Leigh Feldman on Medicare

FY 2026 Proposed Rules Are Out! Overview of the IPPS Proposed Rule

Last Friday, the Centers for Medicare & Medicaid Services (CMS) officially launched the health policy community into reg season, releasing in one fell swoop all the fiscal year (FY) 2026 Medicare proposed regulations for...more

4/17/2025 / Centers for Medicare & Medicaid Services (CMS) , Deregulation , Healthcare , Healthcare Facilities , Healthcare Reform , Hospitals , Medicare , Proposed Rules , Regulatory Reform , Regulatory Requirements , Rulemaking Process , Trump Administration

CMS Releases FY 2026 Hospital Inpatient Prospective Payment System (IPPS) Proposed Rule

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

4/16/2025 / Centers for Medicare & Medicaid Services (CMS) , Healthcare , Healthcare Facilities , Hospitals , Medicare , Payment Systems , Proposed Legislation , Proposed Rules , Regulatory Requirements , Reporting Requirements

Game On! 2026 Medicare Fee-for-Service Rulemaking Is About to Tip Off

Game On! 2026 Medicare Fee-for-Service Rulemaking Is About to Tip Off - It’s March, which means one thing for sports fans: the madness of the NCAA men’s and women’s basketball tournaments. However, to folks in the...more

3/27/2025 / Centers for Medicare & Medicaid Services (CMS) , Final Rules , Healthcare , Healthcare Reform , Hospitals , Medicare , Proposed Rules , Regulatory Agenda , Regulatory Reform , Regulatory Requirements , Trump Administration

Price Transparency: A Regulatory Priority

The Trump administration is beginning to lay out its regulatory (and deregulatory) priorities, and on February 25, 2025, the administration spotlighted one of those priorities in an executive order on price transparency....more

3/6/2025 / Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Enforcement Actions , Executive Orders , Health Care Providers , Medicare , Price Transparency , Regulatory Agenda , Rulemaking Process , Trump Administration

Healthcare Policy Options to Reduce the Deficit

The Trump Administration and 119th Congress will likely be targeting trillions of dollars in savings in the year ahead. Healthcare makes up a significant portion of mandatory spending and therefore likely will be a large part...more

1/24/2025 / Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Federal Budget , Healthcare , Healthcare Reform , Medicaid , Medicare , Medicare Advantage , Medicare Payment Reform , MedPAC , Section 340B , Trump Administration

Virtual Care Policy Update: What to Expect in Lame Duck

The Consolidated Appropriations Act (CAA), 2023 (Public Law 117-328), signed into law on December 29, 2022, extended certain key virtual care flexibilities instituted during the COVID-19 public health emergency (PHE) through...more

11/12/2024 / Consolidated Appropriations Act (CAA) , Controlled Substances , DEA , HDHP , Health Insurance , Health Savings Accounts , Healthcare , Healthcare Reform , Lame Duck Session , Legislative Agendas , Medicare , Pharmaceutical Industry , Public Health Emergency , Regulatory Agenda , Telehealth , Telemedicine

CMS Releases CY 2025 Physician Fee Schedule Final Rule

On November 1, 2024, the Centers for Medicare & Medicaid Services (CMS) released the calendar year (CY) 2025 Revisions to Payment Policies Under the Physician Fee Schedule (PFS) and Other Revisions to Medicare Part B...more

11/6/2024 / Centers for Medicare & Medicaid Services (CMS) , Final Rules , Health Care Providers , Hospitals , Medicare , MIPS , Outpatient Prospective Payment System (OPPS) , Physician Fee Schedule , Physicians

Medicare FFS Regs: Thrills and Chills Under the Trump and Biden Administrations

Happy Halloween! In the health policy world, there are two things on everyone’s mind this spooky season: the upcoming election and the major calendar year (CY) 2025 Medicare fee-for-service (FFS) final regs that should be...more

10/31/2024 / Biden Administration , Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Fee-for-Service , Health Care Providers , Healthcare , Inpatient Prospective Payment System (IPPS) , Legislative Agendas , Medicare , New Legislation , New Regulations , Outpatient Prospective Payment System (OPPS) , Regulatory Agenda , Telehealth , Telemedicine , Trump Administration

CMS Releases Final Procedural Notice on Transitional Coverage for Emerging Technology (TCET)

The Centers for Medicare & Medicaid Services (CMS) issued the final procedural notice on Transitional Coverage for Emerging Technologies (TCET), effective as of August 12, 2024. TCET is a new pathway that uses existing...more

8/20/2024 / Centers for Medicare & Medicaid Services (CMS) , Food and Drug Administration (FDA) , Insurance Industry , MACs , Manufacturers , Material Adverse Change Clauses (MACs) , Medicare , Public Comment , Technology Sector

CMS Releases Final TCET Notice – Implications and Next Steps

Last week, the Centers for Medicare & Medicaid Services (CMS) issued a final procedural notice for the new Transitional Coverage for Emerging Technologies (TCET) pathway for certain US Food & Drug Administration (FDA)...more

