News & Analysis as of

Reimbursements

Ankura

Medicare Finalizes 3.8% Physician Reimbursement Increase

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On Oct. 31, the Centers for Medicare and Medicaid Services (CMS) released the 2026 Physician Fee Schedule Final Rule (Final Rule), which outlines the changes to payments under the Medicare Physician Fee Schedule (PFS) for...more

Smart & Biggar

Canada’s Drug Agency releases new resource and data on drug approval and reimbursement pathway

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Canada’s Drug Agency (CDA-AMC) published data on Canada’s drug system as part of the Data Systems and Analytics program. The new data cover the following information for oncology and non-oncology drugs from 2020-2024...more

Bass, Berry & Sims PLC

CMS Announces Model for Technology-Assisted Chronic Condition Management

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On December 1, the Centers for Medicare & Medicaid Services (CMS) announced the Advancing Chronic Care with Effective, Scalable Solutions Model (ACCESS), a 10-year voluntary alternative payment model (APM) that will pay...more

Sheppard Mullin Richter & Hampton LLP

CMS Finalizes Medicare Payment Policies for Hospital Outpatient and Ambulatory Surgery Center Services

The Centers for Medicare & Medicaid Services (“CMS”) final rule for Medicare payment for services provided in hospital outpatient departments (paid under the Outpatient Prospective Payment System or “OPPS”) and ambulatory...more

DLA Piper

UK pharma gets a festive boost with US tariff-free deal

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As kids woke to naughty elves on their shelves on 1 December, ministers also provided UK-based pharmaceutical companies a shot-in-the-arm behind door #1 of their advent calendars. The UK government announced on Monday, 1...more

Troutman Pepper Locke

HRSA’s 340B “Rebate Pilot” Faces APA Challenge

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A coalition of hospital associations and individual safety‑net providers recently filed suit in the U.S. District Court for the District of Maine challenging the Health Resources and Services Administration’s (HRSA) newly...more

Littler

The Netherlands: Should Employers Seek Reimbursement for Study Costs?

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In principle, employees who undergo compulsory training within the meaning of Article 7:611a of the Dutch Civil Code do not have to repay any fees for such training; their employer bears all the costs of course fees, books,...more

Benesch

CMS Announces New ACCESS Model, Advancing a National Outcomes-Based Framework for Chronic Care, Health Equity and Community...

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The Centers for Medicare & Medicaid Services (“CMS”), through the CMS Innovation Center (“CMMI”), has announced the ACCESS Model—Advancing Clinical Care, Equity and System Sustainability, a national demonstration model...more

A&O Shearman

UK Private Prosecutor Ordered To Pay Costs of Judicial Review Proceedings

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The number of private prosecutions in the UK has skyrocketed in the past decade, increasing the risk of costly legal proceedings for companies and individuals alike. A new High Court judgment may put a dampener on things. ...more

Stikeman Elliott LLP

Regulation of Preferred Pharmacy Networks in Ontario

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Changes to the Insurance Act will create an “Any Willing Provider” framework that will require group insurance providers to allow any pharmacy to dispense drugs that it reimburses on the same terms as it offers to other...more

Davis Wright Tremaine LLP

Anthem to Target Participating Facilities Using Nonparticipating Providers

Anthem recently announced that effective January 1, 2026, it intends to reduce reimbursement and may terminate commercial network agreements with participating facilities that continue to use nonparticipating providers to...more

Nelson Mullins Riley & Scarborough LLP

“Reasonableness” in State Warranty Reimbursement Statutes Takes a Hit in 2025

Legislatures in several states overhauled their warranty reimbursement statutes in 2025, which generally require OEMs to pay “reasonable” reimbursement to dealers for labor performed by service technicians for repairs to...more

Polsinelli

What 340B Hospitals Need to Know About CMS’s CY 2026 OPPS Final Rule

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Key Takeaways - CMS launches Drug Acquisition Cost Survey beginning Jan. 1, 2026. OPPS hospitals must submit NDC-level pricing data for both 340B and non-340B drugs, which CMS will use to inform CY 2027 reimbursement...more

