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Recap of Hospital “Wins” in New Budget Deal

Although written about widely in the last week, let’s recap how hospitals benefit under the budget deal signed into law on February 9.


  • A two-year delay in cuts to Disproportionate Share Hospital payments
  • Medicare payment extensions for rural providers
  • Four additional years of funding for the Children’s Health Insurance Program
  • Opioid addiction funding
  • Repeal of the Independent Payment Advisory Board


In addition, various provisions in the budget address ACOs. For example,


  • Separate payments for ACO use of telehealth services, but only if the ACOs are in Medicare Shared Savings Program (MSSP) Track 2, Track 3, or future two-sided risk ACO models with prospective assignment
  • Beneficiaries assigned prospectively at the beginning of a performance year for MSSP ACOs
  • Beneficiaries allowed to choose to align with an MSSP ACO where their main primary care provider participates (but beneficiaries still retain the freedom to choose any provider)
  • ACO Beneficiary Incentive Program (see last week’s newsletter/blog)


. . . and EHRs and virtual care


  • CMS not required to tighten meaningful use standards for the Electronic Health Record Incentive Program over time
  • Beginning January 2019, stroke symptom patients can receive treatment through telehealth—geographic restriction eliminated


Rules and Regulations


The bill codifies CMS regulatory changes that aim to streamline and clarify rules for providers regarding compliance with the Stark Law. It also updated both the civil and criminal penalties for fraud and abuse in federal health programs.




Offsets and cuts in the bill include:


  • Rescission of $985 million from the Medicaid Improvement Fund
  • Reduction in the 2019 Medicare Physician Fee Schedule update from 0.5 percent to 0.25 percent
  • Reduced acute care inpatient hospital payment when a beneficiary is discharged early to a hospice program
  • $1.35 billion in cuts over 10 years from the Prevention and Public Health Fund created by the ACA
  • Rescission of $220 million from the Medicare Improvement Fund


(Source: “Budget Deal Includes Big Wins for Hospitals,” HFMA Weekly, February 16, 2018)



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