Michael LaBattaglia on Reimbursements

CMS Issues IPPS and LTCH Final Rule for FY 2025

On August 1, 2024, CMS filed a display copy of its final rule for Fiscal Year (FY) 2025 pertaining to the Inpatient Prospective Payment Systems (IPPS) for general acute care hospitals and long-term care hospitals (LTCHs) (the...more

8/7/2024 / Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Final Rules , Inpatient Prospective Payment System (IPPS) , Long Term Care Facilities , Medicare , Proposed Rules , Provider Reimbursement Review Board , Reimbursements

CMS Announces Proposed $9 Billion Remedy for Hospitals Underpaid by Unlawful Rate Cut for 340B Drugs

On July 7, 2023, CMS published its highly-anticipated proposed rule identifying its remedy to reimburse hospitals unpaid by its unlawful 340B drug payment policy (the Proposed Rule). While the Supreme Court found CMS’s 340B...more

7/14/2023 / Centers for Medicare & Medicaid Services (CMS) , Federal Register , Hospitals , Outpatient Prospective Payment System (OPPS) , Reimbursements , Remand , SCOTUS , Section 340B

Court Rules on Retrospective Relief for 340B Hospitals Without Vacating CMS’s Rules

On January 10, 2023, Judge Contreras of the United States District Court for the District of Columbia ruled that CMS’s 340B drug reimbursement rates dating back to January 1, 2018, were unlawful and underpaid affected...more

1/24/2023 / American Hospital Association et al v Becerra Secretary Of Health And Human Services et al , Centers for Medicare & Medicaid Services (CMS) , Drug Pricing , Outpatient Prospective Payment System (OPPS) , Prescription Drugs , Reimbursements , SCOTUS , Section 340B

Supreme Court Overturns Medicare Outpatient Drug Rate Cut for 340B Hospitals

On June 15, 2022, the Supreme Court issued a unanimous ruling in American Hospital Assn. v. Becerra declaring that CMS’s 2018 and 2019 reimbursement outpatient drug rate cut to 340B hospitals was “contrary to the statute and...more

6/28/2022 / American Hospital Association et al v Becerra Secretary Of Health And Human Services et al , Centers for Medicare & Medicaid Services (CMS) , Drug Pricing , Medicare , Reimbursements , SCOTUS , Section 340B

CMS Declines to Adopt Policy Reducing Reimbursement for “Medicare” Organs for Transplant Hospitals and Organ Procurement...

On December 17, 2021, CMS issued a final rule with comment period addressing certain provisions of the fiscal year 2022 IPPS/LTCH PPS proposed rule that were designated to be addressed in “future rulemaking,” including...more

12/28/2021 / Centers for Medicare & Medicaid Services (CMS) , Inpatient Prospective Payment System (IPPS) , Medicare , Prospective Payment System (PPS) , Reimbursements , Rulemaking Process

Federal Court Holds PRRB Definition of Provider-Operated Too Narrow and Awards South Carolina Hospital Pass Through Reimbursement...

On March 29, 2021, Judge Margaret B. Seymour, in the United States District Court for the District of South Carolina, set aside a decision from CMS’s Provider Reimbursement Review Board (Board) denying reimbursement relating...more

4/7/2021 / Amicus Briefs , Centers for Medicare & Medicaid Services (CMS) , Medicare , PRRB , Reimbursements

CMS Issues Guidance to States Regarding Social Determinants of Health Strategies

On January 7, 2021, CMS issued a guidance letter to state health officials describing opportunities under Medicaid and the Children’s Health Insurance Program (CHIP) to address social determinants of health (SDOH). The...more

1/18/2021 / Centers for Medicare & Medicaid Services (CMS) , Children's Health Insurance Program (CHIP) , Disabilities , Medicaid , New Guidance , Reimbursements , Value-Based Care

Michael LaBattaglia

King & Spalding

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