Affordable Care Act, Centers for Medicare & Medicaid Services (CMS), Value-Based Purchasing

CMS Issues IPPS and LTCH Final Rule for FY 2023

King & Spalding on 8/10/2022

On August 1, 2022, CMS issued its annual Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System Final Rule for FY 2023 (the Final Rule). In the Final Rule, CMS...more

Proposed ‘Kitchen Sink’ Medicaid Rule Could Bring Changes for Pharmaceutical Manufacturers

ArentFox Schiff on 6/24/2020

The Centers for Medicare & Medicaid Services (CMS) published a Proposed Rule on June 19, 2020 (the Proposed Rule) which, among other things, suggests updates to Medicaid policies and practices related to drug pricing and...more

New Risks, New Rewards, New Exposure

King & Spalding on 6/24/2020

Value-Based Purchasing, Multiple Best Prices, Expanded Alternative URA, and other MDRP Drug Pricing Changes in Proposed Rule - On June 17, 2020, the Centers for Medicare & Medicaid Services (“CMS”) released a major...more

CMS Releases the 2016 OPPS Final Rule

Baker Donelson on 11/16/2016

On November 1, 2016, CMS published its final policy changes, quality provisions, and payment rates for 2017, as they relate to the Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center...more

CMS Releases FY 2017 Hospital Inpatient Prospective Payment System and Long-Term Care Hospital Prospective Payment System Final...

King & Spalding on 8/10/2016

On August 2, 2016, CMS released a final rule (Final Rule) with updates to the Hospital Inpatient Prospective Payment System (Hospital IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) affecting...more

Home Health PPS CY 2017 Proposed Rule: Payments Rebased, Quality Measures Updated

Baker Donelson on 7/12/2016

Downward adjustments to home health episode payments arising from rebasing of the national payment rates, case mix adjustments, and an increase to the fixed dollar loss ratio for calculating outliers will result in an overall...more

Manatt on Medicaid: CMS Approves California's Delivery System Reform Incentive Payment (DSRIP) Waiver Renewal

Manatt, Phelps & Phillips, LLP on 1/28/2016

On December 30, 2015, the Centers for Medicare and Medicaid Services (CMS) approved California's request to renew its waiver under Section 1115 of the Social Security Act. A significant component of the waiver is the Delivery...more

The Deeper Dive: Medicare’s Fundamental Shift Toward P4P - What priorities should providers focus on in navigating the changing...

BakerHostetler on 10/28/2015

While Medicare’s path toward pay for performance (P4P) has evolved over time, 2015 is proving to be a landmark year. July marked the 50th anniversary of the Medicare program. And in self-described “historic announcements”...more

Manatt on Medicaid: Medicaid at 50—The Program’s Evolution and Future

Manatt, Phelps & Phillips, LLP on 10/27/2015

Editor’s note: Born as an afterthought to Medicare five decades ago, Medicaid has evolved from an adjunct to state welfare programs into the nation’s largest health insurer. Medicaid’s 50th birthday is a fitting time to...more

GAO Releases Report on Initial Results of CMS’s Hospital Value-Based Purchasing Program

King & Spalding on 10/14/2015

The U.S. Government and Accountability Office (GAO) issued an October 2015 report to congressional committees concluding that the initial results of the Hospital Value-Based Purchasing (HVBP) program show “no apparent shift”...more

Health Update - September 2015

Manatt, Phelps & Phillips, LLP on 9/25/2015

Latest Healthcare False Claims Act Roundup and Top 3 Best Practices to Reduce Exposure - As the legal landscape in healthcare becomes increasingly complex, healthcare companies that receive federal program funds face...more

Home Health, CY 2016 Proposed Rule: Emphasis on Value-Based Purchasing

Baker Donelson on 8/25/2015

On July 10, 2015, CMS published the calendar year (CY) 2016 home health prospective payment system (PPS) proposed rule [PDF]. While the proposed rule updates and revises certain payment rates and quality measures, it also...more

Also In The News - Health Headlines - August 2015

King & Spalding on 8/7/2015

CMS Issues SNF Final Payment Rule for FY 2016 – On July 30, 2015, CMS released the final Medicare FY 2016 payment rule for skilled nursing facilities (SNFs). The final rule will result in an estimated increase of $430 million...more

