News & Analysis as of

Prospective Payment System (PPS)

CMS Issues FY 2019 SNF Proposed Rule

by King & Spalding on

On April 27, 2018, CMS issued a proposed rule that would update the payments rates under the prospective payments system (PPS) for skilled nursing facilities (SNFs). Additionally, the proposed rule includes proposals for the...more

CMS Proposes Overhaul of SNF Reimbursement System, Increases FY 2019 Payments

The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule on April 27, 2018 to overhaul the payment system for skilled nursing facilities (SNFs). Specifically, the rule would “update the payment rates used...more

California Medicaid Agency Proposes Significant Restrictions on FQHC and RHC Reimbursement

by Foley & Lardner LLP on

California’s Medicaid agency has posted draft language of a new state plan amendment (SPA) that would make major changes to federally qualified health center (FQHC) and Rural Health Clinic (RHC) reimbursement. Public comments...more

BPCI Advanced – CMS Offers a Familiar Program with a New Twist

by Baker Ober Health Law on

The Centers for Medicare & Medicaid Services (CMS) is launching BPCI Advanced – the successor program to the Bundled Payments for Care Improvement Initiative. Providers that like the current BPCI program, or simply missed the...more

CMS Releases MLN Matters Article on Care Coordination Services and Payment for Rural Health Clinics and Federally-Qualified Health...

by King & Spalding on

CMS recently issued a Medicare Learning Network (MLN) Matters article in connection with Change Request 10175 (issued August 11, 2017), which provides instructions for payment to Rural Health Clinics (RHCs) billing under the...more

Medicare Home Health Payments to Drop by $80 Million under Final 2018 Rule

by Reed Smith on

The final CMS calendar year (CY) 2018 Medicare home health prospective payment system (HH PPS) rule cuts Medicare payments by 0.4% ($80 million) in 2018 compared to 2017 levels, but CMS did not adopt a more sweeping case mix...more

Home Health Payment Rule Published

by Baker Ober Health Law on

On November 1, 2017, CMS released the Final Rule for the 2018 home health prospective payment system rate update, including the CY 2019 case mix adjustment methodology refinements. CMS also made changes to the Value Based...more

CMS Updates End-Stage Renal Disease Prospective Payment System

by McGuireWoods LLP on

On Nov. 1, 2017, the Centers for Medicare & Medicaid Services (CMS) published a final rule that updates payment policies and rates under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for renal dialysis...more

Final Home Health Rule Drops Controversial Proposed Payment Model

by Bass, Berry & Sims PLC on

Last week, home health agencies welcomed the Centers for Medicare & Medicaid Services' (CMS) decision to drop a controversial proposed payment model and leave largely unchanged the current payment system. Responding to...more

CMS Boosting Medicare ESRD Facility Payments by 0.5% for 2018

by Reed Smith on

The Centers for Medicare & Medicaid Services (CMS) has issued its final Medicare end-stage renal disease (ESRD) prospective payment system (PPS) rates and policies for calendar year 2018. CMS projects that the final rule will...more

CMS Corrects Final FY 2018 IPPS, LTCH, and SNF Payment Rules

by Reed Smith on

CMS has released corrections to two major fiscal year (FY) 2018 Medicare payment rules. First, CMS has made numerous technical corrections to the FY 2018 inpatient prospective payment systems (IPPS) and long term care...more

CMS Proposes New Payment Model and Other Changes for Home Health Agencies

by Bass, Berry & Sims PLC on

Among the various payment updates proposed by the Centers for Medicare and Medicaid Services (CMS) this summer, the proposed payment update for the home health agency prospective payment system (HHA-PPS), published in the...more

CMS Finalizes IPPS/LTCH Payment and Policy Changes for FY 2018

by Reed Smith on

CMS has published its final rule to update the Medicare acute hospital inpatient prospective payment system (IPPS) and long-term care hospital (LTCH) prospective payment system (PPS) for fiscal year (FY) 2018. CMS projects...more

