On July 10, the Centers for Medicare & Medicaid Services (CMS) released the Medicare Physician Fee Schedule Proposed Rule (Proposed Rule) for the calendar year 2025. The Proposed Rule would implement certain provisions of the...more
7/30/2024
/ Centers for Medicare & Medicaid Services (CMS) ,
Drug Treatment ,
FDA Approval ,
Food and Drug Administration (FDA) ,
Medicaid ,
Medicare ,
Opioid ,
Physician Fee Schedule ,
Popular ,
Proposed Rules ,
SAMHSA ,
Substance Abuse ,
Telemedicine
On January 18, 2024, the Centers for Medicare & Medicaid Services (CMS) announced a new innovation model designed to improve quality of care and behavioral and physical health outcomes for Medicaid and Medicare patients with...more
On November 2, 2023, the Centers for Medicare and Medicaid Services (CMS) issued its 2024 Physician Fee Schedule final rule (Final Rule) for calendar year 2024 that will, in part, implement some of the most important changes...more
Starting January 1, 2023, Medicare will cover telehealth-based treatment services delivered by federally-accredited opioid treatment programs (OTPs), commonly referred to as “methadone clinics.” This new reimbursement is...more
11/10/2022
/ Consolidated Appropriations Act (CAA) ,
DEA ,
Drug Treatment ,
Final Rules ,
Medicare ,
Opioid ,
Physician Fee Schedule ,
Public Health Emergency ,
Ryan Haight Act ,
SAMHSA ,
Social Security Act ,
Substance Abuse ,
Telehealth
Starting January 1, 2023, Medicare will expand and increase coverage of certain services and providers to advance access to prevention and treatment services for substance use disorders (SUD) and mental health services. These...more
In the 12-month period starting in April 2021, over 100,000 people have died from drug overdoses, a 28.5% increase from the same period the year before. While the opioid crisis has been a declared public health emergency...more
Medical groups that have division-based or service-level approaches to physician compensation should spend their summer evaluating their models in light of Stark Law revisions that go into effect on January 1, 2022. The...more
Payment misalignment in Medicare FFS for Substance Use Disorder (SUD) treatment as the subject of potential legislative and/or regulatory reforms -
New opportunities for investor-backed behavioral health platforms in...more
3/3/2021
/ Biden Administration ,
Coronavirus/COVID-19 ,
Drug Treatment ,
Medicaid ,
Medicare ,
Medicare Advantage ,
Medicare Part A ,
Medicare Part B ,
Medicare Part D ,
Mental Health Parity Rule ,
Opioid ,
Substance Abuse
On May 6, 2019, a federal district court held that the Department of Health and Human Services’ (HHS) 2018 and 2019 rate reductions for 340B Program participants, including safety net On May 6, 2019, a federal district court...more
5/22/2019
/ Appeals ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
Drug Pricing ,
Hospitals ,
Medicare ,
Outpatient Prospective Payment System (OPPS) ,
Pharmaceutical Industry ,
Prescription Drugs ,
Remand ,
Section 340B
Providers and suppliers who have been assessed overpayments for Medicare services are entitled, by statute, to a stay of recoupment while the provider or supplier’s appeal is pending – but only at the first two levels of...more
7/19/2018
/ Administrative Appeals ,
Administrative Law Judge (ALJ) ,
Centers for Medicare & Medicaid Services (CMS) ,
Due Process ,
Health Care Providers ,
Medicare ,
Medicare Provider Agreements ,
Overpayment ,
Physician Medicare Reimbursements ,
Recoupment ,
ZPIC