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Medicare Payment Reform

Sheppard

Proposed Medicare Payment Policy Changes for Hospitals and Long-Term Care Hospitals

Sheppard on

The Centers for Medicare & Medicaid Services (“CMS”) recently published its proposed payment rules for general acute care hospital inpatient services and long-term care hospital (“LTACH”) inpatient services for federal fiscal...more

McDermott+

LEAD: CMS brings Medicare Advantage-like flexibility to original Medicare

McDermott+ on

The CMS Innovation Center has released the request for applications (RFA) for the Long-term Enhanced ACO Design (LEAD) model, a new 10-year accountable care initiative that will begin in 2027....more

Davis Wright Tremaine LLP

[Event] Healthcare Industry Summit 2026 - May 6th, Portland, OR

Please save the date for our 2026 Healthcare Industry Summit—our premier annual event, hosted for the first time in Portland, Oregon. Join us as we gather cross-disciplinary lawyers and esteemed experts from across the...more

McDermott+

MedPAC recommends ASCs report cost data, again

McDermott+ on

Every March, the Medicare Payment Advisory Commission (MedPAC) releases a comprehensive report to Congress outlining its recommendations for updating Medicare payments – and last week, MedPAC issued its 2026 report....more

King & Spalding

Two Congressmembers Propose Bill that Would Restrict Eligibility for Rural Reclassification

King & Spalding on

On February 5, 2026, Congressman David Taylor (R-OH) and Congresswoman Carol Miller (R-WV) proposed a bill titled the Defend Rural Health Act of 2026 (the “Bill”). The Bill would amend the Medicare statute to tighten the...more

McDermott+

Establishing OPPS payment for IPO procedures: Challenges and methodological considerations

McDermott+ on

The Centers for Medicare & Medicaid Services (CMS) recently finalized a policy to eliminate the inpatient only (IPO) list over a three-year period beginning in 2026, creating an immediate need to assign ambulatory payment...more

Robinson+Cole Health Law Diagnosis

New Year Brings Old Obligations with a Recent Twist: PAMA Reporting is Back

After uncertainty over the last few months, the last few weeks saw potential changes to the Protecting Access to Medicare Act of 2014 (PAMA) under section 6226 of the Consolidated Appropriations Act of 2026. On January 20,...more

Hendershot Cowart P.C.

CMS Fundamentally Restructures Skin Substitute Payment: Key Takeaways for Dermatologists, Wound Care Specialists

Hendershot Cowart P.C. on

The Centers for Medicare & Medicaid Services (CMS) is fundamentally changing how it classifies and pays for most skin substitutes. On October 31, CMS announced policy changes for skin substitute Medicare payments,...more

Ropes & Gray LLP

Is International Pricing Coming Onshore for Testing? CMS Proposes Models Tying Medicare Part B and Part D Drug Rebates to...

Ropes & Gray LLP on

On December 19, 2025, the Centers for Medicare & Medicaid Services (“CMS”) proposed two mandatory Center for Medicare and Medicaid Innovation (“CMMI”) drug payment models to test whether alternative methods for calculating...more

McDermott+

ACCESS arrives: Key highlights for potential applicants

McDermott+ on

On December 19, 2025, the Centers for Medicare & Medicaid Services (CMS) Innovation Center released the official request for applications for the Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) model....more

McDermott+

Season’s greetings: Holiday healthcare wishes from McDermott+

McDermott+ on

Happy holidays! We are coming to the end of 2025, and what a year in healthcare it was! With a new administration, the Centers for Medicare & Medicaid Services (CMS) and other federal agencies have been extremely busy...more

ArentFox Schiff

Staying on TEMPO: Five Things for Digital Health Companies to Know About the FDA’s New Pilot

ArentFox Schiff on

Federal regulators are taking a coordinated step to accelerate the responsible integration of digital health technologies into routine care....more

Sheppard

CMS Finalizes Medicare Payment Policies for Hospital Outpatient and Ambulatory Surgery Center Services

Sheppard on

The Centers for Medicare & Medicaid Services (“CMS”) final rule for Medicare payment for services provided in hospital outpatient departments (paid under the Outpatient Prospective Payment System or “OPPS”) and ambulatory...more

King & Spalding

CMS to Open Applications in 2026 for the Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model, a New Payment...

