News & Analysis as of

Fee-for-Service Comment Period

Akin Gump Strauss Hauer & Feld LLP

CMS Proposes New Hospital Reporting Requirements and Signals Major Shift in Hospital Rate-Setting Methods

- Tucked into a massive Medicare payment rule is a proposal to fundamentally change how CMS sets hospital payment rates. - Recognizing that a hospital’s chargemaster rarely reflects true market costs, CMS seeks to use...more

King & Spalding

CMS Issues Proposed Rule Aimed at Increasing Transparency and Reducing Medicaid Program Spending

King & Spalding on

On November 18, 2019, CMS published the proposed Medicaid Fiscal Accountability Rule (the Proposed Rule) which, if finalized, would result in dramatic changes to the Medicaid program. Through the Proposed Rule, CMS aims to...more

Health Care Compliance Association (HCCA)

Report on Medicare Compliance Volume 28, Number 42. News Briefs: November 2019 #4

Report on Medicare Compliance 28, no. 42 (November 25, 2019) - In a surprising CMS memo that just surfaced, top CMS attorneys echo the sentiments of the Department of Justice about the limits of enforcement actions based...more

Foley Hoag LLP - Medicaid and the Law

CMS Medicaid Fiscal Accountability Regulation Published

Earlier this week, CMS released for publication a proposed rule that would add some degree of transparency and oversight to the somewhat opaque world of Medicaid financing. It’s a topic that’s fascinated us here at the...more

Polsinelli

Assessing the Stark and Anti-Kickback Proposals for Value-Based Arrangements

Polsinelli on

Through two separate notices of proposed rule-making (NPRMs), the Centers for Medicare & Medicaid Services (CMS) and the Department of Health and Human Services (HHS) Office of Inspector General (OIG), seek to remove...more

WilmerHale

Proposed Changes to Stark and Anti-Kickback Regulations May Provide New Flexibility for Healthcare Providers

WilmerHale on

On October 9, 2019, the Department of Health and Human Services (HHS) announced proposals for a number of new and revised exceptions to the Stark Law and safe harbors for the Anti-Kickback Statute (AKS) that are intended to...more

Robinson+Cole Health Law Diagnosis

CMS Announces New Direct Contracting Care Models

On April 22, 2019, the Centers for Medicare and Medicaid Services (CMS) announced two new voluntary risk-sharing payment models—Professional Population-Based Payment (PBP) and Global PBP. ...more

Sheppard Mullin Richter & Hampton LLP

Blog Series Part 7: CMS Proposed Rule on Policy and Technical Changes to the Medicare Advantage, Medicare Prescription Drug...

Part C and Part D Quality Rating System - The November 1, 2018 proposed rule issued by the Centers for Medicare & Medicaid Services (“CMS”) includes enhancements and substantive changes to the Star Rating System in order...more

Sheppard Mullin Richter & Hampton LLP

Blog Series Part 5: CMS Proposed Rule on Policy and Technical Changes to the Medicare Advantage, Medicare Prescription Drug...

Part D Plan Sponsors’ Access to Medicare Parts A and B Claims Data Extracts - As detailed in previous posts in this series, one major objective that the Centers for Medicare and Medicaid Services (“CMS”) addressed in a...more

Polsinelli

Making Sense of the MACRA Final Rule, Part 1 of 3: Essential Concepts

Polsinelli on

On Oct. 14, the Centers for Medicare & Medicaid Services (CMS) published a final rule with comment period implementing the bipartisan Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The nearly 2,400 pages of...more

Polsinelli

CMS Publishes Proposed Rule Implementing MACRA Physician Payment Model

Polsinelli on

On April 27, 2016, the Centers for Medicare & Medicaid Services (CMS) posted a pre-publication version of a proposed rule implementing changes to Medicare payment for physician services authorized under the bipartisan...more

Foley & Lardner LLP

CMS Proposes Additional Changes to MSSP Regulations

Foley & Lardner LLP on

The Centers for Medicare and Medicaid Services (CMS) recently issued a proposed rule modifying the Medicare Shared Savings Program (MSSP) regulations (the “Rule”). Among other changes, the Rule proposes (a) to modify the...more

McDermott Will & Emery

Preview of Medicare Advantage and Part D Advance Notice and Call Letter: CMS Likely to Address Risk Adjustment, Provider Network,...

McDermott Will & Emery on

The federal government will soon kick off the all-important annual sub-regulatory cycle for the Medicare Advantage (MA) and Part D programs, issuing proposed policy changes and payment rates for calendar year (CY) 2017. The...more

King & Spalding

Omnibus Proposed Guidance Released for 340B Drug Pricing Program

King & Spalding on

Last week, the Health Resources and Services Administration (HRSA), part of HHS, released proposed new guidance for covered entities enrolled in the 340B Drug Pricing Program, as well as drug manufacturers required to make...more

Mintz - Health Care Viewpoints

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

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

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