On April 11, 2025, the Centers for Medicare & Medicaid Services (CMS) issued the fiscal year (FY) 2026 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment...more
Under Medicare, a plethora of policies directly correlate to whether the patient or provider is located in an urban or rural area when the service is delivered. These policies range from rules that limit coverage of...more
On August 1, 2024, the Centers for Medicare & Medicaid Services (CMS) posted the Hospital Inpatient Prospective Payment System (IPPS) final update for fiscal year (FY) 2025, along with proposed policy and regulation changes....more
The Physician Practice Management (PPM) and ASC Symposium 2024 is the destination event for PPM and ASC industry leaders and health industry investors. Join us as we deliver actionable insights on the state of the market and...more
5/3/2024
/ Ambulatory Surgery Centers ,
Artificial Intelligence ,
Business Development ,
Business Opportunities ,
Continuing Legal Education ,
Events ,
Exit Strategies ,
Fraud and Abuse ,
Health Care Providers ,
Healthcare Facilities ,
Investment Banks ,
Investment Opportunities ,
Investors ,
Joint Venture ,
Medicare ,
Mental Health ,
Partnerships ,
Physicians ,
Prior Authorization ,
Privacy Laws ,
Private Equity ,
Private Equity Firms ,
Private Equity Funds ,
Reimbursements ,
Risk Management ,
Substance Abuse ,
Telehealth ,
Value-Based Care
It’s Thanksgiving week, so instead of eating eggs with your regs, you should sit back, relax and reflect on the regs you are thankful for as you eat your turkey legs (or whatever you enjoy on Thanksgiving). Many of the...more
11/21/2023
/ Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
Digital Health ,
Final Rules ,
Healthcare ,
Healthcare Reform ,
Inpatient Prospective Payment System (IPPS) ,
Medicare ,
Mental Health ,
New Legislation ,
New Regulations ,
No Surprises Act (NSA) ,
Outpatient Prospective Payment System (OPPS) ,
Physician Fee Schedule ,
Regulatory Agenda ,
Telehealth
On August 1, 2023, the Centers for Medicare & Medicaid Services (CMS) released the fiscal year (FY) 2024 Inpatient Prospective Payment System (IPPS) final rule. The rule updates Medicare payment policies and quality reporting...more
On July 7, 2023, the Centers for Medicare and Medicaid Services (CMS) released the proposed rule Hospital Outpatient Prospective Payment System: Remedy for 340B-Acquired Drugs Purchased in Cost Years 2018-2022 to address how...more
On April 26, 2023, the House Energy and Commerce Committee Health Subcommittee held a legislative hearing on 17 healthcare bills, including one that would direct the Centers for Medicare & Medicaid Services (CMS) to implement...more
Although we are still awaiting final results of the November 8, 2022, midterm elections, the US House of Representatives appears likely to flip to Republican control, while the US Senate will remain in Democratic hands....more
On March 10, 2021, US Congress finalized and passed the American Rescue Plan of 2021 (ARPA), the latest COVID-19 relief package that largely tracks President Joe Biden’s initial $1.9 trillion proposal. The ARPA extends...more
4/8/2021
/ American Rescue Plan Act of 2021 ,
Biden Administration ,
Budget Reconciliation ,
COBRA ,
Consolidated Appropriations Act (CAA) ,
Coronavirus/COVID-19 ,
Drug Pricing ,
Employee Benefits ,
Employer Group Health Plans ,
Families First Coronavirus Response Act (FFCRA) ,
FMAP ,
Health Insurance ,
Medicaid ,
Medicare ,
Minimum Wage ,
Paycheck Protection Program (PPP) ,
Prescription Drugs ,
Public Health Emergency ,
Relief Measures ,
Telehealth ,
Vaccinations
[co-authors: Mara McDermott and Katie Waldo, McDermott+Consultants]
This report from McDermott Will & Emery and McDermott+Consulting provides a detailed analysis of the latest Provider Relief Fund (PRF) distributions,...more
9/14/2020
/ Children's Health Insurance Program (CHIP) ,
Dental Practice ,
Department of Health and Human Services (HHS) ,
Fund Distribution ,
Health Care Providers ,
Hospitals ,
Indian Health Service (IHS) ,
Medicaid ,
Medicare ,
Nursing Homes ,
Provider Relief Fund ,
Rural Health Care Providers ,
Skilled Nursing Facility
Hospitals and health systems are facing consumer demand for innovation, the need to expand and enhance streams of revenue and the push for improved quality, all while navigating changing regulations, federal enforcement,...more
2/6/2020
/ Antitrust Litigation ,
