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McDermott Will & Emery

CMS Requests Hospitals Submit Gender-Affirming Care Data

McDermott Will & Emery on

On May 28, 2025, the Centers for Medicare & Medicaid Services (CMS) sent a letter to “select hospitals” that provide gender-affirming care services, requesting information about how those hospitals adhere to quality standards...more

Mintz - Health Care Viewpoints

PBM Legislation in the Reconciliation Bill is Far From Sweeping PBM Reform

Over the past few years, Congress has attempted to pass “federal PBM reform.” Members of Congress have held numerous hearings related to PBMs and introduced numerous bills seeking to regulate PBMs (we regularly track these...more

Mintz - Health Care Viewpoints

New York Department of Health Publishes Material Transactions Reporting Form

In our February 14, 2025 blog post, we detailed a proposed expansion of Article 45-A of New York’s Public Health Law (hereinafter, the Disclosure of Material Transactions Law) included in the proposed Fiscal Year 2026 New...more

Ropes & Gray LLP

CMS Publishes Federal Fiscal Year 2026 Hospital Payment Proposed Rule

Ropes & Gray LLP on

On April 11, 2025, the Centers for Medicare & Medicaid Services (“CMS”) published its annual proposed rule for the federal fiscal year (“FFY”) 2026 inpatient prospective payment system (“IPPS”) and long-term care hospital...more

Bricker Graydon LLP

CMS Extends Mandatory SNF Off-Cycle Revalidations to August 1, 2025

Bricker Graydon LLP on

On April 17, 2025, the Centers for Medicare and Medicaid Services (CMS) formally announced an extension for the mandatory off-cycle revalidation deadline for skilled nursing facilities (SNFs)....more

Polsinelli

CMS Extends Revalidation Deadline for Skilled Nursing Facilities to August 1, 2025

Polsinelli on

In its April 17 MLN Newsletter, the Centers for Medicare and Medicaid Services (CMS) once again extended the deadline for skilled nursing facilities (SNF) to submit their off-cycle revalidation from May 1 to August 1, 2025....more

Polsinelli

CMS Spring Provider Enrollment Updates

Polsinelli on

Centers for Medicare & Medicaid Services (CMS) released several pieces of Medicare provider enrollment guidance this spring, both emphasizing current policy and requirements as well as providing guidance and clarification...more

Arnall Golden Gregory LLP

SNF Off-Cycle CMS-855A Reporting Delayed to August 1, 2025

Mandatory Medicare reporting for skilled nursing facilities (“SNFs”) has been delayed to August 1, 2025, to the relief of many in the industry. As a reminder, the Centers for Medicare & Medicaid Services (“CMS”) required the...more

Bricker Graydon LLP

The Mandatory SNF Provider Enrollment Revalidation Deadline is May 1, 2025

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The Centers for Medicare and Medicaid Services (CMS) has long required skilled nursing facilities (SNFs) enrolled in the Medicare and Medicaid programs to disclose information regarding organizational structure, governing...more

Epiq

How Plaintiff and Defense Attorneys Can Protect Beneficiaries’ Finances and Health Care in MMSEA Section 111 Reporting

Epiq on

Insufficient collaboration between plaintiff and defense attorneys regarding Medicare, Medicaid, and SCHIP Extension Act (MMSEA) Section 111 reporting requirements creates administrative complications which can negatively...more

Polsinelli

HCPF Makes Clarifications to Mandatory Facility-Based Professionals’ Reporting Requirements Under Colorado Hospital Discounted...

Polsinelli on

What is Colorado Hospital Discounted Care? Colorado’s Hospital Discounted Care law, effective September 1, 2022, brought a detailed and comprehensive yet highly confounding overhaul to the way hospitals, freestanding...more

Nelson Mullins Riley & Scarborough LLP

Senate Bill 316: An Overview for North Carolina Hospitals

Earlier this week, Senate Bill 316 (the “Bill”) was filed in the North Carolina state legislature. The Bill covers a large swathe of healthcare-related issues, and the additional regulatory elements of the Bill would likely...more

ArentFox Schiff

Massachusetts Enacts Drug Pricing Legislation: Introducing PBM Licensure, Mandatory Cost Reporting, and Consumer Cost-Sharing...

