On February 9, 2024, Judge Trevor McFadden of the United States District Court for the District of Columbia issued a decision holding that CMS miscalculated the Medicare reimbursement owed to five plaintiff hospitals for the...more
On July 13, 2023, CMS published a proposed rule to update the payment policies, payment rates, and other provisions for services furnished under the Medicare Outpatient Prospective Payment System (OPPS) and the Ambulatory...more
On July 1, 2022, CMS issued a proposed rule in which the agency proposes to update and potentially liberalize the distance rules applicable to Critical Access Hospitals (CAHs) as well as procedures for monitoring the...more
On April 18, 2022, CMS issued its annual Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System Proposed Rule for FY 2023 (the Proposed Rule). In the Proposed Rule,...more
4/27/2022
/ Affordable Care Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Hospitals ,
Inpatient Prospective Payment System (IPPS) ,
Long-Term Care ,
Medicare ,
Medicare Advantage ,
Payment Rates ,
Proposed Rules ,
Rulemaking Process ,
Wage Index
On August 2, 2021, CMS published the Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) final rule for federal fiscal year (FY) 2022. The final...more
8/10/2021
/ Centers for Medicare & Medicaid Services (CMS) ,
Coronavirus/COVID-19 ,
Health Care Providers ,
Healthcare Facilities ,
Healthcare Workers ,
Hospitals ,
Inpatient Prospective Payment System (IPPS) ,
Long Term Care Facilities ,
Medicare ,
Medicare Advantage ,
Prospective Payment System (PPS) ,
Reporting Requirements ,
Vaccinations ,
Wage Index
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
On February 10, 2020, the White House unveiled its proposed budget (the Budget) for FY 2021, which would decrease funding for HHS by 10 percent. Medicare and Medicaid would bear the brunt of these cuts. For both programs...more
On January 10, 2020, the U.S. Government Accountability Office (GAO) issued a report claiming that the Health Resources and Services Administration (HRSA) does not use adequate controls to confirm the eligibility of private...more
n November 1, 2019, CMS posted the final rule establishing the payment rates for the Hospital Outpatient Prospective Payment System (OPPS) and the Ambulatory Surgery Center (ASC) Payment System for calendar year (CY) 2020...more
11/15/2019
/ Ambulatory Surgery Centers ,
Appeals ,
Centers for Medicare & Medicaid Services (CMS) ,
Final Rules ,
Food and Drug Administration (FDA) ,
Health Care Providers ,
Hospitals ,
Inpatient Prospective Payment System (IPPS) ,
Lack of Authority ,
Medical Devices ,
Medicare ,
Off-Campus Departments ,
Outpatient Prospective Payment System (OPPS) ,
Payment Rates ,
Prescription Drugs ,
Price Transparency ,
Prior Authorization ,
Provider Payments ,
Rural Health Care Providers ,
Section 340B
On September 25, 2019, the United States Court of Appeals for the Eleventh Circuit affirmed a lower court’s decision to deny a motion for a preliminary injunction to stay the implementation of the new policy for allocating...more
10/4/2019
/ Amended Rules ,
Appeals ,
Department of Health and Human Services (HHS) ,
Health Care Providers ,
Hospitals ,
Injunctive Relief ,
Likelihood of Success ,
Motion To Stay ,
Organ Transplant Centers ,
Preliminary Injunctions ,
Remand
On July 23, 2019, Judge Rosemary Collyer of the United States District Court for the District of Columbia issued an opinion ruling in favor of ten Florida hospitals in their case challenging the calculation of their Medicare...more
In a ruling dated June 10, 2019, the United States Court of Appeals for the Fifth Circuit sided with Mississippi hospitals in a dispute over the calculation of the Medicare DSH payment. Forrest General Hospital v. Azar, No....more
On April 23, 2019, CMS issued its annual Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System Proposed Rule for FY 2020 (the Proposed Rule), which will affect...more
4/30/2019
/ Centers for Medicare & Medicaid Services (CMS) ,
Comment Period ,
Graduate Medical Education ,
Health Care Providers ,
Healthcare ,
Hospitals ,
Inpatient Prospective Payment System (IPPS) ,
Long Term Care Facilities ,
Medicare ,
Proposed Rules ,
Quality Payment Program (QPP) ,
Regulatory Requirements
The display copy of the proposed rulemaking for the FY 2020 Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS) was posted on the Federal Register website last week (the Proposed Rule). The IPF PPS pays...more
Last week, the United States Court of Appeals for the Eighth Circuit issued a consolidated opinion for three cases in which it upheld the methodology that CMS used to calculate the volume decrease adjustment (VDA) for...more
In early December, CMS posted on its website a second round of FAQs about the price transparency guidelines the agency adopted earlier this year in the inpatient prospective payment system (IPPS) rulemaking for federal...more
The United States Court of Appeals for the District of Columbia Circuit recently held in Saint Francis Medical Center v. Azar that Medicare’s reopening regulation, which prohibits providers from seeking to revise payment...more
For the second time in less than one year, CMS has updated its instructions for completing Worksheet S-10 of the Medicare cost report for hospitals. The new instructions expand the definition of charity care, as reported in...more
Hospitals may seek redesignation to a neighboring core-based statistical area for wage index purposes under the rules that set forth the geographic reclassification process. See 42 C.F.R. § 412.230 et seq. Those rules...more