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340B Update: D.C. District Court Overturns OPPS 340B Reimbursement Cut for CY 2018

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

CMS Issues Final Medicare PFS Rule for CY 2019

On November 1, 2018, the Centers for Medicare and Medicaid Services (CMS) released in pre-publication form the Medicare Physician Fee Schedule (PFS) Final Rule for Calendar Year (CY) 2019 (PFS Final Rule)....more

CMS Issues CY 2019 OPPS Final Rule

On November 2, 2018, the Centers for Medicare & Medicaid Services (“CMS”) issued in pre-publication format the final rule for the Medicare Hospital Outpatient Prospective Payment System (“OPPS”) and the Medicare Ambulatory...more

CMS Issues Proposed Medicare PFS Rule for CY 2019

On July 27, 2018, the Medicare Physician Fee Schedule (PFS) Proposed Rule for Calendar Year (CY) 2019 (PFS Proposed Rule) was published in the Federal Register....more

CMS Issues Proposed OPPS Rule for CY 2019

On July 31, 2018, the Centers for Medicare & Medicaid Services (“CMS”) published a proposed rule for the Medicare Hospital Outpatient Prospective Payment System (“OPPS”) and the Medicare Ambulatory Surgical Center payment...more

K&L Gates Triage: Proposed Changes to the Federal Satellite Facility Rules

The Centers for Medicare & Medicaid Services (“CMS”) recently proposed certain changes to the existing satellite facility rules in its Inpatient Prospective Payment System (“IPPS”) and Long Term Acute Care Hospital (“LTCH”)...more

U.S. District Court Upholds CMS’s Application of the Statutory Requirement that Hospitals Be “Primarily Engaged” in Providing...

On January 25, 2018, the U.S. District Court for the Eastern District of Pennsylvania granted summary judgment in favor of the Centers for Medicare & Medicaid Services (“CMS”) following an eye hospital’s appeal of the...more

Medicare Diabetes Prevention Program Enrollment is Now Open

As of January 1, 2018, the Centers for Medicare & Medicaid Services (“CMS”) began enrolling suppliers in its new Medicare Diabetes Prevention Program (“MDPP”). If successfully enrolled prior to April 1, 2018, MDPP suppliers...more

340B Update for Hospitals: CMS Publishes FAQs Clarifying Use of Modifiers in Connection with 340B Program Reimbursement Cut on...

On December 13, 2017, the Centers for Medicare & Medicaid Services (“CMS”) published subregulatory guidance to answer questions about billing for drugs acquired through the 340B Drug Pricing Program (“340B Program”)...more

CMS Finalizes Changes in CY 2018 OPPS and PFS Final Rules

On November 1, 2017, the Centers for Medicare & Medicaid Services (“CMS”) released its final rule with comment period revising the Medicare Hospital Outpatient Prospective Payment System (“OPPS”) and the Medicare Ambulatory...more

CMS Proposes Substantial Payment Reductions in CY 2018 for Off-Campus Hospital Outpatient Departments Subject to the Site-Neutral...

On July 20 and 21, 2017, respectively, the Centers for Medicare & Medicaid Services (“CMS”) released a proposed rule addressing changes to the hospital Outpatient Prospective Payment System (“OPPS Proposed Rule”) and Medicare...more

CMS Finalizes Rule Establishing New Emergency Preparedness Requirements

As clean-up efforts continue in the wake of Hurricane Matthew, companies in North Carolina, South Carolina, Georgia, Florida, and throughout the Southeast are focused on the importance of emergency preparedness in ensuring...more

CMS Announces Final Rule Implementing Site-Neutral Payment Rule for Certain Off-Campus Hospital Outpatient Provider-Based...

On November 1, 2016, the Centers for Medicare & Medicaid Service (“CMS”) released the pre-publication form of its much-anticipated Hospital Outpatient Prospective Payment System (“OPPS”) CY 2017 final rule with comment period...more

CMS Releases Details on Site-Neutral Payment Provision under Bipartisan Budget Act

On July 6, the Centers for Medicare and Medicaid Services (“CMS”) released the Medicare hospital outpatient prospective payment system (“OPPS”) and the Medicare ambulatory surgical center (“ASC”) payment system proposed rule...more

Disclosure of Substance Use Disorder Records Enters the 21st Century: SAMHSA Proposes Changes to Part 2, But Do They Go Far...

Background - As many health care practitioners, health information management professionals, and health lawyers know, balancing patients’ privacy interests with the need to access accurate, up-to-date medical information can...more

New Law Excludes New Provider-Based Off-Campus Outpatient Hospital Locations from OPPS

On November 2, 2015, President Barack Obama signed into law a bill that significantly changes how Medicare pays for outpatient services furnished at certain hospital locations. The Bipartisan Budget Act of 2015 (“BBA”)...more

Non-Stark Law Proposed Changes to Policies and Payments under the Physician Fee Schedule for CY 2016

On July 15, 2015, the Centers for Medicare and Medicaid Services (“CMS”) published proposed regulations governing policies and payments made under the Physician Fee Schedule (“PFS”) for calendar year 2016 (the “Proposed...more

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