Juliet McBride at King & Spalding

CMS Proposes New DMEPOS Coverage Policies and Payment Rates, and Seeks to Codify HCPCS Application, Benefit Category and Payment...

On November 4, 2020, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule (the Proposed Rule) outlining proposals for the coverage and payment for durable medical equipment, prosthetics, orthotics, and...more

12/22/2020 / 21st Century Cures Act , Centers for Medicare & Medicaid Services (CMS) , DMEPOS , Filing Deadlines , Food and Drug Administration (FDA) , HCPCS , Medicare , Payment Rates , Proposed Rules

D.C. Circuit Clears the Way for Hospitals to Challenge Base-Year Factual Determinations

The United States Court of Appeals for the District of Columbia Circuit recently held in Saint Francis Medical Center v. Azar that Medicare’s reopening regulation, which prohibits providers from seeking to revise payment...more

7/30/2018 / Appeals , Centers for Medicare & Medicaid Services (CMS) , Hospitals , Medicare

OIG Issues Advisory Opinion Regarding Proposed Pilot Program Involving Health Technology Collaboration Between Health System and...

On December 4, 2017, the HHS Office of Inspector General (OIG) issued an Advisory Opinion No. 17-07 regarding a proposed pilot program involving a health technology collaboration funded by a pharmaceutical manufacturer and...more

12/27/2017 / Department of Health and Human Services (HHS) , Digital Health , Medicare , OIG , Pharmaceutical Industry

Courts May Not Review CMS’s Determination to Grant or Deny a Hospital’s Expansion Application Under Stark

In a decision issued on November 21, 2017, the D.C. Circuit affirmed the district court determination that the Affordable Care Act (ACA) bars judicial review of CMS’s determination to grant or deny a hospital’s Stark Law...more

11/30/2017 / Affordable Care Act , Centers for Medicare & Medicaid Services (CMS) , Hospitals , Medicaid Expansion , Stark Law

OIG Makes Monthly Update to Its Work Plan

Last month, the HHS Office of Inspector General (OIG) announced that it would start updating its Work Plan website on a monthly basis instead of only once or twice per year. Consistent with this new initiative, the OIG...more

8/25/2017 / Department of Health and Human Services (HHS) , Medicare Part B , OIG , Patient Safety , Work Plans

OIG Initiates Monthly Updates to its Work Plan and Adds New Items

The HHS Office of Inspector General (OIG) recently announced that, effective June 15, 2017, the agency will update its Work Plan website monthly instead of only once or twice per year. In developing its Work Plan, OIG...more

7/26/2017 / Ambulance Providers , CHIPRA , Department of Health and Human Services (HHS) , Electronic Medical Records , Health Insurance , Inpatient Prospective Payment System (IPPS) , Medicare Part B , OIG , Work Plans

CMS Actuary Predicts an Additional 13 Million Uninsured Under the ACA Repeal Legislation

In a report published on June 13, 2017, the independent chief actuary of CMS estimated that an additional 13 million people will be uninsured in ten years if the American Health Care Act of 2017 (ACHA), the latest ACA repeal...more

6/30/2017 / Affordable Care Act , American Health Care Act (AHCA) , Centers for Medicare & Medicaid Services (CMS) , Health Insurance , Healthcare Reform , Medicaid

ACA Repeal and Replace Update: House Vote Expected This Week; CBO Estimates Impact of Repeal and Replace Legislation; CMS...

After narrowly passing the Budget Committee, the Republican-sponsored health reform repeal and replace bill, the American Health Care Act (AHCA), is scheduled for a floor vote for Thursday, March 23, 2017, seven years to the...more

3/30/2017 / Affordable Care Act , Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Health Insurance , Healthcare Reform , Medicaid , Premiums , Repeal

Seventh Republican Proposal to Replace the Affordable Care Act Is Introduced, “Patient Freedom Act of 2017”

On January 23, 2017, Senate Republicans Bill Cassidy, M.D. (LA), Susan Collins (ME), Shelley Moore Capito (WV) and Johnny Isakson (GA) introduced the legislative text for the Patient Freedom Act of 2017, a proposed...more

2/10/2017 / Affordable Care Act , Health Insurance , Healthcare Reform , Medicaid , Medicare , Repeal

First Circuit Upholds Exclusion of Dual-Eligible Patients That Are Not Entitled to SSI Benefits from Both the DSH Medicaid...

The U.S. Court of Appeals for the First Circuit recently ruled in favor of HHS, overturning a $17 million district court decision, in a dispute dating back as far as the 1993 fiscal year over whether hospitals may include,...more

11/15/2016 / Appeals , Department of Health and Human Services (HHS) , Disproportionate Share Adjustments , DSH , Hospitals , Medicaid , Medicare Part A , Supplemental Security Income (SSI)

HHS Issues Guidance Regarding Importance of Business Associate Agreements Between Covered Entities and Cloud Services Vendors

The Health and Human Services Office for Civil Rights (OCR) recently issued guidance regarding the importance of covered entities and cloud service vendors maintaining business associate agreements (BAAs) where electronic...more

10/26/2016 / Business Associates , Cloud Computing , Covered Entities , Department of Health and Human Services (HHS) , Health Insurance Portability and Accountability Act (HIPAA) , OCR , Vendors

Projected Decline of Americans Lacking Health Insurance Over Next Decade

The CMS Office of the Actuary recently released a report estimating that the percentage of Americans lacking health insurance will decline over the next decade. The actuary’s office predicts that in 2025, 8 percent of the...more

7/28/2016 / Centers for Medicare & Medicaid Services (CMS) , Health Insurance

Juliet McBride

King & Spalding

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