The Centers of Medicare and Medicaid Services (CMS) issued a Final Rule (the Rule) on April 29, 2021 extending and making various revisions to the Comprehensive Care for Joint Replacement Model (the CJR Model). The CJR Model...more
On October 29, 2020 the United States Departments of Health and Human Services, Labor and Treasury (the Departments) issued a final rule entitled Transparency in Coverage (the Rule). The Rule continues on the Trump...more
11/5/2020
/ Department of Health and Human Services (HHS) ,
Department of Labor (DOL) ,
Executive Orders ,
Final Rules ,
HCPCS ,
Health Insurance ,
Pharmacy Benefit Manager (PBM) ,
Public Disclosure ,
TPAs ,
Transparency ,
U.S. Treasury
On November 15, 2019, the Federal Government issued two rules: one in final form and one in proposed form, both designed to increase price transparency in health care. The rules follow on the Executive Order announced by...more
12/27/2019
/ Affordable Care Act ,
Comment Period ,
Department of Health and Human Services (HHS) ,
Employer Group Health Plans ,
Final Rules ,
Health Care Providers ,
Health Insurance ,
Health Plan Sponsors ,
Hospitals ,
Price Transparency ,
Proposed Rules
The Centers for Medicare and Medicaid Services (CMS) issued a final rule (the Rule) on December 21, 2018, which reshapes the Medicare Shared Savings Program (MSSP). Termed “Pathways to Success,” the Rule, among other...more
On December 20, 2016, the Centers for Medicare & Medicaid Services (CMS) issued a final rule (the Final Rule) which includes three new mandatory episode-based payment programs for cardiac care, as well as the expansion of the...more
The Centers for Medicare and Medicaid Services (CMS) and the Office of Inspector General (OIG) of the Department of Health and Human Services just issued a final rule setting forth waivers of specified fraud and abuse laws...more
11/2/2015
/ ACOs ,
Centers for Medicare & Medicaid Services (CMS) ,
Final Rules ,
Fraud and Abuse ,
Gainsharing ,
Healthcare ,
Home Health Care ,
Medicare ,
Medicare Shared Savings Program ,
OIG ,
Required Documentation ,
Waivers
This is the fifth post in Health Care Law Today’s series on the final rule.
The final Medicare Shared Savings Program (“MSSP”) rule released on June 4, 2015, contains a number of modifications to the financial...more
This is the third post in Health Care Law Today’s series on the final rule. This post addresses changes to sharing of beneficiary identifiable data.
In its December 8, 2014 proposed rule revising the Medicare Shared...more
This is the second post in Health Care Law Today’s series on the final rule. This post addresses Eligibility Requirements, and the Application and the Renewal Process.
ACO Eligibility Requirements -
Under the...more
6/24/2015
/ ACO Participant Agreements ,
ACOs ,
Applications ,
Board of Directors ,
Centers for Medicare & Medicaid Services (CMS) ,
Compliance ,
Corporate Governance ,
Duty of Loyalty ,
Eligibility ,
Fiduciary Duty ,
Final Rules ,
Governance Standards ,
Health Care Providers ,
Healthcare ,
Medicaid ,
Medicare ,
Medicare Shared Savings Program ,
Renewal Options ,
Suppliers ,
Transparency
This is the first post in Health Care Law Today’s Series on the final rule.
The Centers for Medicare and Medicaid Services (“CMS”) released a final rule, on June 4, 2015, addressing changes to its Medicare Shared Savings...more
Many critics have suggested that the November 11, 2011 final rule establishing the MSSP created a financial model that over time would not be sustainable. ACOs viewed the requirement to take risk after the initial three years...more