Last week, the Supreme Court issued its opinion in Advocate Christ Medical Center v. Kennedy, siding with the government and holding that, for purposes of the Medicare disproportionate share hospital (DSH) calculation,...more
5/9/2025
/ Becerra Secretary Of Health And Human Services v Empire Health Foundation For Valley Hospital Medical Center ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
Government Agencies ,
Healthcare ,
Healthcare Facilities ,
Hospitals ,
Medicaid ,
Medicare ,
Payment Systems ,
SCOTUS ,
Statutory Interpretation ,
Supplemental Security Income (SSI)
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
4/22/2025
/ Centers for Medicare & Medicaid Services (CMS) ,
Healthcare ,
Healthcare Facilities ,
Hospitals ,
Inpatient Prospective Payment System (IPPS) ,
Long-Term Care ,
Medicare ,
Payment Systems ,
Proposed Rules ,
Prospective Payment System (PPS) ,
Regulatory Agenda ,
Regulatory Requirements ,
Rulemaking Process
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
3/31/2025
/ Audits ,
Centers for Medicare & Medicaid Services (CMS) ,
Government Agencies ,
Healthcare ,
Healthcare Fraud ,
Hospitals ,
Medicare ,
Medicare Administrative Contractors (MAC) ,
OIG ,
Regulatory Oversight ,
Reimbursements
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
4/17/2024
/ Centers for Medicare & Medicaid Services (CMS) ,
Consolidated Appropriations Act (CAA) ,
Food and Drug Administration (FDA) ,
Graduate Medical Education ,
Inpatient Prospective Payment System (IPPS) ,
Long Term Care Facilities ,
Manufacturers ,
Medicare ,
Payment Systems ,
Proposed Rules ,
Prospective Payment System (PPS) ,
Provider Reimbursement Review Board ,
Supply Chain ,
Supply Shortages
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
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
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
On April 27, 2021, CMS issued the fiscal year (FY) 2022 proposed rule for the hospital inpatient prospective payment system (IPPS) and long-term care hospital (LTCH) prospective payment system (the Proposed Rule). Among...more
5/10/2021
/ ACOs ,
American Rescue Plan Act of 2021 ,
Bad Debt ,
CARES Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Children's Health Insurance Program (CHIP) ,
Consolidated Appropriations Act (CAA) ,
Coronavirus/COVID-19 ,
Graduate Medical Education ,
Hospitals ,
Inpatient Prospective Payment System (IPPS) ,
Interim Final Rules (IFR) ,
Long-Term Care ,
Medicaid ,
Medicare ,
Medicare Advantage ,
Medicare Part A ,
Medicare Shared Savings Program ,
Proposed Rules ,
Public Health Emergency ,
Rural Health Care Providers
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
12/28/2020
/ CARES Act ,
Children's Health Insurance Program (CHIP) ,
Commercial Insurance Policies ,
Coronavirus/COVID-19 ,
Department of Health and Human Services (HHS) ,
Food and Drug Administration (FDA) ,
Medicaid ,
Medicare ,
Paycheck Protection Program (PPP) ,
Payment Systems ,
Provider Relief Fund ,
Reimbursements ,
SBA
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
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
On September 1, 2020, HHS announced that assisted living facilities (ALFs) that do not bill Medicare or Medicaid may now apply for funding under the Provider Relief Fund Phase 2 General Distribution allocation. HHS has...more
Last week, HHS announced that it will now accept additional applicants for the Provider Relief Fund Phase 2 General Distribution. All eligible providers will only receive funding of up to 2 percent of their reported total...more
Following President Trump’s declaration of a national emergency related to COVID-19 on March 13, 2020, CMS has been swiftly approving states’ requests for flexibilities for their Medicaid programs as they continue to battle...more
On November 25, 2019, CMS released a Request for Application (RFA) describing how organizations can apply to participate in two of three Direct Contracting Model options. The Direct Contracting Model is a set of voluntary...more