Health Care Update - August 2015

Mintz - ML Strategies on 8/4/2015

CMS Releases Final Payment Rules (IPPS, IRF, LTCHs, Hospice, and Psych): At the end of last week, the Centers for Medicare and Medicaid Services (CMS) released a set of final 2016 payment rules affecting acute care hospitals...more

CMS Issues FY 2016 IPPS and LTCH Final Rule

King & Spalding on 8/4/2015

On July 31, 2015, CMS issued its final rule to update the fiscal year (FY) 2016 Medicare payment policies and rates under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective...more

Medicaid Managed Care Update: Accelerating State-Led Payment and Delivery System Reform

McDermott Will & Emery on 7/27/2015

In the wake of the implementation of the Affordable Care Act, the recent Medicare Managed Care Proposed Rule (the Proposed Rule) exemplifies the accelerated push by the Department of Health and Human Services and Centers for...more

CMS Proposes Initiative to Tie Home Health Payments to Quality Performance

King & Spalding on 7/24/2015

On July 10, 2015, CMS published in the Federal Register the CY 2016 Home Health Prospective Payment System proposed rule effective for episodes ending on or after January 1, 2016. CMS estimates that the net impact of the...more

CMS Issues CY 2016 Medicare Physician Fee Schedule Proposed Rule

King & Spalding on 7/22/2015

On July 8, 2015, CMS issued its annual proposed rule outlining payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) for CY 2016. In the proposed rule,...more

CMS Proposes Value-Based Purchasing Model, Other Updates to the 2016 Home Health Prospective Payment System

McDermott Will & Emery on 7/20/2015

The U.S. Department of Health and Human Services (HHS) Centers for Medicare & Medicaid Services (CMS) published its proposed update to the home health prospective payment system (HHPPS) for calendar year (CY) 2016 in the July...more

Delivery System Reform 2.0: Scaling Alternative Payment Models is the New Normal

Mintz - Health Care Viewpoints on 7/15/2015

For some health care providers, a pair of recent announcements made by the Obama Administration to implement mandatory alternative payment models (APMs) for home health value-based purchasing and bundled payments for hip and...more

Oh Baby: Medicare Wants to Focus on Early Elective Deliveries

Faegre Drinker Biddle & Reath LLP on 5/21/2014

Deep within the proposed FY 2015 Inpatient Prospective Payment System (IPPS) rule released a few weeks back is an interesting proposed new measure to the Medicare hospital Value-Based Purchasing (VBP) program – elective...more

CMS Releases CY 2014 Hospital OPPS and ASC Final Rule

Baker Donelson on 12/13/2013

CMS has published its Calendar Year (CY) 2014 Final Rule for Medicare policy and payment rates for hospital outpatient prospective payment systems (OPPS) and Ambulatory Surgical Center (ASC) services. This final rule with...more

CMS Releases FY 2014 Hospital IPPS Final Rule

King & Spalding on 8/6/2013

On August 2, 2013, CMS released the annual Hospital Inpatient Prospective Payment System Final Rule for FY 2014 (the “Final Rule”), effective for discharges occurring on or after October 1, 2013....more

CMS Provides Progress Report to Senate Finance Committee on Healthcare Reform Efforts, Highlighting Decrease in Hospital...

King & Spalding on 3/12/2013

On February 28, 2013, the acting principal deputy administrator and director of CMS, Jonathan Blum, provided a progress report to the Senate Finance Committee on CMS’s efforts to reform the healthcare delivery system,...more

Medicare Program Issues Proposed Rule for Acute and Long-Term Care Hospital Inpatient Prospective Payment Systems for Fiscal Year...

Foley & Lardner LLP on 5/21/2012

On May 11, 2012, the Centers for Medicare and Medicaid Services (CMS) published in the Federal Register a proposed rule that would, among other things, update payment policies and rates for acute care hospitals paid under the...more

Patient Protection and Affordable Care Act (PPACA) › Centers for Medicare & Medicaid Services (CMS) › Value-Based Purchasing

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