Amy O'Neill on Centers for Medicare & Medicaid Services (CMS)

CMS Lifts COVID-19 Vaccine Requirements for Long Term Care Facilities

On May 31, 2023, CMS issued a final rule (Final Rule) repealing COVID-19 vaccination requirements for staff and testing requirements for staff and patients of long-term care (LTC) facilities. These were previously required...more

6/8/2023 / Centers for Medicare & Medicaid Services (CMS) , Coronavirus/COVID-19 , Department of Health and Human Services (HHS) , Final Rules , Interim Final Rules (IFR) , Long Term Care Facilities , Medicaid , Medicare , Public Health Emergency

HHS Publishes Ownership Data for Hospice and Home Health Agencies

On April 20, 2023, HHS announced that it is releasing ownership data for all Medicare-certified hospice and home health agencies not previously available to the public in this way. There are more than 6,000 hospices and...more

4/26/2023 / Acquisitions , Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Enforcement , Home Health Agencies , Hospice , Medicare

U.S. Supreme Court Will Not Review D.C. Circuit Court’s Revival of False Claims Act Liability for Medicare Advantage Plans Failing...

On June 21, 2022, the Supreme Court denied certiorari in the case of UnitedHealthcare Co., et al v. Becerra et al., Case No. 21-1140, wherein UnitedHealthcare attempted to overturn the D.C. Circuit Court’s revival of CMS’s...more

7/6/2022 / Centers for Medicare & Medicaid Services (CMS) , False Claims Act (FCA) , Medicare Advantage , Overpayment , SCOTUS , UnitedHealth

CMS Releases Final Rule Regarding Payment Policies under the Physician Fee Schedule and Several Other Changes to Medicare Part B...

Last week, CMS issued a final rule addressing several topics, including changes to the physician fee schedule (PFS) and changes to Medicare Part B payment policies. Key changes include a net reduction in the PFS conversion...more

11/16/2021 / ACOs , Centers for Medicare & Medicaid Services (CMS) , Coronavirus/COVID-19 , Final Rules , Medicare Part B , Medicare Shared Savings Program , Payment Systems , Physician Fee Schedule , Public Health Emergency , Telehealth , Vaccinations

OIG Audit Alleges that CMS Made $1.9 Million in Overpayments for Chronic Care Management Services During 2017 and 2018

In a report issued by OIG in August of 2021, OIG alleged that for Chronic Care Management (CCM) services, “providers billed for and received overpayments totaling $1,918,278, and beneficiaries were required to pay a total of...more

8/18/2021 / Audits , Centers for Medicare & Medicaid Services (CMS) , Chronic Care Managment (CCM) , Medicare , OIG

CMS Issues New Rule Imposing Education About, and Access to, COVID-19 Vaccines and Reporting Requirements for Nursing Home and...

On May 11, 2021, CMS issued an interim final rule requiring that nursing homes and other congregate care facilities: (1) educate all residents and staff about COVID-19 vaccines; (2) offer COVID-19 vaccines to all residents...more

5/19/2021 / Centers for Disease Control and Prevention (CDC) , Centers for Medicare & Medicaid Services (CMS) , Coronavirus/COVID-19 , Interim Final Rules (IFR) , Medicaid , Medicare , Nursing Homes , Reporting Requirements , Vaccinations

Court of Appeals Upholds CMS Rule Requiring Public Disclosure of Prices Negotiated Between Hospitals and Insurance Companies

On December 29, 2020, the U.S. Court of Appeals for the District of Columbia Circuit upheld a CMS final rule promulgated in November 2019 that requires hospitals to disclose various forms of pricing information related to the...more

1/7/2021 / Affordable Care Act , American Hospital Association , Appeals , Centers for Medicare & Medicaid Services (CMS) , Hospitals , Insurance Industry , Medicare , PHSA , Price Transparency , Pricing , Public Disclosure , Reimbursements , Secretary of HHS

OIG’s Interactive Map Displaying Details on Nursing Home Complaint Trends Has Been Updated with Data from 2016, 2017, and 2018

OIG recently updated its interactive map that displays details on nursing home complaint trends to incorporate data from 2016 through 2018. OIG had previously conducted a study and published an interactive map showing...more