8/15/2024 / Centers for Medicare & Medicaid Services (CMS) , Emerging Technologies , Food and Drug Administration (FDA) , Health Insurance , Healthcare , Legislative Agendas , Medical Devices , Medicare , New Legislation , Regulatory Agenda

CMMI Finalizes TEAM: Comparison of Proposed and Final Policies

The fiscal year 2025 Inpatient Prospective Payment System (IPPS) final regulation has been released! Embedded in this massive, 2,987-page final reg is a new episode-based payment model, called the Transforming Episode...more

8/8/2024 / CMMI , Final Drafts , Inpatient Prospective Payment System (IPPS) , Medicare , Proposed Regulation , Regulatory Agenda

CMS Releases FY 2025 Hospital Inpatient Prospective Payment System (IPPS) Final Update

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

8/6/2024 / Centers for Medicare & Medicaid Services (CMS) , Final Rules , Health Care Providers , Healthcare , Hospitals , Inpatient Prospective Payment System (IPPS) , Medicare , Payment Systems

CMS Proposes New CoP for Obstetrical Services: With Great Power Comes Great Responsibility

In case you need a reminder given everything going on in Washington, DC, the Calendar Year (CY) 2025 Physician Fee Schedule (PFS) and CY 2025 Outpatient Prospective Payment System (OPPS) proposed regs were released a couple...more

7/25/2024 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Healthcare , Healthcare Reform , Medicare , New Regulations , Outpatient Prospective Payment System (OPPS) , Physician Fee Schedule , Popular , Regulatory Agenda

CMS Releases CY 2025 Physician Fee Schedule Proposed Rule

On July 10, 2024, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2025 Revisions to Payment Policies Under the Physician Fee Schedule (PFS) and Other Revisions to Medicare Part B...more

7/17/2024 / Centers for Medicare & Medicaid Services (CMS) , Medicare , MIPS , Physician Fee Schedule , Physicians , Telehealth

Breaking Down Federal Policies to Address Drug Shortages

In the wake of persistent drug shortages that compromise patient care and safety, the Biden administration and Congress have proposed policies to strengthen the pharmaceutical supply chain. Using authorities under both...more

5/31/2024 / Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Food and Drug Administration (FDA) , Inpatient Prospective Payment System (IPPS) , Medicaid , Medicare , Outpatient Prospective Payment System (OPPS) , Prescription Drugs , Section 340B , Supply Chain , Supply Shortages , Transparency

Site Neutral Payment Considerations: Site-of-Service Patterns Vary by Geography

Site neutral payment proposals are currently a key topic among policymakers. This +Insight explores how Medicare fee-for-service (FFS) site-of-service patterns vary across states and metropolitan statistical areas (MSAs). Our...more

3/8/2024 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Healthcare Reform , Hospitals , Medicare , MedPAC , Off-Campus Departments , Physicians , Site-Neutral Exception

Impact of Site Neutral Payment Proposals May Vary in Rural and Urban Populations

Introduction- Site neutral payment proposals may affect access differently across patient populations. In this +Insight, we focus on how site-of-service patterns for drug administration services, which both the Medicare...more

3/1/2024 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Hospitals , Inpatient Prospective Payment System (IPPS) , Legislative Agendas , Medicare , MedPAC , Outpatient Prospective Payment System (OPPS) , Regulatory Agenda , Rural Areas , Site-Neutral Exception

Prior Authorization in Traditional Medicare: Yes, It Exists

When stakeholders think about prior authorization in the Medicare program, they usually focus on its use in Medicare Advantage (MA), and not how it is used in traditional Medicare. In fact, a few weeks ago, the Centers for...more

2/22/2024 / Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Health Care Providers , Healthcare , Medicare , Medicare Advantage , Prior Authorization

Regs During an Election Year: What’s on the Menu?

Last week, McDermott+Consulting launched an election 2024 resource page, where you can find a 2024 health policy outlook and other insights into the November election. While regulations aren’t necessarily top-of-mind when...more

1/25/2024 / Biden Administration , Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Drug Pricing , EMTALA , Health Insurance , Healthcare , Healthcare Reform , Managed Care Contracts , Medicare , Medicare Advantage , Medicare Part D , OMB , Pharmaceutical Industry , Prescription Drugs , Reproductive Healthcare Issues

2024: The Year of the Telehealth Cliff

What does December 31, 2024, mean to you? New Year’s Eve? Post-2024 election? Too far away to know? Our answer: December 31, 2024, is when we will go over a “telehealth cliff” if Congress fails to act before that date,...more

1/15/2024 / Coronavirus/COVID-19 , Healthcare , Healthcare Reform , Medicare , Medicare Advantage , Public Health Emergency , Telehealth , Telemedicine

REGS & TURKEY LEGS: The Regs We’re Thankful For

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

Leigh Feldman

McDermott Will & Emery

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