News & Analysis as of

Centers for Medicare & Medicaid Services

Alston & Bird Healthcare Week in Review

by Alston & Bird on

Alston & Bird’s Week in Review provides a synopsis of the latest news in health care regulations, notices, and guidance; federal legislation and Congressional committee action; reports, studies, and analyses; and other health...more

CMS Aims to Decrease Burdens and Increase Innovation in Medicare Parts C and D With New April 2018 Guidance

by BakerHostetler on

In regulations published on April 16, 2018, the Centers for Medicare & Medicaid Services (CMS) issued two new documents containing guidance primarily on the Medicare Advantage (MA) program and on the Medicare prescription...more

Telemedicine Reimbursement and Regulation: an Overview for Providers

by Snell & Wilmer on

The advent of telemedicine supplies a unique and convenient gateway for patients and providers to connect. The benefits of telemedicine range from increased access to care for patients, to increased efficiency and lower...more

Key Takeaways from Final 2019 Payment Notice Rule

by King & Spalding on

Last week, CMS issued a final rule which aims to relax certain Affordable Care Act (ACA) health plan regulations, found at 45 C.F.R. Parts 147, 153, 154, 155, 157, and 158, while increasing marketplace competition. In...more

New 2019 ACA Payment Policies for Individual and Small Group Markets

by Baker Donelson on

On April 9, the Department of Health and Human Services (HHS) released the long-anticipated final Notice of Benefits and Payment Parameters (NBPP) for plan year 2019, providing standards for health insurers and the health...more

CMS Removes Data Requirement for MRIs on Beneficiaries with Implanted Cardiac Devices

by King & Spalding on

CMS’s recent national coverage decision ends the Coverage with Evidence Development (CED) requirement for physicians seeking to perform MRIs on patients with a cardiovascular implanted electronic device (CIED)....more

Medicare Advantage to Address Social Determinants of Health: An Important Step for Value-Based Care

On April 4, 2018, the Centers for Medicare & Medicaid Services (“CMS”) finalized guidance and policies for the Medicare Advantage program that will expand the supplemental benefits afforded to beneficiaries to include items...more

CMS Announces New Initiatives For Innovating Patient Care

by Fox Rothschild LLP on

Last month, CMS Administrator Seema Verma announced several initiatives to innovate the delivery of patient care at the ground level. In collaboration with the Trump Administration and other federal agencies, CMS is taking...more

K&L Gates Triage: Ride Sharing and Health Care Regulatory Considerations

by K&L Gates LLP on

Transportation is often cited as one of the top barriers to health care for individuals in the United States. To reduce this burden and increase access to care, many health care providers are now partnering with ride-sharing...more

CMS to Use Enforcement Discretion to Help States Comply with the Medicaid Home Health Final Rule

by Arnall Golden Gregory LLP on

On April 5, 2018, the Centers for Medicare & Medicaid Services (CMS) issued an Informational Bulletin regarding compliance with the Medicaid Home Health Final Rule (the “Medicaid HH Final Rule”). The Medicaid HH Final Rule...more

Federal Telehealth Policies Summary

by Holland & Knight LLP on

On Feb. 9, 2018, Congress passed and President Donald Trump signed into law the Bipartisan Budget Act of 2018 (BBA). This wide-reaching legislation enacts major changes for telehealth policy in Medicare by incorporating...more

CMS releases annual health insurance exchanges final rule

by Hogan Lovells on

On April 9, 2018, the Centers for Medicare & Medicaid Services (CMS) released the Benefit and Payment Parameters final rule for 2019 (2019 Payment Notice) applicable to qualified health plans (QHPs) offered on health...more

CMS Benefit and Payment Rule: What is Success for the ACA?

On Monday, CMS published a number of policies changing the dynamics of the individual market, including the Benefit and Payment Parameters for 2019 Final Rule, guidance on hardship exemptions, and a bulletin on transitional...more

CMS Uses Regulatory Levers to Chip Away at Affordable Care Act Protections

by Locke Lord LLP on

On Monday, the Centers for Medicare and Medicaid Services (“CMS”) released (1) the Notice of Benefit and Payment Parameters for 2019 final rule (“Final Rule”), (2) the Final Annual Issuer Letter and (3) guidance on hardship...more

Capitol Hill Healthcare Update

by BakerHostetler on

HOUSE PANEL TO QUESTION GOTTLIEB ON FDA BUDGET - Food and Drug Administration (FDA) Commissioner Scott Gottlieb will testify Tuesday before a House appropriations subcommittee on his agency’s fiscal 2019 budget – which...more

OIG Report: CMS Paid Practitioners for Telehealth Services That Did Not Meet Medicare Requirements

by Foley & Lardner LLP on

The Office of Inspector General (OIG) at the Department of Health & Human Services (HHS) just published a new report on OIG’s review of Medicare payments for telehealth services. The objective of the OIG review was to...more

CMS Adopts 2019 ACA Health Plan Policies

by Reed Smith on

CMS has released its final rule updating policies applying to qualified health plans (QHPs) offered on Affordable Care Act (ACA) Exchanges for 2019. In the final rule, CMS stresses its goal of providing states greater...more

Alston & Bird Healthcare Week in Review

by Alston & Bird on

Alston & Bird’s Week in Review provides a synopsis of the latest news in health care regulations, notices, and guidance; federal legislation and Congressional committee action; reports, studies, and analyses; and other health...more

Precision Medicine Advances: Medicare Coverage of Next Generation Sequencing Testing

by Baker Ober Health Law on

Medicare recently released a new national coverage determination (NCD) that addresses certain diagnostic laboratory tests using Next Generation Sequencing (NGS) for patients with advanced cancer. NGS technology has made it...more

CMS Offers Expanded Settlement Options to Reduce Appeals Backlog

by Bass, Berry & Sims PLC on

In January 2018, Centers for Medicare & Medicaid Services (CMS) announced additional information regarding a new Low Volume Appeals (LVA) settlement option and an expanded Settlement Conference Facilitation (SCF) as part of...more

CMS Proposes “Wind Down” Plan for Federal Exchanges

Despite the Trump Administration’s unsuccessful attempts to fully repeal and replace the Affordable Care Act (the “ACA”), the Administration has continued to target the ACA. In the Administration’s latest salvo, the Centers...more

Flurry of Medicare Advantage and Part D Changes Includes Significant Policy Shifts

by McDermott Will & Emery on

Last week, CMS released new regulations and guidance for Medicare Advantage Organizations (MAOs) and Part D Sponsors. These documents—along with the Bipartisan Budget Act of 2018 that was passed in January—reflect significant...more

First Circuit Rejects CMS FAQs Clarifying Medicaid DSH Payment Calculations

by King & Spalding on

On April 4, 2018, the United States Court of Appeals for the First Circuit affirmed a district court ruling that rejected CMS’s enforcement of two FAQs that clarified how certain reimbursements made to hospitals for...more

Moving? Selling? Don't Forget to Report Your CHOW to Medicare

by Baker Ober Health Law on

In a recent edition of MLN Connects, CMS reminded health care providers and suppliers of their obligation to report changes in ownership as part of their conditions of participation under Medicare....more

Medicare Secondary Payer Act Alert

by Wilson Elser on

The recent decision in Mayo v. NYU Langone Med. Ctr., 2018 NY Slip Op. (U) 30456 (N.Y. Sup. Ct. March, 13, 2018), voiding a settlement on grounds of mutual mistake, holds important lessons for those seeking to resolve a claim...more

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