for the Million Hearts: CVD Risk Reduction Model due to high interest. The model will incentivize providers to target Medicare beneficiaries with the highest risk of CVD for patient-centered care.

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policy

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.

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policy

This conference call will cover major policies included in the IPPS and LTCH PPS final rule, including quality initiatives. Question and answer period to follow presentation.

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quality

The Million Hearts: CVD Risk Reduction Model will incentivize providers to calculate CVD risk for Medicare beneficiaries and target those with the highest risk for patient-centered care.

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policy

RACs will not conduct postpayment reviews of patient status for Medicare claims with an inpatient admission between Oct. 1 and Dec. 31, 2015.

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policy

NOTICE Act seeks to educate patients about impact of observation status, including on cost-sharing and skilled nursing facility eligibility.

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Essential Insights

As we mark 50 years of Medicaid and Medicare, we reflect on the experiences of others within and beyond the four walls of essential hospitals.

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New edition of Walls Down coincides with 50th anniversary of Medicaid and Medicare, spotlights value of coverage to access and health.

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policy

Sen. Grassley requested a hearing on recent 340B GAO report. House calls and clinical trials for Medicare patients each pass one chamber. Committees review Medicare hospital payments, HIT, and marketplaces.

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policy

Proposed rule would update physician payment rates for Medicare services, change physician quality programs, and solicit comment on MACRA requirements.

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quality

Interactive map tracks real-time weather along with locations of Medicare patients who rely on electrically powered medical equipment.

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policy

CBO also found that if a full ACA repeal took effect on Jan. 1, 2016, the federal deficit would increase by $137 billion between 2016 and 2025.

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policy

The House will vote to repeal two major ACA provisions this week - medical device tax and the IPAB - and consider four Medicare Advantage bills. Health committees are reviewing mental health and HIT.

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policy

The agency also finalized a new risk/reward model that offers a greater share of savings for providers who take on more financial risk.

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policy

Topics include Medicare Advantage, the ACA's medical device tax, Medicaid fraud and abuse, and the Medicare appeals process.

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policy

New law replaces sustainable growth rate with new update schedule and creates quality reporting and merit-based payment systems

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quality

The Million Hearts: CVD Risk Reduction Model will incentivize providers to calculate cardiovascular risk for eligible Medicare beneficiaries and target those with the highest risk for patient-centered care. Applications are due Sept. 4.

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policy

The Energy and Commerce Committee is scheduled to vote on 21st Century Cures Wednesday, possibly including an amendment that would make changes to the 340B Drug Pricing Program.

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policy

House votes on defense and late-term abortions, while the Senate votes on the trade bill, faces pharma pressure on biologics. Health committees review 21st Century Cures and Medicare patients' chronic conditions.

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policy

The final policy takes into account changes to Medicare DSH payments, improving the accuracy of payments to hospitals.

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policy

There is particular interest in mechanisms for greater comprehensiveness in care delivery, care for complex patients, care coordination, and value-driven reimbursement.

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policy

Plus, senators are concerned with the CMS rating system for Medicare Advantage plans.

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institute

Brief finds that hospitals with more than 400 beds, teaching hospitals, those treating complex patients, and essential hospitals more likely to receive penalties; no evidence that penalties align with outcomes

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Essential Insights

Top issues include protecting Medicaid and Medicare from cuts, protecting the 340B program, and risk adjusting quality incentive program measures

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policy

The proposals seek to add flexibility for participants and encourage participants to assume more risk to be be rewarded with greater shared savings.

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policy

Multiple exceptions are proposed to the fraud and abuse regulations that govern Medicare and Medicaid, including changes to the definition of "remuneration" in the CMP regulations and codification of the gainsharing CMP.

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policy

Congress concluded business until after the Nov. 4 election, passing legislation to fund the government through Dec. 11. Bills funding children's health services and addressing postacute care quality were also sent to the president's desk.

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policy

During its September public meeting, MedPAC discussed alternatives to the two-midnight policy, the need for audit reform, and the 3-day SNF rule. The commission will continue to focus on these issues.

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policy

America's Essential Hospitals urged CMS to ensure any changes to the MSSP encourage and emphasize quality of care for beneficiaries.

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policy

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.

