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Centers for Medicare & Medicaid Services (CMS) Social Security Act

Holland & Knight LLP

FDA Warning Letter Marks Significant Shift in Enforcement of Laboratory Developed Tests

Holland & Knight LLP on

The U.S. Food and Drug Administration's (FDA) March 21, 2024, warning letter to Agena Bioscience Inc. (Agena), a genetic diagnostic test developer, generated a lot of immediate commentary among regulatory lawyers and...more

Baker Donelson

Significant Changes Affecting Hospitals in CMS's FY 2025 IPPS Final Rule

Baker Donelson on

CMS published its FY 2025 Medicare Hospital Inpatient Prospective Payment System (IPPS) final rule on August 1, 2024. Under this final rule, CMS is implementing several changes to its Hospital Inpatient Quality Reporting...more

King & Spalding

Transitional Coverage for Emerging Technologies: CMS’s Latest, But Not Necessarily Greatest, Coverage with Evidence Approach

King & Spalding on

On August 7, 2024, the Centers for Medicare & Medicaid Services (“CMS” or the “Agency”) issued a final procedural notice (“Notice”) outlining a new Medicare coverage pathway, aimed at achieving timelier and predictable access...more

Arnall Golden Gregory LLP

Proposed Legislation Focuses on Private Equity and REITs in Healthcare

Efforts to draw attention to and, in some instances, dissuade private equity investment in healthcare have been on the rise. For example, in late 2023, the Centers for Medicare & Medicaid Services finalized a rule increasing...more

Baker Donelson

What the Supreme Court's "Chevron Deference" Ruling Could Mean for Health Care Law

Baker Donelson on

Baker Donelson recently published Anticipating SCOTUS Ruling on Chevron Deference – What to Know and Five Ways to Prepare explaining the United States Supreme Court's upcoming ruling which is expected to impact the regulatory...more

Mintz - Health Care Viewpoints

Contract Year 2025 Policy and Technical Changes to the Medicare Advantage Program

As part of its 2025 Medicare Advantage and Part D Final Rule (the Final Rule), the Centers for Medicare & Medicaid Services (CMS) finalized a number of regulatory changes relating to how Medicare Advantage (MA) plans offer...more

McCarter & English, LLP

CMS Extends Medicaid Waivers through June 2025

In an informational bulletin, the Centers for Medicare & Medicaid Services (CMS) announced it will further extend waivers for “unwinding” under Section 1902(e)(14)(A) of the Social Security Act until June 30, 2025. The...more

Mintz - Health Care Viewpoints

CMS Publishes Final Rules Implementing Part C and Part D Program Changes

On April 23, 2024, the Centers for Medicare & Medicaid Services (CMS) published final rules setting forth Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit Program for Contract Year 2024--Remaining...more

Proskauer - Health Care Law Brief

Long Awaited Approval of the 1115 Waiver Amendment for NYS Medicaid – Just in Time for the New York State Executive Budget State...

On Tuesday, January 16, 2024, Governor Kathy Hochul released the SFY 2025 New York State Executive Budget (“Executive Budget”). While still subject to legislative approval, the Executive Budget incorporates the recently...more

Epstein Becker & Green

New Coverage, Delivery, and Payment for Health-Related Social Needs Services Under New York’s Approved 1115 Medicaid Waiver...

Epstein Becker & Green on

On January 9, 2024, the Centers for Medicare & Medicaid Services (CMS) approved New York’s recent 1115 demonstration waiver. Among other things, this most recent demonstration waiver provides significant federal funding...more

Arnall Golden Gregory LLP

UPDATE: CMS Finalizes Rule Requiring Greater SNF Ownership Transparency, Including Private Equity and REIT Disclosures, and...

The Centers for Medicare & Medicaid Services (“CMS”) released a final rule on November 15, 2023 (published on November 17, 2023) (the “Rule”), requiring greater skilled nursing facility (“SNF”) ownership transparency. The...more

McCarter & English, LLP

Next Stop, Revalidation Station: CMS Final Rule for Nursing Home Transparency to Prompt Off-Cycle Revalidation, Revised Form...

