Alek Pivec

Alek Pivec

King & Spalding

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CMS Solicits Comments on Improving Medicare Advantage Data Transparency

On January 25, 2024, CMS released a Request for Information (RFI) seeking public input on how it can enhance and increase transparency of Medicare Advantage (MA) data. CMS says that the RFI “builds on our existing MA data...more

2/1/2024  /  Centers for Medicare & Medicaid Services (CMS) , GAO , Medicaid , Medicare , Medicare Advantage , MedPAC , OIG , Request For Information , Transparency , Value-Based Payments

CMS Issues Guidance for Medicare Contractors to Pay For Section 1115 Day

On March 16, 2023, CMS issued Change Request 12669, which contains instructions for Medicare Administrative Contractors (MACs) to begin the process of retroactively reimbursing DSH hospitals for inpatient days attributable to...more

3/22/2023  /  Centers for Medicare & Medicaid Services (CMS) , Medicaid , Medicare , Medicare Administrative Contractors (MAC) , New Guidance

CMS Proposes for the Third Time to Exclude Section 1115 Uncompensated Care Pool Days from Medicare DSH

On February 24, 2023, CMS issued a proposed rule that would modify the Medicare Disproportionate Share Hospital (DSH) payment regulation to limit the universe of Section 1115 demonstration beneficiaries who can be “regarded...more

3/1/2023  /  Appeals , Centers for Medicare & Medicaid Services (CMS) , DSH , EHB , Insurance Industry , Medicaid , Medicare , Proposed Rules

CMS Reworks the Medicare Cost Report for Hospitals

On December 29, 2022, CMS posted on its website Transmittal 18, which implements sweeping changes to the Medicare cost report for hospitals and its accompanying instructions. The revisions affect nearly every facet of...more

1/23/2023  /  Appeals , Centers for Medicare & Medicaid Services (CMS) , Coronavirus/COVID-19 , Debt , Medicaid , Medicare , Provider Relief Fund , Reimbursements

CMS Reverses Approval of Work Requirements and Premiums for Georgia Medicaid

On December 23, 2021, CMS announced that it was rescinding its prior approval of the Georgia Pathways to Coverage demonstration project, which would have required Georgia residents to work as a condition of Medicaid...more

1/4/2022  /  Centers for Medicare & Medicaid Services (CMS) , Executive Orders , Georgia , Medicaid

CMS Issues Medicare IPPS and LTCH Proposed Rule for FY 2021

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

CMS Issues Medicare IPPS and LTCH Final Rule for FY 2021

On September 2, 2020, CMS issued the fiscal year (FY) 2021 final rule for the hospital inpatient prospective payment system (IPPS) and long-term care hospital (LTCH) prospective payment system (the Final Rule). This article...more

9/11/2020  /  Bad Debt , Centers for Medicare & Medicaid Services (CMS) , DSH , Dual Eligibility , EHR , Final Rules , Financial Assistance Policies , Graduate Medical Education , Inpatient Prospective Payment System (IPPS) , Long Term Care Facilities , Medicaid , Medical Reimbursement , Medicare , Medicare Advantage , Patient Prospective Payment System

Proposed Budget Would Cut Medicare and Medicaid Funding in FY 2021

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

2/24/2020  /  Budget Cuts , Federal Budget , Federal Funding , Health Care Providers , Health Insurance , Hospitals , Medicaid , Medicare , Physicians , Trump Administration

Florida Hospitals Prevail in Litigation Challenging the Exclusion of Low Income Pool Days from the Medicare Disproportionate Share...

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

7/31/2019  /  Centers for Medicare & Medicaid Services (CMS) , Disproportionate Share Adjustments , Hospitals , Inpatient Billing , Medicaid , Medicare

Fifth Circuit Orders CMS to Count Mississippi Hospitals’ UCCP Days in the Medicaid Fraction of the Medicare DSH Payment Formula

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

7/8/2019  /  Appeals , Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Hospitals , Medicaid , Medicare , Social Security Act

CMS Begins Audits of Worksheet S-10 for FY 2015 Cost Reports

In the Inpatient Prospective Payment System (IPPS) rulemaking for fiscal year (FY) 2019, the Centers for Medicare and Medicare Services (CMS) announced that it would begin auditing the charity care and bad debt costs...more

10/10/2018  /  Audits , Centers for Medicare & Medicaid Services (CMS) , Inpatient Prospective Payment System (IPPS) , MACs , Medicaid , Medicare
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