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Final Rules Provider Payments

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Policy Update - CMS Releases Final Rule: Medicaid Program; Ensuring Access to Medicaid Services

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On April 22, 2024 the Centers for Medicare & Medicaid Services (CMS) published the Medicaid Program; Ensuring Access to Medicaid Services final rule. The rule has a particular focus on home- and community-based services...more

Manatt, Phelps & Phillips, LLP

[Webinar] Final Medicaid Rules, Part Three: Home and Community Based Services - June 4th, 10:00 am - 11:00 am PT

This program is part three of Manatt’s New Federal Rules on Medicaid Access and Managed Care webinar series. After releasing sweeping proposed rules on Medicaid access and managed care in spring 2023, the Centers for...more

Manatt, Phelps & Phillips, LLP

[Webinar] Final Medicaid Rules, Part Two: Managed Care Payments, Quality and Oversight - May 21st, 12:00 pm - 1:00 pm PT

This program is part two of Manatt’s New Federal Rules on Medicaid Access and Managed Care webinar series. After releasing sweeping proposed rules on Medicaid access and managed care in spring 2023, the Centers for...more

Manatt, Phelps & Phillips, LLP

[Webinar] Final Medicaid Rules, Part One: Access, Enrollee Engagement and Provider Payment Transparency - May 14th, 12:00 pm -...

This program is part one of Manatt’s New Federal Rules on Medicaid Access and Managed Care webinar series. After releasing sweeping proposed rules on Medicaid access and managed care in spring 2023, the Centers for...more

Cozen O'Connor

CMS Issues Final Rule Impacting Prior Authorization Process

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Last week CMS issued its final rule “CMS Interoperability and Prior Authorization” (CMS-0057-F), unchanged from its proposed rule in 2022, which addresses prior authorizations. Prior authorization, a “utilization management”...more

King & Spalding

CMS Issues FY 2024 Final Rule Updating Medicare Payment and Policies for Inpatient Rehabilitation Facilities

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On July 27, 2023, CMS issued a final rule updating Medicare payments and policies under the Inpatient Rehabilitation Facility (IRF) Prospective Payment System and the IRF Quality Reporting Program for FY 2024 (Final IRF...more

Nelson Mullins Riley & Scarborough LLP

HHS Finalizes Payment Rates and Policies for the 2024 Medicare Advantage Program

On March 31, 2023, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), announced the finalized capitation rates and payment policies for the 2024 Medicare...more

McDermott Will & Emery

Clarity for Rural Emergency Hospitals and Changes for Critical Access Hospitals: CMS Finalizes Conditions of Participation and...

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Rural emergency hospitals (REHs) are a new provider type that will allow Medicare to pay for emergency department and other outpatient hospital services in rural areas beginning on January 1, 2023, without requiring the...more

Baker Donelson

COVID-19 Pandemic Trickles Into Some Aspects of SNF PPS FY 2021 Final Rule

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On August 5, 2020, CMS issued its final rule updating FY2021 payment rates used under the prospective payment system (PPS) for Skilled Nursing Facilities (SNFs). The FY 2021 payment rates will be implemented to reflect the...more

King & Spalding

CMS Publishes Final Rule for CY 2020 Hospital Outpatient Prospective Payment System

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n November 1, 2019, CMS posted the final rule establishing the payment rates for the Hospital Outpatient Prospective Payment System (OPPS) and the Ambulatory Surgery Center (ASC) Payment System for calendar year (CY) 2020...more

Bricker Graydon LLP

Federal court invalidates CMS site-neutral payment cuts for hospital off-campus provider-based locations

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On September 17, 2019, the United States District Court for the District of Columbia ruled that the Center for Medicare and Medicaid Services (CMS) exceeded its authority and failed to follow the statutory process for setting...more

Baker Donelson

New Horizons Calling for Action Under Home Health Agency Final Rule

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On November 13, 2018, CMS/HHS published in the Federal Register the Home Health Final Rule. 83 FR 56406 (Nov. 13, 2018). We provided an overview of the proposed rule in Payment Matters on September 14, 2018. Home health...more

Baker Donelson

CMS Increases Hospice Payments, Updates Quality Reporting Requirements for 2019

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CMS updated payment rates, implemented statutory changes, and continued to provide guidance on quality reporting measures and requirements in the FY 2019 Hospice Wage Index and Payment Rate Update Final Rule published on...more

Sheppard Mullin Richter & Hampton LLP

No Longer in Suspense: CMS Issues Final Rule Announcing that Risk Adjustment Program Transfers for 2017 will be Distributed in...

The Final Rule. In a Final Rule posted by CMS last Tuesday, July 24, 2018, CMS announced that $10.4 billion in “risk adjustment transfers” (“Risk Transfers”) for benefit year 2017 (as calculated pursuant to the Affordable...more

Baker Donelson

CMS Reinstates ACA Risk Adjustment Payments

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On Tuesday, July 24, the Centers for Medicare and Medicaid Services (CMS) issued a final rule intended to clarify the program methodology and reinstate payments under the Affordable Care Act's (ACA) permanent risk adjustment...more

Seyfarth Shaw LLP

CMS Publishes Final Rule to Cancel Medicare Episode Payment and Cardiac Rehab Incentive Payment Models, and to Cut Back Joint...

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This is the first in a series of alerts from Seyfarth’s Health Law practice highlighting significant changes in health care regulations and policy as providers and other industry participants enter 2018. ...more

Baker Donelson

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

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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

Baker Donelson

Home Health Payment Rule Published

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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

Bass, Berry & Sims PLC

Final Home Health Rule Drops Controversial Proposed Payment Model

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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

Polsinelli

Medicare Mandatory Bundled Payments Rule: Minor Aspects Delayed, Others On-Schedule for July Implementation

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In a move the Centers for Medicare & Medicaid Services cites as a reaction to President Donald Trump's regulatory freeze, CMS announced that implementation of certain minor aspects of the final rule expanding Medicare...more

Seyfarth Shaw LLP

The Brave New World of Physician Medicare Payment: MACRA Makes Sweeping Changes

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On November 14, 2016, CMS published its final rule implementing the physician payment provisions of the Medicare Access and CHIP Reauthorization Act (“MACRA”). The rule became effective January 1, 2017. Data collection from...more

Baker Donelson

Final Rule Implements Quality Payment Program under MACRA

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If you are a physician, mid-level provider, or work with those providers, then you have been bombarded with new acronyms for new programs and promises to remove older acronyms from your Medicare vocabulary. Medicare...more

Baker Donelson

CMS Final Rule and 21st Century Cures Act Include Good and Bad News for Provider-Based Sites

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CMS recently published its final outpatient prospective payment system (OPPS) rule, which includes its new policies governing payment related to services furnished at off-campus provider-based departments (OPBDs). 81 Fed....more

Baker Donelson

CMS Releases the 2016 OPPS Final Rule

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On November 1, 2016, CMS published its final policy changes, quality provisions, and payment rates for 2017, as they relate to the Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center...more

Baker Donelson

CMS Issues CY 2017 ESRD Final Rule

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On October 28, 2016, CMS issued the final rule updating the payment policies and rates under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for renal dialysis services beginning in CY 2017. The rule also...more

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