News & Analysis as of

Centers for Medicare & Medicaid Services Health Care Providers

CMS Terminates and Scales Back Mandatory Bundled Payment Models

by Polsinelli on

The Centers for Medicare & Medicaid Services (CMS) recently published a final rule that cancels the Episode Payment Models (EPMs) and the Cardiac Rehabilitation (CR) incentive payment model, each of which were slated to begin...more

CMS Extends Medicare Prior Authorization Program for Repetitive Scheduled Non-Emergent Ambulance Transport

by Reed Smith on

CMS is extending for another year the Medicare prior authorization program for repetitive, scheduled non-emergent ambulance transport services rendered by ambulance providers in selected states. As previously reported, CMS...more

CMS Schedules Feb. 13 Town Hall Meeting on IPPS New Tech Applications

by Reed Smith on

On February 13, 2019, CMS is holding a public Town Hall meeting to discuss requests for add-on payments for new medical technologies under the Medicare hospital inpatient prospective payment system (IPPS). ...more

Manatt on Health: North Carolina: Amended 1115 Waiver Application

On November 20, 2017, North Carolina submitted an amended 1115 waiver application to the Centers for Medicare & Medicaid Services (CMS) seeking authority to invest $1.2 billion over five years in a range of targeted...more

What's Next Now that Mandatory EPM and Cardiac Rehabilitation Payment Models Have Been Terminated?

by Baker Ober Health Law on

CMS released its Final Rule canceling the Episode Payment Model (EPM) and Cardiac Rehabilitation Incentive Payment Model (CR Incentive Payment Model). This was an expected result following August's proposed rule to cancel...more

Holidays Come Early as CMS Proposes to Significantly Narrow Training Requirements Under Medicare Advantage and Part D Plan...

by Reed Smith on

A recent Centers for Medicare & Medicaid Services (CMS) proposed rule (the Proposed Rule) would mark the end of a heavily criticized and frequently revised compliance program training requirement currently imposed on Medicare...more

2018 Reimbursement Cuts for Some Off-Campus Hospital Provider-Based Departments

by McGuireWoods LLP on

On Nov. 2, 2017, the Centers for Medicare and Medicaid Services (CMS) finalized a rule changing reimbursement rates under the Medicare Physician Fee Schedule (MPFS) for certain non-excepted hospital off-campus provider-based...more

CMS Scraps Cardiac/Hip Fracture Episode Payment Model, Downsizes CJR Program

by Reed Smith on

The Centers for Medicare & Medicaid Services (CMS) has officially cancelled a planned program to require certain hospitals to participate in Medicare episode payment models (EPMs) for acute myocardial infarction, coronary...more

CMS Plans To Eliminate Home Health Agency Subunits in 2018

by Arnall Golden Gregory LLP on

On November 17, 2017, the Centers for Medicare and Medicaid Services (CMS) issued a Memorandum to State Survey Agency Directors outlining the process by which Medicare will eliminate existing Home Health Agency (HHA)...more

Alston & Bird Healthcare Week in Review

by Alston & Bird on

On November 27, 2017, the Food and Drug Administration (FDA) issued a guidance entitled, Pediatric Information for X-ray imaging Device Premarket Notifications. The guidance outlines FDA’s rationale regarding information that...more

CMS Waives Medicaid Retroactive Eligibility For Iowa: Is Your State Next?

by Cozen O'Connor on

Since 1973, the Social Security Act has mandated that states provide retroactive Medicaid benefits for three months prior to the individual’s application. SSA § 1902(a)(34). Congress enacted this provision to provide...more

CMS Provides Advice On Electronic Laboratory Alerts

by Fox Rothschild LLP on

CMS recently issued an Advisory Opinion suggesting that physicians who refer diagnostic tests reimbursable under Medicare to a laboratory may, under certain circumstances, receive electronic pop-up notifications in the...more

MACRA Quality Payment Program Final Rule: Implications for 2018 and Beyond

On November 2, 2017, CMS published its final rule (the “Final Rule”) on the 2018 Quality Payment Program (“QPP”), authorized by the Medicare Access and CHIP Reauthorization Act of 2015 (“MACRA”). This final rule adopted many...more

Williams Mullen On Call - November 2017

by Williams Mullen on

Welcome to the third edition of Williams Mullen On Call. In this edition, we are pleased to provide two very timely interviews. The first interview is with Mandy K. Cohen, MD, MPH, Secretary of the North Carolina Department...more

Medicare Providers Face December 1 Deadline to Request Review of Medicare Payment Adjustments

by Akerman LLP - Health Law Rx on

Providers have just a couple more days to challenge Medicare’s proposed 2018 value modifier payment adjustments. On September 18, 2017, Medicare released quality reports and measures used to calculate quality-based payment...more

CMS Releases MLN Matters Article on Care Coordination Services and Payment for Rural Health Clinics and Federally-Qualified Health...

by King & Spalding on

CMS recently issued a Medicare Learning Network (MLN) Matters article in connection with Change Request 10175 (issued August 11, 2017), which provides instructions for payment to Rural Health Clinics (RHCs) billing under the...more

CMS Modifies Medicare Physician Quality Payment Program Rules for 2018

by Reed Smith on

CMS has issued a final rule with comment period making changes to the Quality Payment Program (QPP) for 2018, the second performance year for the reformed physician payment framework mandated by the Medicare Access and CHIP...more

Health Care E-Note - November 2017

by Burr & Forman on

Health care law and policy occupy a prime place in the current news cycle. Much of the attention revolves around the actions or inactions of Congress and the White House, particularly with regard to their impact on the future...more

CMS Releases 2018 HCPCS Update

by Reed Smith on

The 2018 update to the alphanumeric Healthcare Common Procedure Coding System (HCPCS) files is now available on the CMS website. The files include the Level II alphanumeric HCPCS procedure and modifier codes, their long and...more

Home Health Payment Rule Published

by Baker Ober Health Law on

On November 1, 2017, CMS released the Final Rule for the 2018 home health prospective payment system rate update, including the CY 2019 case mix adjustment methodology refinements. CMS also made changes to the Value Based...more

Hospitals & Physician Organizations Summary Report - November 2017

by Benesch on

Uncertainty and pressures continue to mount for healthcare providers, creating a new operating environment – Uncertainty around Medicaid and other programs, the shift to value-based care, margin pressures, the need to search...more

CMS Releases Broad-Ranging Medicare Advantage and Part D Proposed Rule

by McDermott Will & Emery on

CMS released a broad-ranging proposed rule for the Medicare Advantage and Part D Programs on Thursday, November 16, 2017. The proposed rule addresses a broad and diverse range of MA and Part D regulatory requirements,...more

New Home Health Rules Effective in January 2018—Some Traps for the Unwary

The Centers for Medicare & Medicaid Services (CMS) have issued new Conditions of Participation (CoP) for home health agencies (HHA) that are effective January 13, 2018. The CoP were originally scheduled to take effect on...more

CMS Updates End-Stage Renal Disease Prospective Payment System

by McGuireWoods LLP on

On Nov. 1, 2017, the Centers for Medicare & Medicaid Services (CMS) published a final rule that updates payment policies and rates under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for renal dialysis...more

MACRA Final Rule Continues Gradual Transition and Provider Flexibility for 2018

by Baker Donelson on

On November 2, the Centers for Medicare and Medicaid Services (CMS) released the final rule implementing policies for Year 2 (2018) of the Quality Payment Program established under the Medicare Access and CHIP Reauthorization...more

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