News & Analysis as of

Hospitals Centers for Medicare & Medicaid Services

Health Update - May 2017

Mapping the Healthcare M&A Landscape Under the New Administration - Editor’s Note: The healthcare M&A market continues to be among the most active sectors. In a recent webinar, Manatt examined how the policies and goals of...more

CMS Announces Solicitation for the Rural Community Hospital Demonstration Program

by King & Spalding on

CMS announced solicitation for applications for participation in the Rural Community Hospital Demonstration Program (Demonstration). In this request for applications, CMS is seeking information from interested hospitals...more

CMS Seeks Comments on Overhauling Hospital IPPS

by Baker Ober Health Law on

CMS is asking for feedback on how Medicare can make the health care delivery system simpler for patients and health care providers. This spring's Fiscal Year 2018 Hospital Inpatient Prospective Payment System (IPPS) and the...more

CMS Releases FY 2018 Hospital Inpatient Prospective Payment System Proposed Rule and Request for Information

by King & Spalding on

On April 14, 2017, CMS issued the annual Hospital Inpatient Prospective Payment System (IPPS) Rule for FY 2018 (the “Proposed Rule”) which will affect discharges on or after October 1, 2017. CMS estimates that IPPS operating...more

Ten Things Investors Need to Know About Value-Based Healthcare

by Ropes & Gray LLP on

This article highlights key business and legal issues related to value-based healthcare for investors considering opportunities in the healthcare industry. 1. Value-Based Arrangements Are Here to Stay Value-based...more

CMS Gamed System to Identify Hospitals Gaming System?

by Faegre Baker Daniels on

You can’t make this stuff up. When CMS conducted a study to identify hospitals that game the quality data reporting system, it used an approach that made the data reporting look better than it actually was. That bottom line...more

IPPS Proposed Rule Increases Hospital Payment; Solicits Ideas for Achieving Transparency, Relieving Administrative Burden

by BakerHostetler on

The Centers for Medicare & Medicaid Services (CMS) recently issued its proposed rule updating fiscal year (FY) 2018 payment policies and rates under the Medicare inpatient prospective payment system (IPPS). As highlighted...more

New teaching hospitals that started training residents before October 1, 2012, should verify their GME FTE cap calculations

by Dentons on

Due to potential inconsistencies in CMS's cap-setting calculation methodologies, new teaching hospitals that first started training residents after the 1996 cap-setting base year, but before October 1, 2012, are well-advised...more

CMS Proposes IPPS/LTCH Payment and Policy Changes for FY 2018; Requests Comments on Broader Policy Issues

by Reed Smith on

CMS has published its proposed rule to update the Medicare acute hospital inpatient prospective payment system (IPPS) and long-term care hospital (LTCH) prospective payment system (PPS) for fiscal year (FY) 2018. CMS also...more

Medicare Two-Midnight Rule and Observation Status Updates

by Baker Ober Health Law on

What's new from Medicare in the areas of the Two-Midnight rule and observation services? CMS recently published updates to a Medicare manual reflecting clarifications to its Two-Midnight policy, a Medicare Quality Improvement...more

Bundled Payments Out in the Cold? Another Delay for Mandatory Bundled Payment Models

by BakerHostetler on

This most recent delay raises questions concerning how the Trump administration intends to implement value-based payment in the Medicare program. The Centers for Medicare and Medicaid Services (CMS) has delayed again the...more

CMS mandates new Stark Self-Referral Disclosure Protocol form

by Thompson Coburn LLP on

The Centers for Medicare and Medicaid Services’ (CMS) Self-Referral Disclosure Protocol (SRDP) outlines a process for providers to disclose to CMS potential or actual violations of the Stark law...more

CMS Finalizes New SRDP Disclosure Form and Process

by Baker Ober Health Law on

Parties disclosing actual or potential violations of the Stark law will use a new series of forms under CMS's Voluntary Self-Referral Disclosure Protocol (SRDP) process as of June 1, 2017. According to CMS, the new forms...more

D.C. District Court Dismisses a Hospital’s Challenge of Another Hospital’s Failure to Provide Wage Documentation to CMS

by King & Spalding on

On March 21, 2017, the U.S. District Court for the District of Columbia ruled that a hospital lacked standing to challenge a decision of the Provider Reimbursement Review Board (the “PRRB”), since the hospital failed to...more

2017 Brings Big Changes for Off-Campus Provider-Based Facilities

by Williams Mullen on

Historically, the Centers for Medicare and Medicaid Services (CMS) has reimbursed items and services furnished by provider-based departments (PBDs), both on and off campus, under the Medicare Hospital Outpatient Prospective...more

CMS Revises the Self-Referral Disclosure Protocol Requiring the Use of Prescribed Forms for Disclosure of Stark Law Violations

by McDermott Will & Emery on

The Centers for Medicare and Medicaid Services (CMS) recently posted revisions to the Voluntary Self-Referral Disclosure Protocol (SRDP). In an attempt to streamline the self-disclosure process, CMS requires the use of new...more

CMS Clarifies Medicaid DSH Rules for Treatment of Third Party Payments in Calculating Uncompensated Care Costs

by Reed Smith on

CMS has published a final rule intended to codify its existing interpretation of how third-party payments are considered in the calculation of Medicaid uncompensated care costs for the purpose of making Medicaid...more

CMS Delays Effective Date for Episode Payment Model (EPM) Final Rule

by King & Spalding on

CMS has announced that the effective date for the Final Rule for certain EPMs will be delayed until May 20, 2017. This is the second delay for the Final Rule. CMS previously pushed the effective date from February 18 to March...more

U.S. District Court Rules that Hospital May Face FCA Liability Over Medical Directorship Arrangements that Lacked Written...

by King & Spalding on

On March 15, 2017, the U.S. District Court for the Western District of Pennsylvania held in United States ex rel. Emanuele v. Medicor Assocs., 2017 BL 80113, W.D. Pa., No. 10-cv-245, 3/15/17, that a hospital that created...more

D.C. District Court Upholds CMS’s Predicate Fact Three-Year Reopening Limitation

by King & Spalding on

On March 10, 2017, Judge John Bates of the U.S. District Court for the District of Columbia upheld CMS’s three-year cost report reopening limitation, as applied to “predicate fact” determinations. The regulation at issue is...more

When is a Physician Liable for Stark Law Violations?

by Ruder Ware on

I frequently hear attorneys claim the Stark law applies equally to hospitals and physicians. This position is sometimes taken in the process of negotiating a transaction between a hospital and a physician or physician group....more

Healthcare Law Update: March 2017

by Holland & Knight LLP on

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

Delayed ETA for EPMs – CMS Delays New Bundled Payment Models

by Baker Ober Health Law on

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

Fifth Circuit Upholds CMS’s Critical Access Hospital Guidelines

by King & Spalding on

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

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

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