Debra McCurdy

Debra McCurdy

Reed Smith

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OIG Spreads Holiday Cheer By Increasing “Nominal Value” Limits for Gifts to Medicare Beneficiaries

The Office of Inspector General (OIG) has increased the value of permissible gifts that may be made to Medicare beneficiaries without running afoul of the civil monetary penalty (CMP) provision prohibiting beneficiary...more

12/9/2016 - Beneficiaries Civil Monetary Penalty Inducements Medicaid Medicare OIG

CMS Releases 2017 Medicare DMEPOS and Clinical Lab Fee Schedules

CMS has announced 2017 Medicare fee schedule rates for durable medical equipment (DME) prosthetic orthotics and supplies (DMEPOS) furnished in non-competitive bidding areas. The calendar year 2017 DMEPOS update factor is 0.7...more

12/7/2016 - CMS Competitive Bidding DMEPOS Durable Medical Equipment Medicare

Out with the Old Rules? Will Trump and Republicans Target Health Care Regulations for Reversal in the New Year under...

The Congressional Review Act (CRA) has been used to overturn only one final rule in 20 years, but that situation may be about to change. According to a new Congressional Research Service (CRS) analysis, a “specific set of...more

11/23/2016 - Congressional Review Act Donald Trump HHS Long Term Care Facilities Medicaid Medicare Opioid

GAO Calls for Easier Public Access to SNF Expenditure Data

The Government Accountability Office (GAO) recently issued a report highlighting concerns with the public accessibility and reliability of skilled nursing facility (SNF) expenditure data collected by CMS. While CMS has posted...more

11/22/2016 - CMS GAO Public Access Laws Skilled Nursing Facility

CMS Proposes Restrictions on New Medicaid Managed Care Pass-Through Payments

CMS is proposing to prohibit states from adopting new or increased “pass-through” payments to hospitals, nursing facilities, and physicians under their Medicaid managed care contracts beyond those in place when the...more

11/22/2016 - CMS Health Care Providers Managed Care Contracts Medicaid

CMS Posts Final 2017 Medicare Clinical Lab Payment Determinations

CMS has released the final 2017 Medicare clinical laboratory fee schedule (CLFS) payment determinations for new and reconsidered test codes, including determinations regarding whether CMS will use crosswalking or gapfilling...more

11/22/2016 - Clinical Laboratories CMS Medicare

CMS Releases 2017 Medicare Deductible and Coinsurance Amounts

CMS has announced Medicare Part A and B beneficiary cost sharing amounts for 2017. With regard to Part A, the 2017 deductible for hospital inpatient admissions for the first 60 days of care will be $1,316, followed by $329...more

11/22/2016 - Beneficiaries CMS Health Care Providers Medicare Medicare Part A Medicare Part B

CMS Finalizes Medicare OPPS, ASC Rates and Policies for 2017

CMS has published its final rule with comment period updating the Medicare Hospital Outpatient Prospective Payment System (OPPS) and the Ambulatory Surgical Center (ASC) Payment System rates and policies for CY 2017. CMS...more

11/22/2016 - Affordable Care Act CMS Health Care Providers Medicare MPFS Outpatient Prospective Payment System (OPPS)

Obama Administration Releases Regulatory Agenda – But Changes Expected Under Trump Administration

The Obama Administration has updated its regulatory agenda, listing the anticipated timing of pending and future regulatory actions, including a number of Department of Health and Human Services regulations. Note, however,...more

11/21/2016 - HHS Obama Administration Regulatory Agenda Trump Administration

New OIG Investigations to Look at Wide Range of Medicare, Medicaid Services in FY 2017

The HHS Office of Inspector General (OIG) has issued its FY 2017 Work Plan, which lays out the OIG’s current audit, evaluation, and other legal and investigative priorities. The largest number of new initiatives by far target...more

11/21/2016 - Health Care Providers HHS Medicaid Medicare Medicare Part A Medicare Part B OIG Skilled Nursing Facility

$20 Increase in Medicare Outpatient Therapy Cap Limits Announced for 2017

Medicare outpatient therapy limits are set to increase slightly in 2017. Specifically, the 2017 cap will be $1,980 for physical therapy and speech-language pathology combined and $1,980 for occupational therapy, compared to...more

11/21/2016 - Health Care Providers Medicare Medicare Access and CHIP Reauthorization (MACRA) Outpatient Services Physical Therapists

CMS to Cut Medical Review Audits for Certain Advanced Alternative Payment Model Participants

In order to improve “clinician engagement” and minimize administrative burdens, CMS has announced an 18-month pilot program to reduce medical review audits for participants in selected Advanced Alternative Payment Models...more

11/16/2016 - Alternative Payment Models (APM) CMS Medicare Medicare Administrative Contractors (MAC) Recovery Audit Contractors (RACs)

CMS Proposes Updated Fire Safety Standards for Dialysis Facilities

CMS has issued a proposed rule that would require certain dialysis facilities participating in Medicare or Medicaid to meet updated fire safety standards. The proposed fire safety rule, published November 4, 2016, would...more