ArentFox Schiff on

On January 8, Massachusetts Governor Maura Healy signed into law “An Act Relative To Pharmaceutical Access, Costs And Transparency.” The Act will have a profound impact on all parties involved in setting and applying drug...more

Rivkin Radler LLP

NYS OMIG Publishes 2025 Work Plan

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On January 29, the New York State Office of the Medicaid Inspector General (OMIG) published its 2025 Work Plan, which provides a preview of the OMIG’s program integrity initiatives for the upcoming year. While this post...more

Parker Poe Adams & Bernstein LLP

How the Centers for Medicare and Medicaid Services 2025 Payment System Final Rule Impacts Ambulatory Surgical Centers

On November 1, 2024, the Centers for Medicare & Medicaid Services (CMS) issued the 2025 hospital outpatient prospective payment system and ambulatory surgical centers (ASC) rule. The rule updates Medicare payment rates for...more

McDermott Will & Emery

New York Executive Budget Proposes Amendments to MCO Provider Tax

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The New York State Executive Budget for Fiscal Year (FY) 2026 proposes significant updates to the managed care organization (MCO) provider tax, aiming to enhance Medicaid funding through innovative financial strategies. The...more

Woodruff Sawyer

Reminder: RxDC Reporting Due June 1st

Woodruff Sawyer on

With the 2024 reference year RxDC reporting deadline approaching in June, plan sponsors should re-familiarize themselves with the reporting requirements. The 2024 reference year RxDC Reporting Instructions have been released,...more

McCarter & English, LLP

New Jersey Regulatory Update Part I - January 2025

Below is Part I of our New Jersey Regulatory Update focusing on regulations that were finalized in 2024 by various New Jersey agencies that impact healthcare. The final regulations range from additional transparency...more

Mintz - Health Care Viewpoints

Massachusetts Aligns with National Trends and Enacts Sweeping Legislation to Regulate Pharmaceutical Benefit Managers

On the heels of a nationwide push to regulate pharmacy benefit managers (PBMs), Massachusetts enacted a landmark piece of legislation to increase transparency and oversight within the pharmaceutical supply chain, specifically...more

Dickinson Wright

Arizona’s New Behavioral Healthcare Laws – Part 2

Dickinson Wright on

In 2024, the Arizona legislature passed five new Arizona laws directly affecting behavioral health care in Arizona. These laws run the gamut between refining definitions, requiring peer specialist trainings, new requirements...more

Goodell, DeVries, Leech & Dann, LLP

Understanding CMS “Immediate Jeopardy” Investigations in Healthcare Facilities

When it comes to ensuring patient safety, healthcare facilities operate under a complex regulatory framework, including oversight from the Centers for Medicare & Medicaid Services (CMS). One of the more intense processes CMS...more

Burr & Forman

Failure to Return Credit Balances (Especially to Medicare and Medicaid) Can Create Significant Liability

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Every health care provider has “credit balances,” which occur when a provider receives more money than it is owed for services rendered. Credit balances can be caused by a number of factors, including incorrect coding,...more

Winthrop & Weinstine, P.A.

“Minnesota Has A Fraud Problem” – Governor Walz Responds By Issuing Executive Order to Establish Statewide Financial Crimes and...

On Monday, January 6, 2025, Governor Walz issued the first Executive Order of 2025, EO 25-01, which creates a centralized state fraud investigations unit administered and overseen by the Minnesota Bureau of Criminal...more

Nelson Mullins Riley & Scarborough LLP

Attention SNFs: Enhanced 855A Disclosure Requirements Have Arrived

Against the backdrop of increasing regulatory scrutiny of private equity ownership in the healthcare space, Medicare skilled nursing and Medicaid nursing facilities (“SNF”) and private equity companies looking to acquire SNFs...more

Holland & Knight LLP

Significant Changes to SNF Disclosure Requirements Prompt Need for Regulatory Review

Holland & Knight LLP on

To enhance quality of operations and increase transparency in ownership within skilled nursing facilities (SNFs), the Centers for Medicare & Medicaid Services (CMS) issued its Final Rule for ownership disclosures for Medicare...more

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