Hedy Silver Rubinger on Medicare

Proposed Legislation Focuses on Private Equity and REITs in Healthcare

Efforts to draw attention to and, in some instances, dissuade private equity investment in healthcare have been on the rise. For example, in late 2023, the Centers for Medicare & Medicaid Services finalized a rule increasing...more

7/1/2024 / Centers for Medicare & Medicaid Services (CMS) , Change of Ownership , Department of Health and Human Services (HHS) , Healthcare , Investment , Medicare , Private Equity , Private Equity Funds , REIT , Social Security Act

UPDATE: CMS Finalizes Rule Requiring Greater SNF Ownership Transparency, Including Private Equity and REIT Disclosures, and...

The Centers for Medicare & Medicaid Services (“CMS”) released a final rule on November 15, 2023 (published on November 17, 2023) (the “Rule”), requiring greater skilled nursing facility (“SNF”) ownership transparency. The...more

12/7/2023 / Affordable Care Act , Centers for Medicare & Medicaid Services (CMS) , Change of Ownership , Corporate Transparency Act , Disclosure Requirements , Internal Revenue Code (IRC) , Medicare , Nursing Homes , Private Equity , Real Estate Investments , REIT , Skilled Nursing Facility , Social Security Act , Transparency

CMS Expands Access to Behavioral Health Outpatient Services

The Centers for Medicare & Medicaid Services (“CMS”) announced it is expanding access to behavioral health services for Medicare beneficiaries through intensive outpatient services coverage. In general, Medicare will cover...more

11/15/2023 / Ambulatory Surgery Centers , Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Healthcare Facilities , Medicare , Medicare Beneficiaries , Outpatient Prospective Payment System (OPPS) , Outpatient Services

UPDATE: CMS Finalizes Hospice 36-Month Rule

The Centers for Medicare & Medicaid Services (“CMS”) has finalized 2024 home health rules to include application of the home health “36-month rule” to hospice providers. The revised rule will forbid any change in majority...more

11/6/2023 / Acquisitions , Centers for Medicare & Medicaid Services (CMS) , Change of Ownership , Health Care Providers , Healthcare Facilities , Home Health Agencies , Hospice , Medicare

Home Health & Hospice Quarterly - Q3

AGG’s Home Health & Hospice team publishes a quarterly newsletter covering legal and regulatory topics specific to the home and community-based healthcare industry. The fields of end-of-life and home healthcare present...more

10/6/2023 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Home Health Care , Hospice , Medicare

CMS Proposes Expansion of 36-Month Rule to Include Hospice Providers

The Centers for Medicare & Medicaid Services (“CMS”) issued a Proposed Rule on July 10, 2023, that, if finalized, will revise the Medicare Provider Enrollment requirements to expand the current Home Health Agency (“HHA”)...more

8/29/2023 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Home Health Agencies , Hospice , Medicare

CMS Announces Enhanced Oversight for New Hospices in Four States

Effective July 13, 2023, the Centers for Medicare & Medicaid Services (“CMS”) announced a period of enhanced oversight for new hospices in Arizona, California, Nevada, and Texas. According to the Medicare Learning Network...more

8/3/2023 / Centers for Medicare & Medicaid Services (CMS) , Change of Ownership , Health Care Providers , Healthcare Facilities , Hospice , Medicare , Medicare Administrative Contractors (MAC)

Proposed Rule Highlights Continued Push by CMS for Skilled Nursing Facility Ownership Transparency

In recent years, the Biden administration and Congress have pushed for greater transparency in skilled nursing facility ownership. In an effort focused on increased ownership disclosures specifically related to private equity...more

5/4/2023 / Centers for Medicare & Medicaid Services (CMS) , Medicare , Nursing Homes , REIT , Reporting Requirements , Skilled Nursing Facility , Transparency

Push for Greater Nursing Home Ownership Transparency Continues With Introduction of the Linking Investors and Nursing Home Quality...

The nursing home industry has seen increased efforts by the federal government to enhance transparency, with a focus on ownership disclosures (both past and present ownership) of facilities enrolled in Medicare. The efforts...more

8/24/2022 / Change of Ownership , Disclosure , Healthcare Facilities , Investors , Medicare , Nursing Homes , Skilled Nursing Facility , Transparency

Proposal Calls for Increased Transparency of Ownership for Privately Owned Nursing Homes

Continuing the theme of increased transparency of ownership of nursing homes included in the 2010 Affordable Care Act, the White House issued a Fact Sheet titled “Protecting Seniors and People with Disabilities by Improving...more

3/9/2022 / Affordable Care Act , Assisted Living Facilities (ALFs) , Biden Administration , Business Ownership , Centers for Medicare & Medicaid Services (CMS) , Change in Ownership , Department of Health and Human Services (HHS) , Elder Care , Health and Safety , Health Care Providers , Healthcare , Healthcare Reform , Long Term Care Facilities , Medicaid , Medicare , Nursing Homes , Private Equity , REIT , Transparency

CHOW Considerations for Medicare Chain Providers: The Importance of Knowing Your MAC

All Medicare providers must update their enrollment information to reflect changes in ownership (CHOWs) within 30 days after the CHOW. Providers must report CHOWs to the applicable Medicare Administrative Contractor (MAC)....more

7/21/2021 / Change of Ownership , Health Care Providers , Medicare , Medicare Administrative Contractors (MAC)

Nursing Home Industry Group Recommends Policy Change Aimed at Ownership Transparency and Accountability

A group of individuals with ties to the nursing home industry recently published a commentary in the journal Health Affairs and opined that complex ownership structures used by many nursing home operators make it difficult to...more

