Debra McCurdy

Debra McCurdy

Reed Smith

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CMS Publishes Corrections to 2015 Medicare Physician Fee Schedule Final Rule

CMS has published corrections to its final 2015 Medicare physician fee schedule rule. Among other things, the rule reflects a previously-announced correction to the conversion factor for the first quarter of 2015 ($35.7547),...more

3/27/2015

Obama Administration Finalizes Health Insurance Wraparound Coverage Rule

The Departments of Labor, Health and Human Services, and Treasury published a final rule on March 18, 2015 that amends the definition of excepted benefits to allow group health plan sponsors, in limited circumstances, to...more

3/27/2015

House Approves Medicare Access and CHIP Reauthorization Act

Repeals SGR Formula, Adopts Medicare and Other Policy Changes - Today the U.S. House of Representatives approved a major Medicare package, the Medicare Access and CHIP Reauthorization Act (MACRA), which would reform...more

3/27/2015 - CHIP DMEPOS Healthcare Medicare Physician SGR Formula Physicians

Congressional Health Policy Hearings

Congressional committees have held several hearings this week on health policy issues. On March 24, the Energy and Commerce Health Subcommittee held a hearing on the 340B drug pricing program....more

3/27/2015 - Congressional Investigations & Hearings Healthcare Prescription Drugs Section 340B

CMS Proposes Removing Two NCDs under Expedited Process

In 2013, CMS adopted an expedited administrative process to remove certain national coverage determinations (NCDs) older than 10 years since their most recent review. In December 2014, CMS removed seven NCDs under this...more

3/27/2015 - CMS Healthcare

CMS Proposed Rules in the Pipeline

CMS recently sent several major proposed rules to the White House Office of Management and Budget for regulatory clearance – the last step before publication in the Federal Register. OMB is reviewing proposed rules to update...more

3/27/2015 - CMS Healthcare Inpatient Prospective Payment System OMB Patient Prospective Payment System Proposed Regulation Skilled Nursing Facility

Ways & Means Committee Schedules March 24 Hearing on Use of Data Analysis to Stop Medicare Fraud

On March 24, the House Ways and Means Subcommittee on Oversight is holding a hearing on CMS’s use of the Fraud Prevention System (FPS) to identify and stop Medicare fraud. ...more

3/23/2015 - CMS Congressional Investigations & Hearings Healthcare Fraud Medicare

CMS Report Assesses Effectiveness/Impact of Medicare Quality Measures

CMS has released the “2015 National Impact Assessment of Quality Measures Report,” which examines the effectiveness of quality measures used in CMS hospital, ambulatory, and post-acute quality programs. ...more

3/20/2015 - CMS Healthcare Quality of Care Standards

MedPAC Report to Congress on Medicare Policy

The Medicare Payment Advisory Commission (MedPAC) has released its annual recommendations to Congress on Medicare policies, including Medicare fee-for-service (FFS) payment updates and a status report on the Medicare...more

3/20/2015 - Fee-for-Service Health Care Providers Medicare Medicare Advantage Medicare Part D MedPAC

GAO Calls for Expanded HHS Efforts to Reduce Antipsychotic Drug Use in Community Settings

The Government Accountability Office (GAO) has issued a report examining the extent to which antipsychotic drugs are prescribed for older adults with dementia in nursing homes and other settings. ...more

3/20/2015 - GAO HHS Medicare Medicare Part D Nursing Homes Prescription Drugs

House Approves Medicare DMEPOS Competitive Bidding, Hospital Observation, Controlled Substances, & Trauma Care Bills

Yesterday the House of Representatives approved the following health policy bills: ..H.R. 284, the Medicare DMEPOS Competitive Bidding Improvement Act of 2015 – which would require Medicare suppliers that bid under a...more

3/20/2015 - Controlled Substances DMEPOS Healthcare Hospitals New Legislation

OIG Posts FY 2014 State Medicaid Fraud Control Unit (MFCU) Data

The HHS Office of Inspector General (OIG) has released detailed statistical data on MFCU enforcement actions, recoveries, and expenditures for fiscal year 2014. ...more

3/20/2015 - Enforcement Actions Healthcare Fraud HHS Medicaid

CMS Posts Initial Results for Physician Value-based Payment Modifier

Under the ACA, the Physician Value-Based Modifier (Value Modifier) policy rewards physicians and groups of physicians who provide high quality and cost effective care, while penalizing those who did not meet objectives. ...more

