News & Analysis as of

Centers for Medicare & Medicaid Services Medicaid

A Category 5 Compliance Problem: Hurricane Irma Gives Providers a Stark Reminder of Emergency Preparedness Realities

by Carlton Fields on

The havoc that Hurricane Irma caused in the Caribbean and most of Florida reminds us of the Centers for Medicare and Medicaid Services (CMS) requirements for emergency preparedness, which take effect November 15....more

OIG Study Finds States Are Not Using Medicaid Payment Suspensions

by King & Spalding on

A recent HHS OIG review of 2014 data on fraud allegations found that significant challenges were limiting the States’ use of payment suspensions, even in the face of what CMS determined were credible allegations of provider...more

When Is a Hospital Not a Hospital? New Guidance Sheds (Some) Light on the Definition

by McDermott Will & Emery on

The Centers for Medicare and Medicaid Services released guidance on September 6, 2017, intended to clarify the definition of “hospital.” The guidance provides factors that may be considered to determine whether a hospital is...more

Inspector General Audit Could Impact Skilled Nursing Facilities

by Ruder Ware on

Skilled nursing facilities (SNF) may see even more scrutiny from the Centers of Medicare and Medicaid Services (CMS) because of a recent audit conducted by the Office of Inspector General of the U.S. Department of Health and...more

Manatt on Health: September 2017

1332 Waivers Under Review at CMS - The Trump administration has approved one 1332 waiver to date, but four more are pending, including a sweeping Iowa waiver. Here is where things stand today...more

HHS Seeks to Ease Burden of Hurricane on Health Care Organizations

by Baker Ober Health Law on

As Hurricane Harvey continues to have a devastating impact throughout Southeast Texas, Louisiana and the Southeast, our thoughts are with the hundreds of thousands struggling through this difficult time....more

CMS Digging In on Medicaid DSH Payments

by BakerHostetler on

During the summer months, several developments have occurred concerning the Medicaid Disproportionate Share Hospital (DSH) policy that the Centers for Medicare & Medicaid Services (CMS) has implemented, to the detriment of a...more

Manatt on Health: Medicaid Edition - CMS Approves Florida 1115 Waiver, Increasing Uncompensated Care Funding

Editor’s Note: With efforts to repeal and replace the Affordable Care Act (ACA) flagging, stakeholders are redirecting their attention toward Medicaid Section 1115 demonstrations. The Trump administration has encouraged...more

CMS revises CJR program, cancels cardiac bundles

by Thompson Coburn LLP on

On Aug. 15, 2017, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule seeking to reduce mandatory participation requirements in the Comprehensive Care for Joint Replacement (CJR) program for hospitals...more

Reminder: Medical Providers Must Be Attentive to Credit Balances and Other Overpayments

It has now been a number of years since the enactment of Section 6402(a) of the Affordable Care Act ("ACA"), which requires among other things that any recipient of a Medicare or Medicaid overpayment report and return it...more

Federal Government to Target False EHR Incentive Payments

by Barley Snyder on

While health care reform remains bogged down, the federal government’s efforts to curtail fraud, waste and abuse in its health care programs fervently continues. Most recently, the U.S. Department of Health and Human...more

California Hospitals Successfully Beat Back Medicaid Payment Cut

by King & Spalding on

Almost a decade ago, California submitted a State plan amendment (SPA) to the Centers for Medicare and Medicaid Services (CMS) that would retroactively implement a ten-percent rate reduction in outpatient services provided to...more

CMS Issues IPPS and LTCH PPS Final Rule for FY 2018

by King & Spalding on

On August 2, 2017, CMS issued the Fiscal Year (FY) 2018 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long Term Acute Care Hospital (LTCH) Prospective Payment System Final Rule (Final Rule) that updates...more

CMS’s 340B Proposal Is Likely Unlawful—Here’s Why

by Morgan Lewis on

The agency’s recent proposal to reduce certain drug reimbursement is unprecedented and not based on a reasonable interpretation of its statutory authority....more

Post-Repeal and Replace: What’s a Sponsor to Do?

by Epstein Becker & Green on

In the wake of the demise of recent Affordable Care Act “repeal and replace” efforts, both “skinny” and full boat, health care financial sponsors may wonder how they should be thinking about opportunities and threats related...more

CMS Proposes Methodology to Implement Statutory Medicaid DSH Reductions

by Reed Smith on

CMS has issued a proposed rule establishing a methodology to reduce state Medicaid disproportionate share hospital (DSH) allotments annually beginning with fiscal year (FY) 2018, as mandated by the Affordable Care Act (and...more

ALERT: HHA's Should Make Use of Delay in New Medicare Rules

by Pullman & Comley, LLC on

Now that the Centers for Medicare & Medicaid Services (CMS) have published a Final Rule delaying the effective date of the revised Medicare Conditions of Participation (CoP) for home health agencies (HHAs) until January 13,...more

Witnesses at Congressional Hearing on 340B Urge Congress To Give HRSA Broader Regulatory Authority

On July 18, 2017, just days after CMS went public with its proposal to reduce Medicare Part B reimbursement to certain 340B covered entities, Congress held its first hearing on 340B Program Oversight since March 2015. A...more

OIG Approves Cost-Sharing Arrangement Involving Clinical Research Study

by Baker Ober Health Law on

The U.S. Department of Health and Human Services, Office of the Inspector General (OIG), issued a favorable advisory opinion, No. 17-02, regarding a proposed arrangement under which the cost-sharing amounts owed by...more

CMMI Focuses on Behavioral Health

by Pierce Atwood LLP on

CMS recently announced that the Center for Medicare and Medicaid Innovation (CMMI) is interested in lowering the cost of care for Medicare and Medicaid beneficiaries with behavioral health conditions while improving the...more

CMS Summit on Potential Behavioral Health Innovative Payment Model (Sept. 8, 2017)

by Reed Smith on

The CMS Center for Medicare and Medicaid Innovation is holding a public summit on September 8, 2017 to explore creating a behavioral health innovative payment model intended to improve health care quality and access, while...more

CMS Issues Corrections to Medicare/Medicaid LTC Conditions of Participation

by Reed Smith on

CMS has made numerous technical and typographical corrections to its October 4, 2016 final rule revising the requirements that long-term care facilities must meet to participate in the Medicare and Medicaid programs. ...more

Health Care Weekly Preview from ML Strategies – July 2017 #3

We head into the last week of July with the Findings of the Senate Parliamentarian in hand, who ruled late Friday that several provisions in the Better Care Reconciliation Act (BCRA) released on June 26th would be subject to...more

Can People Losing Medicaid Under BCRA Afford Marketplace Coverage?

Next steps regarding Congressional action on repeal and replace remain uncertain, with the President again supporting repeal coupled with replace, members attempting to bridge their differences over the Better Care...more

Home Health Agencies Get More Time to Prepare for New Medicare Rules

Home health agencies (HHAs) can breathe a sigh of relief now that the Centers for Medicare & Medicaid Services (CMS) have published a Final Rule delaying the effective date of the revised Medicare Conditions of Participation...more

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