On July 27, 2023, CMS issued a final rule (Final Rule) which revises Medicare policies and rates for the Inpatient Psychiatric Facility (IPF) Prospective Payment System (PPS) for the 2024 fiscal year (FY 2024). Among other...more
Earlier this month, CMS issued a pair of proposed rules to update reimbursement for home health and end-stage renal disease services. The CY 2023 Home Health Prospective Payment System (HH PPS) rate update proposed rule (the...more
n January 6, 2022, CMS published a proposed rule (Proposed Rule) which would revise Medicare Advantage (Part C) and Medicare Prescription Drug Benefit (Part D) regulations. CMS simultaneously released a fact sheet (Fact...more
Last week, President Biden presented an outline of a $1.75 trillion Build Back Better (BBB) social spending reconciliation framework resulting from months of negotiations with House and Senate Democrats. Congressional...more
11/3/2021
/ Affordable Care Act ,
Biden Administration ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
Department of Veterans Affairs ,
Federal Poverty Line ,
FMAP ,
Healthcare ,
Healthcare Reform ,
Home and Community Based Services (HCBS) ,
Long Term Care Facilities ,
Medicaid ,
Medicare ,
Mental Health ,
Nursing Homes
On September 29, 2021, OIG issued Advisory Opinion No. 21-13 analyzing a proposal for a clinical study that would involve subsidizing Medicare beneficiaries’ cost-sharing obligations in connection with a clinical study...more
On September 15, 2021, CMS published a proposed rule to repeal a final rule that would have allowed Medicare to automatically cover certain medical devices as soon as they receive FDA approval (the Proposed Rule). The final...more
On Friday of last week, HHS published two long-awaited final rules implementing significant changes to the regulations under the Stark Law and Anti-Kickback Statute (AKS). The two final rules are: (i) Revisions to the Safe...more
11/30/2020
/ Anti-Kickback Statute ,
Centers for Medicare & Medicaid Services (CMS) ,
Cybersecurity ,
Department of Health and Human Services (HHS) ,
DMEPOS ,
Electronic Health Record Incentives ,
Fee-for-Service ,
Final Rules ,
Medical Devices ,
OIG ,
Popular ,
Safe Harbors ,
Self-Referral ,
Stark Law ,
Value-Based Care
n November 1, 2019, CMS posted the final rule establishing the payment rates for the Hospital Outpatient Prospective Payment System (OPPS) and the Ambulatory Surgery Center (ASC) Payment System for calendar year (CY) 2020...more
11/15/2019
/ Ambulatory Surgery Centers ,
Appeals ,
Centers for Medicare & Medicaid Services (CMS) ,
Final Rules ,
Food and Drug Administration (FDA) ,
Health Care Providers ,
Hospitals ,
Inpatient Prospective Payment System (IPPS) ,
Lack of Authority ,
Medical Devices ,
Medicare ,
Off-Campus Departments ,
Outpatient Prospective Payment System (OPPS) ,
Payment Rates ,
Prescription Drugs ,
Price Transparency ,
Prior Authorization ,
Provider Payments ,
Rural Health Care Providers ,
Section 340B
On August 22, 2019, the United States District Court for the District of Columbia held that CMS had unlawfully changed its “must-bill” policy, without going through notice-and-comment rulemaking, when it denied bad-debt...more
On November 1, 2018, CMS issued a final rule (“Final Rule”) which finalizes numerous changes to the Medicare Physician Fee Schedule (“PFS”), the Quality Reporting Program, and the Medicare Shared Savings Program (“MSSP”). ...more
On April 24, 2018, CMS issued the annual Hospital Inpatient Prospective Payment System (IPPS) and Long Term Acute Care Hospital (LTCH) Prospective Payment System (PPS) Proposed Rule for FY 2019 (the Proposed Rule) which will...more
On October 14, 2016, CMS issued its Final Rule for the new physician payment system under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). MACRA replaced the Medicare Sustainable Growth Rate (SGR) with a new...more
10/25/2016
/ Alternative Payment Models (APM) ,
Centers for Medicare & Medicaid Services (CMS) ,
EHR ,
Final Rules ,
Medicare ,
Medicare Access and CHIP Reauthorization (MACRA) ,
Medicare Part B ,
MIPS ,
Payment Systems ,
Physician Payments ,
Physicians ,
PQRS ,
Quality Payment Program (QPP) ,
Sustainable Growth Rate (SGR) ,
Value-Based Payments
On September 8, 2016, CMS issued its Final Rule establishing requirements for hospitals and other providers and suppliers to plan and prepare for natural and man-made disasters. CMS explained that it is adopting the new...more
On August 17, 2016 the United States District Court for the District of Columbia granted summary judgment in favor of HHS in a dispute over whether Part C days can be treated as “days entitled to benefits under Part A” for...more
8/25/2016
/ Arbitrary and Capricious ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
Disproportionate Share Adjustments ,
Hospitals ,
Managed Care Contracts ,
Medicare ,
Medicare Part A ,
Medicare Part C ,
Notice and Comment ,
Summary Judgment