On July 25, 2023, HHS, the Department of Labor, and the Department of the Treasury (the Departments) issued proposed rules (Proposed Rules) and other information regarding health plan and issuer compliance with mental health...more
8/7/2023
/ Centers for Medicare & Medicaid Services (CMS) ,
Compliance ,
Consolidated Appropriations Act (CAA) ,
Department of Health and Human Services (HHS) ,
Department of Labor (DOL) ,
Health Insurance ,
Mental Health ,
MHPAEA ,
NQTLs ,
Proposed Rules ,
Substance Abuse ,
U.S. Treasury
On April 5, 2023, the Centers for Medicare & Medicaid Services (CMS) issued a Final Rule (CMS-4201-F) regarding the Medicare Advantage (MA) and Part D programs. The Final Rule includes changes related to various aspects of...more
4/10/2023
/ Centers for Medicare & Medicaid Services (CMS) ,
Continuity of Care ,
Department of Health and Human Services (HHS) ,
Final Rules ,
Health Care Providers ,
Medical Necessity ,
Medicare Advantage ,
Medicare Part D ,
OIG ,
Regulatory Agenda ,
Regulatory Requirements ,
Two-Midnight Rule
Hospitals that participate in the 340B program may be entitled to additional monies from Medicare Advantage plans in the wake of the Supreme Court’s decision in AHA v. Becerra.
In AHA v. Becerra, a unanimous Supreme Court...more
On August 23, 2022, Senate Finance Committee Chair Ron Wyden (D-Ore.) announced he was launching an inquiry into potentially deceptive marketing tactics by organizations offering Medicare Advantage benefits and Part D...more
On April 8, 2021, CMS issued proposed rules for the Fiscal Year (FY 2022) Skilled Nursing Facility (SNF) Prospective Payment System (PPS) and FY 2022 hospice payments. CMS estimates that the aggregate impact of the payment...more
4/16/2021
/ Centers for Medicare & Medicaid Services (CMS) ,
Conditions of Participation (CoP) ,
Consolidated Appropriations Act (CAA) ,
Hospice ,
Medicare Part A ,
Patient-Driven Payment Model (PDPM) ,
Payment Systems ,
Proposed Rules ,
Reporting Requirements ,
Request For Information ,
Skilled Nursing Facility ,
Value-Based Purchasing
On November 20, 2020, CMS issued a final rule (the Final Rule) strengthening the Organ Procurement Organization (OPO) Conditions for Coverage. The new Conditions of Coverage will subject OPOs to greater scrutiny with the...more
On October 21, 2020, CMS announced that it is pushing the implementation of its radiation oncology payment model (RO Model) back from January 1, 2021 to July 1, 2021 in response to industry concerns regarding the...more
On August 24, 2020, CMS released a notice extending its timeline to publish its final rule with significant changes to the Stark regulations that was proposed in October 2019. Previously, CMS had indicated that it intended...more
On May 18, 2020, CMS released guidelines for State and local officials for phased nursing home reopenings. The guidelines include recommendations for (1) the criteria for relaxing certain restrictions and mitigating the...more
On January 8, 2019, almost exactly a year after CMS removed total knee arthroplasties from the Medicare Inpatient-Only List, CMS released additional guidance regarding the application of the Two-Midnight Rule to these cases. ...more
On November 1, 2018, CMS issued a final rule (“Final Rule”) which finalizes numerous changes to the Medicare Physician Fee Schedule (“PFS”), the Quality Reporting Program, and the Medicare Shared Savings Program (“MSSP”). ...more
On September 20, 2018, CMS published a proposed rule that the agency states is aimed at reducing the regulatory burden for providers by revising certain aspects of the Medicare Conditions of Participation and Conditions of...more
On May 31, 2018, CMS published a notice indicating its intention to re-launch a previously abandoned home health demonstration project, but with some modifications. CMS proposes that the new demonstration project would...more
On April 23, 2018, CMS released CMS-1727-R (the Ruling), which announced that it will follow the United States District Court’s decision in Banner Heart Hospital v. Burwell, 201 F. Supp. 3d 131 (D.D.C. 2016). The Banner...more
On April 24, 2018, the Centers for Medicare & Medicaid Services (CMS) released the Fiscal Year (FY) 2019 Inpatient Prospective Payment System (IPPS) Proposed Rule (CMS-1694-P). Among other changes, CMS proposes eliminating...more
On September 6, 2017, CMS’s Center for Clinical Standards and Quality/Survey & Certification Group announced revisions to Appendix A of the State Operations Manual (SOM), which governs hospital surveys. The revisions are...more
On February 15, 2017, CMS issued a proposed rule which the Trump administration contends will reform and stabilize the individual and small group health insurance market exchanges created pursuant to the Affordable Care Act...more
On November 22, 2016, CMS published its annual list of quality and efficiency measures under consideration for adoption through the rulemaking process. CMS is considering approximately 100 measures for incorporation into...more
This week, CMS announced several important developments relating to provider participation in alternative payment models (APMs). On October 25, 2016, CMS released a fact sheet summarizing key developments relating to APMs...more
On September 16, 2016, approximately 112 congressional representatives submitted a letter to HHS Secretary Sylvia Matthews Burwell and CMS acting Administrator Andy Slavitt requesting that CMS not implement its proposal...more
On July 6, 2016, CMS released the Calendar Year (CY) 2017 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Proposed Rule. In addition to significant proposals...more