3/20/2015 - Affordable Care Act Healthcare Physicians Value-Based Purchasing

CMS Invites Stakeholders to Join "Health Care Payment Learning and Action Network" to Promote Alternative Payment Models

As previously reported, CMS has established a public-private partnership, the Health Care Payment Learning and Action Network, to support HHS’s goal of moving Medicare and the broader health industry from a FFS model towards...more

3/20/2015 - CMS Fee-for-Service Healthcare Healthcare Providers Public-Private Partnerships

House to Vote Today on DMEPOS Competitive Bidding, Hospital Observation Policy, and Other Health Policy Bills

On March 16, 2015, the House of Representatives is scheduled to consider the following health policy legislation...more

3/20/2015 - DMEPOS Healthcare Healthcare Providers Legislative Agendas

CMS Finalizes SMART Act MSP Appeals Provisions

The Centers for Medicare & Medicaid Services (CMS) has published a final rule that implements Medicare Secondary Payer (MSP) appeals provisions under the Strengthening Medicare and Repaying Taxpayers Act of 2012 (SMART Act). ...more

3/19/2015 - CMS Final Rules Medicare Medicare Secondary Payer Act SMART Act

OIG Reviews Medicare Reimbursement for Critical Access Hospital (CAH) Swing-Bed Services

A recent OIG report examines increasing use of CAH “swing-bed” services, which the OIG describes as being equivalent to services performed at a SNF, but which are reimbursed at 101% of a CAH’s reasonable cost rather than at...more

3/19/2015 - CAH Healthcare Medicare OIG Skilled Nursing Facility

CMS Announces New "Next Generation" ACO Model; Schedules 3/17 Call

On March 10, 2015, CMS announced the Next Generation Accountable Care Organization (ACO) Model, its latest Affordable Care Act (ACA) innovation initiative intended to promote Medicare quality improvement and care...more

3/18/2015 - ACOs CMS Healthcare Next Generation ACO (NGACO)

New Postings on the Reed Smith Health Industry Washington Watch Blog

The Reed Smith Health Industry Washington Watch blog has been updated to report on recent health policy developments, including the following...more

3/18/2015 - CMS DMEPOS Healthcare Medicare Medicare Shared Savings Program MedPAC Regulatory Agenda

GAO Seeks Stronger CMS Measurement of State Medicaid Program Integrity System Effectiveness

Based on a review of 10 state Medicaid Management Information Systems (MMIS) used to process claims and support program integrity efforts, the GAO has concluded that the effectiveness of these systems is not known because CMS...more

3/18/2015 - CMS GAO Healthcare Information Management Medicaid

CMS Posts Deadlines for 2016 Medicare Shared Savings Program Application Cycle; Schedules Informational Calls

CMS is gearing up for the program year 2016 Medicare Shared Savings Program, under which physicians, hospitals, and certain other types of providers and suppliers may form Accountable Care Organizations (ACOs) to provide...more

3/13/2015 - ACOs Deadlines Healthcare Medicare Shared Savings Program

CMS Releases April 2015 Medicare Part B Drug ASP Update

CMS has posted its April 2015 update to the Medicare average sales price (ASP) drug pricing files, which contain the payment amounts CMS will use to pay for Part B covered drugs for the second quarter of 2015....more

3/13/2015 - CMS Healthcare Medicare Medicare Part B Prescription Drugs

March Congressional Health Policy Hearings

On March 10, 2015, the Senate Health, Education, Labor and Pensions (HELP) Committee held a hearing on “Continuing America’s Leadership in Medical Innovation for Patients,” featuring testimony from NIH Director Francis...more

3/12/2015 - 340B Congressional Investigations & Hearings Health IT HELP Innovation

OIG Repeats Calls for Expanded Medicare Part B Drug Price Substitution Policy

The OIG has issued the latest in a long line of reports comparing Medicare Part B drug average sales prices (ASP) and average manufacturer prices (AMP), this time with a focus on 2013 pricing. By way of background, CMS has...more

3/12/2015 - CMS Healthcare Medicare Medicare Part B OIG Pharmaceutical Manufacturers Prescription Drug Coverage Prescription Drugs

FDA Draft Guidance Addresses Electronic Informed Consent in Clinical Investigations

Today the Food and Drug Administration (FDA) published a notice announcing the availability of a draft guidance document entitled “Use of Electronic Informed Consent in Clinical Investigations: Questions and Answers.” The...more

3/10/2015

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