ArentFox Schiff

Class Action Challenges ERISA Compliance of Tobacco Cessation Program

ArentFox Schiff on

Generally, the Employee Retirement Income Security Act of 1974 (ERISA) prohibits discrimination based on a plan participant’s health status-related factor, such as a medical condition, medical history, or genetic information....more

Robinson+Cole Health Law Diagnosis

Update on Processing of Telehealth Claims Impacted During the Government Shutdown

The recent government shutdown caused multiple Medicare statutory payment provisions to lapse on October 1, 2025, due to the absence of Congressional action. With the passage of the Continuing Appropriations, Agriculture,...more

McDermott Will & Schulte

Executive briefing: Strategic inflection points in digital health & health tech

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The digital health and health tech sectors are undergoing a period of accelerated transformation amidst a fragmented regulatory landscape. Companies are looking within and to peers to determine how to pursue innovation while...more

Downey Brand LLP

California Public Utilities Commission Stretches Out the Reimbursement Period for Data Center’s Energization Costs to Reduce...

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November 19, 2025 Energy Law The search for a reliable source of electricity to power data centers has led developers to explore self-generation options, virtual or real power purchase agreements, or the restart of...more

McDermott+

The Ambulatory Specialty Model: Officially coming your way in 2027

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We are still waiting for the Centers for Medicare & Medicaid Services (CMS) to issue the remaining three calendar year (CY) 2026 Medicare payment rules....more

Sheppard Mullin Richter & Hampton LLP

Preparing for HRSA’s 340B Rebate Model Pilot Program and the Beacon Platform

On October 30, HRSA announced that it had selected eight drug manufacturers to participate in its 340B Rebate Model Pilot Program, spanning 10 drugs representing a range of widely used therapies. These include...more

Arnall Golden Gregory LLP

AGG Files Amicus Brief on Behalf of the National Alliance for Care at Home and AAHPM

AGG Healthcare attorneys Bill Dombi and Jason Bring and Litigation & Dispute Resolution attorney TC Ogletree filed an amicus (or “friend of the court”) brief on behalf of the National Alliance for Care at Home (the...more

Polsinelli

Telehealth and Hospital-at-Home Rules Reinstated After October Lapse; DEA Signals Extension of Telemedicine Prescribing...

Polsinelli on

Key Takeaways - Congress restores Medicare telehealth and Hospital-at-Home flexibilities through Jan. 30, 2026: The extension, signed into law Nov. 12, reverses the lapse in coverage that began Oct. 1 and ensures continued...more

Chambliss, Bahner & Stophel, P.C.

Private Equity and Nursing Homes: What Families Need to Know

Private equity firms are increasingly acquiring nursing homes, which can lead to quality-of-care issues, staffing cuts, reduced services and supplies, and financial strategies that prioritize profit over resident care. ...more

King & Spalding

2026 Physician Fee Schedule Final Rule Changes to ASP Calculation and Reporting Policies and Other Drug Payment Policies

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On October 31, 2025, the Centers for Medicare & Medicaid Services (CMS) issued the Calendar Year (CY) 2026 Medicare Physician Fee Schedule (PFS) final rule. The final rule,1 which was published in the Federal Register on...more

Bradley Arant Boult Cummings LLP

The Longest-Running Federal Government Shutdown Is Over – What Does That Mean for Telehealth Providers?

As Bradley previously reported, statutory telehealth flexibilities previously passed in response to the COVID-19 pandemic expired on September 30, meaning that, effective October 1, 2025, Medicare telehealth services became...more

Robinson+Cole Health Law Diagnosis

From Risk to Readiness: Navigating the Payor Audit Landscape

As payer audits become more frequent and complex, laboratories and healthcare providers must be equipped to respond effectively. Labs are especially vulnerable due to high-cost services and billing complexity. Triggers...more

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