News & Analysis as of

Centers for Medicare & Medicaid Services

2017 End of Year Plan Sponsor “To Do” List (Part 1) Health & Welfare

by Snell & Wilmer on

As 2017 comes to an end, we are pleased to present our traditional End of Year Plan Sponsor “To Do” Lists. This year, we are presenting our “To Do” Lists in four separate Employee Benefits Updates. This Part 1 will cover...more

Federal Court Strikes DOJ's Risk Adjustment False Claims Act Case - For Now

by Pepper Hamilton LLP on

On October 5, a federal district court in California dealt a significant setback to the government’s efforts to extend False Claims Act (FCA) liability to Medicare risk adjustment submissions....more

Integrating MassHealth Long-Term Services and Supports: Considerations for ACOs and MCOs

I. INTRODUCTION AND CONTEXT - MassHealth, Massachusetts’ Medicaid program, is the largest payer of long-term services and supports (LTSS) in the Commonwealth and administers a number of LTSS programs, some in conjunction...more

Association Health Plans—Can The Trump Administration Expand Access Without Congress?

In recent weeks, the Trump Administration has been considering allowing health insurance to be purchased across state lines and expanding access to “Association Health Plans” (AHPs) that could take economic advantage of...more

OIG Finds Continued Procedural Errors in Hospital Outlier Payment Reconciliations

by Baker Ober Health Law on

The U.S. Department of Health and Human Services, Office of Inspector General (OIG) recently released a report concluding that there are vulnerabilities in the process of reconciling Medicare hospital outlier payments....more

Will CMS Consider Your Institution to Be a Hospital? Guidance on the "Primarily Engaged In" Standard

by Baker Ober Health Law on

Recent guidance from CMS suggests that some hospitals, and particularly specialty hospitals that provide mostly outpatient care, may soon find themselves the focus of surveyors' scrutiny. In early September, CMS issued...more

CMS Completes Final Medicare Part D Reconciliation for 2016

CMS has completed the 2016 Final Part D Payment Reconciliation. Each Medicare Part D plan sponsor’s reconciliation reports will be available on October 12, 2017....more

OIG Finds Acute Care Hospitals Improperly Billed for Outpatient Services Provided to Inpatients of Other Hospitals

by Baker Ober Health Law on

Acute care hospitals that provide Medicare outpatient services to inpatients of other hospitals should be billing and collecting payment from the other inpatient hospitals and not from Medicare....more

Manatt on Health: October 2017

Massachusetts Waiver Amendment Requests Partial Expansion and Closed Formulary - On September 8, 2017, Massachusetts submitted a waiver amendment request to the Centers for Medicare & Medicaid Services (CMS) to modify its...more

Under What Circumstances Can a Private Qui Tam Plaintiff Overrule Government Agency Experts' Use of Administrative Discretion to...

• How have appellate courts applied the Supreme Court’s ruling in Escobar? • If the government is aware of the relator’s allegation, but does not undertake any administrative action to address the defendant’s alleged...more

CMS Memorandum Requires Legionella Risk Reduction in Healthcare Facilities

by Holland & Knight LLP on

According to a recent review of Legionnaires' disease outbreaks, 34 percent were associated with long-term care facilities and hospitals. Patients at risk of contracting Legionnaires' disease include smokers, those with...more

Trump Administration Shelves Additional Obama Medicare/Health Plan Proposals

by Reed Smith on

The Trump Administration has formally withdrawn a number of pending Department of Health and Human Services (HHS) proposals that never reached the final rule stage. This includes: a controversial Part Medicare B drug payment...more

CMS Announces CY 2018 Amount in Controversy Thresholds for Medicare Appeals

by Reed Smith on

CMS has released the calendar year (CY) 2018 amount in controversy (AIC) threshold amounts for Administrative Law Judge (ALJ) hearings and judicial review under the Medicare appeals process. The CY 2018 AIC threshold amounts...more

CMS Corrects Final FY 2018 IPPS, LTCH, and SNF Payment Rules

by Reed Smith on

CMS has released corrections to two major fiscal year (FY) 2018 Medicare payment rules. First, CMS has made numerous technical corrections to the FY 2018 inpatient prospective payment systems (IPPS) and long term care...more

CMS Releases 2018 Open Payments/Sunshine Act Reporting Thresholds

by Reed Smith on

CMS has announced inflation-adjusted de minimis reporting thresholds for 2018 under the Open Payments/Physician Payments Sunshine Act program. Specifically, payments or transfers of value of less than $10.49 do not need to...more

Window On Washington - This Week in the Nation's Capital - Issue 29

by Clark Hill PLC on

Hurricane Supplemental Includes $29B for Disaster Aid and Flood Insurance: Of the $29B, the National Flood Insurance Program will receive $16B to pay flood claims. The House plans to pass the bill next week and the Senate the...more

Bipartisan Congressional Opposition Mounts Against Proposed CY 2019 Home Health Groupings Model in Home Health PPS Proposed Rule

by King & Spalding on

On July 28, 2017, CMS published the calendar year (CY) 2018 Home Health Prospective Payment System (PPS) Proposed Rule (the Proposed Rule) in which it proposed a new CY 2019 Home Health Groupings Model (HHGM). The proposed...more

Value-Based Contracting for Prescription Drugs and Medical Devices: An Innovative Solution Impaired by Outdated Regulations

by Pepper Hamilton LLP on

Often lost in the cacophony of headlines surrounding rising health care costs is the promise that value-based contracting offers as a possible solution. In contrast to the traditional fee-for-service model, value-based...more

You-Can’t-Make-this-Up Award

by Faegre Baker Daniels on

From time to time a development in health law confirms the adage that truth is stranger than fiction. That’s why we hand out the You-Can’t-Make-this-Up Award for real life developments that seem to defy the imagination....more

CMS issues new guidance on interim rates for new teaching hospitals

by Dentons on

Prompted by confusion among Medicare Administrative Contractors (MACs) regarding how to initiate payments to new teaching hospitals, CMS issued on September 22, 2017, a One-Time Notification, Transmittal 1923, "Calculating...more

K&L Gates Triage: Emergency Preparedness and Response in Long Term Care

by K&L Gates LLP on

This is the first episode in a three-part series on emergency preparedness and response in long-term care. Recent hurricanes affecting the United States have brought to light the importance of health care providers devising a...more

CMS Unexpectedly Withdraws Three Proposed Rules

The Centers for Medicare and Medicaid Services (CMS) recently announced the withdrawal of three proposed rules that, in one case, had been pending since 2014. The first proposed rule that CMS decided to scrap was proposed in...more

CMS Issues New Instructions for Completing Worksheet S-10 and Extends Deadline for Providers to Submit Updated Data for FYs 2014...

by King & Spalding on

For the second time in less than one year, CMS has updated its instructions for completing Worksheet S-10 of the Medicare cost report for hospitals. The new instructions expand the definition of charity care, as reported in...more

Trump Administration Seeks Stakeholder Input on New Direction

by K&L Gates LLP on

On September 20, 2017, the Centers for Medicare and Medicaid Services (“CMS”) released an informal request for information (“RFI”) seeking stakeholder feedback on the future direction of the Center for Medicare and Medicaid...more

Capitol Hill Healthcare Update

by BakerHostetler on

With congressional Republicans’ efforts to repeal the Affordable Care Act (ACA) on hold at least for now, the bipartisan leaders of the Senate HELP Committee are seeking to rekindle their work to shore up the health law’s...more

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