Debra McCurdy

Debra McCurdy

Reed Smith

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CMS Releases Proposed 2018 Medicare Advantage/Part D Reimbursement Methodologies and Policies

CMS has released its 2018 Advance Notice and Call Letter, which outline proposed updates to Medicare Advantage (MA) and Part D plan reimbursement methodologies and policies. CMS notes that it its proposed policies focus on...more

2/24/2017 - Alternative Payment Models (APM) CMS Health Care Providers Medicare Advantage Medicare Part D

CMS Schedules 2017 Meetings to Consider HCPCS Code Applications

CMS has just announced the dates for its annual meetings to discuss pending applications for new and revised HCPCS codes: - May 16 – 18, 2017: Drugs/Biologicals/Radiopharmaceuticals/Radiologic Imaging Agents - June...more

2/24/2017 - CMS HCPCS Health Care Providers

Medicare & Medicaid Remain Vulnerable to Fraud and Abuse, GAO Warns

The Government Accountability Office (GAO) is out with the latest installment of its “High-Risk Series,” which identifies federal programs “that are especially vulnerable to waste, fraud, abuse, and mismanagement, or that...more

2/24/2017 - CMS GAO Health Care Providers HHS Medicaid Medicare

CMS Teleconference to Discuss SNF Value-Based Purchasing Program (March 15)

On March 15, 2017, CMS is hosting a call to discuss the Skilled Nursing Facility (SNF) Value-Based Purchasing (VBP) Program, which is scheduled to begin in fiscal year 2019. The call will focus on confidential quarterly...more

2/24/2017 - CMS Health Care Providers Skilled Nursing Facility

CMS Proposes Changes to Stabilize ACA Health Insurance Markets

At the same time Republican Congressional leaders are attempting to develop legislation to repeal and replace the Affordable Care Act (ACA), CMS has published a proposed rule that is intended to help stabilize the Affordable...more

2/24/2017 - Affordable Care Act CMS Health Insurance Health Insurance Exchanges Open Enrollment

Trump Temporarily Tables Effective Date of the New Episode Payment Model Rule – But No Change to July 1, 2017 Implementation

As mandated by the Trump Administration’s regulatory review policy, CMS is delaying the effective date of its January 3, 2017 final rule establishing mandatory Medicare episode payment models (EPM) for acute myocardial...more

2/22/2017 - CMS Episode Payment Models (EPM) Regulatory Freeze Trump Administration

ICD-10 Coordination and Maintenance Committee Meeting Scheduled for March 7-8, 2017

The ICD-10 Coordination and Maintenance Committee is meeting on March 7 and 8, 2017, to discuss proposed code changes to ICD-10-CM and ICD-10-PCS. The March 7, 2017 session will focus on procedure codes, and the March 8...more

2/21/2017 - CMS Health Care Providers ICD-10

House Panel Votes to Tighten Medicaid Income Standard

The House Energy and Commerce Subcommittee on Health has approved two bills that would modify Medicaid eligibility rules to consider additional sources of income. First, HR 829 would establish standards for states to consider...more

2/14/2017 - Eligibility Medicaid Modified Adjusted Gross Income

CMS Provides Sneak Preview of Future DMEPOS Competitive Bidding Plans Before Retracting Announcement

One week after unveiling the next round of Medicare durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) competitive bidding, the Centers for Medicare & Medicaid Services (CMS) has announced a “temporary...more

2/14/2017 - CMS Competitive Bidding DMEPOS Durable Medical Equipment Medicare

Regulatory Freeze Notwithstanding, Trump Administration Increases Health Fraud CMPs

The Department of Health and Human Services (HHS) is once again applying an inflation increase to maximum civil monetary penalty (CMP) amounts for HHS agencies and programs – less than five months after the last inflation...more

2/3/2017 - Civil Monetary Penalty DOJ False Claims Act (FCA) HHS Inflation Adjustments

Congressional Budget Resolution Provides Framework for ACA Repeal Legislation, Hearings Focusing on ACA Issues

The House and Senate have approved a budget resolution (S.Con.Res. 3) providing instructions to Congressional committees on the federal spending framework for fiscal years 2017 through 2026. Notably, the resolution would...more

2/1/2017 - Affordable Care Act Legislative Agendas Repeal

DOJ/OIG Update on FY 2016 Health Care Fraud and Abuse Control (HCFAC) Program Recoveries

Federal health fraud recoveries for FY 2016 totaled $3.3 billion, according to the latest HCFAC program annual report. The HCFAC program is credited with more than $31.0 billion in Medicare Trust Funds recoveries since it...more

