Hospitals Centers for Medicare & Medicaid Services

News & Analysis as of

CMS's Proposed IPPS and LTCH FY 2017 Rule: Key Takeaways

On April 18, 2016, CMS released its proposed rule addressing new payment rates and policies under both the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS),...more

Health Law Insights Newsletter - Issue 8 - April 2016

McCarter & English, LLP’s Health Care Group presents Issue 8 of the Health Law Insights, which discusses the latest legal issues in the health care industry. NATIONAL - New Payment Model for Part B Drugs Proposed -...more

CMS Launches Initiative to Reduce Avoidable Hospitalizations of Nursing Facility Residents with Announcement of Six Cooperative...

Following up on CMS’s August 2015 announcement that it was creating “a new funding opportunity” intended “to reduce avoidable hospitalizations by funding higher-intensity interventions in nursing facilities for residents who...more

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

Rhode Island's Medicaid reforms will save the State $75 million this year; HHS finds that Medicaid expansion improves behavioral healthcare; and California's Marketplace may exclude poor performing hospitals from its QHP...more

At The Intersection of New Bundled Payment Programs and New Discharge Rules: Private Equity Opportunities

Recently, CMS has promulgated new bundled payment rules for Comprehensive Joint Replacement(CJR) that require the mandatory participation of approximately 800 hospitals across the US. This bundle includes not only the...more

All Right Stop, Collaborate and Listen! CMS Is Back with Its Brand New Invention, Preparing for CJR Gainsharing

Understandably, there is anticipation surrounding the April 1st start date for CMS’s newest bundled payment program, the Comprehensive Care for Joint Replacement (CJR) program. As participant hospitals consider gainsharing...more

Health Law Insights Newsletter - Issue 7 - March 2016

McCarter & English, LLP’s Health Care Group presents Issue 7 of the Health Law Insights, which discusses the latest legal issues in the health care industry. NATIONAL - Providers’ Obligation to Report Medicare...more

MedPAC Report Recommends Reduction in Medicare Part B Payments to 340B Hospitals

On March 15, 2016, the Medicare Payment Advisory Commission (MedPAC) released its latest report to Congress that included 340B Implications for Medicare Part B Drugs along with a quick fact sheet regarding the report. Key...more

GAO Reviews Safeguards on State Supplemental Medicaid Payments to Hospitals

According to the GAO, 505 hospitals received Medicaid payment surpluses (payments that exceeded the costs of providing services) totaling about $2.7 billion in 2012, resulting in part from lump-sum supplemental payments...more

Federal Court Upholds CMS Rule Defining Primary and Secondary Roads Between Hospitals

A Texas Federal district court upheld CMS’s distinction between primary and secondary roads connecting hospitals, which is a factor used to determine whether a hospital is a critical access hospital (“CAH”). ...more

A&B Healthcare Week in Review

I. REGULATIONS, NOTICES, & GUIDANCE - On March 8, 2016, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule entitled, “Medicare Program; Part B Drug Payment Model.” The proposed rule seeks...more

Comprehensive Joint Replacement Bundled Payment Program Begins April 1st

Approximately 800 hospitals in 67 Metropolitan Statistical Areas will begin mandatory participation in the Comprehensive Care for Joint Replacement (CJR) Model on April 1, 2016. The CJR bundled payment program applies to...more

CMS Extends EHR Incentive Program Hardship Application Deadline to July 1, 2016

CMS is allowing eligible professionals, eligible hospitals, and critical access hospitals to apply for Medicare Electronic Health Record (EHR) Incentive Program hardship exceptions until July 1, 2016 to avoid adjustments to...more

CMS Issues Corrections to CJR Rule, Including Clarification of Target Price Methodology

CMS has published a notice correcting errors in its November 24, 2015 final rule to implement the Comprehensive Care for Joint Replacement (CJR) model. While most of the changes are technical, CMS does clarify its...more

Also in The News - Health Headlines - February 2016 #2

ALSO IN THE NEWS: CMS Extends Deadline for Hardship Exception Applications – On February 26, 2016, CMS updated its online instructions for submitting a hardship exception application to reflect that hardship exception...more

Recent EHR Meaningful Use Program Updates

As we enter the sixth year of the Medicare and Medicaid Electronic Health Records Incentive Programs (commonly referred to as the “Meaningful Use Programs”), the Centers for Medicare & Medicaid Services (CMS) continues to...more

CMS Grants Extension to Apply for 2015 Meaningful Use Hardship Exemption

The Centers for Medicare and Medicaid Services (“CMS”) continues to work to ensure it is responsive to providers who tried to meet meaningful use standards in 2015 but faced hardships in their efforts. Eligible professionals,...more

New Stark Law Exception for Non-Physician Practitioner Subsidies: A Gift or Pandora's Box for Hospitals?

As of January 1, 2016, a new Stark Law exception allows hospitals to give subsidies to physician practices for the recruitment of non-physician practitioners (“NPPs”). In the Phase III Stark Law regulations, the Centers for...more

CMS Model Payment & Initiatives - The Growing Target of Quality & Care Improvement in Skilled Nursing Facilities

Like it or not, the Centers for Medicare & Medicaid Services (CMS) is expanding its strong commitment to focus on quality and care improvement as the basis for payment to providers throughout the continuum of care....more

Second Circuit Invalidates CMS Regulation and Holds That Hospitals Designated as Rural May Apply for an Urban Wage Index While...

On February 4, 2016, the United States Court of Appeals for the Second Circuit struck down HHS regulations that prohibited hospitals from seeking classification as “urban” for purposes of their standardized amount and wage...more

Health Care Update - February 2016 #4

What to Expect from Congress this Work Period - The next Hill work period basically runs from February 22nd to March 23rd. As Congress returns, here’s a brief look at the pending health care issues on the radar for this...more

King & Spalding Submits Comments to CMS Regarding Two-Midnight Rule, Rejecting Agency’s Latest Rationale for Payment Reduction

On February 2, 2016, on behalf of more than 200 client hospitals, King & Spalding responded to CMS’s latest justification for its two-midnight rule and associated 0.2 percent payment reduction, published at 80 Fed. Reg. 75107...more

Initial residency period (IRP) issues (Part II): What happens when a resident trains longer than expected?

The Medicare program reimburses a higher proportion of a hospital’s per-resident direct graduate medical education (DGME) training costs for the limited period of time required for each resident to become board-certified in...more

Manatt on Health Reform: Weekly Highlights - February 2016 #3

Alabama receives federal approval for its Medicaid transformation waiver, while Michigan's Governor submits a Medicaid waiver on behalf of Flint residents; CMS announces $7.7 billion in reinsurance payments; and Vermont seeks...more

Private Equity Market Intelligence: Physician/Hospital Quarterly Report - Q4

Key Findings - ..ACA enrollment reached 11.3 million by the end of the third open enrollment period, surpassing HHS expectations. Three-quarters of the enrollees were from the 38 states that use the healthcare.gov...more

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