News & Analysis as of

Centers for Medicare & Medicaid Services Medicaid

States May Be Looking to Balance Budgets on the Backs of Medicaid Health Plan Reserves

by Alston & Bird on

As state governments look for ways to cover their budgetary shortfalls, Medicaid managed care organizations (MCOs) are an attractive target for cash-strapped states because many MCOs have accumulated “Medicaid savings”...more

Final Home Health Rule Drops Controversial Proposed Payment Model

by Bass, Berry & Sims PLC on

Last week, home health agencies welcomed the Centers for Medicare & Medicaid Services' (CMS) decision to drop a controversial proposed payment model and leave largely unchanged the current payment system. Responding to...more

Top Takeaways for Medicare Physician and Hospital Payments in 2018

by Holland & Knight LLP on

The Centers for Medicare & Medicaid Services (CMS) on Nov. 1, 2017, released the Medicare Hospital Outpatient Prospective Payment System (OPPS) and the Medicare Ambulatory Surgical Center (ASC) Payment System Final Rule for...more

FCA Settlement Alert: Physician Compliance with CMS’ 60-Day Overpayment Rule

by Williams Mullen on

On October 13, 2017, the U.S. Attorney’s Office for the Middle District of Florida announced a settlement for over $440,000 with First Coast Cardiovascular Institute, P.A. (“First Coast”), a large cardiovascular physician...more

New Audits and Penalties on Medicaid Plans and Providers Related to Encounter Data in Value-Based Payment Models

by Epstein Becker & Green on

For value-based payments, encounter data[1] provides valuable information in much the same way that claims data does for fee-for-service arrangements. With the growing prevalence of value-based payments, especially in the...more

Special Needs Plans: A Minibus Rider

As Part of an ongoing series, we have previously provided details on the structure, funding, and evaluation of the Maternal, Infant, Early Childhood, Home Visiting (MIECHV) program, Medicare therapy caps, and community health...more

Trump Administration Shelves Additional Obama Medicare/Health Plan Proposals

by Reed Smith on

The Trump Administration has formally withdrawn a number of pending Department of Health and Human Services (HHS) proposals that never reached the final rule stage. This includes: a controversial Part Medicare B drug payment...more

Value-Based Contracting for Prescription Drugs and Medical Devices: An Innovative Solution Impaired by Outdated Regulations

by Pepper Hamilton LLP on

Often lost in the cacophony of headlines surrounding rising health care costs is the promise that value-based contracting offers as a possible solution. In contrast to the traditional fee-for-service model, value-based...more

CMS Unexpectedly Withdraws Three Proposed Rules

The Centers for Medicare and Medicaid Services (CMS) recently announced the withdrawal of three proposed rules that, in one case, had been pending since 2014. The first proposed rule that CMS decided to scrap was proposed in...more

CMS Seeks New Direction for Center for Medicare and Medicaid Innovation

by King & Spalding on

On September 20, 2017, the Center for Medicare and Medicaid Innovation (“CMMI”) issued an informal Request for Information (“RFI”) seeking public feedback on “a new direction to promote patient-centered care and test...more

OIG Work Plan – September 2017 Update

by Baker Ober Health Law on

Beginning in June 2017, the OIG began making monthly Work Plan updates. These monthly updates create some practical challenges for health care providers and compliance professionals trying to make operational and compliance...more

A Category 5 Compliance Problem: Hurricane Irma Gives Providers a Stark Reminder of Emergency Preparedness Realities

by Carlton Fields on

The havoc that Hurricane Irma caused in the Caribbean and most of Florida reminds us of the Centers for Medicare and Medicaid Services (CMS) requirements for emergency preparedness, which take effect November 15....more

OIG Study Finds States Are Not Using Medicaid Payment Suspensions

by King & Spalding on

A recent HHS OIG review of 2014 data on fraud allegations found that significant challenges were limiting the States’ use of payment suspensions, even in the face of what CMS determined were credible allegations of provider...more

When Is a Hospital Not a Hospital? New Guidance Sheds (Some) Light on the Definition

by McDermott Will & Emery on

The Centers for Medicare and Medicaid Services released guidance on September 6, 2017, intended to clarify the definition of “hospital.” The guidance provides factors that may be considered to determine whether a hospital is...more

Inspector General Audit Could Impact Skilled Nursing Facilities

by Ruder Ware on

Skilled nursing facilities (SNF) may see even more scrutiny from the Centers of Medicare and Medicaid Services (CMS) because of a recent audit conducted by the Office of Inspector General of the U.S. Department of Health and...more

Manatt on Health: September 2017

1332 Waivers Under Review at CMS - The Trump administration has approved one 1332 waiver to date, but four more are pending, including a sweeping Iowa waiver. Here is where things stand today...more

HHS Seeks to Ease Burden of Hurricane on Health Care Organizations

by Baker Ober Health Law on

As Hurricane Harvey continues to have a devastating impact throughout Southeast Texas, Louisiana and the Southeast, our thoughts are with the hundreds of thousands struggling through this difficult time....more

CMS Digging In on Medicaid DSH Payments

by BakerHostetler on

During the summer months, several developments have occurred concerning the Medicaid Disproportionate Share Hospital (DSH) policy that the Centers for Medicare & Medicaid Services (CMS) has implemented, to the detriment of a...more

Manatt on Health: Medicaid Edition - CMS Approves Florida 1115 Waiver, Increasing Uncompensated Care Funding

Editor’s Note: With efforts to repeal and replace the Affordable Care Act (ACA) flagging, stakeholders are redirecting their attention toward Medicaid Section 1115 demonstrations. The Trump administration has encouraged...more

CMS revises CJR program, cancels cardiac bundles

by Thompson Coburn LLP on

On Aug. 15, 2017, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule seeking to reduce mandatory participation requirements in the Comprehensive Care for Joint Replacement (CJR) program for hospitals...more

Reminder: Medical Providers Must Be Attentive to Credit Balances and Other Overpayments

It has now been a number of years since the enactment of Section 6402(a) of the Affordable Care Act ("ACA"), which requires among other things that any recipient of a Medicare or Medicaid overpayment report and return it...more

Federal Government to Target False EHR Incentive Payments

by Barley Snyder on

While health care reform remains bogged down, the federal government’s efforts to curtail fraud, waste and abuse in its health care programs fervently continues. Most recently, the U.S. Department of Health and Human...more

California Hospitals Successfully Beat Back Medicaid Payment Cut

by King & Spalding on

Almost a decade ago, California submitted a State plan amendment (SPA) to the Centers for Medicare and Medicaid Services (CMS) that would retroactively implement a ten-percent rate reduction in outpatient services provided to...more

CMS Issues IPPS and LTCH PPS Final Rule for FY 2018

by King & Spalding on

On August 2, 2017, CMS issued the Fiscal Year (FY) 2018 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long Term Acute Care Hospital (LTCH) Prospective Payment System Final Rule (Final Rule) that updates...more

CMS’s 340B Proposal Is Likely Unlawful—Here’s Why

by Morgan Lewis on

The agency’s recent proposal to reduce certain drug reimbursement is unprecedented and not based on a reasonable interpretation of its statutory authority....more

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