News & Analysis as of

Value-Based Purchasing

King & Spalding

CMS Issues Fiscal Year 2025 Final Rule for Skilled Nursing Facilities

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On July 31, 2024, CMS issued a final rule (the Final Rule) for fiscal year (FY) 2025 updating Medicare payment policies and rates for skilled nursing facilities (SNFs) under the SNF Prospective Payment System (PPS). Under the...more

Roetzel & Andress

Value-Based Contracting: Is It Right For Your Practice?

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On the #HealthLawHotSpot this week, host Ericka Adler is joined by special guest Janie Tremlett from CWH Advisors, for an exploration of whether physicians should add value-based contracting to their practices. Ericka and...more

King & Spalding

CMS Issues Final Rule for Skilled Nursing Facility Prospective Payment System for 2024

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On July 31, 2023, CMS issued its final rule updating the rates and Medicare payment policies under the Skilled Nursing Facility Prospective Payment System (SNF PPS) for FY 2024 (the Final Rule). The Final Rule also includes...more

K&L Gates LLP

Proposal to Change the Scoring Methodology for the Hospital Medicare Value-Based Purchasing Program to Address Health Equity

K&L Gates LLP on

The 1 May 2023 Federal Register contains a proposal from the Centers for Medicare & Medicaid Services (CMS) to revise the scoring methodology under the Hospital Value-Based Purchasing Program (Hospital VBP Program) as part of...more

Stevens & Lee

FY 2024 Proposed Medicare Reimbursement Changes for Certain Nursing and Inpatient Facilities

Stevens & Lee on

On April 3-4, Centers for Medicare & Medicaid Services (CMS) issued a number of proposed rules that would materially impact reimbursement rates for skilled nursing facilities (SNFs), inpatient psychiatric facilities (IPFs)...more

King & Spalding

CMS Issues IPPS and LTCH Final Rule for FY 2023

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On August 1, 2022, CMS issued its annual Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System Final Rule for FY 2023 (the Final Rule). In the Final Rule, CMS...more

McDermott Will & Emery

Biden Administration Takes Action to Improve Competition, Transparency and Quality for Hospitals and Nursing Homes

McDermott Will & Emery on

The Centers for Medicare & Medicaid Services (CMS) recently published detailed databases summarizing changes of ownership of Medicare-enrolled hospitals and skilled nursing facilities (SNFs). The databases currently include...more

Holland & Knight LLP

CMS Releases FY 2023 IPPS and LTCH Proposed Rule

Holland & Knight LLP on

The Centers for Medicare & Medicaid Services (CMS) on April 18, 2022, published its annual proposed rule for the federal fiscal year (FY) 2023 Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH)...more

Mintz - Health Care Viewpoints

Medicaid Best Price 101: A Review of Medicaid Best Price Policy and New CMS Guidance on Medicaid Best Price Reporting for Value...

At the end of March 2022, the Centers for Medicare & Medicaid Services (CMS) released guidance to drug manufacturers and states on reporting Medicaid Best Price under value based purchasing (VBP) arrangements (Medicaid Best...more

Bradley Arant Boult Cummings LLP

Fiscal Year 2023 Skilled Nursing Facility Proposed Rule Summary

On April 11, 2022, the Centers for Medicare & Medicaid Services (CMS) released the FY 2023 Medicare Proposed Rule for Skilled Nursing Facilities (SNFs). Key policy changes include a proposed recalibration of the Patient...more

Blank Rome LLP

The Medicaid Drug Rebate Program and Value-Based Purchasing

Blank Rome LLP on

On March 23, 2022, the Centers for Medicare and Medicaid Services (“CMS”) issued long-awaited guidance regarding how drug manufacturers are to report multiple best prices (“BPs”) to the Medicaid Drug Rebate Program (“MDRP”)...more

Fisher Phillips

Biden Proposes Nursing Home Reforms During State of The Union Address

Fisher Phillips on

If you blinked, you may have missed it, but President Biden announced a plan in Tuesday night’s State of the Union address to “set higher standards for nursing homes” to “make sure your loved ones get the care they deserve...more

Rivkin Radler LLP

[Webinar] Lunch & Learn Series: Compliance and Legal Considerations for Value Based Arrangements - March 10th, 12:00 pm - 1:00 pm...

