News & Analysis as of

Health Care Reform Implementation Update - April 21, 2014

On April 14, the Congressional Budget Office (CBO) and the Joint Committee on Taxation (JCT) reported their findings that show a smaller rise in insurance premium costs under the Affordable Care Act (ACA) than previously...more

Manatt on Medicaid: The Numbers

Even as the news media tries to untangle the latest data on Marketplace enrollment, an equally important and still-evolving story is playing out on the Medicaid side of the open enrollment equation. According to a Centers for...more

CMS Releases Long-Awaited Details for Sunshine Act Compliance

The Physician Payment Sunshine Act (the "Act") was enacted as part of the Patient Protection and Affordable Care Act for the purpose of promoting transparency between the medical industry and health care providers. It...more

CMS Final Rule on Moratoria for the Enrollment of New Home Health Agencies and Ambulance Suppliers and Providers

On February 4, 2014, the Centers for Medicare and Medicaid Services (CMS) issued in the Federal Register a notice of temporary moratoria on enrollment of new home health agencies (HHA) and ambulance suppliers and providers in...more

CMS Expands Moratorium On New Home Health Agencies To Broward County; Extends Moratorium In Miami-Dade and Monroe Counties

On January 30, 2014, the Centers for Medicare and Medicaid Services (“CMS”) announced the expansion of its moratorium on the enrollment of new home health agencies in Medicare, Medicaid, and the Children’s Health Insurance...more

Health Care Reform Implementation Update - December 19, 2013

The deadline to enroll in coverage for January 1 was officially extended by a week, but the new December 23 deadline is fast approaching, and premium payments are required to be paid by the last day of 2013 for January 2014...more

Capital Thinking: Health Care

LEGISLATIVE ACTIVITY - The House will take another turn this week on hearings related to health care reform implementation with a focus on the Healthcare.gov website troubles. The House is also planning a vote on H.R....more

Health Care Reform Implementation Update - August 12, 2013

The House Energy and Commerce Committee voted unanimously on legislation that would repeal the sustainable growth rate (SGR) formula that has historically led to annual decreases in physician payments that are fixed at the...more

CMS Imposes Six-Month Moratoria on New Enrollments of Home Health Agencies and Ambulance Suppliers in Three Fraud “Hot Spots”

Last week, CMS announced temporary moratoria on the enrollment of new home health providers and ambulance suppliers in Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP) in three fraud “hot spots.”...more

CMS Issues Final Rule on Medicaid and Children’s Health Insurance Program Eligibility Provisions, Appeals, and Related...

On July 5, 2013, CMS issued a final rule supplementing the Exchange final rule, reflecting new statutory eligibility provisions and implementing changes related to Medicaid and the Children’s Health Insurance Program (CHIP)...more

Health Care Reform Implementation Update - July 16, 2013

Capitol Hill and the agencies went back and forth last week on the impact and consideration involved in delaying the Affordable Care Act’s (ACA) employer mandate; votes in the House are expected this week on it, as well as a...more

Sunshine Act Requires Reporting All Payments to Physicians

Beginning August 1, 2013, manufacturers of Medicare or Medicaid covered drugs, medical devices, biologicals and medical supplies must collect and make publicly available data on physicians and teaching hospitals with whom the...more

CMS Announces $1 Billion in Funding for Innovation Grants

On May 15, 2013, CMS released a funding opportunity announcement for round two of the Health Care Innovation Awards. The grants are administered by the CMS Innovation Center, which is authorized by the Affordable Care Act to...more

Health Care Reform Implementation Update - May 6, 2013

Last week the Centers for Medicare & Medicaid Services (CMS) issued new proposed regulations on FY 2014 payment updates and regulatory policy changes for inpatient and long term care hospitals, skilled nursing facilitates,...more

Here Comes the Sun: Final Rules Implementing the Federal Sunshine Law

On February 1, 2013, the Centers for Medicare & Medicaid Services (CMS) released the long-awaited final rule implementing the Federal Sunshine Law (42 U.S.C. 1320a-7h). (The rule was subsequently published in the Federal...more

CMS Issues Final Rule for Implementing Sunshine Act

On February 8, 2013, 16 months after the statutory deadline, the Centers for Medicare & Medicaid Services (CMS) published in the Federal Register the final regulation implementing the physician payment transparency...more

CMS Issues Final Physician Payment Sunshine Act Regulations

On February 1, 2013, the Centers for Medicare and Medicaid Services (CMS) published the long-awaited final regulations implementing the Physician Payment Sunshine Act (Act or Sunshine Act). The Sunshine Act requires drug,...more

CMS Issues Final Rule to Implement Physician Payments Sunshine Act

On Friday, February 1, 2013, the Centers for Medicare and Medicaid Services (CMS) released the highly anticipated final rule to implement the federal Physician Payments Sunshine Act (the “Sunshine Act”). The final rule will...more

Health Care Reform Implementation Update - February 4, 2013

Several agency actions on the Affordable Care Act out of HHS and Treasury last week include proposed regulations detailing exemptions from the shared responsibility tax, such as an exemption for those who would qualify for...more

CMS Proposes Rule to Increase Medicaid Cost-Sharing

On January 22, 2013, CMS published a proposed rule in the Federal Register that would allow states to increase cost-sharing for Medicaid beneficiaries. Specifically, for individuals with incomes below 100% of the federal...more

Health Care Reform Implementation Update - January 23, 2013

In the past week, the health insurance exchanges were rebranded as “health insurance marketplaces;” HHS extended the deadline for states to opt into administering their own marketplaces and announced $1.5 billion in new...more

CMS Announces $532 Medicare Enrollment Fee for 2013

CMS announced a $532 application fee for calendar year (CY) 2013 for institutional providers that are initially enrolling in the Medicare, Medicaid, or CHIP programs, revalidating their Medicare, Medicaid or CHIP enrollment,...more

Who is Committing Healthcare Fraud?

The financial recoveries for healthcare fraud are staggering. The Justice Department and Health and Human Services (Office of Inspector General (“OIG”) and Centers for Medicare and Medicaid Services (“CMS”)) regularly...more

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