Citing the high cost of insulin as a common barrier to proper diabetes treatment, CMS has announced a new model to allow beneficiaries additional Part D plan options with lower out-of-pocket costs for insulin. Under the Part...more
On November 1, 2019, CMS released the Calendar Year (CY) 2020 Physician Fee Schedule (PFS) final rule (the Final Rule). The Final Rule updated payment policies, payment rates, and quality provisions for services furnished...more
On July 30, 2019, the D.C. Circuit issued a favorable jurisdictional decision on behalf of King & Spalding client the American Clinical Laboratory Association (ACLA), reversing the district court. Accepting ACLA’s arguments,...more
On August 2, 2019, CMS issued its annual Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System Final Rule for FY 2020 (the Final Rule). Highlights include...more
8/9/2019
/ Affordable Care Act ,
CEHRT ,
Centers for Medicare & Medicaid Services (CMS) ,
Final Rules ,
Inpatient Prospective Payment System (IPPS) ,
Inpatient Quality Reporting ,
Long Term Care Facilities ,
Medicare ,
Payment Systems ,
Psychiatric Hospitals ,
Wage Index
On May 23, 2018, the U.S. District Court for the District of South Carolina entered a multi-million dollar judgment against Latonya Mallory, former CEO of Health Diagnostic Laboratory (HDL) and Floyd Calhoun Dent III and...more
Genesis Medical Center in Davenport, Iowa has reached a settlement with the Department of Justice related to improper hospital admissions from January 1, 2013 to December 31, 2016. According to the DOJ, Genesis “improperly...more
On July 25, 2017, the United States Court of Appeals for the District of Columbia Circuit held that HHS violated the terms of the Medicare statute by failing to undertake notice-and-comment rulemaking in implementing its...more
Under the Improper Payments Information Act of 2002, as amended, the Department of Health and Human Services (HHS) is required to annually report on improper payments and meet certain improvement metrics. In a report...more
On March 31, 2017, Judge Rosemary Collyer of the United States District Court for the District of Columbia held that plaintiffs UnitedHealthcare Insurance Company et al. (“United”) had standing to challenge CMS’s overpayment...more
On January 12, 2017, Medicare Payment Advisory Commission (MedPAC) members unanimously voted to maintain Medicare’s existing updates (i.e., maintain the increases Congress and the HHS Secretary have already established) to...more
On August 2, 2016, CMS released a final rule (Final Rule) with updates to the Hospital Inpatient Prospective Payment System (Hospital IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) affecting...more
8/10/2016
/ Administrative Procedure Act ,
Affordable Care Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Final Rules ,
Hospitals ,
IMPACT Act ,
Inpatient Prospective Payment System (IPPS) ,
Inpatient Quality Reporting ,
Long Term Care Facilities ,
Medicare ,
Provider Payments ,
Two-Midnight Rule ,
Value-Based Purchasing
HHS announced a Proposed Rule on July 5, 2016 aimed at reducing the backlog of appeals at the Office of Medicare Hearings and Appeals (OMHA) and Departmental Appeals Board (DAB) for Medicare payment and coverage...more
7/7/2016
/ Administrative Appeals ,
Administrative Law Judge (ALJ) ,
Administrative Proceedings ,
Appeals ,
Department of Health and Human Services (HHS) ,
Expedited Actions Process ,
Judicial Review ,
Medicare ,
Medicare Appeals Council ,
Newly Discovered Evidence ,
OMHA ,
Proposed Rules