Debra McCurdy

Debra McCurdy

Reed Smith

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CMS Releases 2016 Medicare DMEPOS Fee Schedule – Reflecting Steep Cuts Based on DMEPOS Competitive Bidding Rates

On November 24, 2015, CMS released the Medicare durable medical equipment (DME), prosthetics, orthotics, and supplies (DMEPOS) fee schedule for the first half of 2016 – reflecting the agency’s first adjustments to nationwide...more

11/24/2015 - Affordable Care Act CMS Competitive Bidding DMEPOS Medicare

CMS Sets 2016 Medicare Deductible and Coinsurance Amounts

On November 16, 2016, CMS published Medicare Part A and B beneficiary cost sharing amounts for 2016. With regard to Part A, the 2016 deductible for hospital inpatient admissions for the first 60 days of care will be $1,288,...more

11/24/2015 - CMS Co-Insurance Payments Deductibles Hold Harmless Medicare Part A Medicare Part B

CMS Call: 2016 Medicare Physician Quality Reporting Programs (Dec. 8)

On December 8, 2015, CMS is hosting a call to discuss how the 2016 Medicare Physician Fee Schedule final rule impacts Medicare quality reporting programs. Specifically, the call will address changes to the Physician Quality...more

11/24/2015 - CMS Electronic Health Record Incentives Medicare Access and CHIP Reauthorization (MACRA) Medicare Shared Savings Program MIPS MPFS PQRS Value-Based Payments

Congress Clears Controlled Substances Act Scheduling Legislation

On November 16, 2015, the House of Representatives approved HR 639, the Improving Regulatory Transparency for New Medical Therapies Act, clearing it for the President. The legislation would amend the Controlled Substances...more

11/24/2015 - Controlled Substances Act DEA Drug Safety FDA Approval Hatch-Waxman Pending Legislation

CMS Seeking Comments on Medicare IRF/LTCH Patient Experience Surveys

On November 20, 2015, CMS is publishing two notices requesting public comments on the development of surveys regarding patient and family member experiences with the care received in (1) inpatient rehabilitation facilities...more

11/20/2015 - CMS Comment Period Inpatient Quality Reporting Long Term Care Facilities Medicare

CMS Releases Final Medicare Clinical Lab Fee Schedule Determinations for 2016

CMS has announced its final 2016 Medicare clinical laboratory fee schedule (CLFS) payment determinations for new and reconsidered test codes, including...more

11/20/2015 - CLFS Clinical Laboratories Clinical Laboratory Testing CMS Medicare

CMS Publishes Final Rule on Medicaid Fee-For-Service Ratesetting for Assuring Access to Covered Medicaid Services

On November 2, 2015, CMS published a final rule with comment period that is intended to provide a transparent, data-driven process for states to follow when they set Medicaid provider payment rates, effective January 4, 2016....more

11/17/2015 - CMS Comment Period Fee-for-Service Final Rules Medicaid Provider Payments Request For Information

CMS Finalizes “Comprehensive Care for Joint Replacement” Model

On November 16, 2015, CMS released its final rule to establish a Medicare Comprehensive Care for Joint Replacement (CJR) model that will test whether bundled payments to acute care hospitals for lower extremity joint...more

11/17/2015 - Bundled Payments CCJR CMS Final Rules Hospitals Medicare

CMS Finalizes Medicare Physician Fee Schedule Rates, Policies for 2016

On November 17, 2015, the Centers for Medicare & Medicaid Services (CMS) published the final rule to update the Medicare physician fee schedule (MPFS) for calendar year (CY) 2016. Despite the Medicare Access and CHIP...more

11/17/2015 - CMS Comment Period Final Rules Medicare MPFS PAMA PQRS

Energy and Commerce Health Subcommittee Advances Mental Health, Medicaid, Synthetic Drug Legislation

On November 4, 2015, the House Energy and Commerce Health Subcommittee approved the following health policy bills: ..HR 2646, the Helping Families in Mental Health Crisis Act – includes a series of reforms intended to...more

11/17/2015 - Congressional Committees Controlled Substances Health Care Providers Medicaid Mental Health Pending Legislation

CMS Invites Comments on MACRA Episode Groups

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) requires CMS to establish care episode groups and patient condition groups, which will be used to measure resource use under the new Merit-Based Incentive...more

11/17/2015 - Alternative Payment Models (APM) CMS Comment Period Medicare Access and CHIP Reauthorization (MACRA) MIPS

CMS Update on Medicare-Medicaid Plan Quality Ratings Strategy

CMS has provided an update on vision for developing a star rating system for Medicare-Medicaid Plans (MMPs). While CMS does not expect to have the full star rating system in place during the testing of the...more

11/17/2015 - CMS Comment Period Medicaid Medicare Star Ratings

Upcoming Health Policy Hearings - November 2015

Several Congressional hearings are scheduled next week and into December on health policy issues, including...more

