News & Analysis as of

Medicaid › Medicare Part A

Medicaid is a partnership program between states and the federal government to provide healthcare coverage for lower income individuals, people with disabilities, older people, and certain families with... more +
Medicaid is a partnership program between states and the federal government to provide healthcare coverage for lower income individuals, people with disabilities, older people, and certain families with children.  less -
Foley & Lardner LLP

Medicare Overpayments: CMS Proposes Regulation Establishing Six Month Suspended Deadline for 60-Day Refund Rule

Foley & Lardner LLP on

The 60-day Refund Rule, created by the 2010 Affordable Care Act, requires providers to report and return Medicare and Medicaid overpayments within 60 days of identifying them. See Section 1128J(d) of the Social Security Act,...more

McDermott+

President Biden Releases FY 2025 Budget: What’s NOT in It?

McDermott+ on

Earlier this week, President Biden released his Fiscal Year (FY) 2025 President’s Budget. As a reminder, every year, the White House releases a budget that serves as its official funding request to Congress for the following...more

ArentFox Schiff

2024 Senior Housing Market Outlook

ArentFox Schiff on

Could 2024 bring renewed growth for the skilled nursing and senior housing market or will proposed regulatory changes and the lingering effects of COVID-19 stymie hopes for a potential rebound? With rising occupancy rates...more

King & Spalding

CMS Proposes Changes to the Medicare Advantage and Part D Programs Aimed at Improving Beneficiary Protections, Access to Care, and...

King & Spalding on

On November 6, 2023, CMS released a pre-publication version of a proposed rule (Proposed Rule) that is set to publish in the Federal Register on November 15, 2023, and that would amend the regulations governing Medicare...more

McDermott+

Overall Medicare Hospital Payments Will Increase in FY 2024, but Some Hospitals Could See a Decrease

McDermott+ on

Congress may be on summer break, but reg season is in full swing. Last week, the Centers for Medicare & Medicaid Services (CMS) released a final reg that will impact Medicare hospital payments in fiscal year (FY) 2024, which...more

Chambliss, Bahner & Stophel, P.C.

What Is Hospice Care at Home?

Chambliss, Bahner & Stophel, P.C. on

Hospice care is a type of health care that patients with terminally ill conditions rely on at the end of their lives. This type of care focuses on pain management and emotional, spiritual, and familial support for patients...more

Holland & Knight LLP

Holland & Knight Health Dose: October 4, 2022

Holland & Knight LLP on

Holland & Knight Health Dose is an in-depth weekly dose of legislative and regulatory insights to keep stakeholders abreast of happenings in Washington, D.C., impacting the health sector. This week's topics include... ...more

Holland & Knight LLP

Supreme Court Backs Rule That Decreases Medicare Payments to Safety-Net Hospitals

Holland & Knight LLP on

The U.S. Supreme Court settled an Administrative Procedures Act (APA) dispute on June 24, 2022, involving Medicare's formula to adjust rates paid to safety-net hospitals, clarifying a statute that dictates how to calculate...more

Ruder Ware

CMS Releases Key Medicare Figures for 2022

Ruder Ware on

The Centers for Medicare and Medicaid Services (“CMS”) recently released key Medicare figures for 2022 that will affect all elderly and disabled individuals who receive program benefits.  This notice summarizes the changes...more

Mintz - Health Care Viewpoints

Telehealth Update:  New Bill Seeks to Understand the Impact of Telehealth During COVID-19 as State COVID-19 Orders Expire

Mintz - Health Care Viewpoints on

As previously discussed, many of the telehealth flexibilities in place during the COVID-19 pandemic are set to expire at the end of the federal Public Health Emergency (PHE), unless federal and state legislators act to make...more

Dorsey & Whitney LLP

The Supreme Court - July 2, 2021

Dorsey & Whitney LLP on

Hughes v. Northwestern University, No. 19-1401: Whether allegations that a defined-contribution retirement plan paid or charged its participants fees that substantially exceeded fees for alternative available investment...more

King & Spalding

CMS Issues Medicare IPPS and LTCH Proposed Rule for FY 2021

King & Spalding on

On April 27, 2021, CMS issued the fiscal year (FY) 2022 proposed rule for the hospital inpatient prospective payment system (IPPS) and long-term care hospital (LTCH) prospective payment system (the Proposed Rule). Among...more

Dorsey & Whitney LLP

District of New Jersey Rules Prescription Drug Events Tainted By Alleged Kickback Schemes Constitute False Claims

Dorsey & Whitney LLP on

A federal judge recently ruled that submission of electronic data to the government can, under appropriate circumstances, give rise to liability under the False Claims Act. In U.S. ex rel. Marc Silver et al. v. Omnicare Inc....more

ArentFox Schiff

Investigations Newsletter: Court Rules Prescription Drug Event and Enrollee Encounter Data Are 'Claims for Payment' Under the...

