News & Analysis as of

Manatt on Health Reform: Weekly Highlights: December 2014 #4

With the holiday season underway, this week the Federal government awarded $110 million in exchange establishment grants, released proposed rules to permit employees to receive employer-sponsored insurance and tax credits,...more

Touching Up that Old Two Step: CMS Proposes Revisions to its Beneficiary Assignment Methodology

On Dec. 1, 2014, the Centers for Medicare and Medicaid Services (“CMS”) released a new proposed rule for Accountable Care Organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP). This advisory focuses...more

CMS Proposes Financial Revisions to MSSP to Encourage Continued and Expanded Participation

Many critics have suggested that the November 11, 2011 final rule establishing the MSSP created a financial model that over time would not be sustainable. ACOs viewed the requirement to take risk after the initial three years...more

States Doubling Down on Delivery and Payment Reform Efforts

Although health care reform implementation via the Affordable Care Act (ACA) has focused mostly on federal changes to the health care marketplace, individual States are getting some much needed help to design and implement...more

CMS Issues Additional Sunshine Act Guidance With Respect to Payments to Speakers at Continuing Medical Education Events

In a final rule published in the Federal Register on November 13, 2014, the Centers for Medicare and Medicaid Services (CMS) eliminated the federal Sunshine Act reporting exclusion for payments to physicians at continuing...more

Health Headlines: Also in the News - December 2014 #3

ONC Issues New Federal Health IT Strategic Plan –On December 8, 2014, the Office of the National Coordinator for Health Information Technology (ONC) released its Federal Health IT Strategic Plan 2015-2020 (Plan). The Plan...more

CMS ACO Proposed Rule to Extend One-Sided Risk Track While Incentivizing Performance-Based Risk

On December 1, 2014, the U.S. Centers for Medicare & Medicaid Services (CMS) released a 429-page Proposed Rule setting forth significant changes that will affect the evolution of the Medicare Shared Savings Program (MSSP) and...more

CMS Proposes Changes to the Medicare Shared Savings Program

The Centers for Medicare and Medicaid Services (CMS) recently published a proposed rule (Proposed Rule) that would revise regulations governing accountable care organizations (ACOs) that participate in the Medicare Shared...more

Health Reform + Related Health Policy News - December 2014, Issue 1

In This Issue: - Top News ..Congress Passes Omnibus Spending Package ..HRSA Cancels Plan for 340B ‘Mega Reg’; Congress Weighs Options ..Supreme Court to Hear Challenge to ACA...more

CMS Issues Rewards and Incentive Guidance to MA Plans

On December 4, 2014, CMS issued additional guidance regarding rewards and incentives programs (“RI Programs”). This guidance elaborates on whether an RI Program can target members with specific diseases, whether rewards can...more

Beneficiary Assignment in the Proposed Revised Medicare Shared Savings Program Regulations

This post addresses the changes that the rule would make to how CMS assigns beneficiaries to an ACO participating in the MSSP. The Proposed Rule places a renewed emphasis on primary care for beneficiary assignment. Section...more

CMS Proposes Posting Overall Star Rating for HHAs on Home Health Compare Website in 2015

On December 11, 2014, CMS issued a fact sheet detailing its proposal for assigning an overall star rating for each home health agency (HHA) on the Home Health Compare website starting in 2015. An HHA’s star rating would be...more

Recent Changes to Stark Law's Whole Hospital Exception

The federal physician self-referral law, or Stark Law, provides a number of exceptions to the law's prohibition of physician referrals of designated health services to an entity in which the physician has an ownership or...more

CMS Proposes Sharing More Data With ACOs Participating in the Medicare Shared Savings Program

CMS may be ready to ramp up the data it is willing to share with Accountable Care Organizations (“ACOs”) that participate in the Medicare Shared Savings Program (“MSSP”). CMS explained in the November 2011 final rule...more

Changing Basic Rules of the Game: CMS Proposed Rule Relating to ACO Governance and Contracting

The Centers for Medicare and Medicaid Services released a new proposed rule for Accountable Care Organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP). This advisory expands upon our initial...more

CMS Announces Next Phase in Medicare DMEPOS Competitive Bidding Program

On December 11, 2014, CMS announced the bidding timeline for the Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program Round 2 Recompete and National Mail-Order...more

MSSP Proposed Rule Seeks to Enhance ACO Transparency and Patient Engagement

Under the Medicare Shared Savings Program (“MSSP”) ACO proposed rule, CMS has proposed additional program requirements, beneficiary protections and participation agreement procedures to enhance ACO transparency and improve...more

Highlights of the 2015 Home Health Prospective Payment Rule

On November 6, 2014, CMS published its final Medicare home health prospective payment system (HH PPS) rule for calendar year (CY) 2015. As highlighted below, notable changes in the HH PPS final rule [PDF] include: (1) a...more

CMS Invites Comment on Availability of Waivers for ACOs That Particularly Affect Post-Acute Care

Solutions and opportunities may be on the horizon for post-acute providers (“PAPs”) and hospitals participating (or thinking of participating) in ACOs that have reservations about taking on additional downside cost risk...more

New Rule Permits CMS to Revoke Medicare Billing Privileges for Providers/Suppliers with “Pattern or Practice” of Denied Claims

On December 5, 2014, the Centers for Medicare & Medicaid Services (CMS) issued a final rule titled “Requirements for Medicare Incentive Reward Program and Provider Enrollment” (“the Rule”). The Rule implemented several...more

CMS’s Proposed Changes to the MSSP Aim to Grow Two-Sided Risk Models and Modify Processes for Evaluating and Facilitating Care...

The Centers for Medicare & Medicaid Services (CMS) has published long-awaited changes to the Medicare Shared Savings Program (MSSP). The official version of the proposed rule (the Proposed Rule), released December 8th, 2014,...more

New CMS Enrollment Rules Strengthen Oversight of Medicare Providers

On December 5, 2014, CMS published a final rule to strengthen its oversight of Medicare providers. The rule includes safeguards designed to prevent providers with unpaid debt from re-entering Medicare and to remove providers...more

Medicare Shared Savings Program Proposed Rule: Enough Incentive to Encourage More ACO Risk?

On December 1, 2014, the Centers for Medicare & Medicaid Services (“CMS”) released a proposed rule (“Proposed Rule”) setting forth long-anticipated changes to the Medicare Shared Savings Program (“MSSP”), including payments...more

CMS Releases Proposed New Rule for Accountable Care Organizations

On Dec. 1st, the Centers for Medicare and Medicaid Services released a new proposed rule for Accountable Care Organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP). The voluminous proposal covers a...more

CMS Clarifies Definition of Uninsured Under the Hospital-Specific Limitation on Medicaid DSH Payments

On Friday, November 28, 2014, CMS issued a Final Rule providing that, for purposes of the hospital-specific limitation on Medicaid disproportionate share hospital (DSH) payments, the definition of “uninsured” will now be...more

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