10/31/2019 / Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Nursing Homes , OIG , Surveys

Victory for Hospitals as Judge Rules that CMS’s Reduction of Medicare Payments for Outpatient E&M Services Was Ultra Vires

On September 17, 2019, U.S. District Judge Rosemary M. Collyer of the U.S. District Court for the District of Columbia awarded summary judgment in favor a group of more than 40 hospitals on their challenge to CMS’s decision...more

9/28/2019 / Administrative Procedure Act , American Hospital Association , Centers for Medicare & Medicaid Services (CMS) , Congressional Intent , Exhaustion Doctrine , Health Care Providers , Hospitals , Judicial Review , Lack of Authority , Medicare , Medicare Payment Reform , Off-Campus Departments , Outpatient Prospective Payment System (OPPS) , Provider Payments , Summary Judgment , Ultra Vires

Provider Reimbursement Review Board Seeks Input on Board Rules

On March 18, 2019, the Provider Reimbursement Review Board (PRRB) announced that it is inviting comments, suggestions, and other feedback in connection with five topic areas: (1) continued implementation and improvement of...more

4/12/2019 / Centers for Medicare & Medicaid Services (CMS) , Comment Period , Health Care Providers , Hospitals , Medicare , Provider Reimbursement Review Board

American Hospital Association and Others File Second Lawsuit Contesting Medicare Rate Cut for 340B Discount Drugs

On September 5, 2018, the American Hospital Association, the Association of American Medical Colleges, America’s Essential Hospitals, Eastern Maine Healthcare Systems, Henry Ford Health System, and Fletcher Hospital, Inc....more

9/11/2018 / Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Hospitals , Medicare , Outpatient Prospective Payment System (OPPS) , Section 340B

CMS Announces Proposed Rule to Revise the Medicare Shared Savings Program

On August 9, 2018, CMS issued a proposed rule for restructuring the Medicare Shared Savings Program (Shared Savings Program) which would, among other things, change the participation options available under the program for...more

8/15/2018 / ACOs , Centers for Medicare & Medicaid Services (CMS) , Fee-for-Service , Medicare , Medicare Shared Savings Program

CMS Announces Proposed Calendar Year 2019 Physician Fee Schedule with Significant Focus on Streamlining Documentation Processes...

On July 12, 2018, CMS released the unpublished version of the Calendar Year (CY) 2019 Proposed Physician Fee Schedule (PFS). The CY 2019 Proposed PFS reflects a response by CMS to stakeholder feedback regarding the need to...more

7/17/2018 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Medicaid , Medicare , Physician Fee Schedule , Physicians

Insurers Not Entitled to Full ACA Risk Corridors Payments Says the United States Court of Appeals for the Federal Circuit

Resolving a split in the lower courts, the Federal Circuit issued two decisions on June 14, 2018, wherein the Court held that health insurers Moda Health Plan Inc. (Moda Health) and Land of Lincoln Mutual Health (Land of...more

6/21/2018 / Affordable Care Act , Appropriations Bill , Centers for Medicare & Medicaid Services (CMS) , Health Insurance , Premiums , Risk Adjustment Formula , Secretary of HHS

D.C. Circuit Upholds CMS’s Outlier Reconciliation Process Finding Notice and Comment Rulemaking Was Not Required

On December 26, 2017, the United States Court of Appeals for the District of Columbia Circuit overturned a summary judgment decision of the District Court and held that the provisions of the 2010 Medicare Claims Processing...more

1/4/2018 / Centers for Medicare & Medicaid Services (CMS) , MACs , Medicare , Summary Judgment

CMS Extends Deadline for Providers to Submit an Initial or Revised Worksheet S-10 for FYs 2014 and 2015 until January 2, 2018

Following a second update in less than a year to the instructions for completing Worksheet S-10, CMS has now also provided a further extension for providers to file an initial or revised Worksheet S-10, which is used by...more

11/1/2017 / Centers for Medicare & Medicaid Services (CMS) , DSH , Hospitals , Inpatient Prospective Payment System (IPPS) , Medicare Administrative Contractors (MAC)

Amy O'Neill

King & Spalding

Popular Topics by This Author

Latest Posts › Centers for Medicare & Medicaid Services (CMS)