11/16/2015 - Congressional Committees Congressional Investigations & Hearings Diagnostic Tests Drug Pricing FDA

Medicare Home Health PPS Payments to Fall by $260 Million in 2016

CMS published its final CY 2016 Medicare Home Health Prospective Payment System (PPS) rule on November 5, 2015. CMS projects that overall Medicare payments to home health agencies (HHAs) will be reduced by 1.4% — or $260...more

11/13/2015 - CMS Final Rules Home Health Agencies Medicare Value-Based Purchasing

CY 2016 Medicare OPPS Spending to Drop by 0.4% under Final OPPS Rule; ASC Payments Get Small Boost

On November 13, 2015, the Centers for Medicare & Medicaid Services (CMS) is publishing its final rule updating the Medicare Hospital Outpatient Prospective Payment System (OPPS) and the Ambulatory Surgical Center (ASC)...more

11/13/2015 - Ambulatory Surgery Centers CMS Comment Period Final Rules OPPS Two-Midnight Rule

HHS OIG FY 2016 Work Plan Outlines Oversight Priorities

The HHS OIG has released its FY 2016 Work Plan, which outlines the top audit, evaluation, and other legal and investigative initiatives that the OIG intends to conduct this fiscal year. As in years past, Medicare and Medicaid...more

11/12/2015 - Affordable Care Act Fraud Prevention Medicaid Medicare OIG Work Plans

President Obama Signs Bill to Encourage PACE Program Innovation

On November 5, 2015, President Obama signed into law S. 1362, the Program of All-Inclusive Care for the Elderly (PACE) Innovation Act. The PACE Innovation Act authorizes the Secretary of Health and Human Services (HHS) to...more

11/12/2015 - CMMI Elder Issues New Legislation PACE Social Security Act

OIG Policy Statement Outlines Conditions Under Which Hospitals May Waive Beneficiary Copayments for Outpatient Self-Administered...

The OIG has issued a policy statement clarifying the conditions under which hospitals may discount or waive Medicare beneficiary copayment amounts for self-administered drugs (SADs) received in outpatient settings without...more

11/12/2015 - Anti-Kickback Statute Inducements Medicare OIG Policy Statement Prescription Drugs

Final ESRD PPS Rule to Boost Overall Medicare Payment by $10 Million in CY 2016

On November 6, 2015, CMS published its final rule to update the Medicare end-stage renal disease (ESRD) prospective payment system (PPS) for calendar year (CY) 2016. CMS estimates that the rule will increase overall Medicare...more

11/12/2015 - CMS ESRD Final Rules Medicare PAMA

Bipartisan Budget Law Extends Medicare Sequestration, Includes Medicaid Drug Rebate, Off-Campus Hospital Outpatient Department,...

On November 2, 2015, President Obama signed into law H.R. 1314, the “Bipartisan Budget Act of 2015” (BBA). The two-year, $80 billion budget/debt-ceiling deal is funded in part by several significant Medicare and Medicaid...more

11/12/2015 - Bipartisan Budget Generic Drugs Medicaid Medicare OPPS Sequestration

Congressional Health Policy Hearings and Markups Scheduled this Week

Today, November 3, 2015, the House Energy and Commerce Health Subcommittee has scheduled hearings and votes on a variety of health policy bills. First, the Subcommittee will discuss the following five bills intended to...more

11/3/2015 - Affordable Care Act CHIP Co-Op Congressional Committees Congressional Investigations & Hearings Controlled Substances Critical Access Hospitals Health Care Providers Healthcare Healthcare Reform Hospitals Medicaid Medicare Mental Health Pending Legislation

CMS Adopts Changes to Medicare & Medicaid EHR Policies

The Centers for Medicare & Medicaid Services (CMS) has published a sweeping final rule with comment period that specifies the requirements that eligible professionals (EPs), eligible hospitals, and critical access hospitals...more

10/28/2015 - CEHRT CMS Comment Period Critical Access Hospitals Electronic Health Record Incentives Electronic Medical Records Final Rules Health Care Providers Health Information Technologies Healthcare HHS Hospitals Meaningful Use Medicaid Medicare Medicare Access and CHIP Reauthorization (MACRA) MIPS ONC Reporting Requirements Unique Device Identifiers

House Energy & Commerce Panel Releases Draft Bill to Regulate Diagnostic Lab Tests, Schedules November 17 Hearing

The House Energy and Commerce Health Subcommittee has scheduled a November 17, 2015 hearing on the regulation of diagnostic tests and laboratory operations. The hearing will feature FDA and CMS officials who will testify on...more

10/28/2015 - Clinical Laboratories CMS Congressional Committees Congressional Investigations & Hearings Diagnostic Tests FDA Health Care Providers Healthcare Proposed Legislation Public Comment Regulatory Oversight

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