Centers for Medicare & Medicaid Services

News & Analysis as of

ACA Repeal and Replace Update: House Vote Expected This Week; CBO Estimates Impact of Repeal and Replace Legislation; CMS...

After narrowly passing the Budget Committee, the Republican-sponsored health reform repeal and replace bill, the American Health Care Act (AHCA), is scheduled for a floor vote for Thursday, March 23, 2017, seven years to the...more

Seventh Circuit Grants Interlocutory Appeal in Rx Discount Program Qui Tam Suit to Answer Several Important Questions

In United States ex rel. Garbe v. Kmart Co., 824 F.3d 632 (7th Cir. 2016), the Seventh Circuit granted interlocutory appeal following numerous motions for partial summary judgment to consider four questions: (1) whether the...more

A New Era for Medicaid

Congress is currently debating the American Health Care Act (AHCA), the “repeal and replace” legislation that calls for fundamental changes to Medicaid. As currently proposed, AHCA will cut Medicaid spending by $880 billion...more

Long-Term Care Facilities Subject to New Medicare Requirements for Participation Must Comply with Staffing, Training, and...

On October 4, 2016, the Centers for Medicare & Medicaid Services (CMS) issued a final rule which represents the most sweeping changes in twenty-five years regarding the requirements for participation for long-term care (LTC)...more

Healthcare Law Update: March 2017

Enforcement - OIG Issues Advisory Opinion Allowing Free or Reduced-Cost Lodging and Meals - On March 3, 2017, the U.S. Department of Health and Human Services' (HHS) Office of Inspector General (OIG) issued...more

Third-Party Payment of Premiums: Controversy and HHS Guidance

Since the passage of the Affordable Care Act (ACA), the payment of healthcare premiums by third parties has been the subject of controversy. As Congress develops its plan to repeal and replace the ACA, it is uncertain how...more

Delayed ETA for EPMs – CMS Delays New Bundled Payment Models

On March 21, 2017, CMS issued the anticipated delay related to the new Episode Payment Model (EPM) bundled payment program regulations that were finalized in January. The rule, Advancing Care Coordination Through Episode...more

Health Update - March 2017

The Future of Essential Health Benefits - Editor's Note: The Essential Health Benefits (EHB) rule may be among the many parts of the Affordable Care Act (ACA) that are on the chopping block as the Trump Administration and...more

Federal district court interprets Stark Laws writing requirement

On March 15, 2017, the US District Court for the Western District of Pennsylvania, ruling on cross motions for summary judgment in U.S. ex rel. Tullio Emanuele v. Medicor Associates Inc. et al., provided the first...more

Medicare’s Pre-Claim Review Demonstration Project to Begin in Florida

In August 2016, the Centers for Medicare & Medicaid Services (CMS) initiated a three-year Pre-Claim Review Demonstration for home health agencies (HHA) in Illinois, with plans to expand the demonstration shortly afterwards to...more

The Transition to Value-Based Health Care: A View from Washington of President Trump’s First 60 Days

“A View from Washington of President Trump’s First 60 Days,” the inaugural segment of our value-based health care teleconference series, was hosted by Thomas Bulleit, who heads the Ropes & Gray health care practice in the...more

Price, Verma Taking a Fresh Look at Obama Administration’s EPM/CJR Final Rule; Changes Pushed Back to at Least October 1, 2017

HHS Secretary Thomas Price and CMS Administrator Seema Verma have signaled that the Trump Administration is eyeing changes to one of the last major Medicare policies issued by the Obama Administration. Specifically, CMS is...more

Fifth Circuit Upholds CMS’s Critical Access Hospital Guidelines

CMS’s definitions of “primary roads” and “secondary roads,” as used to determine what constitutes a critical access hospital, withstood another court challenge last week....more

States May See Earliest Opportunities to Alter Health Care Landscape

While the titans on Capitol Hill clash over the best answer to the Affordable Care Act (ACA), the Trump administration is promoting action at the state level that could produce meaningful impact soon. Health industry...more

Federal Health Care Leaders Write Governors About New Direction for Medicaid

While much of the attention related to health care this week is focused on our nation’s capital, all 50 state governors have received a letter from recently confirmed U.S. Health & Human Services Secretary Tom Price and...more

President’s Budget Blueprint Increases Funds For Health Care Fraud Enforcement

The President has released a “budget blueprint” for fiscal year 2018. Although there are many aspects of the budget blueprint to digest, several budget items signal that government health care fraud enforcement remains a...more

Senate Confirms Verma as CMS Administrator; Trump Nominates Gottlieb for FDA, Hargan as Deputy HHS Secretary

The Senate has approved the nomination of Seema Verma to be CMS Administrator on a vote of 55 to 43. In other nomination news, President Trump has nominated Scott Gottlieb to be Commissioner of Food and Drugs. Dr. Gottlieb is...more

Trump Administration Signals More Administrative Flexibility for State Medicaid Programs, with Emphasis on “Most Vulnerable...

In her first act as CMS Administrator, Seema Verma joined HHS Secretary Tom Price in writing to the nation’s Governors to urge collaboration on improving the Medicaid program, with an emphasis on services for “truly...more

Provider Payments Under a Medicaid Per Capita Cap

In a February 24th blog post, we described Medicaid block grants and per capita caps in terms of A x B = C to demonstrate how those payment policies work. ‘A’ is the amount a state is paid per beneficiary, ‘B’ is the number...more

Manatt on Health Reform: Weekly Highlights - March 2017 #2

CBO finds that the number of uninsured would nearly double under the American Health Care Act; CMS's new Administrator is confirmed; and New Mexico and Massachusetts move to protect reproductive healthcare under ACA repeal....more

Direct Primary Care: Getting Calls from Patients While Avoiding Calls from Law Enforcement

For providers interested in simplifying the provider-patient relationship, one option is direct primary care. Ironically, though, simplification can be complicated, particularly when the government is involved. One of the...more

Massachusetts Department of Public Health – Final Hospital Licensure Regulations

The Massachusetts Department of Public Health (DPH) has promulgated final Hospital Licensure Regulations. Approved by unanimous vote of the Massachusetts Public Health Council (PHC) on March 8, 2017, DPH anticipates that the...more

Caution About Fake Phone Calls from Health Care Agencies

Individuals should be cautious about sharing personally identifiable information when contacted via phone, including by health care agencies. The Centers for Medicare & Medicaid released an alert earlier this week warning of...more

Manatt on Health Reform: Weekly Highlights - March 2017

House Republicans release long-awaited ACA repeal and replace legislation, Arkansas proposes a new waiver amendment to lower expansion adult eligibility levels, and California and Maine are considering new policies to tackle...more

Trump Executive Orders Create Uncertainty for Health Care & Pharmaceutical Industries

As we’ve previously discussed on Health Law and Policy Matters, agencies within the Department of Health and Human Services (DHHS) pushed through several final rules towards the end of the Obama Administration. However, since...more

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