News & Analysis as of

Medicare

Health Care : Helpful Hints – May 2018

by Burr & Forman on

OIG Issues New Advisory Opinion on May 7, 2018 - The Office of Inspector General (“OIG”) approved a proposed arrangement involving medical devices/supplies. OIG Advisory Opinion No. 18-02 concerns an arrangement where a...more

Health Care Weekly Preview from ML Strategies – May 2018 #2

With two weeks left in this work period, we are already seeing signals that the House E&C effort to pass an opioid package may spill into June. The House Ways & Means Committee is joining the conversation. On Friday, they...more

Recent Fraud Settlements Illustrate Current Compliance Risk Areas

by Ruder Ware on

One of the reasons compliance officers and health care attorneys read fraud settlements is to identify issues the government is focused on. The cases the government decides to pursue are very indicative of the areas of fraud...more

Virginia, Maryland, and kids bear early brunt of partisan health care attacks

As the nation churns toward the midterm elections, the Trump Administration has sent stark messages to voters about how they may wish to respond to Republicans’ unceasing attacks on health care and health insurance for the...more

Trump Administration Drug Pricing Blueprint: Overview and Analysis

• The administration’s drug pricing Blueprint combines proposals that are already under way with new initiatives that may or may not be adopted. • Many of the more dramatic proposals would require federal rulemaking or...more

President Trump’s Remarks on Lowering Drug Prices; Industry Reactions

by Goodwin on

On May 11, President Trump delivered remarks about his administration’s new plan to help lower drug prices. The President blamed “soaring drug prices” on “everyone involved in the broken system,” including “the drug makers,...more

Proposal to Create New Medicare Benefit for Long-Term Care

by King & Spalding on

On May 2, House Energy and Commerce Committee Ranking Member Frank Pallone (D-NJ) released a discussion draft of the Medicare Long-Term Care Services and Supports (LTSS) Act of 2018, to establish a new LTSS benefit within the...more

Office of Medicare Hearings and Appeals To Hold Open Door Call on Upcoming Expansion of Settlement Conference Facilitation Program

by Arnall Golden Gregory LLP on

In preparation for the upcoming expansion of its Settlement Conference Facilitation (SCF) program, the Office of Medicare Hearings and Appeals (OMHA) has directed interested providers and suppliers to review the SCF Expansion...more

CMS Expands Health Related Supplemental Benefits in Medicare Advantage Plans

by Dorsey & Whitney LLP on

Last month, the Centers for Medicare and Medicaid Services (“CMS”) announced new flexibility in what Medicare Advantage plans may cover as “supplemental health care benefits.” The announcement was part of CMS’ release of...more

Administration Releases Blueprint to Lower Drug Prices, Reduce Out-of-Pocket Costs

by Holland & Knight LLP on

• "American Patients First: The Trump Administration Blueprint to Lower Drug Prices and Reduce Out-of-Pocket Costs" outlines actions that the Administration proposes to lower prescription drug prices. • The plan includes...more

K&L Gates Triage: ACO Improvements in the Bipartisan Budget Act of 2018 (Part 2)

by K&L Gates LLP on

In the second segment of this two-part series discussing recent program changes introduced by the Bipartisan Budget Act of 2018 for Accountable Care Organizations (ACOs) participating in the Medicare Shared Savings Program...more

CMS Pushes for Hospital Price Transparency in Proposed Rule

On April 24, 2018, the Centers for Medicare & Medicaid Services (“CMS”) announced a new proposed rule (CMS-1694-P) (“Proposed Rule”). In an attempt to “empower patients through better access to hospital price information,”...more

President Trump Delivers Much Anticipated Drug Pricing Speech

On Friday, after weeks of delay, the President finally delivered his Drug Pricing Speech and released the HHS Blueprint detailing the Trump Administration’s plan to lower drug prices and reduce out-of-pocket costs....more

CMS Publishes Six Proposed Medicare Payment Rules: What It All Means

by Morgan Lewis on

Key themes emerging from the hundreds of pages of proposed Medicare payment and policy rules impacting hospitals and post-acute providers include encouraging price transparency, promoting exchange of healthcare data, and...more

Who Pays? The Promise of Telehealth, Part II in a Series Addressing the Role of Telehealth in the Delivery of Health Care in New...

by Hodgson Russ LLP on

Advances in telecommunications, including improvements in high resolution imaging and access to broadband, are accelerating the availability of telehealth. Still, an important question remains: who pays for telehealth...more

President Trump Gives Speech on Prescription Drug Prices and Releases Blueprint to Lower Drug Prices and Reduce Out-of-Pocket...

by Dorsey & Whitney LLP on

On May 11, 2018, President Trump gave his long-awaited speech on his administration’s plan to lower prescription drug prices. In addition, the administration published its Blueprint to Lower Drug Prices and Reduce...more

Window On Washington - Vol. 2, Issue 19

by Clark Hill PLC on

Outlook for This Week in the Nation's Capital - Farm Bill. The House is trying to move its bill to reauthorize farm programs this week but it’s unclear at this point if it will have the votes to pass....more

Deciphering the OIG's Findings in its Recent Report on Non-Compliant Telehealth Claims

by Baker Ober Health Law on

Last summer, we alerted our clients to the OIG's inclusion of telehealth claims to its work plan, and we now see the results of the OIG's focused review in a report first released at the beginning of April....more

CMS Releases FY 2019 Proposed Payment Rules

by Baker Ober Health Law on

On April 24 and 27, 2018, CMS launched its annual gaggle of proposed regulations – each with the theme of "Patients over Paperwork" – with the stated goal of "advanc[ing] the agency's priority of creating a patient-driven...more

Enrollment Dangers for Surgical Hospitals Following New Medicare Compliance Criteria

On April 11, 2018, the Centers for Medicare & Medicaid Services (CMS) issued a notice of revocation of Medicare enrollment to Blue Valley Hospital in Overland Park, Kansas (Blue Valley) for failing to meet Medicare standards...more

CMS Seeks Input on Direct Provider Contracting

The Centers for Medicare & Medicaid Services (CMS) announced that it is seeking input on direct provider contracting (DPC) between “payers and primary care or multi-specialty groups to inform potential testing of a DPC model”...more

CMS Releases Innovation Center New Direction RFI Feedback and Issues New RFI for Direct Provider Contracting

Last fall, the Centers for Medicare & Medicaid Services (CMS) announced a new direction for its Center for Medicare & Medicaid Innovation, CMS’s platform for testing innovative models for delivering high-quality care at lower...more

OIG Report Indicates CMS Paid Practitioners for Telehealth Services that did not meet Medicare Requirements - Health Care...

by Hinshaw & Culbertson LLP on

CMS estimates it paid $3.7 million to practitioners for telehealth services that did not meet Medicare requirements. That's the finding of a recent report of the Office of Inspector General (OIG) of the Department of Health...more

Capitol Hill Healthcare Update

by BakerHostetler on

GOP LAWMAKERS: EUROPE, CANADA ‘FREE RIDING’ ON US DRUG INNOVATION - More than two dozen House Republicans last week called on President Donald Trump to leverage upcoming trade negotiations to stop other nations from “free...more

Medicare cost reporting changes on the horizon

by Dentons on

On April 24, 2018, CMS released its fiscal year 2019 hospital inpatient prospective payment system (IPPS) proposed rule (the Proposed Rule), in which the agency has proposed a number of changes to supporting documentation...more

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