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.

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.

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.

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

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

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

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.

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.

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

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.

Unlawful cuts to Medicare Part B reimbursement at 340B hospitals and other harmful policy changes threaten the program, a key part of the patchwork of federal support essential hospitals rely on to meet their mission.

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

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.

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.

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

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.

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.

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

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

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.

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.

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

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

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.

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.

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.

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

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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

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.

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.

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

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.

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

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

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.

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.

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

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.

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

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

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

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.

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.

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.

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.

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.

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.

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.

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

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.

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

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

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.

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

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.

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.

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

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.

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.

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.

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.

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

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.

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

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

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

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.

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

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.

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

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.

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.

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.

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

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.

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.

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

The 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.

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.

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.

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

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.

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

Hospital staff participating in the Medicare Electronic Health Record Incentive Program will learn how to register, attest, and submit measures using the QualityNet Secure Portal.

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

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

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

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.

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

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

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.

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.

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

CMS is seeking broad feedback on a new direction for the Centers for Medicare & Medicaid Innovation, with increased emphasis on patient-centered care and market-based reforms.

The 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.

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.

By cutting reimbursement rates for Part B drugs to 340B hospitals, the Centers for Medicare & Medicaid Services would harm essential hospitals, which care for the nation’s poorest, most complex, and costliest patients.

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.

Communities rely on essential hospitals for trauma and other lifesaving care, physician training, emergency response, and other vital services. Essential hospitals, in turn, rely on policymakers for support to keep these services available to all. Learn more about this careful balance.

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.

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.

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

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.

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.

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

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

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

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

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

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

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

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

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

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

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.

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

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

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

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

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

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

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

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

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

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

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

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

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.

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.

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

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

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

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

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

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.

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

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.

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

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

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

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.

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

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

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

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

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

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

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.

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.

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.

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.

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

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.

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.

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

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.

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

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.

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

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

Essential hospitals rely on Medicare as a vital funding source for about a quarter of their patients. But funding shortfalls and regulatory changes that would further undermine the program put vulnerable patients at risk.

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.

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.

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.

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

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.

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.

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

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

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

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

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.

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.

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.

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.

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.

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.

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.

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.

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

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

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.

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

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.

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.

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

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

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.

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.

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

Socioeconomic factors affect health and health care outcomes. Medicare's Hospital Readmissions Reduction Program must account for this to avoid unfairly penalizing hospitals that care for large volumes of vulnerable patients.

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

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

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

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.

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.

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.

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

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.

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.

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

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

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

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.

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.

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.

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.

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.

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

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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

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..."

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

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.

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.

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.

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.

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.

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.

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.

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.

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

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