News & Analysis as of

Quality of Care Standards

Tying GME Funding to Quality Metrics

by Dentons on

"Pay-for-performance" initiatives have become the norm within Medicare payment programs. However, Medicare funding for graduate medical education (GME) is still based on statutory formulae that are not linked to outcome or...more

New Home Health Rules Effective in January 2018—Some Traps for the Unwary

The Centers for Medicare & Medicaid Services (CMS) have issued new Conditions of Participation (CoP) for home health agencies (HHA) that are effective January 13, 2018. The CoP were originally scheduled to take effect on...more

The UK Care Sector | Problem or Opportunity for Investors?

by McDermott Will & Emery on

For investors considering the UK care sector, the Care Quality Commission (CQC) State of Care report released 10 October 2017 again raises alarm bells. Beds in nursing homes declined meaningfully, and funding pressures are...more

Massachusetts Senators Hold Healthcare Roundtable Discussions

by Mintz Levin on

This past August, the Massachusetts Senate and the Millbank Memorial Fund Healthcare Working Group held three roundtable discussions geared towards finding solutions to rising healthcare costs and providing patients with more...more

Hospice Quality Reporting Program Notices of Noncompliance and Reconsideration Requests

by Poyner Spruill LLP on

The Centers for Medicare and Medicaid Services (CMS) has issued notification letters to hospice providers that are not in compliance with the Hospice Quality Reporting Program requirements. According to CMS, all noncompliance...more

ALERT: HHA's Should Make Use of Delay in New Medicare Rules

by Pullman & Comley, LLC on

Now that the Centers for Medicare & Medicaid Services (CMS) have published a Final Rule delaying the effective date of the revised Medicare Conditions of Participation (CoP) for home health agencies (HHAs) until January 13,...more

GAO Releases Report on Evaluation Methodology in Hospital Value-Based Purchasing Program

by King & Spalding on

On June 30, 2017, the Government Accountability Office (GAO) released a report on the Hospital Value-Based Purchasing (HVBP) program, which evaluates hospital performance on quality and efficiency measures, and provides...more

CMS Proposes Delaying Implementation of New Home Health Agency CoPs

by Arnall Golden Gregory LLP on

On January 13, 2017, the Centers for Medicare & Medicaid Services (CMS) published a final rule revising the conditions of participation (CoPs) for home health agencies to participate in and qualify for the Medicare and...more

OIG Publishes Semiannual Report to Congress

Earlier this month, the Office of the Inspector General for the Department of Health and Human Services (“OIG”) published its Semiannual Report to Congress covering the period from October 1, 2016 to March 31, 2017. The...more

CMS Proposes Six-Month Delay for New Medicare and Medicaid Conditions of Participation for Home Health Agencies

by Stinson Leonard Street on

The Centers for Medicare & Medicaid Services (CMS) recently proposed a six-month delay for home health agencies (HHAs) to implement the revised conditions of participation (CoPs) that HHAs must satisfy to participate in the...more

Manatt on Medicaid: Monthly Expansion Recap - March 2017

Arizona - Appeals Court Hears Arguments in Medicaid Expansion Lawsuit - A three-judge State Appeals Court panel heard an appeal of the Maricopa County Superior Court's decision that Arizona's Medicaid expansion plan...more

CMS Issues Final Rule on New Medicare and Medicaid Conditions of Participation for Home Health Agencies

by Stinson Leonard Street on

The Centers for Medicare & Medicaid Services (CMS) recently issued a final rule, 42 C.F.R. pt. 484, implementing significant changes to the conditions of participation (CoPs) that home health agencies (HHAs) must satisfy to...more

Burr Alert: New Requirements of Participation for Skilled Nursing Facilities

by Burr & Forman on

On October 4, 2016, The Centers for Medicare and Medicaid Services (“CMS”) released the final rules regarding the requirements of participation for skilled nursing facilities. One of the most significant changes to the...more

Food for Thought (and Health): Day 2 Notes from the JP Morgan Healthcare Conference

Addressing the Social Determinants of Health: Is the healthcare industry pushing a rock up a hill? We collectively are trying to provide healthcare with improved quality and reduced cost, but the structure of the nation’s...more

CMS Releases the First Comprehensive Overhaul of Nursing Home Conditions of Participation in Over 25 Years

by Ruder Ware on

On October 4, 2016, the Center for Medicare and Medicaid Services (CMS) published a final rule to revise the requirements that Long-Term Care facilities must meet to participate in the Medicare and Medicaid programs. CMS...more

Clouding the Issue: Impact of Cloud-Based Software Service Providers on HIPAA Covered Entities and Business Associates

by Ward and Smith, P.A. on

The message from patients to healthcare providers is clear: increase the quality of health services while decreasing cost.  The message from the federal government to healthcare providers and their business associates is even...more

House Republicans Push Back on Medicare’s New Mandatory Bundled Payment Models

On July 25, 2016, the Centers for Medicare & Medicaid Services (CMS) announced a proposed rule that promises to deliver coordinated, high-quality care for Medicare beneficiaries. The proposed rule (effective July 1, 2017)...more

CMS Issues Final Rule Overhauling SNF/NF Requirements of Participation

The Centers for Medicare & Medicaid Services (CMS) issued a wholesale revision to the rules governing long term care (LTC) facilities on September 28, 2016. Prompted by the changing population of nursing homes which have...more

Also In The News - Health Headlines - August 2016 #4

by King & Spalding on

CMS Reports ACO Savings and Improved Quality of Care – CMS issued a press release on August 25, 2016 announcing the 2015 performance year results for the Medicare Shared Savings Program and the Pioneer Accountable Care...more

Home Health PPS CY 2017 Proposed Rule: Payments Rebased, Quality Measures Updated

by Baker Ober Health Law on

Downward adjustments to home health episode payments arising from rebasing of the national payment rates, case mix adjustments, and an increase to the fixed dollar loss ratio for calculating outliers will result in an overall...more

CMS 2016 Nursing Home Action Plan Overview

by Benesch on

On May 17, the Centers for Medicare & Medicaid Services (CMS) released its new Action Plan for Further Improvement of Nursing Home Quality (Action Plan). The Action Plan is CMS’ strategic plan for nursing homes that is...more

CMS Proposes Updates to Hospital Conditions of Participation

by King & Spalding on

CMS recently published a proposed rule to update certain of the hospital and critical access hospital (CAH) Medicare and Medicaid conditions of participation (CoPs). With its goals of modernizing hospital and CAH CoPs,...more

Healthcare Systems Offer Shared Medical Visits to Address Physician Shortages and Chronic Illnesses

With the advent of an increasing aging population, physicians and other healthcare providers are seeking alternative approaches in offering patients access to quality health care. Among the innovations in healthcare delivery...more

CMS Update to Medicaid Managed Care Regulations Should Prompt Significant Change

by Foley & Lardner LLP on

The Centers for Medicare & Medicaid Services (“CMS”) has released the final version of its much anticipated revisions to the regulations governing Medicaid managed care (the “Final Rule”). First proposed in May 2015, the...more

Tennessee Legislature Passes Sweeping Changes to CON Law

On April 20, 2016, the Tennessee House and Senate completed final actions to pass legislation that makes significant modifications to the state’s certificate of need (CON) laws. The legislation, SB1842/HB1730 was sponsored by...more

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