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policy

Models should use evidence-based social and behavioral insights to increase engagement in health outcomes for Medicare beneficiaries, Medicaid beneficiaries, dual-eligible patients, and/or Children’s Health Insurance Program (CHIP) beneficiaries.

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policy

Data entry deadline has passed, contact National Healthcare Safety Network help desk for questions or assistance

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policy

The final rule updates Medicare payment policies, rates for inpatient stays at general acute care hospitals, and provisions related to quality improvement programs.

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policy

Congress considers Veteran Affairs, Medicare, and immigration bills as August recess nears; House holds hearing on state Medicaid funding.

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policy

The agency proposes to increase payment rates by an outpatient department fee schedule increase factor of 2.1 percent for CY 2015. CMS also proposes to collect data on services provided in off-campus provider-based departments by requiring hospitals and physicians to identify these services using a modifier on hospital and physician claims.

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policy

CMS will introduce star ratings to Hospital Compare, Dialysis Facility Compare, and Home Health Compare as part of an effort to make information on quality of care easier to understand and compare.

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policy

Congress returns to session focused on improving access in the VA health care system. The Senate Appropriations Committee will review the president's request for funding to contain illegal immigration of minors, and House committees will look at 21st Century Cures and Medicare reforms.

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policy

CMS proposes to update how participants in the MSSP capture and submit quality metric data to gauge improvements to quality of care. The proposed update includes changes to the measure set and the benchmark time period.

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policy

CMS released the rule July 3. The agency proposes to increase payment rates by an outpatient department fee schedule increase factor of 2.1 percent for CY 2015. In addition, CMS proposes to collect data on services provided in off-campus provider-based departments by requiring hospitals and physicians to identify these services using a modifier on hospital and physician claims.

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policy

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

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policy

Congress is on recess for July 4th. Last week leaders in the Finance and Ways and Means committees introduced the IMPACT Act regarding postacute care in Medicare. Energy and Commerce held hearings on Medicare program integrity and digital health's impact on 21st century cures.

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policy

Acute care facilities that participate in the Hospital Inpatient Quality Reporting Program must enter Medicare beneficiary numbers on event records for all Medicare patients into the National Healthcare Safety Network, beginning July 1.

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policy

House GOP Leadership elected Rep. Kevin McCarthy as majority leader and Rep. Steve Scalise as Whip. This week, the House Energy and Commerce Committee will hold two health care related hearings, one on their 21st Century Cures initiative and the second on Medicare program integrity.

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policy

MedPAC announced that it will look into alternatives for the two-midnight rule. The potential alternative policy will clarify the inpatient payment system to clarify when a patient is considered an inpatient and alter payment mechanisms to require less observation care.

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policy

The Labor/HHS appropriations bill vote was cancelled due to Republican threats to derail the process over ACA funding. House Majority Leader Cantor's loss has House Republicans vying for his seat. MedPAC shares its biannual report to Congress on Wednesday.

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policy

America's Essential Hospitals submitted public comments to the Ways and Means committee regarding Medicare hospital payment issues, including the two-midnight rule, short inpatient stays, and RAC auditing, addressed in a committee hearing in May.

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policy

CMS is urging hospitals to register soon for the QualityNet Secure Portal to ensure access on July 1 to meet reporting requirements for the Hospital Inpatient Quality Reporting and Hospital Outpatient Quality Reporting Programs.

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policy

Providers with pending appeals on the number of Medicaid eligible days used in the calculation of the Medicaid fraction of their disproportionate patient percentage must provide supporting information and documentation to the PRRB by July 22.

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policy

The subcommittee focused on three issues pertaining to hospital inpatient reimbursement: 1) the two-midnight rule that redefined which hospital stays qualify for inpatient reimbursement; 2) RAC reviews of hospital payment determinations; and 3) provider appeals of Medicare payment determinations.

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policy

The Ways and Means Committee reviewed hospital issues as part of the Medicare Program. Two Louisiana delegates urged CMS to accept nonprofit-provided premium assistance. The Senate Veterans Affairs Committee held a hearing featuring Secretary Shinseki.

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policy

For inpatient admissions with dates of admission between Oct. 1, 2013, and March 31, 2015, MACs and recovery audit contractors will not conduct postpayment patient status reviews. MACs will continue to conduct prepayment probe reviews of short stays with dates of admission between Oct. 1, 2013, and March 31, 2015.

