News & Analysis as of

Health Care Providers Alternative Payment Models (APM)

Manatt, Phelps & Phillips, LLP

Senate Finance Explores Medicare Physician Payment and Graduate Medical Education Reform

On May 17, the Senate Finance Committee released a long-awaited white paper describing its legislative effort focused on bolstering chronic care through physician payment. Following a committee hearing April 11, the white...more

McDermott+

A Buffet of Hospital Alternative Payment Models: Will Too Many Entrees Be Overwhelming?

McDermott+ on

Over the last several months, the Center for Medicare and Medicaid Innovation (CMMI), within the Centers for Medicare & Medicaid Services (CMS), has introduced several alternative payment models (APMs) geared toward...more

Epstein Becker & Green

California’s Office of Health Care Affordability Kicks into Action: Are Organizations Ready for Increased Scrutiny in Health Care...

Epstein Becker & Green on

State governments are increasingly entering the field of health care market oversight and enforcement. In what was once an issue typically left to the federal government, state governments are looking for ways to...more

Jones Day

California Health Care Providers to Face Greater Headwinds as State Implements Health Care Cost Targets

Jones Day on

Pursuant to California's Health Care Quality and Affordability Act (the "HCQA"), the newly created Office of Health Care Affordability ("OHCA") recently proposed statewide health care cost targets and standards and goals for...more

Bass, Berry & Sims PLC

CMS Announces New MSSP Model Aimed at Improving Primary Care

Bass, Berry & Sims PLC on

The Centers for Medicare & Medicaid Services (CMS) recently announced the ACO Primary Care Flex Model (ACO PC Flex Model or Model), a new voluntary payment model for primary care furnished through low-revenue Accountable Care...more

Holland & Knight LLP

Key Value-Based Care Developments to Watch in 2024

Holland & Knight LLP on

The goal of value-based care (VBC) is to promote better care for individual patients and improved health outcomes for communities at reduced costs. This is an important and admirable purpose as many VBC stakeholders attempt...more

Foley & Lardner LLP

Behavioral Health: CMS Innovation Model Outlines Changes for the Delivery of Integrated Behavioral and Physical Health Care

Foley & Lardner LLP on

On January 18, 2024, the Centers for Medicare & Medicaid Services (CMS) announced a new innovation model designed to improve quality of care and behavioral and physical health outcomes for Medicaid and Medicare patients with...more

Hall Benefits Law

Health Care Stakeholders Support Passage of The Value in Health Care Act

Hall Benefits Law on

Seventeen healthcare stakeholder groups have come together to support The Value in Health Care Act, a bill that a bipartisan coalition reintroduced in Congress this summer. The bill supports a shift in the medical care...more

McDermott+

The MIPS Effect: A Surprise Twist in Estimating Medicare Payments for Clinicians Next Year

McDermott+ on

As physician groups and other stakeholders work to finalize comment letters on the calendar year (CY) 2024 Physician Fee Schedule (PFS) proposed regulation by September 11, 2023, the Centers for Medicare & Medicaid Services...more

Miles & Stockbridge P.C.

CMS Innovation Center Requests Comments for New Episode-Based Payment Model

The Centers for Medicare & Medicaid Services (CMS) published a Request for Information (RFI) on July 18 regarding the design of a future, episode-based payment model on behalf of CMS’s Center for Medicare and Medicaid...more

McDermott Will & Emery

Top Takeaways | 2023 Value-Based Care Symposium | Health System Innovation in Value-Based Care

McDermott Will & Emery on

In this session, panelists focused on the unique challenges and opportunities facing health systems as they move into value-based care (VBC)...more

Holland & Knight LLP

CMS Issues 2023 Medicare Physician Fee Schedule Proposed Rule

Holland & Knight LLP on

The Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2023 Medicare Physician Fee Schedule (PFS) Proposed Rule on July 7, 2022, which impacts Medicare Part B payments starting Jan. 1,...more

Manatt, Phelps & Phillips, LLP

[Webinar] Leveraging State Benchmarking Models to Address Health Care Cost Growth - April 12th, 4:00 pm - 5:00 pm ET