2/1/2017 - DOJ Fraud and Abuse Health Care Providers Healthcare Fraud OIG

CMS Proposes Stringent New Medicare Standards for Providers and Suppliers of Prosthetics and Custom-Fabricated Orthotics

CMS has issued a proposed rule that would set forth qualifications that providers and suppliers must meet in order to furnish, fabricate, or bill for prosthetics and custom-fabricated orthotics under the Medicare program. The...more

1/31/2017 - CMS DMEPOS Health Care Providers Medicare

Senate Finance Committee to Vote on Price HHS Nomination

On January 31, 2017, the Senate Finance Committee is set to vote on the nomination of Rep. Thomas Price to be Secretary of Health and Human Services....more

1/31/2017 - HHS Senate Finance Committee

HRSA Publishes Final Rule on 340B Drug Pricing Program Ceiling Price and Manufacturer Civil Monetary Penalties

The Health Resources and Services Administration (HRSA) has published a final rule to implement civil money penalty (CMP) provisions added to section 340B of the Public Health Service Act under the Affordable Care Act. In...more

1/31/2017 - Affordable Care Act Civil Monetary Penalty Drug Pricing HRSA Pharmaceutical Industry Prescription Drugs Public Health Service Act Section 340B

Congressional Hearings to Focus on Medicaid Reform

The House Energy & Commerce Committee has scheduled two hearings this week on Medicaid policy: a January 31 hearing on “Medicaid Oversight: Existing Problems and Ways to Strengthen the Program,” and a February 1 hearing on...more

1/31/2017 - Legislative Agendas Medicaid Medicaid Reform

House Takes Early Action on Noncontroversial Public Health Bills

Early in the new Congress, the House of Representatives has approved, without objection, the following bipartisan public health bills: - H.R. 309, the National Clinical Care Commission Act, to establish a National...more

1/31/2017 - Data Collection Health Care Providers HHS Legislative Agendas Public Health

Upcoming CMS Call on IMPACT Act Implementation (Feb 23)

On February 23, 2017, CMS is hosting a call on the Improving Medicare Post-Acute Care Transformation of 2014 (IMPACT Act) which requires the reporting of standardized patient assessment data by post-acute care provider. The...more

1/31/2017 - CMS Health Care Providers IMPACT Act Medicare

OIG Reports on Impact of “High-Priced Drugs” on Medicare Part D Catastrophic Coverage Spending

At the request of Congress and others, the Office of Inspector General (OIG) conducted a review of “high-priced drugs” (defined by OIG as exceeding $1,000 per month) and their impact on the Medicare program. The OIG found...more

1/30/2017 - CMS Drug Pricing Medicare Medicare Part D OIG

OIG Report Cites Continuing Vulnerabilities Under Medicare’s 2-Midnight Policy

The Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) has issued a report, “Vulnerabilities Remain Under Medicare’s 2-Midnight Hospital Policy,” which assessed changes in hospital...more

1/30/2017 - CMS Health Care Providers HHS Medicare OIG

President Trump’s Regulatory Review to Impact Recent Health Rules

As has been the tradition for incoming administrations, the Trump Administration has ordered a regulatory freeze and review of final rules published by the Obama Administration that had not yet gone into effect. In a January...more

1/26/2017 - CMS Episode Payment Models (EPM) HRSA Regulatory Freeze SAMHSA Trump Administration

Trump Executive Order Directs Executive Agencies to Minimize “Unwarranted” ACA Economic and Regulatory Burdens

President Donald Trump’s first official act in office was to sign an executive order declaring it the policy of his Administration to seek prompt repeal of the Affordable Care Act (ACA) – but in the meantime, he calls for...more

1/26/2017 - Affordable Care Act Barack Obama Executive Orders Repeal Trump Administration

CMS Finalizes Tighter Rules for New Medicaid Managed Care Pass-Through Payments

CMS has finalized without change its proposed rule to block states from adopting or increasing Medicaid managed care “pass-through” payments to hospitals, nursing facilities, and physicians beyond those in place when...more

1/23/2017 - CMS Health Care Providers Hospitals Medicaid Provider Payments

CDC Issues Final Quarantine Rule to Strengthen Control of Communicable Diseases

The Centers for Disease Control and Prevention (CDC) has issued a final rule to strengthen the federal government’s ability to prevent the introduction, transmission, and spread of communicable diseases into the United States...more

1/19/2017 - CDC Public Health

SAMHSA Releases Final and Supplemental Proposed Rules on Substance Abuse Records Privacy Protections

A new Substance Abuse and Mental Health Services Administration (SAMHSA) final rule is intended to modernize federal regulations governing the confidentiality of substance abuse records. SAMHSA explains in the preamble that...more

1/19/2017 - HHS SAMHSA Substance Abuse

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