Centers for Medicare & Medicaid Services

News & Analysis as of

CMS’s Final Medicaid Rule Tweaks the Proposed Rules Related to Marketing, Physician Incentive Arrangements and Long-term Care

On April 25, 2016, the Centers for Medicare & Medicaid Services (CMS), released the Medicaid managed care final rule entitled, “Medicaid and Children’s Health Insurance Program (CHIP) Programs; Medicaid Managed Care, CHIP...more

CMS Temporarily Suspends QIO Patient Status Reviews of Short Stay Inpatient Claims under the Two Midnight Rule

According to press reports, on May 4, 2016, CMS directed Beneficiary and Family Centered Care Quality Improvement Organizations (BFCC-QIOs) tasked with reviewing the appropriateness of short stay inpatient claims under the...more

CMS Proposes Fiscal Year 2017 Payment for Skilled Nursing Facilities and Provisions for FY 2019 Value-Based Purchasing...

Overall, the Proposed Rule details CMS’s proposals for SNFs in CMS’s accelerating pace of shifting Medicare payment from volume to value toward the administration’s goals and timeline for moving the Medicare program, and the...more

CMS Announces Final Rule Updating Fire Safety for Healthcare Facilities

The Centers for Medicare and Medicaid Services (CMS) recently published a final rule updating fire safety requirements for healthcare facilities in an effort to increase patient safety and adapt to the needs of an aging...more

CMS Announces Plans to Streamline the Stark Self-Referral Disclosure Protocol

On May 6, 2016, CMS published a notice (Notice), required under the Paperwork Reduction Act (PRA), seeking public comment on its plans to revise the information collected under the Medicare Self-referral Disclosure Protocol...more

House Committee Proposes Relief for Some Off-Campus Provider-Based Departments

On Wednesday May 18, 2016, members of the U.S. House Ways and Means Committee introduced a proposal to continue OPPS payment for those off-campus provider-based departments that were “mid-build” as of November 1, 2015. Under...more

Manatt on Health Reform: Weekly Highlights - May 2016 #4

Uninsurance hit a record-breaking low of 9.1% in 2015; Vermont legislators pass a bill to increase drug formulary and price transparency; and California rolls out its State-funded Medi-Cal expansion to undocumented children....more

OPPS Advisory Panel Meeting Set for August 22-23, 2016; CMS Moving to One Panel Meeting Per Year

CMS is hosting its next meeting of the Advisory Panel on Hospital Outpatient Payment (Panel) on August 22-23, 2016. The purpose of the Panel is to advise HHS and CMS on ambulatory payment classification clinical integrity and...more

And You Thought RAC Audits Couldn’t Get Any Worse

If there’s one thing that unites the hospital industry—even the fiercest competitors—it’s hatred of audits by recovery audit contractors, or RACs. Why? For one thing, because RACs operate on a contingency fee basis. They...more

Congress Considers Broader Hospital Site-Neutral Payment Exceptions and Other Payments Changes

In Depth - The House Ways and Means Committee next week is expected to consider and approve the Helping Hospitals Improve Patient Care Act of 2016, legislation that would create broader exceptions under much maligned...more

CMS Announces Risk-Based Adjusted Additional Documentation Request Limits for Institutional Providers

On May 3, 2016, CMS announced the availability of a revised method to calculate additional documentation request (ADR) limits for Institutional Providers in the Recovery Audit Contractor (RAC) Program. Under the new method,...more

Manatt on Medicaid: Beneficiary Support and Enrollment Requirements

On April 25, 2016, the Centers for Medicare and Medicaid Services (CMS) released its final rule that significantly overhauls regulations governing Medicaid managed care. The final rule establishes new requirements for...more

CMS Seeks Comment on Self-Disclosure Protocol Form

On May 6, 2016, CMS published an information collection request notice regarding the existing Medicare self-referral disclosure protocol (SRDP). Specifically, CMS intends to streamline the current SRDP and revise the...more

MACRA/O Level Changes Coming with MIPS and APMs: An In-Depth Look at Medicare’s Proposed Physician Payment System Reform

1. Executive Summary - With the dirt barely settled on the unmourned grave of the Medicare sustainable growth rate (SGR) methodology for updating physician fee schedule payments, CMS published a proposed rule that would...more

8 tips for engaging ACO boards to meet requirements in the Final Waivers

In the Final Waivers for the Medicare Shared Savings Program (MSSP) issued by the CMS and the OIG, the regulators modified the requirements for the ACO governing body stating that it must provide “the basis for the...more

A&B Healthcare Week in Review

I. REGULATIONS, NOTICES, & GUIDANCE - On May 6, 2016, the Centers for Medicare & Medicaid Services (CMS) issued an interim final rule entitled, “Patient Protection and Affordable Care Act; Amendments to Special...more

MACRA for Health IT Vendors – New Rule Presents New Opportunities

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and the corresponding proposed rule, published on May 9 and going into effect on January 1, 2017, will directly impact health IT vendors. Most significantly,...more

New Amendments Grant Failing ACA Co-Op Program Access to Private Capital and Limit Special Enrollment Eligibility

Earlier this month, the Centers for Medicare and Medicaid Services (CMS) passed an interim final rule that amends regulations governing Consumer Operated and Oriented Plans (Co-ops) and tightens restrictions on special...more

Manatt on Medicaid: Observations from New York's DSRIP Implementation

Editor's note: Medicaid is the largest healthcare payer in virtually every state. States are increasingly leveraging that position to drive payment and delivery system reform efforts. One powerful tool to enable...more

CMS Unveils Revised Voluntary Self-Referral Disclosure Protocol

On May 6, 2016, the Centers for Medicare and Medicaid Services (CMS) released proposed revisions to its Voluntary Self-Referral Disclosure Protocol (SRDP), through which providers may disclose actual or potential violations...more

First-of-its-Kind PACE Acquisition

PACE operators may become the next target of interest for healthcare private equity investors following a first-of-its-kind acquisition of a PACE operator by private equity sponsor Welsh Carson Anderson & Stowe (WCAS), which...more

Physician Payment: CMS Proposes Quality Payment Program, Advanced APMs, and Merit-Based Incentive Payment System

CMS published its 426 page proposed rule on the Quality Payment Program (QPP) – the successor to oft-maligned Sustainable Growth Rate adjustment – on May 9, 2016. The QPP will adjust physician and mid-level provider...more

Reducing the Delay Between FDA Approval and CMS Reimbursement Coverage

The Centers for Medicare & Medicaid Services (CMS) recently confirmed that the Parallel Review program (first announced in 2010 and most recently extended until December 18, 2015) will be made permanent. ...more

CMS Announces July 18 Public Meeting on 2017 Medicare Clinical Lab Fee Schedule

CMS has scheduled a July 18, 2016 public meeting on payment for new and substantially revised clinical diagnostic laboratory test codes for payment under the 2017 Medicare clinical laboratory fee schedule (CLFS). The meeting...more

CMS Proposes Extension of Medicare Self-Referral Disclosure Protocol Lookback Period to Six Years

CMS has published a notice inviting comments on a revised Medicare Self-Referral Disclosure Protocol (SRDP), which is a vehicle for providers and suppliers to voluntarily self-disclose actual or potential violations of the...more

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