Centers for Medicare & Medicaid Services Hospitals

News & Analysis as of

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

D.C. Circuit Precludes Review of DSH Uncompensated Care Data

On July 26, 2016, the United States Court of Appeals for the District of Columbia Circuit decided Fla. Health Sciences Ctr. v. Burwell. In that case, the Court analyzed a statutory bar against judicial review of estimates...more

Why the Final CMS Rule Could Have Been Worse

Long-term care providers and organizations involved with post-acute care will find a lot to dislike in the 713-page final rule released by the Centers for Medicare & Medicaid Services (CMS) on September 28, 2016. The final...more

Managing the Transition to Transformation: Quality and Payment Reform: Who Is Asking for What and Why?

McDermott’s Managing the Transition to Transformation series is designed to help health systems and other health care industry leaders address the many challenges presented by the transformation in payment and care delivery...more

Also In The News - Health Headlines - September 2016 #3

CMS Rejects Ohio’s Section 1115 Medicaid Demonstration Waiver Application – On September 9, 2016, CMS denied Ohio’s application for a new demonstration section 1115 Medicaid waiver, citing concerns over the State’s request to...more

Do CMS Ratings Punish Hospitals for Serving the Poor?

Does the CMS star rating system reward hospitals for serving the affluent and punish those that serve the poor? The answer is a resounding yes, according to a recently published analysis by Bloomberg BNA. The analysis...more

House of Representatives Approves Bill to Delay LTCH 25% Rule Implementation, Make Other LTCH Reforms, and Tighten Medicare...

On September 21, 2016, the House Ways and Means Committee approved H.R. 5713, the “Sustaining Healthcare Integrity and Fair Treatment Act of 2016” or “SHIFT Act.” The primary focus of the SHIFT Act is to provide an...more

House Approves Medicare ESRD Coverage, Rural Hospital Supervision Bills

On September 21, 2016, the House of Representatives approved HR 5659, the Expanding Seniors Receiving Dialysis Choice Act of 2016, which would allow Medicare beneficiaries with end stage renal disease (ESRD) to enroll in...more

The Proposed Medicaid DSH Rule: Hospitals, States and Associations Declare It Legally Insufficient

The Centers for Medicare and Medicaid Services (CMS) recently released a proposed rule addressing the treatment of third-party payments when calculating uncompensated care costs for the Medicaid disproportionate share...more

CMS Lifts Temporary Suspension of Short Stay Reviews

Effective September 12, 2016, Beneficiary and Family Centered Care (BFCC) Quality Improvement Organizations (QIOs) resumed their hospital initial patient status reviews. The purpose of these reviews is to determine the...more

The MOON Notification is Coming: CMS Publishes Final Changes

CMS is moving forward with implementing the Medicare Outpatient Observation Notice (MOON) as announced in its FY 2017 IPPS Final Rule [PDF] on August 2, 2016, and published in the Federal Register on August 22, 2016 (Final...more

D.C. District Ct Applies Prohibition on Administrative and Judicial Review to IRF PPS Rates

On July 25, 2016, Judge John D. Bates of the United States District Court for the District of Columbia issued a memorandum opinion broadly construing 42 U.S.C. § 1395ww(j) to prohibit administrative or judicial review of a...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

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

Compliance Concerns Raised Over Proposed Hospital Outpatient Department Rule

In an August 26, 2016, letter to the Centers for Medicare & Medicaid Services (CMS), the American Hospital Association (AHA) expressed serious concern over the portion of the calendar year 2017 hospital outpatient prospective...more

Manatt on Health Reform: Weekly Highlights - August 2016 #5

A federal report finds that Marketplace premiums are lower in expansion states; Massachusetts and Pennsylvania launch prescription drug monitoring systems; and Kentucky submits a slightly modified Medicaid expansion waiver to...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

Also In The News - Health Headlines - August 2016 #3

CMS Releases Medicare Outpatient Observation Notice For Public Comment – CMS announced that the public has the opportunity to comment on the Medicare Outpatient Observation Notice (MOON). The MOON is a standardized form...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’s Interim Final Rule to Permit “Stacking” of Reclassifications Puts Pressure on Urban Hospitals to Evaluate Advantages of...

Hospitals may seek redesignation to a neighboring core-based statistical area for wage index purposes under the rules that set forth the geographic reclassification process. See 42 C.F.R. § 412.230 et seq. Those rules...more

CMS Releases the 2017 IPPS and LTCH PPS Final Rule, Including MOON Requirements

On August 2, 2016, CMS issued its final rule addressing new payment rates and policies under both the Hospital Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System...more

HHS Wins Summary Judgment Against Hospitals Disputing CMS’s Treatment of Part C Days as Days “Entitled to Part A” for Purposes of...

On August 17, 2016 the United States District Court for the District of Columbia granted summary judgment in favor of HHS in a dispute over whether Part C days can be treated as “days entitled to benefits under Part A” for...more

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