News & Analysis as of September 24, 2024

Fee-for-Service

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The Patient Protection and Affordable Care Act (PPAC), also known as Obamacare, is a United States federal statute passed in March of 2010. The Act creates a nationwide insurance system and provides federal... more +

CMS Finalizes Major Reforms to Medicaid, Part 2: Medicaid Managed Care Reg

McDermott+ on 5/3/2024

Medicaid Regs Part 2! Last week, Regs & Eggs took a deep dive into the Ensuring Access to Medicaid Services final reg, one of two regs that the Centers for Medicare & Medicaid Services (CMS) released to add new requirements...more

CMS Issues Final Rule Extending and Revising Comprehensive Care Joint Replacement Episode-Based Payment Model

Foley & Lardner LLP on 5/20/2021

The Centers of Medicare and Medicaid Services (CMS) issued a Final Rule (the Rule) on April 29, 2021 extending and making various revisions to the Comprehensive Care for Joint Replacement Model (the CJR Model). The CJR Model...more

Hospital Price Transparency Final Rule

Faegre Drinker Biddle & Reath LLP on 12/10/2019

The Centers for Medicare and Medicaid Services (CMS) published the Price Transparency Requirements for Hospitals to Make Standard Charges Public Final Rule (the Final Rule, effective January 1, 2021), in the Federal Register...more

If You're Reading This, You're Too Late: Key Drivers in Rising Health Care Defaults

Baker Donelson on 7/30/2018

Health care bankruptcy filings more than tripled in 2017 as compared to 2016 with no end in sight to the financial struggles facing owners and operators in the sector. According to Bloomberg, health care bankruptcies have...more

Manatt on Medicaid: Maine Releases Draft Waiver Request Proposing New Eligibility Requirements

Manatt, Phelps & Phillips, LLP on 5/2/2017

On April 25, 2017, the Maine Department of Health and Human Services released for public comment a draft Section 1115 waiver application to implement new eligibility and coverage requirements for MaineCare, the State’s...more

Digital Health: An Improving Environment for Investors

McDermott Will & Emery on 7/12/2016

The integration of technology into health care delivery is exploding throughout the health industry landscape. Commentators speculating on the implications of the information revolution’s penetration of the health care...more

Manatt on Medicaid: CMS Finalizes Overhaul of Medicaid and CHIP Managed Care Rules

Manatt, Phelps & Phillips, LLP on 5/13/2016

Overview - On April 25, 2016, the Centers for Medicare and Medicaid Services (CMS) released its highly anticipated final rule to overhaul the regulatory framework governing Medicaid managed care and make conforming...more

CMS’ New Initiative Intended to Transform Primary Health Care

Balch & Bingham LLP on 4/18/2016

CMS’ efforts to improve the delivery of primary health care moved into new territory this week when the agency announced a new five-year delivery model, Comprehensive Primary Care Plus (CPC+), which CMS’ chief medical officer...more

A&B Healthcare Week in Review

Alston & Bird on 2/26/2016

I. REGULATIONS, NOTICES, & GUIDANCE - On February 24, 2016, the Centers for Medicare & Medicaid Services (CMS) issued a guidance entitled, “Special Enrollment Confirmation Process” that will enhance program integrity...more

The Deeper Dive: Medicare’s Fundamental Shift Toward P4P - What priorities should providers focus on in navigating the changing...

BakerHostetler on 10/28/2015

While Medicare’s path toward pay for performance (P4P) has evolved over time, 2015 is proving to be a landmark year. July marked the 50th anniversary of the Medicare program. And in self-described “historic announcements”...more

Delivery System Reform 2.0: Scaling Alternative Payment Models is the New Normal

Mintz - Health Care Viewpoints on 7/15/2015

For some health care providers, a pair of recent announcements made by the Obama Administration to implement mandatory alternative payment models (APMs) for home health value-based purchasing and bundled payments for hip and...more

Federal Trade Commission and Department of Justice Hold Joint Workshop on Payment Models and Competition Within the Health Care...

Epstein Becker & Green on 4/15/2015

On February 24-25, 2015, the Federal Trade Commission (“FTC”) and Antitrust Division of the Department of Justice (“DOJ”) co-hosted a second public workshop as part of the “Examining Health Care Competition” series to study...more

Washington Healthcare Update

McGuireWoods LLP on 2/24/2015

This Week: Upcoming Hearing: HHS Sec. Burwell Appearing Before E&C Committee on FY2016 Budget... CMS Issues 2016 Payment and Policy Updates for Medicare Health and Drug Plans... CMS Releases Improved Rating System for Nursing...more

CMS Extends Moratoria on Enrollment of New Providers and Suppliers in Six Locales

King & Spalding on 2/10/2015

Last week, CMS announced that it has extended temporary moratoria on the enrollment of new ambulance suppliers and home health agencies within designated metropolitan areas in Florida, Illinois, Michigan, Texas, Pennsylvania,...more

CMS Proposes Significant Rate Cuts and Other Changes to Medicare Advantage and Prescription Drug Plans

Epstein Becker & Green on 2/24/2014

The Advance Notice ("Advance Notice") of Methodological Changes for Calendar Year ("CY") 2015 for Medicare Advantage ("MA") Capitation Rates, Part C and Part D Payment Policies and 2015 Call Letter was released by the Centers...more

Polsinelli Podcast - Health Care Payment Changes: From Service to Value

Polsinelli on 2/24/2014

Healthcare is changing for consumers and providers under the Affordable Care Act. Less publicized is the way providers are now being paid and the way they will work together. In this week's Polsinelli "Inside Law," podcast,...more

CMS Publishes Annual Update On Recovery Audit Activity, Says Program Returned Nearly $490 Million to Medicare Trust Fund in 2011

King & Spalding on 2/13/2013

On February 5, 2013, CMS sent Congress a report summarizing developments related to its Medicare recovery audit program for fiscal year (FY) 2011. According to the report (titled Recovery Auditing in the Medicare and...more

CMS Announces Participants in Bundled Payments for Care Improvement Initiative

King & Spalding on 2/7/2013

On January 31, 2013, CMS announced the organizations that will be participating in its Bundled Payments for Care Improvement (BPCI) initiative. Established under CMS’s innovation authority provided for in the Patient...more

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