As state leaders continue to grapple with unsustainable rates of health care cost growth, benchmarking programs have continued to proliferate across states as a strategy for better understanding health care cost drivers,...more

Manatt, Phelps & Phillips, LLP

[Webinar] Levers of Change: Remapping the Health Care Landscape - March 9th, 1:00 pm - 2:00 pm ET

President Biden set an ambitious health care agenda in his campaign and maintained that focus as he took office. The Biden administration has expressed a strong commitment to “protect and build on the Affordable Care Act,...more

Manatt, Phelps & Phillips, LLP

The Manatt State Cost Containment Update - February 2022: Manatt Spotlights

February Spotlight - In each edition, Manatt will feature a “deep dive” topic that shares new cross-cutting benchmarking program developments as states seek to evolve and advance their cost growth benchmarking programs to...more

Proskauer - Health Care Law Brief

CMS releases guidance on Expanded Home Health Value-Based Purchasing (“HHVBP”) Model

On November 2, 2021, the Centers for Medicare & Medicaid Services (“CMS”) issued a final rule (“Final Rule”) that advances the shift from paying for Medicare home health services based on volume to a system that pays based on...more

Manatt, Phelps & Phillips, LLP

Supporting the Future of Primary Care in California Through Aligned Hybrid Payment Models - A Call to Action

Introduction - The vision of primary care as the foundation for all health care is one shared by many who work in and around the U.S. health care system. Patients, policymakers, providers, payers and purchasers generally...more

Holland & Knight LLP

CMS Releases CY 2022 OPPS and ASC Proposed Rule

Holland & Knight LLP on

The Centers for Medicare & Medicaid Services (CMS) on July 19, 2021, released its calendar year (CY) 2022 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Proposed...more

Manatt, Phelps & Phillips, LLP

State Benchmarking Models: Promising Practices to Understand and Address Health Care Cost Growth

As states grow increasingly concerned with rising health care costs, establishing health care cost growth benchmarking programs can provide a structure and process for increasing health system transparency and developing...more

Manatt, Phelps & Phillips, LLP

[Webinar] State Benchmarking Models: Promising Practices to Understand & Address Health Care Cost Growth - June 17th, 1:00 pm -...

Learn How States Are Using Cost Growth Benchmarking to Increase Health System Transparency and Contain Rising Health Care Costs at a New Manatt Webinar. As states grow increasingly concerned over soaring health care costs,...more

K&L Gates LLP

COVID-19: K&L Gates Triage: Alternative Payment Models: Tied to an Improved COVID-19 Response?

K&L Gates LLP on

In this week's episode, Gabe Scott and Steve Pine discuss recent data showing how health systems participating in Alternative Payment Models compare to other health systems in responding to the COVID-19 crisis, and discuss...more

McGuireWoods LLP

CMS Updates Healthcare Quality Reporting Exceptions in Response to COVID-19 Crisis

McGuireWoods LLP on

As discussed in a previous alert from March 24, 2020, due to the 2019 novel coronavirus (COVID-19) pandemic, the Centers for Medicare & Medicaid Services (CMS) announced it would temporarily ease quality reporting...more

King & Spalding

CMS Announces CMMI Milestones and Updates

King & Spalding on

CMS recently announced updates and milestones for several programs run by the Center for Medicare and Medicaid Innovation (CMMI). CMMI is the internal CMS agency responsible for developing and testing new health care payment...more

Sheppard Mullin Richter & Hampton LLP

Global and Professional Options Direct Contracting Model RFA and LOI Now Active

On April 21, 2019, the Center for Medicare and Medicaid Innovation (“CMMI”) announced the CMS Primary Cares Initiative – a voluntary, risk-based initiative to transform the Medicare program’s reimbursement of primary care...more

Holland & Knight LLP

CMS Issues 2020 MPFS and QPP Final Rule

Holland & Knight LLP on

The Centers for Medicare & Medicaid Services (CMS) on Nov. 1, 2019, published the Calendar Year (CY) 2020 Final Rule for the Medicare Physician Fee Schedule (MPFS). The MPFS dictates Medicare rates and policies under Part B,...more

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