3/3/2021 / Centers for Medicare & Medicaid Services (CMS) , Long Term Care Facilities , Medicaid , Medicare , Nursing Homes , Skilled Nursing Facility , Transparency

Yes, Provider Relief Funding Can Be Used to Cover COVID-19 Vaccination Costs

As long-term care facilities and other health care providers turn their attention and efforts to COVID-19 vaccination, many have inquired about the ability to use Provider Relief Funding (“Funding”) for vaccine-related costs....more

12/17/2020 / Children's Health Insurance Program (CHIP) , Coronavirus/COVID-19 , Department of Health and Human Services (HHS) , Medicaid , Medicare , Provider Relief Fund , Vaccinations

Recent CHOW? Portal Now Open for Purchasers to Apply for Medicare Relief Funds

The Department of Health & Human Services (HHS) announced funding opportunities for (1) CHOW buyers that closed a transaction in 2019 or 2020 and (2) any provider that missed the June 3, 2020 deadline to apply for additional...more

8/11/2020 / Change of Ownership , Department of Health and Human Services (HHS) , Health Care Providers , Medicare , Provider Relief Fund

HHS Offers Medicare Providers Second Chance at Second Tranche Funding ($20 Billion Allocation)

As previously reported, the Department of Health & Human Services (HHS) issued Provider Relief Funds in multiple tranches. One of the largest tranches—$20 billion of the initial $50 billion general distribution—will be...more

8/7/2020 / Centers for Medicare & Medicaid Services (CMS) , Coronavirus/COVID-19 , Department of Health and Human Services (HHS) , Health Care Providers , Medicare , Provider Relief Fund

Recent CHOW? New CHOW-Related Guidance on Provider Relief Funds

Providers that recently acquired a Medicare provider through a change of ownership (CHOW) could face difficulties obtaining some or all of the provider relief funds as previously discussed. The first two tranches of payments...more

5/22/2020 / Change of Ownership , Health Care Providers , Medicare , Provider Relief Fund

Update: Allocation of the Initial $100 Billion Health Care Provider Relief Fund, $75 Billion to Come

HHS Announces Allocation of Initial $100 Billion - The initial $30 billion disbursement from HHS to health care providers across the country was a part of a much larger $100 billion fund. HHS announced an outline of planned...more

4/24/2020 / Coronavirus/COVID-19 , Department of Health and Human Services (HHS) , Federal Funding , Health Care Providers , Medicare , Relief Measures

UPDATE: Relief Fund Attestation Specifics

This article is one in a series related to the Medicare Relief Fund. As noted in a previous article, the new Attestation Portal is available to providers that receive Medicare relief funding. In this article, we review the...more

4/22/2020 / Coronavirus/COVID-19 , Department of Health and Human Services (HHS) , Health Care Providers , Medicare , Relief Measures

UPDATE: Medicare Relief Funds Attestation Now Available

As discussed in our previous article, healthcare providers that received Medicare relief funds must sign an attestation confirming receipt of the funds and agreeing to the terms and conditions of payment. The attestation is...more

4/17/2020 / Department of Health and Human Services (HHS) , Funding , Health Care Providers , Medicare , Relief Measures

Medicare Relief Funds Hit Your Account: Can You Keep Them?

Many Medicare providers awoke the morning of Friday April 10, 2020 to an influx of Medicare funds. The funds are a $30 billion portion of the $100 billion stimulus fund intended to provide relief to healthcare providers...more

4/10/2020 / Accelerated Payments , CARES Act , Centers for Medicare & Medicaid Services (CMS) , Coronavirus/COVID-19 , Health Care Providers , Medicare , Relief Measures

CMS Grants Medicare Provider Enrollment Relief

As the single largest payor for health care in the United States, the Centers for Medicare & Medicaid Services (CMS) has recognized and acted on the need to move quickly in the fight against COVID-19....more

3/26/2020 / Centers for Medicare & Medicaid Services (CMS) , Coronavirus/COVID-19 , Health Care Providers , Medicare , Relief Measures

CMS Increases Scrutiny of Owners through Medicare Provider Enrollment Process

The Centers for Medicare & Medicaid Services (CMS) issued a final rule on September 5, 2019, intended to address program integrity and vulnerability issues....more

9/11/2019 / Centers for Medicare & Medicaid Services (CMS) , Children's Health Insurance Program (CHIP) , Enrollment , Medicaid , Medicare , OIG

CMS Issues New Standards for End Stage Renal Disease Faculties Providing Dialysis Services to Nursing Facility Residents

On August 17, 2018, the Centers for Medicare and Medicaid Services (CMS) issued a Memorandum to state survey agency directors regarding Medicare-approved End Stage Renal Disease (ESRD) facilities that provide dialysis...more

9/5/2018 / Centers for Medicare & Medicaid Services (CMS) , ESRD , Health Care Providers , Medicare

CMS Seeks Input on Direct Provider Contracting

The Centers for Medicare & Medicaid Services (CMS) announced that it is seeking input on direct provider contracting (DPC) between “payers and primary care or multi-specialty groups to inform potential testing of a DPC model”...more

5/9/2018 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Medicare , Medicare Advantage , Medicare Part A , Medicare Part B , Physicians

CMS Proposes Overhaul of SNF Reimbursement System, Increases FY 2019 Payments

The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule on April 27, 2018 to overhaul the payment system for skilled nursing facilities (SNFs). Specifically, the rule would “update the payment rates used...more

5/3/2018 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Medicare , Prospective Payment System (PPS) , Skilled Nursing Facility

Hedy Silver Rubinger

Arnall Golden Gregory LLP

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