11/16/2016 - CMS Dialysis Dialysis Providers ESRD Healthcare Facilities

FY 2018 Federal Financial Participation Matching Amounts Published

The Department of Health and Human Services (HHS) has published the FY 2018 Federal Medical Assistance Percentages (FMAP), Enhanced FMAP, and disaster-recovery FMAP adjustments. These amounts will be used to determine...more

11/16/2016 - CHIP FMAP HHS Medicaid

CMS Schedules Meeting on FY 2018 IPPS New Technology Applications

CMS has announced a February 14, 2017 town hall meeting to discuss FY 2018 applications for add-on payments for new medical services and technologies under the Medicare hospital inpatient prospective payment system (IPPS)....more

11/16/2016 - CMS Health Care Providers Inpatient Prospective Payment System (IPPS) Payment Systems

CMS to Host Calls on Hospital Appeals Settlement Process (Nov. 16 & Dec. 12)

On November 16, 2016, CMS is hosting a call to provide an update on its latest plans to allow eligible providers to settle their inpatient status claims currently under appeal using the Hospital Appeals Settlement process. By...more

11/15/2016 - Appeals CMS Hospitals

CMS Delays Expanding Medicaid Rebate Program, Price Reporting Requirements to Territories Until 2020

CMS has announced that it is delaying until April 1, 2020 its controversial change in the definitions of “States” and “United States” included in the February 1, 2016 Medicaid covered outpatient drug final rule with comment...more

11/15/2016 - CMS Drug Pricing Medicaid Pharmaceutical Industry Reporting Requirements

CMS Seeks Input on Ways to Accelerate Medicaid Home and Community-Based Services

CMS is requesting public input on policy options it can consider to accelerate the provision of home and community-based services (HCBS) to Medicaid beneficiaries. Note that while supporting increased availability of quality...more

11/15/2016 - Beneficiaries CMS HCBS Waivers Long-Term Care Medicaid

Looking Ahead to a Trump Administration: Health Care and Life Sciences Industry Perspectives

Observers are digesting what the Trump Administration will mean for the health care and life sciences industry. Forecasting is more challenging for this incoming Administration than most given the relatively sparse policy...more

11/11/2016 - Affordable Care Act CMMI CMS Donald Trump Drug Pricing False Claims Act (FCA) Fraud and Abuse Healthcare Life Sciences Medicaid Medical Device Tax Political Candidates Presidential Elections

Medicare Dialysis Payments to Increase by $80 Million in CY 2017

CMS has published its final rule to update the Medicare end-stage renal disease (ESRD) prospective payment system (PPS) rates and policies for CY 2017. CMS expects the rule to increase overall Medicare payments to ESRD...more

11/2/2016 - CMS Dialysis ESRD Medicare Patient Prospective Payment System

CMS Finalizes New Rules for Bidders in Medicare DMEPOS Competitive Bidding Program, Revises DMEPOS Fee Schedule Update Policies

CMS has adopted a number of changes to its Medicare durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) policies for 2017, including new competitive bidding program (CBP) requirements and revisions to the...more

11/2/2016 - Breach of Contract CHIP CMS Competitive Bidding DMEPOS Final Rules Medicare Medicare Access and CHIP Reauthorization (MACRA)

Pick a Lane: CMS Finalizes Two-Track System to Implement Significant Changes in Medicare Physician Payment Policies Under MACRA -...

The Centers for Medicare & Medicaid Services (CMS) has finalized sweeping reforms of the Medicare physician fee schedule (MPFS) update framework, as mandated by Congress last year. While CMS transition policies are intended...more

11/1/2016 - Alternative Payment Models (APM) CMS Medicare Medicare Access and CHIP Reauthorization (MACRA) Merit-Based Point System MIPS MPFS Physician Payments Physicians

Payments Fall 0.7 Percent for Medicare Home Health Services in CY 2017

Medicare home health prospective payment system (HH PPS) payments will be reduced by 0.7 percent, or $130 million overall, in calendar year 2017 compared to 2016 levels under the final rule to be published by CMS on November...more

11/1/2016 - CMS Home Health Care Inpatient Quality Reporting Medicare Patient Prospective Payment System Value-Based Purchasing

Medicaid DSH Allotments Announced

CMS recently finalized the federal share disproportionate share hospital (DSH) allotments for federal fiscal year (FY) 2014 and announced preliminary federal share DSH allotments for FY 2016. ...more

11/1/2016 - CMS DSH Hospitals Medicaid

OIG “Investigative Advisory” Highlights Potential Medicaid Fraud, Patient Harm Stemming from Personal Care Services

The OIG has issued an “Investigative Advisory on Medicaid Fraud and Patient Harm Involving Personal Care Services” that identifies various “fraud schemes” it has encountered involving personal care services (PCS) — nonmedical...more

11/1/2016 - Fraud Internal Investigations Medicaid OIG

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