News & Analysis as of

Centers for Medicare & Medicaid Services

Trump Administration Fiscal Year (FY) 2019 Budget and Healthcare Programs

by Holland & Knight LLP on

The Trump Administration on Feb. 12 released its Fiscal Year (FY) 2019 budget request, titled "An American Budget." Unlike last year's budget, which was released in late May, the release of this budget conforms to the typical...more

340B Update: Trump Administration’s 2019 Budget and White House Council of Economic Advisors Signal Further Changes to 340B...

by K&L Gates LLP on

On February 12, 2018, the Trump Administration released its fiscal year (“FY”) 2019 budget request to Congress outlining several proposals related to the 340B Drug Pricing Program (the “340B Program”) including a modification...more

Guidance on Guidance: DOJ Limits Use of Agency Guidance Documents in Civil Enforcement Cases

by McDermott Will & Emery on

In a two-page memorandum, the US Department of Justice (DOJ) announced a broad policy statement prohibiting the use of agency guidance documents as the basis for proving legal violations in civil enforcement actions,...more

Top 5 Ways Telehealth Will Change Under the New Federal Funding Bill

by Foley & Lardner LLP on

The telemedicine industry has been abuzz upon learning that provider-friendly legislation was included in the new federal Bipartisan Budget Act of 2018, signed into law by the President on February 9, 2018. But telehealth...more

2019 White House and HHS Budgets Released: Key Changes to Drug Pricing and Reimbursement Proposed

by Hogan Lovells on

On February 12, 2018, the White House Office of Management and Budget released an overview of the president's Fiscal Year (FY) 2019 Budget (the Budget), which makes, among many others, several proposals regarding drug pricing...more

CMS Announces Change to Student Documentation Requirement Intended to Reduce Burden on Teaching Physicians

On February 2, 2018, the Centers for Medicare & Medicaid Services (CMS) released Transmittal 3971 (Change Request 10412), which revises a section of the Medicare Claims Processing Manual (Manual), that provides guidance...more

GAO Report Calls for Increased CMS Oversight of Medicaid Services in Assisted Living Facilities

by Arnall Golden Gregory LLP on

The Government Accountability Office (GAO) recently released a report entitled “Medicaid Assisted Living Services: Improved Oversight of Beneficiary Health and Welfare is Needed.” The report, released on February 5, 2018,...more

Medicare’s New Remote Patient Monitoring Reimbursement: What Providers Need to Know

by Foley & Lardner LLP on

The new year continues to offer big opportunities for telemedicine and digital health companies, and one of the most notable developments is CMS’ decision to reimburse providers for remote patient monitoring (RPM). Effective...more

New Funding Legislation’s Impact on Health Care Programs

by Foley & Lardner LLP on

Congress passed a funding bill early this morning just after the February 8th deadline. The new legislation will make several changes to the Medicare program, delay cuts to disproportionate share hospitals, provide two years...more

CMS releases updated resource documents for Hospice Quality Reporting Program

by Bricker & Eckler LLP on

On February 1, 2018, the Centers for Medicare and Medicaid Services (CMS) released updated resource documents regarding the requirements and notable information for the Hospice Quality Reporting Program (HQRP). ...more

Meaningful Use and Quality Attestations in QNet: CMS Hosts EHR Hospital Transition Q&A Session

by Arnall Golden Gregory LLP on

The CMS EHR Incentive Program attestation for Medicare eligible hospitals and critical access hospitals (CAHs) has moved to a new platform, the QualityNet Secure Portal (QNet). Starting this year, eligible hospitals and CAHs...more

A New Advantage in Medicare: New Benefit Flexibilities Will Change Medicare Advantage

by Faegre Baker Daniels on

A provision included in the recently enacted budget law will now make it much easier for Medicare Advantage (MA) plans to offer a wide array of supplemental benefits within their plans. This will create new opportunities for...more

