Patient Protection and Affordable Care Act (PPACA) Centers for Medicare & Medicaid Services Medicare

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 +
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 subsidies to reduce the number of uninsured citizens. less -
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Catching Up With the Times: CMS Reforms Long-Term Care Facility Requirements Part III

On October 4, the Centers for Medicare and Medicaid Services (CMS) published the biggest overhaul to federal long-term care regulations since 1991, and impacted facilities can immediately take steps to ensure they’re prepared...more

CMS Finalizes Sweeping Changes to Medicare Physician Payments

The Centers for Medicare & Medicaid Services (CMS) on Oct. 14, 2016, released the highly anticipated Final Rule implementing the Medicare physician payment reforms enacted as part of the Medicare Access and CHIP...more

Health Law Insights Newsletter - Issue 13

McCarter & English, LLP’s Health Care Group presents Issue 13 of the Health Law Insights, which discusses the latest legal issues in the health care industry. - Failure to Update Business Associate Agreement Results in...more

Washington Healthcare Update

This Week: Congress remains in recess, but members write letters on Mylan’s EpiPen…CBO says repealing Part B Demo would cost $395 million…CMS releases data on hospice utilization and finds spending and utilization vary in...more

CMS releases Final Rule Overhauling Long-Term Care Facility Requirements

The Centers for Medicare & Medicaid Services (CMS) recently released its final rule overhauling long-term care (LTC) facility participation requirements for Medicare and Medicaid (“Final Rule”). This much anticipated rule...more

Washington Healthcare Update

This Week: Congress funds the government until Dec. 9. 1. Congress - Continuing Resolution Passes: Funds Zika and Opioid Legislation - On Sept. 28, Congress passed a Continuing Resolution to fund the...more

Washington Healthcare Update

1. Congress - House of Representatives - House Energy and Commerce Committee Republican Leaders Send Letter to HHS OIG Concerning NIH Grant on Traumatic Brain Injury - On Sept. 15, Republican leaders of the...more

Loaned and Awarded GME Slots: When does the three-year rolling average and the IRB ratio cap apply?

Ever since Congress capped teaching hospitals' Medicare-funded residency positions to the number of "full time equivalent" (FTE) allopathic and osteopathic residents the hospital reported in FY 1996, there have been very...more

Raising Kane: CMS’s 60-Day Rule Commands More Than Treble Damages

In August 2015, we published a client advisory on the first judicial opinion interpreting the Affordable Care Act’s (ACA) “60-day overpayment rule,” which requires providers to “report and return” an overpayment of Medicare...more

CMS Releases 2017 Medicare Hospital Payment Rates, Penalties for Poor Performers

Earlier this month, the Centers for Medicare & Medicaid Services (CMS) issued a final rule (Final Rule) modifying the Hospital Inpatient Prospective Payment System (IPPS) and Long Term Acute Care Hospital (LTCH) Prospective...more

The Top 10 Things you Need to Know About Voluntary Disclosures and Government Refunds

In February 2016, CMS issued the highly anticipated Final Rule on reporting and returning Medicare Part A and B overpayments. The Final Rule was meant to clear up some of the confusion among providers regarding such...more

GME in the IPPS Final Rule: Medicare GME slots now up for grabs from three closed hospitals

In the Fiscal Year 2017 inpatient prospective payment system (IPPS) Final Rule published in the Federal Register on August 22, 2016, the Centers for Medicare & Medicaid Services (CMS) announced the next open round of GME...more

60-Day Overpayment FCA Enforcement Action Results in $2.95 Million Settlement

On August 23, 2016, a New York hospital system settled False Claims Act (FCA) allegations that it violated the 60-day overpayment rule by improperly retaining Medicaid overpayments. The whistleblower alleged that three of the...more

Manatt on Medicaid: Monthly Expansion Recap - August 2016

California - Medicaid Enrollees Are Largest Share of Newly Insured - A new survey from the Kaiser Family Foundation found that 33% of Californians uninsured in 2013 are now enrolled in Medi-Cal, the State’s Medicaid...more

CMS Flags Potential Provider “Steering” of Medicare/Medicaid Beneficiaries to Favorable ACA Marketplace Plans to Obtain Higher...

CMS is putting health care providers on notice that it considers it “inappropriate” for providers to offer premium or cost-sharing assistance to Medicare or Medicaid beneficiaries in order to “steer” the patient to an...more

Manatt on Health Reform: Weekly Highlights - August 2016 #3

CMS’s risk adjustment program data signals an improving risk pool while the agency announces plans to modify the program; California enrolls 134,000 undocumented immigrant children into Medicaid; and Oregon approves increases...more

CMS Releases FY 2017 Hospital Inpatient Prospective Payment System and Long-Term Care Hospital Prospective Payment System Final...

On August 2, 2016, CMS released a final rule (Final Rule) with updates to the Hospital Inpatient Prospective Payment System (Hospital IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) affecting...more

CMS Issues Final Update to Medicare Hospice Payment Rules for FY 2017

CMS has released a final rule that updates the Medicare hospice wage index, payment rates, and cap amount for fiscal year (FY) 2017. CMS estimates that the final rule will increase overall Medicare payments to hospices by...more

CMS Publishes FY 2017 Rate Update for Medicare Inpatient Psychiatric Facilities

On August 1, 2016, CMS published a notice updating prospective payment system (PPS) rates for Medicare services furnished by inpatient psychiatric facilities (IPFs) during fiscal year (FY) 2017. CMS is providing a 2.3% rate...more

CMS Finalizes Plan to Expand Medicare/Private Claims Data Available for Care Improvement

CMS has published a final rule to allow organizations approved as “qualified entities” to confidentially share or sell analyses of Medicare and private-sector claims data to providers, employers, and other groups who can use...more

ColoradoCare Stands to Significantly Alter Health Care Services

In November, Colorado voters will cast ballots on Amendment 69, also known as ColoradoCare. ColoradoCare is an ambitious, far-reaching plan to amend the Colorado constitution which would establish a statewide universal...more

The Overpayment Rule and the Implied False Claims Theory: “What You Don’t Know Can Still Hurt You”

In 2010, the Affordable Care Act (“ACA”) enacted new rules governing overpayments made by the Medicare and Medicaid programs. Under these rules, providers have 60 days from the date that the overpayment has been identified to...more

Digital Health: An Improving Environment for Investors

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

CMS 2017 Proposal Reduces Home Health Reimbursements by $180 Million

On June 27, CMS issued a proposal for the 2017 Medicare home health prospective payment system (HH PPS). CMS is proposing a $180 million reduction in 2017. This equates to a 1% drop in reimbursements for home health...more

Manatt on Medicaid: Transparency and Decision Support for Medicaid Managed Care Consumers

Editor's Note: This "Manatt on Medicaid" is the eighth in a series of updates focused on CMS's new Medicaid/CHIP managed care regulations. In the coming weeks, Manatt will be exploring key provisions of the regulations and...more

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