Nursing facilities should prepare to provide the Centers for Medicare & Medicaid Services (CMS) with additional information about their ownership, their managing employees and the parties providing certain financial and...more

Mintz - Health Care Viewpoints

HHS Proposes Appropriate Disincentives for Health Care Providers That Commit Information Blocking

In coordination with the Centers for Medicare & Medicaid Services (CMS), the Department of Health and Human Services (HHS) and Office of the National Coordinator for Health Information Technology (ONC) proposed a...more

King & Spalding

CMS Publishes Final Rule Regarding CMPs for Late Reporting by Medicare Secondary Payers

King & Spalding on

On October 11, 2023, CMS published a final rule (the Final Rule) regarding how and when CMS will impose civil monetary penalties (CMPs) for Medicare secondary payers (MSPs) that untimely report required information. The Final...more

King & Spalding

CMS Issues IPPS and LTCH PPS Final Rule for FY 2024

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On August 1, 2023, CMS issued its annual Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) Final Rule for FY 2024 (the Final Rule). In the Final Rule, CMS,...more

King & Spalding

Federal District Court Grants Injunction Barring CMS from Implementing New Policy on Medicaid Funding Designed to Prevent...

King & Spalding on

On June 30, 2023, the United States District Court for the Eastern District of Texas (the Court) granted the State of Texas’ preliminary injunction motion, enjoining CMS from implementing and enforcing its Informational...more

King & Spalding

A Pathway for Medicare Coverage for Breakthrough Devices: Take Two

King & Spalding on

On June 27, 2023, the Centers for Medicare & Medicaid Services (“CMS” or the “Agency”) issued a “Notice with Comment Period” (“Notice”) describing a new process for providing expedited Medicare coverage for certain eligible...more

Proskauer - Health Care Law Brief

Medicare Advantage 2024 Rate Announcement – Further Impacts to Risk Adjustment

On Friday, March 31, 2023, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2024 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies (Rate Announcement). This Rate...more

King & Spalding

CMS Proposes Changes to Medicaid DSH Third-Party Payer Rule

King & Spalding on

On February 24, 2023, CMS issued a proposed rule updating its Medicaid Disproportionate Share Hospital (DSH) program regulations as a result of legislative changes made by the Consolidated Appropriations Act (CAA) of 2021....more

King & Spalding

GAO Releases Report and Recommendations to CMS to Address Risks Posed by Provider Enrollment Waivers and Flexibilities Implemented...

King & Spalding on

On December 19, 2022, the U.S. Government Accountability Office (GAO) released a report titled, “Medicare: CMS Needs to Address Risks Posed by Provider Enrollment Waivers and Flexibilities” (GAO-23-105494). The report...more

ArentFox Schiff

Medicare Hospital Outpatient Prospective Payment System (HOPPS) and Physician Fee Schedule (PFS) Final Rules Released; What Pharma...

ArentFox Schiff on

The Centers for Medicare & Medicaid Services (CMS) has issued its annual final rules related to both the Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems for calendar year 2023 (the HOPPS...more

Foley & Lardner LLP

CMS Finalizes Changes for Telehealth Services for 2023

Foley & Lardner LLP on

On November 1, 2022, the Centers for Medicare and Medicaid Services (CMS) released its final 2023 Medicare Physician Fee Schedule (PFS) rule. As finalized, some of the most significant telehealth policy changes include: ...more

Sheppard Mullin Richter & Hampton LLP

CMS Pushes Publication of Final FFS Adjuster for RADV Audits Rule to February 1, 2023

CMS announced today a further extension until February 1, 2023, of the deadline for its publication of the long-awaited final rule on the use of extrapolation and the application of a fee-for-service adjuster (FFS Adjuster)...more

King & Spalding

CMS Releases Fact Sheets to Advise Regarding Eventual End of Medicare COVID-19 Waivers

King & Spalding on

In response to the COVID-19 Public Health Emergency (PHE), CMS temporarily waived a significant number of Medicare, Medicaid and Children’s Health Insurance Program (CHIP) requirements and conditions of participation pursuant...more

King & Spalding

CMS Issues Guidance to Improve Care for Children with Medically Complex Conditions

King & Spalding on

On August 1, 2022, CMS issued guidance on the implementation of Section 1945A of the Social Security Act (the Act), which gives states the option to cover health home services for Medicaid-eligible children under age 21 with...more

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