News & Analysis as of

Outlier Payments Centers for Medicare & Medicaid Services (CMS)

Baker Donelson

Home Health Agency PPS Update for 2017: Quality, Quality, Quality

Baker Donelson on

On November 3rd, CMS published the Final Prospective Payment System (PPS) Rule for Home Health Agencies (HHAs) for CY 2017 at 81 FR 76702 (Nov. 3, 2016). The rule implements annual changes to the PPS rate for HHAs and...more

Baker Donelson

D.C. District Court Strikes Down PRRB's Application of "Self-Disallowance" Jurisdictional

Baker Donelson on

In Banner Heart Hospital, et al. v. Burwell, the United States District Court for the District of Columbia (Court) held on August 19, 2016, that the Provider Reimbursement Review Board (PRRB) incorrectly declined to hear an...more

King & Spalding

D.C. District Court Invalidates CMS’s “Protest” Requirement

King & Spalding on

On August 19, 2016, the United States District Court for the District of Columbia granted a group of hospitals’ motion for summary judgment against HHS in a challenge of the Provider Reimbursement Review Board’s (PRRB) denial...more

McDermott Will & Emery

CMS Proposes CY 2017 Home Health PPS Rate, Updates to ValueBased Purchasing Model and Quality Reporting

The US Department of Health and Human Services (HHS) Centers for Medicare & Medicaid Services (CMS) released proposed updates to its Calendar Year (CY) 2017 Home Health Prospective Payment System (HH PPS) in the July 5, 2016,...more

King & Spalding

CMS Publishes Clarification of FY 2004 Outlier Fixed-Loss Threshold As Required by Two Recent Federal Court Rulings

King & Spalding on

On January 22, 2016, CMS published an explanation of its FY 2004 outlier fixed-loss threshold rulemaking. The explanation was required by two 2015 federal court orders in cases brought by hospitals challenging the outlier...more

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