CMS Boosts Medicare Inpatient Psychiatric Facility Rates by $45 Million for FY 2018

by Reed Smith on

CMS has published a notice with comment period updating prospective payment system (PPS) rates for Medicare services furnished by inpatient psychiatric facilities (IPFs) during fiscal year (FY) 2018. CMS estimates that its...more

CMS Finalizes 1% Update to Medicare IRF Rates for FY 2018; Payments to Rise by $75 Million

by Reed Smith on

CMS has finalized Medicare prospective payment system (PPS) rates for inpatient rehabilitation facility (IRF) services for fiscal year (FY) 2018, which begins October 1, 2017. CMS estimates that IRF PPS payments will increase...more

CMS Issues Final FY 2018 SNF PPS Update; Rates to Increase by 1%

by Reed Smith on

CMS has released its final rule to update Medicare skilled nursing facility (SNF) prospective payment system (PPS) rates and policies for FY 2018, which begins October 1, 2017. The final rule incorporates a 1% increase to SNF...more

Rethinking Transparency – Inpatient Prospective Payment System Final Rule Rescinds Proposed Survey Disclosure Rule

by McDermott Will & Emery on

The 2018 IPPS/LTCH PPS proposed rule contained a provision that would have required AOs to make survey reports and acceptable plans of correction publicly available within approximately three months of issuance. The Final...more

CMS Proposes $80 Million Cut in in Home Health PPS Payments for 2018, Additional Significant Reforms for 2019

by Reed Smith on

CMS is proposing to cut CY 2018 Medicare home health prospective payment system (HH PPS) payments by 0.4% — or $80 million overall — compared to 2017 rates under a proposed rule published on July 28, 2017. Furthermore, the...more

CMS Proposes Update to Medicare ESRD PPS Payments for 2018

by Reed Smith on

The Centers for Medicare & Medicaid Services (CMS) has published a proposed rule to update the Medicare end-stage renal disease (ESRD) prospective payment system (PPS) for calendar year (CY) 2018. CMS anticipates that the...more

CMS Extends Comment Period on SNF Case Mix Methodology ANPRM

by Reed Smith on

CMS is extending the comment period on its May 4, 2017 advance notice of proposed rulemaking (ANPRM) discussing plans to revise the basis for the Medicare skilled nursing facility (SNF) prospective payment system (PPS). As...more

CMS Issues Proposed Payment Rules for Skilled Nursing Facilities

by King & Spalding on

In a recently announced proposed rule (CMS-1679-P), CMS proposes to increase aggregate pay by $390 million in fiscal year (FY) 2018 for skilled nursing facilities (SNFs). In a separate notice (CMS-1686-ANPRM), CMS is...more

CMS Proposes Rule to Update Prospective Payment Rates for Inpatient Rehabilitation Facilities

by King & Spalding on

CMS recently proposed a rule that it estimates would increase payment to inpatient rehabilitation facilities (IRFs) by $80 million during fiscal year (FY) 2018 (discharges occurring between October 1, 2017 and September 30,...more

CMS Proposes 1% Update to Medicare IRF PPS Payments for FY 2018

by Reed Smith on

CMS has published a proposed rule to establish FY 2018 Medicare prospective payment system (PPS) rates for inpatient rehabilitation facility (IRF) services. CMS estimates that IRF PPS payments would increase by 1.0% overall...more

CMS Releases FY 2018 Hospital Inpatient Prospective Payment System Proposed Rule and Request for Information

by King & Spalding on

On April 14, 2017, CMS issued the annual Hospital Inpatient Prospective Payment System (IPPS) Rule for FY 2018 (the “Proposed Rule”) which will affect discharges on or after October 1, 2017. CMS estimates that IPPS operating...more

CMS Proposes IPPS/LTCH Payment and Policy Changes for FY 2018; Requests Comments on Broader Policy Issues

by Reed Smith on

CMS has published its proposed rule to update the Medicare acute hospital inpatient prospective payment system (IPPS) and long-term care hospital (LTCH) prospective payment system (PPS) for fiscal year (FY) 2018. CMS also...more

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