Healthcare Centers for Medicare & Medicaid Services

News & Analysis as of

CMS Releases Hospital Inpatient PPS and Long-Term Care Hospital PPS Proposed Rule

CMS released updates to the Hospital Inpatient Prospective Payment System (Hospital IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) in a proposed rule on April 18, 2016 (Proposed Rule). The Proposed...more

CMS Announces New Alternative Payment Model for Primary Care

Earlier this week, CMS announced the launch of an initiative aimed at transforming the way primary care is delivered. The Comprehensive Primary Care Plus (CPC+) model will be a voluntary 5 year program accommodating some...more

Manatt on Health Reform: Weekly Highlights - April 2016 #2

California's Marketplace revises its QHP contract to improve care quality and value, and announces its support for a 1332 waiver to allow undocumented immigrants to purchase Marketplace plans; Wisconsin proposes transitioning...more

New Stark Law Exception Breathes Life into Primary Care, Especially in Underserved Areas

With the recent and significant shortages of primary care providers, the Centers for Medicare & Medicaid Services (“CMS”) recently created a rather important exception to the Stark Law as a means to expand access to primary...more

Program Integrity Changes to the Medicare Provider Enrollment Process

On March 1, 2016, the U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services (CMS) published a proposed rule (Proposed Rule) entitled “Medicare, Medicaid, and Children’s Health Insurance...more

Health Alert: CMS and AHIP Announce New Clinical Quality Measures

On February 16, 2016, the Centers for Medicare & Medicaid Services (CMS) and America's Health Insurance Plans (AHIP), in collaboration with physician groups and other stakeholders, released seven sets of clinical quality...more

CMS Issues Final Rule Implementing Mandatory Bundled Payment Program for Lower Extremity Joint Procedures

The Centers for Medicare & Medicaid Services (CMS) recently issued a final rule (Final Rule) that implements the Comprehensive Care for Joint Replacement model (CJR Model), a new bundled payment program covering certain...more

Recent Changes to the Stark Law Provide Added Flexibility

The 2016 Medicare Physician Fee Schedule Final Rule ("Final Rule") contains recent changes to the Federal Stark Law, the majority of which took effect on January 1, 2016. The issuance of the Final Rule on November 16, 2015...more

Health Law Pulse - January 2016

CHANGES TO STARK LAW, NEW ADVANCE CARE PAYMENTS INCLUDED IN 2016 PHYSICIAN FEE SCHEDULE - The Centers for Medicare & Medicaid Services (CMS) recently published a final rule (Final Rule) regarding physician payment...more

CMS Updates Two-Midnight Rule

The Centers for Medicare and Medicaid Services (CMS) has revised the two-midnight rule to create an exception that will allow payment under Medicare Part A for certain medically necessary hospital stays that do not extend...more

Congress Passes End-of-Year Legislation

Last week, Congress passed three acts impacting the healthcare industry—a tax extenders bill titled Protecting Americans from Tax Hikes of 2015, an Omnibus spending bill titled the Consolidated Appropriations Act of 2016, and...more

Manatt on Health Reform: Weekly Highlights - December 2015 #4

HealthCare.gov enrolls 8.2 million; Manatt and RWJF release an open access dataset on Marketplace plans nationwide; Montana names administrator for its Medicaid expansion; and Michigan gets the green light in the nick of time...more

CMS Finalizes Two New Exceptions and Other Modifications to the Stark Law

On October 30, 2015, the Centers for Medicare and Medicaid Services (“CMS”) posted a final rule, which was published in the Federal Register on November 16, 2015 (“Final Rule”), modifying the regulations implementing the...more

New Law Excludes New Provider-Based Off-Campus Outpatient Hospital Locations from OPPS

On November 2, 2015, President Barack Obama signed into law a bill that significantly changes how Medicare pays for outpatient services furnished at certain hospital locations. The Bipartisan Budget Act of 2015 (“BBA”)...more

CMS: U.S. Healthcare Spending Reaches $3 Trillion

Overall U.S. healthcare spending increased 5.3% in 2014 to reach $3.0 trillion, according to a report from CMS’ Office of the Actuary. The study indicated the growth experienced in 2014 was primarily attributable to...more

A&B Healthcare Week in Review, November 2015

I. REGULATIONS, NOTICES, & GUIDANCE - On November 21, 2015, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule entitled “Patient Protection and Affordable Care Act; HHS Notice of Benefit and...more

CMS and OIG Issue Final Fraud and Abuse Waivers for ACOs

On October 29, 2015, the Centers for Medicare & Medicaid Services and the Office of Inspector General of the Department of Health & Human Services (jointly, the “Agencies”) issued a final rule (Final Rule) regarding waivers...more

CMS Proposes Restrictions on Arbitration Provisions in Nursing Home Resident Agreements

The use of a binding arbitration provision in the pre-admission agreement between a senior living facility and its resident has become quite common. If properly drafted and presented to the resident or his or her...more

Medicare to Implement CJR: Mandatory Bundled Payment Program for Joint Replacement Surgeries

On Nov. 24, the Centers for Medicare & Medicaid Services will publish in the Federal Register the final rule for the Comprehensive Care Joint Replacement (CJR) Program. The CJR Program is a new payment model that requires...more

CMS Finalizes Revisions to Stark to Ease Burden on Providers, Refines “Incident to” Requirements

In its calendar year 2016 Physician Fee Schedule Final Rule published in the Federal Register on November 16, 2015 (Final Rule), the Centers for Medicare and Medicaid Services (CMS) finalized amendments to the federal...more

Health Care E-Note - November 2015

With medical device related acquisitions at all-time highs, and regulatory interest intense from the Federal Trade Commission, the Food and Drug Administration, the Securities and Exchange Commission, and the Office of...more

CMS Gives Providers Some Leverage in RAC Record Collection Requirements: Five Things to Know about ADRs

The Centers for Medicare & Medicaid Services (“CMS”) announced that it has reduced the maximum percentage of records that providers must submit to Recovery Audit Contractors (“RAC”) through the payment auditing process...more

CMS Adopts ESRD PPS and QIP Final Rule for Dialysis Services

On November 6, 2015, the Centers for Medicare and Medicaid Services (CMS) published the final rule regarding the end-stage renal disease (ESRD) prospective payment system (PPS) for renal dialysis services furnished to...more

What Happens to LTC Arbitration Agreements if the Proposed CMS Rules are Implemented?

By now, most industry members are aware that Centers for Medicare and Medicaid Services (CMS) recently published a proposed set of new rules for regulating long term care (LTC) facilities. During the review period, CMS...more

CMS Proposes Rules Requiring LTC Facilities to Implement Compliance and Ethics Programs

Under proposed rules issued by the Centers for Medicare and Medicaid Services (CMS), long term care (LTC) facility operators would be required to develop, implement and maintain a comprehensive compliance and ethics program...more

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