CMS Representative Discusses 2018 Goals and Initiatives at HCCA Atlanta Regional Conference

by Arnall Golden Gregory LLP on

On January 26, 2018, the Health Care Compliance Association (HCCA) held its annual Regional Conference in Atlanta, Georgia. The conference was well attended by compliance officers and counsel from all across the...more

White House Unveils Proposal on Drug Pricing

by Holland & Knight LLP on

On Feb. 9, 2018, the Trump Administration released a 30-page report analyzing domestic and global factors influencing drug pricing. The report by the Council of Economic Advisers (CEA) is expected to inform the HHS' Fiscal...more

CMS Proposes to Increase Payments to Medicare Managed Care Plans for 2019

by King & Spalding on

CMS has released its proposal for 2019 Medicare Part C rates. CMS indicated it expects an average change in revenue of 1.84 percent for Medicare managed care plans for 2019 as a result of the proposed policy changes....more

CMS Low-Volume Appeals Initiative

by Benesch on

On February 5, 2018, the Centers for Medicare and Medicaid Services (“CMS”) began accepting Expressions of Interest (“EOI(s)”) from Medicare fee-for-service providers to participate in a new Low-Volume Appeals Initiative...more

Blog: Drug Costs Targeted in Administration’s Fiscal Year 2019 Budget

by Cooley LLP on

Yesterday, the Administration released its Fiscal Year 2019 (FY19) Budget blueprint. The $4.4 trillion Budget blueprint includes several proposals directed at lowering the cost of prescription drugs. These proposals are...more

Congress Makes Key Changes to Medicare Physician Payment Programs as Part of Short-Term Government Funding Bill

• Congress amended current law to prevent CMS from applying the “MIPS” payment adjustment to separately billed items like drugs and biologics, which will drastically reduce the total amount of payment adjustments to clinical...more

CMS Considers 7-Day Limit on Initial Opioid Prescriptions under Part D

In a Draft Call Letter issued February 1, 2018, the Centers for Medicare & Medicaid Services (CMS) announced that it is considering a number of new strategies to address opioid overutilization within the Medicare Part D...more

The Brand Memo: Establishing “Reasonable and Necessary” In The Face Of DOJ’s New Mandate Prohibiting Reliance On Agency Guidance...

by Reed Smith on

On January 25, 2018, the U.S. Department of Justice (DOJ) issued a memorandum that further limits its ability to rely on sub-regulatory guidance to establish legal requirements for health care providers. The memorandum...more

Capitol Hill Healthcare Update

by BakerHostetler on

TRUMP TO RELEASE FISCAL 2019 BUDGET THIS MORNING - The White House this morning is releasing President Trump’s fiscal 2019 budget blueprint, which will include funding requests for HHS, FDA, CMS and dozens of other...more

CMS Plans Q&A Session on Low Volume Appeals Settlement Option (Feb. 13)

by Reed Smith on

As previously reported, CMS has initiated a “low volume appeals (LVA) settlement” option as part of broader HHS efforts to improve the Medicare appeals process. This option is available for appellants with fewer than 500...more

CMS Cancels Another Pending CMS Innovation Project: the Direct Decision Support (DDS) Model

by Reed Smith on

CMS will not proceed with its planned Direct Decision Support (DDS) innovation model “due to operational and technical issues with the proposed Model design.” When this model was announced in December 2016, it was expected to...more

VA and HHS Team Together to Combat Health Care Fraud, Waste, and Abuse

by Reed Smith on

The Department of Veterans Affairs (VA) and the Centers for Medicare & Medicaid Services (CMS) have announced a partnership to leverage CMS’s program integrity tools to detect and prevent fraud within VA programs. The...more

CMS Encourages Innovation in MA, Asks Part D Plans to Combat Opioid Overuse, and Fine-Tunes Payments

by McDermott Will & Emery on

The Centers for Medicare & Medicaid Services (CMS) has released its annual payment and policy guidance for Medicare Advantage and Part D plans. CMS is continuing to find ways to inject more flexibility into these programs,...more

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