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CMS Issues IPPS and LTCH Proposed Rule for FY 2026

On Friday, April 11, 2025, CMS issued its annual Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) Proposed Rule for Fiscal Year (FY) 2026 (the Proposed...more

OIG Releases Findings on Medicare Contractor Compliance with Medicare Cost Report Oversight Requirements

Last week, OIG’s Office of Audit Services released its latest report on Medicare Administrative Contractors’ (MACs) compliance with Medicare cost report oversight requirements. The report, which is titled Medicare...more

HIPAA Reproductive Healthcare Privacy – Recent Settlement Related to Privacy Rule Violation and Reminder of December 2024 Privacy...

Last week, HHS Office of Civil Rights (OCR) announced a settlement with a Pennsylvania provider (the Provider) concerning an alleged violation of the HIPAA Privacy Rule. Specifically, the Provider impermissibly disclosed a...more

OIG Releases Findings on Compliance with Hospital Price Transparency Rule

Earlier this month, OIG’s Office of Audit Services released its latest report on providers’ compliance with the Hospital Price Transparency Rule (the HPT Rule). The HPT Rule requires hospitals to make public (1) a...more

HHS Finalizes Disincentives for Healthcare Providers That Have Committed Information Blocking

Last week, HHS published its final rule outlining disincentives for certain healthcare providers that have committed information blocking (the Final Rule). The Final Rule also provides information related to OIG’s...more

CMS Issues IPPS and LTCH Proposed Rule for FY 2025

On April 10, 2024, CMS issued its annual Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) Proposed Rule for Fiscal Year (FY) 2025 (the Proposed Rule). In...more

CMS Updates Hospital Price Transparency Technical Implementation Guide

Last week, CMS updated its technical implementation guide to the machine-readable file, a requirement of the Hospital Price Transparency Rule. The updated technical implementation guide—which contains data dictionaries, CSV...more

OIG Issues Favorable Advisory Opinion Concluding Bonuses to Employed Physicians Are Not Kickbacks

Earlier this month, OIG issued Advisory Opinion 23-07, a favorable opinion regarding an employer’s proposal to pay bonuses to its employed physicians based on net profits derived from certain procedures performed by the...more

D.C. Circuit Holds that Those “Entitled to Supplemental Security Income Benefits” Means Receiving Cash Payment for Hospital DSH...

Last week, the D.C. Circuit held that Medicare beneficiaries “entitled to supplemental security income [(SSI)] benefits under Title XVI of the Social Security Act” means only those patients receiving cash payments for...more

CMS Issues Civil Monetary Penalties for Hospital Price Transparency Non-Compliance

Last month, CMS issued three civil monetary penalty (CMP) notices for violations of the hospital price transparency regulations (HPT Rule), which requires hospitals to make public the standard charges of the items and...more

HHS Distributes $560 Million in Provider Relief Fund Payments

Last week, HHS announced the distribution of more than $560 million in Provider Relief Fund (PRF) Phase 4 General Distribution payments. These payments bring the Phase 4 distribution total to approximately $11.5 billion of...more

Provider Relief Fund Reporting Period 2 Now Open

The Provider Relief Fund (PRF) Reporting Portal opened for Reporting Period 2 on January 1, 2022. Recipients who received one or more General and/or Targeted PRF payments exceeding $10,000 in the aggregate from July 1, 2020...more

CARES Act Provider Relief Fund Updates

Last week, HHS announced the distribution of approximately $9 billion in CARES Act Provider Relief Fund (PRF) Phase 4 payments. The average payment for small providers is $58,000, for medium providers is $289,000, and for...more

HHS Releases New Frequently Asked Questions Regarding CARES Act Provider Relief Funds - October 2021

Last week, HHS released seven new and modified Frequently Asked Questions (FAQs) regarding payments distributed to providers via the CARES Act Provider Relief Fund. The FAQs cover a wide range of topics, including appealing...more

Biden Administration Issues Additional No Surprises Act Guidance in New Interim Final Rules

On September 30, 2021, the Biden Administration issued the second set of implementing regulations under the No Surprises Act. The interim final rules, issued by the Departments of Health and Human Services, Labor, and...more

CARES Act Provider Relief Fund Reporting Requirements Updates

On June 11, 2021, HHS published an updated Post-Payment Notice of Reporting Requirements (the Notice). Notably, the Notice describes how the period of availability of CARES Act Provider Relief Fund (PRF) payments is based on...more

King & Spalding Represents Medicaid Beneficiaries in a Suit to Challenge the Approval of the TennCare III Medicaid Demonstration...

On April 22, 2021, thirteen Medicaid beneficiaries, represented by the National Health Law Program, the Tennessee Justice Center, and King & Spalding, filed a complaint in the U.S. District Court for the District of Columbia...more

HHS Releases New Frequently Asked Questions Regarding CARES Act Provider Relief Funds - April 2021

Last week, HHS released eleven modified Frequently Asked Questions (FAQs) regarding payments distributed to providers via the CARES Act Provider Relief Fund. The FAQs cover audits and overpayments, sharing funds with...more

HHS Revokes Arkansas and New Hampshire Medicaid Work Requirements

On March 17, 2021, HHS notified Arkansas and New Hampshire officials that it was withdrawing its approval of demonstration projects which had permitted those states to impose work requirements as a condition for eligibility...more

Provider Relief Fund Updates: COVID-19 Relief Package and OMB 2020 Compliance Supplement Addendum

Last week, as reported in the December 21 Health Headlines, bipartisan congressional leaders announced they had reached an agreement on a COVID-19 relief package––which would be combined into one end of year legislative...more

HHS Releases New Frequently Asked Questions Regarding CARES Act Provider Relief Funds - December 2020

This month, HHS released over twenty new and modified Frequently Asked Questions (FAQs) regarding payments distributed to providers via the CARES Act Provider Relief Fund. The FAQs cover a wide range of topics, including...more

CMS Expands Flexibilities Under Hospital Without Walls Initiative

Last week, CMS announced additional flexibilities that expand its Hospital Without Walls initiative, which provides broad regulatory flexibility that allows hospitals to provide services in locations beyond their existing...more

HHS Expands Eligibility for Provider Relief Fund and Amends Reporting Requirements

On October 22, 2020, HHS expanded the Provider Relief Fund Phase 3 General Distribution eligibility pool to include residential treatment facilities, chiropractors, and eye and vision providers that had not yet received any...more

HHS Publishes General and Targeted Distribution Post-Payment Notice of Reporting Requirements

Under the Provider Relief Fund Terms and Conditions, each recipient is required to submit reports to HHS. This notice supplements HHS’ July 20, 2020 Post-Payment Notice of Reporting Requirements (previously reported on here)....more

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