Rivkin Radler LLP on

Please join us as Christopher Kutner, a partner in the Health Services Practice Group, and Ashley Algazi, an Associate in the Health Services Practice Group, discuss the following topics: - Framework and regulatory review...more

Proskauer - Health Care Law Brief

CMS releases guidance on Expanded Home Health Value-Based Purchasing (“HHVBP”) Model

On November 2, 2021, the Centers for Medicare & Medicaid Services (“CMS”) issued a final rule (“Final Rule”) that advances the shift from paying for Medicare home health services based on volume to a system that pays based on...more

King & Spalding

CMS Issues Final Rule Affecting Home Health, Hospice, Inpatient Rehabilitation Facilities, and Long-Term Care Facilities for CY...

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On November 2, 2021, CMS put on display its final rule that, among other things, updates the home health and home infusion therapy services payment rates for calendar year (CY) 2022; makes significant changes to the provider...more

Manatt, Phelps & Phillips, LLP

Delivering Breakthrough Treatments Affordably

Editor’s Note: In a recent webinar, Manatt Health’s Anthony Fiori, Senior Managing Director, and Alex Dworkowitz, Partner, hosted a panel of innovative thought leaders—including Dr. Sanjiv Shah, Chief Medical Officer of...more

Foley Hoag LLP - Medicaid and the Law

How does Pfizer’s New Warranty Program for XALKORI get around Medicaid Best Price?

On October 13th our friends over at STAT broke the news [sorry, Paywall] about a “warranty” pilot program from Pfizer that offers both patients and health plans (including Medicare Part D plans) the opportunity to receive a...more

Proskauer - Health Care Law Brief

Home Is Where the Health Care Is: New Study Shows Increase in Number of Homebound Older Adults While CMS Expands Home Health...

JAMA Internal Medicine recently published an article finding that the number of homebound adults aged 70 or older more than doubled during the last decade. In 2011, approximately 5% of adults aged 70 or older were homebound...more

Health Care Compliance Association (HCCA)

[Virtual Event] Clinical Practice Compliance Conference - October 12th - 13th, 8:50 am - 6:00 pm CDT

Get the latest updates on government initiatives related to physicians and clinics - HCCA’s Clinical Practice Compliance Conference provides insights, updates, and strategies that are pertinent to developing and managing...more

Baker Donelson

Proposed CY 2022 Home Health PPS Rule Would Expand Value-Based Purchasing Model and Seeks to Gather Health Equity Data Through...

Baker Donelson on

On July 7, 2021, the Centers for Medicare & Medicaid Services (CMS) published its proposed rule to update the Calendar Year (CY) 2022 Home Health Prospective Payment System (HH PPS) and Value-Based Purchasing (HH VBP)...more

Baker Donelson

CMS SNF PPS Proposed FY 2022 Rule – An Overview

Baker Donelson on

On April 15, 2021, Centers for Medicare & Medicaid Services (CMS) published its Proposed Rule for the Medicare Program Prospective Payment System (PPS) and Consolidated Billing for Skilled Nursing Facilities (SNF) and Updates...more

King & Spalding

CMS Issues Proposed Rules for Fiscal Year 2022 SNF and Hospice Payments

King & Spalding on

On April 8, 2021, CMS issued proposed rules for the Fiscal Year (FY 2022) Skilled Nursing Facility (SNF) Prospective Payment System (PPS) and FY 2022 hospice payments. CMS estimates that the aggregate impact of the payment...more

Foley Hoag LLP - Medicaid and the Law

CMS Issues New Guidance for States to Address Social Determinants of Health

The social determinants of health (SDOH) describe the range of environmental, social, and economic factors that can impact health outcomes. According to the Centers for Disease Control and Prevention (CDC), the conditions in...more

Foley Hoag LLP - Medicaid and the Law

A Deeper Dive into CMS’ Multiple Best Prices Policy

As my colleague Tom wrote about in a recent post, the Centers for Medicare & Medicaid Services (CMS) has finally responded to a growing chorus of stakeholders that government price reporting requirements, particularly...more

Foley Hoag LLP - Medicaid and the Law

CMS Finalizes Changes to Medicaid Prescription Drug Rebate Program

Earlier this year, my colleague Ross Margulies and I told you about a new proposed rule issued by CMS that makes several changes to the Medicaid prescription drug rebate program, or the MDRP. Recently, CMS finalized the rule...more

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