King & Spalding on

CMS announced plans to launch the ACCESS Model, a new payment model that tests an outcome-aligned payment approach in Original Medicare with an aim to expand access to new technology-supported healthcare options that help...more

Foley Hoag LLP

CMS Announces ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) Model

Foley Hoag LLP on

Key Takeaways: The ACCESS Model1 tests an outcome-aligned payment (OAP) approach designed to give people with Original Medicare new options to improve their health and prevent and manage chronic disease with...more

Paul Hastings LLP

Washington, We Have a Problem: OIG Calls for Skin Substitute Payment Reform

Paul Hastings LLP on

A new report by the Health and Human Services Office of the Inspector General (OIG) analyzes Medicare Part B spending trends for skin substitute products and reveals that expenditures in non-institutional settings rose nearly...more

Benesch

CMS’s IOTA Model Took Effect July 1, 2025: Implications for Transplant Hospitals and Nephrology Stakeholders

Benesch on

On July 1, 2025, the Centers for Medicare & Medicaid Services (“CMS”), through its Center for Medicare & Medicaid Innovation (“CMMI”), launched the Increasing Organ Transplant Access (“IOTA”) Model. ...more

McDermott+

The paradox: Declining Medicare payment rates versus higher Medicare spending

McDermott+ on

McDermott+ is pleased to bring you Regs & Eggs, a weekly Regulatory Affairs blog by Jeffrey Davis. October 9, 2025 – Several recent Regs & Eggs blog posts have focused on comments that stakeholders submitted on two major...more

McDermott+

Responses to the PFS proposed reg are in: Five major themes

McDermott+ on

McDermott+ is pleased to bring you Regs & Eggs, a weekly Regulatory Affairs blog by Jeffrey Davis. September 18, 2025 – Comments on the calendar year (CY) 2026 Physician Fee Schedule (PFS) proposed rule were due last Friday....more

King & Spalding

OIG Urges CMS to Strengthen Oversight of Postoperative Visit Reporting

King & Spalding on

In August 2025, OIG released report A-05-20-00027, evaluating whether CMS is receiving the postoperative visit data that it requires from practitioners subject to Medicare’s global surgical package reporting rules. OIG’s...more

Gardner Law

NTAP: How to Secure Supplemental Medicare Reimbursement in FY2027

Gardner Law on

The New Technology Add-On Payment (NTAP) program remains one of the most powerful and underutilized tools for securing Medicare reimbursement for novel medical technologies. For eligible products, NTAP provides additional...more

Troutman Pepper Locke

HHS Sets Its Sights on $50B in Cost Savings: Medicare Payments to Nonhospice Providers Potentially Under Fire

Troutman Pepper Locke on

In May 2025, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) published a review, titled “Potential Cost Savings HHS Programs – HHS Actions,” which provided some insight into the OIG’s...more

McDermott+

CY 2026 MA and Part D Final Reg: Policies Under Consideration

McDermott+ on

Last week, the contract year (CY) 2026 Medicare Advantage (MA) and Part D final reg entered the clearance process at the Office of Management and Budget (OMB). As mentioned in a previous Regs & Eggs blog post, OMB’s review is...more

McDermott Will & Schulte

This Week in 340B: March 4 – 10, 2025

Find this week’s updates on 340B litigation to help you stay in the know on how 340B cases are developing across the country. Each week we comb through the dockets of more than 50 340B cases to provide you with a quick...more

McDermott+

Healthcare Policy Options to Reduce the Deficit

McDermott+ on

The Trump Administration and 119th Congress will likely be targeting trillions of dollars in savings in the year ahead. Healthcare makes up a significant portion of mandatory spending and therefore likely will be a large part...more

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