Centers for Medicare & Medicaid Services Hospitals

News & Analysis as of

CMS Issues Final Rule on Off-Campus Hospital Department Reimbursement

As of January 1, 2017, hospitals will receive lower Medicare reimbursement for items and services provided at certain off-campus provider-based facilities. This Alert provides an overview of the new reimbursement framework...more

OPPS Provider-Based Final Rule — A More Practical Approach From CMS

CMS recently finalized sweeping changes to the way Medicare pays hospitals for services furnished in “new” off-campus provider-based departments (referred to as “off-campus PBDs”). CMS revealed the changes on November 1...more

OIG Releases 2017 Work Plan

On November 10, 2016, the Office of Inspector General (“the OIG”) of the U.S. Department of Health and Human Services (“DHHS”) is charged with ensuring the integrity of more than 100 programs administered by DHHS, including...more

Five Things to Know About CMS's Second Round of Settlements for Hospital Appeals

The Centers for Medicare and Medicaid Services (CMS) announced that beginning December 1, 2016, it is offering to settle certain inpatient-status claims to eligible hospitals willing to withdraw from the administrative...more

Federal District Court Finds Hospital-Owned Urgent Care Center Must Comply with EMTALA

On November 1, 2016 the U.S. District Court for the District of Rhode Island denied a hospital-owned urgent care center’s summary judgment motion, contending that the federal Emergency Medical Treatment and Active Labor Act...more

The Wait is Over: CMS Delivers Post-BBA Provider-Based Policies in Final 2017 OPPS

Now that the rule is out, work to implement the BBA changes begins in earnest. CMS commemorated the one-year anniversary of the Bipartisan Budget Act of 2015 (BBA) with the traditional gift of paper, offering...more

CMS Releases the 2016 OPPS Final Rule

On November 1, 2016, CMS published its final policy changes, quality provisions, and payment rates for 2017, as they relate to the Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center...more

CMS to Host Calls on Hospital Appeals Settlement Process (Nov. 16 & Dec. 12)

On November 16, 2016, CMS is hosting a call to provide an update on its latest plans to allow eligible providers to settle their inpatient status claims currently under appeal using the Hospital Appeals Settlement process. By...more

D.C. District Court Bucks the Trend and Rules for Hospital in Provider Tax Case

Many states assess taxes against hospitals and other providers as a means of funding their Medicaid and other healthcare-related programs. The revenue generated by the taxes is used, with CMS’s approval, to fund Medicaid...more

Health Care Group News: A (Temporary) Sigh of Relief for Hospital Expansion: CMS Releases Final Rule regarding Provider-Based...

When Congress enacted the Bi-Partisan Budget Act of 2015 (the Act) on November 2, 2015, Section 603 of the Act effectively halted the development of any new off-campus hospital outpatient departments, also referred to as...more

2017 OPPS Final Rule: Payment to Off-Campus Provider-Based Departments

On November 1, 2016, the Centers for Medicare & Medicaid Services (CMS) issued the 2017 Medicare Outpatient Prospective Payment System (OPPS) Final Rule. One aspect of this rule is the implementation of payment decreases for...more

CMS Announces Settlement Process for Inpatient Status Claims

On November 3, 2016, CMS announced details for a new Hospital Appeals Settlement program to permit eligible providers to settle certain inpatient status claims currently under appeal. According to CMS, the purpose of the 2016...more

CMS Announces Final Rule Implementing Site-Neutral Payment Rule for Certain Off-Campus Hospital Outpatient Provider-Based...

On November 1, 2016, the Centers for Medicare & Medicaid Service (“CMS”) released the pre-publication form of its much-anticipated Hospital Outpatient Prospective Payment System (“OPPS”) CY 2017 final rule with comment period...more

OPPS Final Rule Finalizes Limits for Off Campus Departments

Center for Medicare and Medicaid Services (CMS) issued the long-awaited implementation of the “site-neutrality” provisions of the H.R. 1314 Bipartisan Budget Act of 2015 (BiBA Section 603) on November 1, 2016. The Final Rule...more

CMS Releases CY 2017 Final Rule Implementing Changes to Outpatient Prospective Payment System

The Centers for Medicare & Medicaid Services released the calendar year 2017 final rule implementing changes to the Medicare hospital Outpatient Prospective Payment System, or OPPS, including provisions implementing Section...more

Client Alert: CMS Releases Final CY 2017 Hospital Outpatient and Ambulatory Surgery Center Payment Rule

On November 1, 2016 CMS released its Final Hospital Outpatient Prospective Payment System (“OPPS”)/Ambulatory Surgical Center Payment Rule with Comment Period (“Final Rule”) which, among other things, addresses site-neutral...more

GME Payments for Chief Residents

Whether a teaching hospital may receive DGME and IME payments for the "chief resident year" has long been a source of confusion, particularly given that some specialties require all residents to complete a chief resident...more

CMS Finalizes Policies on Off-Campus Provider-Based Status CMS Will Pay Non-Excepted PBDs in 2017, But Adopts Nearly All Other...

On November 1, 2016, the Centers for Medicare & Medicaid Services (CMS) issued its CY 2017 Outpatient Prospective Payment System (OPPS) Final Rule, which includes the agency’s final policies implementing legislative changes...more

Medicaid DSH Allotments Announced

CMS recently finalized the federal share disproportionate share hospital (DSH) allotments for federal fiscal year (FY) 2014 and announced preliminary federal share DSH allotments for FY 2016. ...more

Manatt on Medicaid: Monthly Expansion Recap - October 2016

National News - Medicaid Expansion Is Associated With Improved Hospital Finances, Study Finds - Hospitals in Medicaid expansion states saw “significantly increased” Medicaid revenue, decreased uncompensated care...more

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

HealthCare.gov consumers begin previewing 2017 coverage options as HHS projects a 9% enrollment increase over last year and an average 22% benchmark premium increase; Oregon study finds increased primary care spending in...more

House Republicans Push Back on Medicare’s New Mandatory Bundled Payment Models

On July 25, 2016, the Centers for Medicare & Medicaid Services (CMS) announced a proposed rule that promises to deliver coordinated, high-quality care for Medicare beneficiaries. The proposed rule (effective July 1, 2017)...more

Hospital Short-Stay Review Ban Lifted by CMS

Effective September 12, 2016, the Centers for Medicare & Medicaid Services (CMS) lifted the temporary ban on patient status reviews of hospital short stays for Medicare beneficiaries. Those reviews are currently conducted by...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

Manatt on Health Reform: Weekly Highlights - October 2016

Vermont moves closer to launching the country’s first all-payer ACO; CMS approves Arizona’s 1115 waiver extension but rejects the State’s proposed work requirement and premiums for those earning below the FPL; and CMS issues...more

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