ArentFox Schiff on

Court Rules Prescription Drug Event and Enrollee Encounter Data Are 'Claims for Payment' Under the False Claims Act - US District Judge Noel L. Hillman approved a whistleblower’s request to file a Fourth Amended Complaint...more

Foley & Lardner LLP

COVID-19 Compounds Opioid Crisis and Treatment Gaps for Vulnerable Americans: Will a Biden Administration and New Congress Expand...

Foley & Lardner LLP on

Payment misalignment in Medicare FFS for Substance Use Disorder (SUD) treatment as the subject of potential legislative and/or regulatory reforms - New opportunities for investor-backed behavioral health platforms in...more

Health Care Compliance Association (HCCA)

Report on Medicare Compliance Volume 30, Number 8. News Briefs: March 2021

Health Care Compliance Association (HCCA) on

Report on Medicare Compliance 30, no. 8 (March 1, 2021) - According to a CMS spokesperson, “CMS has not yet determined when Targeted Probe and Educate reviews will resume.” Meanwhile, “CMS continues to temporarily pause...more

McGuireWoods LLP

Omnibus Appropriations Package Includes Changes for Medicare and Medicaid Beneficiaries

McGuireWoods LLP on

Passed by Congress Dec. 21, 2020, and signed by President Donald Trump Dec. 27, 2020, the $1.4 trillion omnibus Consolidated Appropriations Act includes numerous provisions that directly impact Medicare and Medicaid...more

Mitchell, Williams, Selig, Gates & Woodyard,...

Understanding Medicare

Mitchell, Williams, Selig, Gates & Woodyard,... on

What does Medicare cover? What are the costs of Medicare? What happens if you forget to enroll for Medicare? Medicare is the federal health insurance program for people in the United States who are over the age of 65 or...more

King & Spalding

Ninth Circuit’s Unanimous Decision in Favor of Empire Health Foundation Vacating Medicare’s 2005 Disproportionate Share Regulation...

King & Spalding on

On October 28, 2020, after previously denying the Secretary of Health and Human Services’ (HHS) request for en banc review, the Ninth Circuit issued a mandate rendering effective its unanimous panel decision on behalf of...more

King & Spalding

HHS Publishes General and Targeted Distribution Post-Payment Notice of Reporting Requirements

King & Spalding on

Under the Provider Relief Fund Terms and Conditions, each recipient is required to submit reports to HHS. This notice supplements HHS’ July 20, 2020 Post-Payment Notice of Reporting Requirements (previously reported on here)....more

King & Spalding

CMS Proposes to Codify the Definition of “Reasonable and Necessary” and to Establish a New Medicare Coverage Pathway

King & Spalding on

On September 1, 2020, CMS published a proposed rule that would define “reasonable and necessary” for purposes of coverage under Part A and Part B of the Medicare program, and that would establish a new expedited Medicare...more

Chambliss, Bahner & Stophel, P.C.

Can You Transfer Your Medicare and Medicaid Plans When You Move to Another State?

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If you plan to move states, can you take your Medicare or Medicaid plans with you? The answer depends on whether you have original Medicare, Medicare Advantage, or Medicaid. Medicare - If you have original Medicare...more

King & Spalding

HHS Expands Eligibility for Provider Relief Fund Phase 2 General Distribution

King & Spalding on

Last week, HHS announced that it will now accept additional applicants for the Provider Relief Fund Phase 2 General Distribution. All eligible providers will only receive funding of up to 2 percent of their reported total...more

Foley Hoag LLP - Medicaid and the Law

A Loss in SCOTUS Prompts New CMS Notice of Proposed Rulemaking

Foley Hoag LLP - Medicaid and the Law on

On August 4th, CMS released a proposed rule titled Treatment of Medicare Part C Days in the Calculation of a Hospital’s Medicare Disproportionate Patient Percentage (DPP). We’ve written before about the Medicaid...more

Greenbaum, Rowe, Smith & Davis LLP

COVID-19 And Medicare Alternate Payment Programs

Greenbaum, Rowe, Smith & Davis LLP on

Insurance payments for healthcare services and supplies are frequently based on projections of future costs, often measured against a baseline calculated on past costs. However, COVID-19 and its attendant changes to the...more

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