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policy

CMS finalized its proposal to rescind the requirement that a hospital's governing body include a member of the medical staff and revised its position that each hospital, including those in a multihospital system, have a separate and distinct medical staff. America's Essential Hospitals urged CMS to take both of these actions.

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policy

On April 30, CMS issued the IPPS proposed rule for fiscal year 2015. The rule updates Medicare payment policies, rates for inpatient stays at general acute care hospitals, and provisions related to quality improvement programs. CMS will accept comments on the proposed rule through June 30.

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policy

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.

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policy

CMS released the FY 2015 proposed IPPS rule April 30. The proposed rule updates Medicare payment policies and rates for inpatient stays at general acute care hospitals, as well as provisions regarding quality improvement programs.

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policy

CMS adjusts FFS claims from 2008-2012 for DSH hospitals. The adjustment accounts for changes to Medicare DSH payments and for FY 2014 uncompensated care payments.

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policy

CMS released new data on Medicare Part B payments to more than 800,000 physicians and other health care professionals. The data set includes calendar year 2012 data on the number and type of services provided to beneficiaries, average payments to providers for services, and the provider's average charge for services.

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policy

The plan would partially privatize Medicare and turn Medicaid into state block grants. It also repeals the ACA.

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policy

The bill replaces the SGR with a sensible physician payment system, ensures the continuation of health policies that help low-income patients access health care, and mandates an annual report on Medicaid DSH payments. The association notes that it would not support any methods of paying for the legislation that would "damage access to and quality of care..."

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policy

House and Senate differ on offsets for SGR repeal and replace; ACA alternative details under wraps

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policy

CMS will host a National Provider Call March 18, from 1:30 to 3 pm Eastern time, on 2014 Medicare quality reporting programs. During the call, officials will provide an overview of how to report quality measures in various Medicare programs, including those for electronic health records incentives and accountable care organizations.

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policy

The Centers for Medicare & Medicaid Services has made available resources to help providers prepare for and transition to International Classification of Diseases, 10th Edition (ICD-10) diagnosis and procedure codes by Oct. 1, 2014. Resources include fact sheets, frequently asked question, webinars, and an offer to participate in end-to-end testing.

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policy

Health and Human Services Secretary Kathleen Sebelius will testify on the president's budget before two congressional panels this week. Meanwhile, the House will consider a bill to repeal the sustainable growth rate (SGR) physician payment formula. Republicans are expected to tie SGR fix to repeal of the Affordable Care Act’s individual insurance mandate.

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policy

This week Congress is off to a slow start after heavy snow closed the federal government on Monday. President Obama released his budget, and the House Ways and Means chair introduced a comprehensive tax reform plan. Energy and Commerce will look at ways to protect seniors in the Medicaid program.

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policy

CMS proposes to adjust FFS claims from 2008-2012 for DSH hospitals. The proposed adjustment accounts for changes to Medicare DSH payments and for FY 2014 uncompensated care payments. Comments on the proposed call letter are due March 7.

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policy

As of Feb. 21, hospitals will not receive new RAC ADRs until the next round of contracts are awarded. In addition, CMS announced five changes to the RAC program that will take effect under new RAC contracts. CMS has not announced when it plans to finalize new contracts.

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policy

This week the longest serving member of Congress, Rep. John Dingell, announced he will retire. Dingell served for 29 terms and through 11 different presidents. The House Energy and Commerce Committee will look at the changes CMS is making to Medicare Part D, and House Majority Leader Eric Cantor announced that the chamber would vote on the ACA's 30-hour work week definition.

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policy

Congress has increased the debt limit but did not patch the Medicare physician payment system, as physician groups want a full repeal rather than a temporary fix. The Senate Finance Committee has a new chairman, Sen. Ron Wyden (D-OR). Wyden assumed the position after Sen. Max Baucus (D-MT) left to serve as ambassador to China.

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policy

On November 27, the Centers for Medicare & Medicaid Services (CMS) issued the Outpatient Prospective Payment System (OPPS) final rule for calendar year (CY) 2014. Included in the rule are provisions related to the following: payment for hospital outpatient visits data collection in off-campus, provider-based departments Hospital Outpatient Quality Reporting (OQR) Program Hospital Value-Based Purchasing

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policy

Association develops entitlement reform principles to guide possible future discussions around changes to the Medicare and Medicaid programs.

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