Centers for Medicare & Medicaid Services (CMS) ,
CMIA ,
Cyber Attacks ,
Cybersecurity ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
Federal Trade Commission (FTC) ,
Health Care Providers ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Hospitals ,
Medicare ,
No-Poaching ,
OCR ,
Popular ,
Ransomware
The Centers for Medicare and Medicaid Services has released proposed updates to payment rates and regulations applicable to the Hospital Outpatient Prospective Payment System for Calendar Year 2020, including proposals...more
The US District Court for the District of Columbia recently held that the Centers for Medicare and Medicaid Services (CMS) exceeded its authority by reducing Medicare payment rates for 340B drugs, but, because of the...more
In St. Francis Medical Center v. Azar, 277 hospitals challenged Medicare payment decisions over the past two decades. This recent DC Circuit Court remand may open the door to hospitals receiving additional reimbursement from...more
On February 9, 2018 after a brief shutdown, Congress passed and President Trump signed the Bipartisan Budget Act of 2018, a two-year budget agreement that includes funding for the operation of the federal government until...more
As part of the CY 2018 proposed updates to the Medicare Hospital OPPS, the US Department of Health and Human Services has proposed to decrease Medicare Part B payments to hospitals for 340B drugs by almost 30 percent. The cut...more
Eric Zimmerman, along with McDermott+Consulting Vice Presidents Adaeze Enekwechi and Piper Su, wrote this +Insights publication detailing the possible effects of the Trump Administration's 2018 budget on health programs and...more
5/26/2017
/ Affordable Care Act ,
AHRQ ,
Centers for Disease Control and Prevention (CDC) ,
Children's Health Insurance Program (CHIP) ,
Department of Health and Human Services (HHS) ,
Health Insurance ,
Healthcare Reform ,
HRSA ,
Medicaid ,
Medicare ,
Repeal ,
Trump Administration
On December 7, 2016, the US Congress enacted the 21st Century Cures Act, substantial legislation intended to accelerate “discovery, development and delivery” of medical therapies by encouraging biomedical research investment,...more
1/21/2017
/ 21st Century Cures Act ,
Ambulatory Surgery Centers ,
Digital Health ,
Food and Drug Administration (FDA) ,
Health Care Providers ,
Health Information Technologies ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Hospitals ,
Long Term Care Facilities ,
Manufacturers ,
Medical Devices ,
Medicare ,
Medicare Advantage ,
MedPAC ,
Mental Health ,
Mental Health Parity Rule ,
National Institute of Health (NIH) ,
Off-Campus Departments ,
Opioid ,
Patients ,
Pharmaceutical Industry ,
Research and Development ,
Small Business ,
Substance Abuse ,
Telehealth ,
Transparency
The 21st Century Cures Act encourages biomedical research investment and facilitates innovation review and approval processes, but also serves as a vehicle for a wide variety of other health-related measures, including...more
It is vitally important for the health system board, as well as certain of its key committees, to receive an introductory briefing as soon as possible on the health policy implications of last week’s Presidential and...more
The Centers for Medicare & Medicaid Services released the calendar year 2017 final rule implementing changes to the Medicare hospital Outpatient Prospective Payment System, or OPPS, including provisions implementing Section...more
In Depth -
Background -
On July 6, 2016, the Centers for Medicare & Medicaid Services (CMS) released the CY 2017 Outpatient Prospective Payment System (OPPS) Proposed Rule, which includes proposed regulations to...more
7/12/2016
/ Ambulatory Surgery Centers ,
Bipartisan Budget Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Comment Period ,
Hospitals ,
Medicare ,
MPFS ,
Off-Campus Departments ,
OIG ,
OPPS ,
Payment Systems ,
Physician Fee Schedule ,
Proposed Rules ,
Section 340B
In Depth -
On April 27, the Centers for Medicare and Medicaid Services (CMS) unveiled the much-anticipated (and, for some, feared) proposal to implement the physician payment reforms required under the Medicare Access to...more
In Depth -
The House Ways and Means Committee next week is expected to consider and approve the Helping Hospitals Improve Patient Care Act of 2016, legislation that would create broader exceptions under much maligned...more