HealthLaw HotSpot - A Look at Alternative Reimbursement Models in Value-Based Care
Jones Day Talks Health Care: The Eliminating Kickbacks in Recovery Act
Value-based health care: fraud & abuse laws
Tax Developments Affecting Health Care Organizations and Investor-Owned Hospital Companies
Within its proposed CY 2025 Physician Fee Schedule (PFS) rule (the Proposed Rule), CMS is proposing to implement new payment policies intended to advance health equity and support whole-person care. CMS expects these new...more
The Centers for Medicare & Medicaid Services (CMS) announced a new primary care model—the Making Care Primary (MCP) Model—geared towards smaller, independent primary care practices and organizations that want to participate...more
On May 10, 2023, HHS announced that many telehealth and teleprescribing flexibilities will remain in place after the end of the COVID-19 Public Health Emergency (PHE) on May 11, 2023. Congress extended many telehealth...more
I was struck on the first day of the 41st Annual J.P. Morgan Healthcare Conference by Sanjay Doddamani (CEO of UpStream Healthcare) saying that “Health is a state of independence.” A simple statement, but a very profound and...more
On September 28, 2022, the Centers for Medicare & Medicaid Services (CMS) issued approval letters for Section 1115 Medicaid demonstration applications previously submitted by Oregon and Massachusetts. Section 1115 waivers...more
The Centers for Medicare & Medicaid Services (“CMS”) recently published the proposed 2023 Physician Fee Schedule (“PFS”), which contains several important changes affecting Accountable Care Organizations (“ACOs”) that...more
As part of the CY 2023 Physician Fee Schedule proposed rule (the Proposed Rule) released on July 7, 2022, CMS has proposed significant changes to the Medicare Shared Savings Program (MSSP). The agency’s press release...more
On February 24, 2022, CMS announced major changes to several of its innovation models, including the permanent cancellation of the Geographic Direct Contracting Model—a Trump-era model that tested whether a geographic-based...more
On April 27, 2021, CMS issued the fiscal year (FY) 2022 proposed rule for the hospital inpatient prospective payment system (IPPS) and long-term care hospital (LTCH) prospective payment system (the Proposed Rule). Among...more
Enrolling in such a CMS-sponsored innovation model now has an added benefit: a new Anti-Kickback Statute (AKS) safe harbor. ...In its mission to reward value over volume, the Centers for Medicare & Medicaid Services’ (CMS)...more
On August 11, 2020, the CMS Innovation Center, the office within HHS with authority to create and test healthcare payment systems, announced a new payment model – the Community Health Access and Rural Transformation (CHART)...more
Insurance payments for healthcare services and supplies are frequently based on projections of future costs, often measured against a baseline calculated on past costs. However, COVID-19 and its attendant changes to the...more
According to an April 13, 2020 Press Release issued by the National Association of ACOs (“NAACOS”), a recent NAACOS survey shows that 56% of the survey-participating at-risk accountable care organizations (“ACOs”) – i.e.,...more
On April 30, the Centers for Medicare & Medicaid Services (CMS) announced numerous regulatory waivers and rule changes to, among other things, expand Medicare beneficiaries’ access to coronavirus testing and telehealth...more
DVHA presents budget adjustment proposal - The House Health Care Committee heard from Department of Vermont Health Access Commissioner Cory Gustafson on Tuesday on his department’s 2020 budget adjustment. ...more
The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) and the Centers for Medicare & Medicaid Services (CMS) recently released two proposed rules restructuring the Physician Self-Referral...more
The Centers for Medicare and Medicaid Services (CMS) is launching new value-based programs with great fervor as a central strategy to bend the healthcare cost curve. Value-based reimbursement models linked to achieving the...more
The ACO Specialist Manual is a strategic guide to getting the optimum value-add contributions from each medical specialty in integrated health care. For purposes of this Manual, the teams are generally termed accountable care...more
On April 22, 2019, the Centers for Medicare and Medicaid Services (CMS) announced two sweeping new payment innovation models under the Primary Cares Initiatives. The models will seek to incentivize primary care and other...more
House passes budget bill - The House approved a $6.1 billion FY 2020 budget this week. The bill, H.542, provides for a 3.1 percent growth in spending over FY 2019....more
The Senate Health and Welfare Committee reviewed a report Thursday on the state’s progress with health care payment and delivery system reform efforts. Department of Vermont Health Access Deputy Commissioner Michael Costa...more
This Week: Happy New Year! The 116th Congress begins and healthcare issues are part of the "buzz" of day one. Part of the government is still closed. ...more
On November 1, 2018, the Centers for Medicare & Medicaid Services (CMS) released its 2019 Physician Fee Schedule Final Rule (PFS Rule), which contains a number of significant substantive changes to Medicare payment practices...more
On August 17, 2018, the Centers for Medicare & Medicaid Services (“CMS”) officially published a proposed rule (“Proposed Rule”) in the Federal Register that would significantly alter the Medicare Shared Savings Program...more
The Centers for Medicare & Medicaid Services (CMS) published a proposed rule on August 17, 2018, that would make sweeping changes to the Medicare Shared Savings Program (MSSP), a federal program that incentivizes integrated...more