Amy O'Neill at King & Spalding

U.S. Department of Health and Human Services Office of Inspector General Aims to Increase Transparency of Federal Enforcement...

The Office of Inspector General (OIG) announced on September 27, 2018, that it is increasing transparency of Federal actions against healthcare entities by publicly disclosing: (1) “closed corporate integrity agreements...more

10/12/2018 / Department of Health and Human Services (HHS) , Enforcement Actions , Health Care Providers , OIG , Transparency

American Hospital Association and Others File Second Lawsuit Contesting Medicare Rate Cut for 340B Discount Drugs

On September 5, 2018, the American Hospital Association, the Association of American Medical Colleges, America’s Essential Hospitals, Eastern Maine Healthcare Systems, Henry Ford Health System, and Fletcher Hospital, Inc....more

9/11/2018 / Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Hospitals , Medicare , Outpatient Prospective Payment System (OPPS) , Section 340B

CMS Announces Proposed Rule to Revise the Medicare Shared Savings Program

On August 9, 2018, CMS issued a proposed rule for restructuring the Medicare Shared Savings Program (Shared Savings Program) which would, among other things, change the participation options available under the program for...more

8/15/2018 / ACOs , Centers for Medicare & Medicaid Services (CMS) , Fee-for-Service , Medicare , Medicare Shared Savings Program

CMS Announces Proposed Calendar Year 2019 Physician Fee Schedule with Significant Focus on Streamlining Documentation Processes...

On July 12, 2018, CMS released the unpublished version of the Calendar Year (CY) 2019 Proposed Physician Fee Schedule (PFS). The CY 2019 Proposed PFS reflects a response by CMS to stakeholder feedback regarding the need to...more

7/17/2018 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Medicaid , Medicare , Physician Fee Schedule , Physicians

Insurers Not Entitled to Full ACA Risk Corridors Payments Says the United States Court of Appeals for the Federal Circuit

Resolving a split in the lower courts, the Federal Circuit issued two decisions on June 14, 2018, wherein the Court held that health insurers Moda Health Plan Inc. (Moda Health) and Land of Lincoln Mutual Health (Land of...more

6/21/2018 / Affordable Care Act , Appropriations Bill , Centers for Medicare & Medicaid Services (CMS) , Health Insurance , Premiums , Risk Adjustment Formula , Secretary of HHS

D.C. Circuit Grants Remand Request in Action by the U.S. House of Representatives Against HHS Involving Cost-Sharing Reduction...

On May 16, 2018, the U.S. Court of Appeals for the District of Columbia Circuit granted the parties’ Joint Motion for Remand to vacate the Court’s injunction on HHS’s cost-sharing reduction (CSR) payments. The Joint Motion...more

5/25/2018 / Cost-Sharing , Department of Health and Human Services (HHS) , Remand , Settlement Agreements

New California Bill Attempts to Set Standard Pricing for Healthcare Services and Procedures

Assembly Bill 3087 seeks to establish a nine-person commission tasked with imposing set prices for specific services and procedures provided by hospitals and other healthcare providers in California. Medi-Cal, Medicare, and...more

4/20/2018 / Health Care Providers , Medi-Cal , Medicare

Significant Health Policy Changes Contained in Bipartisan Budget Act of 2018

On February 9, 2018, after passing the House and Senate, the President signed into law the Bipartisan Budget Act of 2018 (BBA). The BBA amends the Budget Control Act of 2011 (BCA) to increase the spending caps on both defense...more

2/14/2018 / Ambulance Providers , Bipartisan Budget Act , Civil Monetary Penalty , Health Care Providers , Healthcare Costs , Healthcare Reform , Medicare , Outpatient Services , Stark Law , Telehealth

D.C. Circuit Upholds CMS’s Outlier Reconciliation Process Finding Notice and Comment Rulemaking Was Not Required

On December 26, 2017, the United States Court of Appeals for the District of Columbia Circuit overturned a summary judgment decision of the District Court and held that the provisions of the 2010 Medicare Claims Processing...more

1/4/2018 / Centers for Medicare & Medicaid Services (CMS) , MACs , Medicare , Summary Judgment

Self-Administered Versions of Orencia and Cimzia Were Included In Calculating Medicare Part B Payment Costs Which Significantly...

A report issued by the OIG on November 21, 2017 found that inclusion of the more costly self-administered versions of Orencia and Cimzia when calculating Medicare Part B costs caused Medicare and its beneficiaries to pay an...more

12/7/2017 / Medicare , Medicare Part B , OIG

CMS Extends Deadline for Providers to Submit an Initial or Revised Worksheet S-10 for FYs 2014 and 2015 until January 2, 2018

Following a second update in less than a year to the instructions for completing Worksheet S-10, CMS has now also provided a further extension for providers to file an initial or revised Worksheet S-10, which is used by...more

11/1/2017 / Centers for Medicare & Medicaid Services (CMS) , DSH , Hospitals , Inpatient Prospective Payment System (IPPS) , Medicare Administrative Contractors (MAC)

Amy O'Neill

King & Spalding

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