News & Analysis as of

Medicare

Trump Administration: 2017 Recap and 2018 Outlook

On January 20, 2017, businessman Donald J. Trump was sworn in as the 45th President of the United States following a contentious and unconventional 2016 presidential election. Republicans also successfully maintained control...more

Court Upholds Procedural Validity of HHS's Outlier Reconciliation Instructions

by Baker Ober Health Law on

On December 26, 2017, the United States Court of Appeals for the District of Columbia Circuit upheld the procedural validity of 2010 manual instructions setting out the criteria by which Medicare outlier payments might be...more

The Battle over Medicare's Treatment of Provider Taxes May be Coming to an End

by Baker Ober Health Law on

For much of the past decade, hospitals and CMS have battled over whether providers may claim, as Medicare reasonable costs, the full amount of provider tax assessments levied upon them by the states in which they operate. In...more

CMS Gives States Options for Complying with Cures Act Mandate to Cap Medicaid DME Rates

by Reed Smith on

As previously reported, the 21st Century Cures Act prohibits federal financial participation (FFP) payments to the states for certain Medicaid durable medical equipment (DME) expenditures that exceed what Medicare would have...more

Capitol Hill Healthcare Update

by BakerHostetler on

House Republicans will gather tonight for a GOP-only meeting to plot strategy on passing a stopgap budget bill, but a breakdown among key senators on separate immigration legislation has elevated the risk of a government...more

2018 Limits Announced for Benefits and Other Tax Provisions

Members of Saul Ewing Arnstein & Lehr’s Tax and Employee Benefits and Executive Compensation Practices have outlined the recently announced 2018 dollar limits on the Social Security Wage Base, compensation and deferrals for...more

In Proposed Regulations CMS Requests Information on Changes to Part D Negotiated Prices

Today, January 16, 2018 is the deadline for interested parties to submit comments to CMS regarding the proposed contract year 2019 Medicare Advantage and Part D regulations. The proposed rule focuses on many issues. In...more

UPCOMING DEADLINES: (1) Form W-2 Reporting Of Employer-Provided Health Coverage; And (2) Medicare Part D Notices To CMS

by Fraser Trebilcock on

Unless subject to an exemption, employers must report the aggregate cost of employer-sponsored health coverage provided in 2017 on their employees’ Form W-2 (Code DD in Box 12) issued in January 2018. Please see IRS Notice...more

Impact of the New Tax Reform Legislation on the Real Estate Industry

by King & Spalding on

On December 22, the President signed the Tax Cuts and Jobs Act (“TCJA”) into law. TCJA changes the taxation of individuals and businesses in many ways. While there are still many open questions to be addressed by technical...more

Day 4 Notes on the 2018 JP Morgan Healthcare Conference

San Francisco (January 11, 2018) – The final day of the 2018 JP Morgan Healthcare Conference gave us food for thought about the topic of healthcare navigation, as well as updates on the home health sector. Post-acute has...more

CMS announces new voluntary episode-payment program: BPCI Advanced

by Thompson Coburn LLP on

On Jan. 9, 2018, the Centers for Medicare and Medicaid Services (CMS) announced a new voluntary episode-payment program, Bundled Payments for Care Improvement Advanced (BPCI Advanced). Following on the success of the initial...more

Low Volume Appeals settlement option announced

by Bricker & Eckler LLP on

The Centers for Medicare & Medicaid Services (CMS) recently announced the Low Volume Appeals (LVA) settlement agreement option, which allows Medicare Fee-For-Service providers, physicians and suppliers (Appellants) to receive...more

The Life Sciences Report - Winter 2018

Life Beyond FDA Clearance or Approval: The Reimbursement Challenge - To medical device manufacturers, winning premarket approval or 510(k) clearance from the U.S. Food and Drug Administration (FDA) is only half the battle....more

Azar’s Nomination Hearing Highlights Medicare Negotiation of Part B Drug Prices

On January 9th, the Senate Committee on Finance conducted its nomination hearing of Alex Michael Azar II, President Trump’s nominee for Secretary of Health and Human Services. Under President George W. Bush, Mr. Azar served...more

Manatt on Health: What’s Ahead in 2018

Congress returned from recess with a large agenda for the new year. The federal government is only funded through January 19 and the next funding bill is expected to carry with it longer-term extensions of the Children’s...more

Day 1 Notes from the 2018 JP Morgan Healthcare Conference in San Francisco

San Francisco (Monday, January 8, 2018): Outside it was raining heavily today in San Francisco, but inside the 2018 JP Morgan Healthcare Conference the weather was distinctly sunny. Nary a hint of gloom or pessimism was heard...more

OIG Scrutiny of Patient Assistance Programs

by Shipman & Goodwin LLP on

Last week, one of the largest charity patient assistance programs in the country, Caring Voice Coalition, announced that it would not be offering financial assistance for any of its disease funds in 2018. This announcement...more

OIG Reaffirms Permissibility of Certain Gainsharing Arrangements

The Department of Health and Human Services Office of the Inspector General (OIG) has issued an Advisory Opinion (Opinion) in connection with a hospital’s gainsharing arrangement (Arrangement) with a designated group of...more

CMS Issues Billing Guidance for Major Joint Replacement (Hip or Knee)

by Tucker Arensberg, P.C. on

In the January 11, 2018 issue of MLN Connects, CMS has now widely publicized that it issued billing guidance for major joint replacements (hip or knee) in May 2017 at ICN909065. CMS reports that major joint replacement is...more

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

by Seyfarth Shaw LLP on

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

CMS Quality Payment Program: Are you ready for round two?

by Bricker & Eckler LLP on

2018 marks the commencement of the second performance year for the Medicare Quality Payment Program (QPP), implemented under the Medicare Access and CHIP Reauthorization Act of 2015 (otherwise known as MACRA). ...more

‘Twas the Season to Contract? A Year-End Review of Network Negotiations and Billing Disputes

As 2017 drew to a close, some health plans and healthcare providers across the country were still busy trying to finalize contracts for in-network services for 2018 and beyond. A number of negotiations made the headlines in...more

CMS Clarifies Part D Coverage for Newer Insulin Delivery Devices

by Holland & Knight LLP on

Centers for Medicare and Medicaid Services (CMS) has just issued guidance to address Medicare Part D coverage for newer insulin delivery devices for the treatment of diabetes. Medicare Part D has historically covered “medical...more

Off-campus provider-based hospital outpatient departments: Challenges and options in 2018

by Bricker & Eckler LLP on

2017 was another challenging year for hospitals grappling with site-neutral payment changes for off-campus provider-based hospital outpatient departments (OCPBDs). ...more

CMS Issues Guidance on Texting Patient Information

On December 28, 2017, the Centers for Medicare and Medicaid Services (CMS) published a memo to state survey agency directors clarifying its position on the use of text messaging among health care providers. ...more

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