In this episode, Darlene Davis, Leah Richardson, and Andrew Ruskin unravel CMS’s proposed rule for the remedy for Medicare payments for drugs purchased under the 340B Program and reimbursed as hospital outpatient services....more
In this episode of Triage, Andrew Ruskin, Darlene Davis, and Gabriel Scott discuss key provisions associated with conversion to CMS’s new rural emergency hospital provider type. They review the purpose of the new provider...more
BACKGROUND - As we noted in prior health care alerts in 2020, the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) significantly overhauled the federal law that governs the confidentiality of substance use...more
On 1 November 2022, the Centers for Medicare & Medicaid Services (CMS) published the 2023 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule (the OPPS Final...more
In this episode, Darlene Davis, Andrew Ruskin, and Lauren Norris Donahue review data that is now available in light of the hospital price transparency rule. They discuss the recent increase in compliance among hospitals,...more
On 1 November 2022, the Centers for Medicare & Medicaid Services (CMS) published the 2023 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule (the OPPS Final...more
On 26 July 2022, the Centers for Medicare & Medicaid Services (CMS) published the 2023 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System proposed rule (the OPPS Proposed...more
On 6 July 2022, the Centers for Medicare & Medicaid Services (CMS) published a rule proposing the Conditions of Participation (CoPs) for Medicare and Medicaid participation of rural emergency hospitals (REHs), to be codified...more
In this episode, Gabriel Scott and Darlene Davis analyze the private payor rates reporting requirements under the Protecting Access to Medicare Act. They discuss the type of entities required to report, potential penalties...more
SCOTUS Rules on Vaccine Mandates: (1) Blocks OSHA’s ETS and (2) Allows CMS Mandate to Go into Effect - On 13 January 2022, the United States Supreme Court issued two rulings on the challenges to the Occupational Safety and...more
UPDATE: Shortly after the publication of this alert on December 20, 2021, the United States Supreme Court announced that it will hear arguments on January 7, 2022 on both the Occupational Safety and Health Administration’s...more
12/24/2021
/ Biden Administration ,
Centers for Medicare & Medicaid Services (CMS) ,
Constitutional Challenges ,
Coronavirus/COVID-19 ,
Employer Liability Issues ,
Employer Mandates ,
Federal Contractors ,
Federal Employees ,
Healthcare Workers ,
Infectious Diseases ,
OSHA ,
Vaccinations ,
Workplace Safety
On 2 November 2021, the Centers for Medicare & Medicaid Services (CMS) released the 2022 Outpatient Prospective Payment System (OPPS)/Ambulatory Surgery Center (ASC) Payment System final rule (OPPS Final Rule), in which the...more
The Centers for Medicare & Medicaid Services (CMS) published an interim final rule with comment titled “Omnibus COVID-19 Health Care Staff Vaccination” (the IFC).1 The IFC establishes COVID-19 vaccination requirements for...more
In this week’s episode, Darlene Davis interviews Andrew Ruskin about updates to the CMS Hospital Price Transparency rule now that it has been in effect for almost one year. The presenters discuss the expanded scope of pricing...more
On 19 July 2021, the Centers for Medicare & Medicaid Services (CMS) released the 2022 Outpatient Prospective Payment System/Ambulatory Surgery Center Payment System proposed rule (OPPS Proposed Rule),1 which includes a...more
In this week’s episode, Darlene Davis, Andrew Ruskin, and Gabriel Scott discuss notable recent developments for reimbursement under the Hospital Outpatient Prospective Payment System (“OPPS”) of drugs purchased under the 340B...more
8/13/2020
/ Appeals ,
Centers for Medicare & Medicaid Services (CMS) ,
Covered Entities ,
Drug Pricing ,
Hospitals ,
Medical Reimbursement ,
Medicare ,
Medicare Part B ,
Medicare Payment Reform ,
Outpatient Prospective Payment System (OPPS) ,
Pharmaceutical Industry ,
Prescription Drugs ,
Proposed Rules ,
Section 340B ,
Statutory Authority ,
Statutory Interpretation
On 31 July 2020, the U.S. Court of Appeals for the District of Columbia Circuit (D.C. Circuit) upheld the U.S. Department of Health and Human Services’ (HHS) decision to allow the Centers for Medicare and Medicaid Services...more
INTRODUCTION - The U.S. Department of Health and Human Services (HHS) and its operating and staff divisions (HHS Divisions) have granted an unprecedented amount of regulatory flexibility to aid health care providers in their...more
On 11 May 2020, the Centers for Medicare & Medicaid Services (CMS) issued in pre-publication form the proposed rule for the Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals (IPPS) and the Long-Term Care...more
On 30 April 2020, the Centers for Medicare & Medicaid Services (CMS) released additional blanket waivers under Section 1135 of the Social Security Act and rules changes though an Interim Final Rule with Comment Period (IFC),...more
On April 27, 2020, the Department of Health and Human Services ("HHS") launched the COVID-19 Uninsured Program Portal, allowing health care providers who have conducted COVID-19 testing or provided treatment for Uninsured...more
On March 9, 2020, the Centers for Medicare and Medicaid Services (“CMS”) issued guidance to State Survey Agency Directors regarding Emergency Medical Treatment and Labor Act (“EMTALA”) requirements and implications related to...more
On November 15, 2019, the Centers for Medicare & Medicaid Services (“CMS”) issued a final rule that will require hospitals to make public a list of their standard charges for items and services furnished to patients starting...more
Summary -
On May 3, 2019, the Centers for Medicare & Medicaid Services (“CMS”) issued long-awaited draft guidance addressing compliance with the hospital Conditions of Participation (“CoPs”) and survey procedures in regard...more
On December 27, 2018, the U.S. District Court for the District of Columbia sided with the plaintiffs by granting a permanent injunction striking down the reimbursement cut for drugs purchased under the 340B Drug Discount...more