News & Analysis as of

Medicare Centers for Medicare & Medicaid Services

Proposed Rule Would Slash Medicare Payment for 340B Drugs

by Foley & Lardner LLP on

The Centers for Medicare and Medicaid Services (CMS) has proposed reducing the Medicare payment rate to hospitals for most separately payable drugs purchased under the 340B program from average sales price (ASP) plus six...more

OIG Approves Cost-Sharing Arrangement Involving Clinical Research Study

by Baker Ober Health Law on

The U.S. Department of Health and Human Services, Office of the Inspector General (OIG), issued a favorable advisory opinion, No. 17-02, regarding a proposed arrangement under which the cost-sharing amounts owed by...more

Health Update - July 2017

Contracting With Technology Vendors: Obligations and Compliance Strategies - Editor’s Note: In a recent webinar, Manatt Health examined how to protect privacy when communicating in the digital age. The session revealed how...more

CMMI Focuses on Behavioral Health

by Pierce Atwood LLP on

CMS recently announced that the Center for Medicare and Medicaid Innovation (CMMI) is interested in lowering the cost of care for Medicare and Medicaid beneficiaries with behavioral health conditions while improving the...more

CMS Summit on Potential Behavioral Health Innovative Payment Model (Sept. 8, 2017)

by Reed Smith on

The CMS Center for Medicare and Medicaid Innovation is holding a public summit on September 8, 2017 to explore creating a behavioral health innovative payment model intended to improve health care quality and access, while...more

CMS Issues Corrections to Medicare/Medicaid LTC Conditions of Participation

by Reed Smith on

CMS has made numerous technical and typographical corrections to its October 4, 2016 final rule revising the requirements that long-term care facilities must meet to participate in the Medicare and Medicaid programs. ...more

Client Alert: Feds Shine a Light on Medicare Advantage Plans and Physicians Related to Risk Adjustment Practices

Although the sufficiency of medical records documentation supporting beneficiary diagnoses for Medicare Advantage (MA) risk adjustment has been on the OIG’s work plan since 2013, the Department of Justice has upped the ante...more

Escobar case limits False Claims Act liability for providers

by Thompson Coburn LLP on

Health care providers, as government contractors, must make certain representations of fact when submitting claims for government program reimbursement, such as Medicare. Sometimes through no fault of the contractor, such...more

Provider Taxes: The Battle over Medicare's Treatment Continues

by Baker Ober Health Law on

For the better part of a decade, hospitals and CMS have fought over the extent to which hospitals may claim as reasonable costs the provider tax assessments levied on them by the individual states in which they operate. In...more

CMS’s 2018 Medicare Physician Fee Schedule Proposed Rule Would Slash Non-Excepted Provider-Based Department Payments

by Dorsey & Whitney LLP on

The Centers for Medicare & Medicaid Services (CMS) released its 2018 Medicare Physician Fee Schedule proposed rule on July 13, 2017. The proposed rule, among other things, proposes to cut Medicare payments for services...more

Medicare Proposes Continued Relief for Critical Access and Rural Hospitals Through 2-Year Moratorium on Direct Supervision...

by Dorsey & Whitney LLP on

On July 13, 2017, CMS released a proposed rule as part of its 2018 Outpatient Prospective Payment System proposals that is aimed at helping to reduce some of the burdens rural hospitals experience in recruiting physicians....more

New Medicare Proposals that Reduce Payment to Hospitals for 340B Drugs in 2018

by Dorsey & Whitney LLP on

On July 13, 2017, CMS released several proposed rules impacting health care, including the 2018 Outpatient Prospective Payment System (OPPS) proposed rule which, among other proposals, could have a significant impact on 340B...more

Home Health Agencies Get More Time to Prepare for New Medicare Rules

Home health agencies (HHAs) can breathe a sigh of relief now that the Centers for Medicare & Medicaid Services (CMS) have published a Final Rule delaying the effective date of the revised Medicare Conditions of Participation...more

CMS Releases Proposed Rule for 2018 Physician Fee Schedule

by King & Spalding on

On July 13, 2017, CMS proposed a rule (Proposed Rule) updating payment policies and rates, as well as the quality provisions, for the Medicare Physician Fee Schedule (PFS). Among other provisions, the Proposed Rule reduces...more

CMS Issues Proposed Rule to Increase Flexibility and Reduce Burden in the Second Year of MACRA’s Quality Payment Program

by Arnall Golden Gregory LLP on

On June 20, 2017, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule (CMS-5522-P) that would make changes to the second year requirements of the Medicare Access and CHIP Reauthorization Act of 2015...more

Six Questions and Answers About CMS’ Recommended Changes to 340B Medicare Reimbursement

In March, I posted about the Uncertain Future of the 340B Drug Discount Program.  When opining about What Could Happen Next I speculated about possible changes to government reimbursement for 340B drugs “so that government...more

Key funding issues for provider-operated allied health residency programs

by Dentons on

Medicare GME reimbursement is designed only to support the training of medical, dental and podiatric residents. The Medicare program does, however, provide separate funding to support certain programs that train nursing and...more

Payor Initiatives with Physicians and Payment Models In The Insurance Marketplace

by Locke Lord LLP on

Payment models that seek to reward physicians, hospitals and other health care providers for achieving certain quality and cost-saving goals, or “value-based purchasing” (VBP), are not new to the healthcare landscape,...more

CMS Proposes Changes to for Second Year of Medicare Physician Quality Payment Program

by Reed Smith on

CMS has proposed new regulations to continue implementing the “Quality Payment Program” (QPP)– the new Medicare physician fee schedule (MPFS) update framework mandated by the Medicare Access and CHIP Reauthorization Act of...more

CMS Proposes Update to Medicare ESRD PPS Payments for 2018

by Reed Smith on

The Centers for Medicare & Medicaid Services (CMS) has published a proposed rule to update the Medicare end-stage renal disease (ESRD) prospective payment system (PPS) for calendar year (CY) 2018. CMS anticipates that the...more

HHS Cannot Pause United’s Challenge to the Medicare C/D Overpayment Rule

by King & Spalding on

As previously reported, UnitedHealthcare Insurance Company (United) is challenging CMS’s Medicare C/D Overpayment Rule as it applies to Medicare Advantage (MA) organizations. HHS sought to stay United’s lawsuit while it...more

More Small Physician Practices May Become Exempt From MACRA

by Fox Rothschild LLP on

On June 20, 2017, The Centers for Medicare & Medicaid Services (“CMS”) released a proposed rule which would exempt a greater number of small practices from complying with the Medicare Access and CHIP Reauthorization Act of...more

"Locum Tenens" Physical Therapist – Does the Change Provide Sufficient Relief?

by Baker Ober Health Law on

CMS recently published guidance to implement Section 16006 of the 21st Century Cures Act, effective June 13, 2017, which allows physical therapists providing services to Medicare beneficiaries to utilize "locum tenens"...more

CMS Suggests Five Ways For Healthcare Providers To Prepare For New Medicare Cards

by Fox Rothschild LLP on

The Medicare Access and CHIP Reauthorization Act of 2015 requires Centers for Medicare and Medicaid Services (“CMS”) to remove Social Security Numbers (“SSNs”) from all Medicare cards. Physicians currently use a SSN-based...more

Uncle Sam’s bad reverse: nursing homes returning to forced arbitration

Look out Baby Boomers and Gen Xers: Just when you or your elderly loved ones may be most vulnerable and needing nursing home care, the government is going back to allowing nursing home administrators to push a pile of...more

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