On July 27, 2023, CMS issued a final rule (Final Rule) which revises Medicare policies and rates for the Inpatient Psychiatric Facility (IPF) Prospective Payment System (PPS) for the 2024 fiscal year (FY 2024). Among other...more
In March, OIG published a new frequently asked questions (FAQ) page, General Questions Regarding Certain Fraud and Abuse Authorities. The FAQ page, located here, includes new guidance for ambulatory surgery center (ASC)...more
Last week, President Biden signed legislation formally ending the COVID-19 national emergency that was originally declared under the Trump administration in March 2020. The bill to end the national emergency, H. J. Res. 7,...more
The proposed FY 2024 New York State Executive Budget announced by Governor Kathy Hochul on February 1, 2023, includes a new requirement to seek approval from the New York Department of Health (DOH) for acquisitions and...more
The American Academy of Emergency Medicine Physician Group (AAEM-PG) sued Envision Healthcare in California, alleging that Envision’s use of so-called “friendly PC” business structures violates California’s laws regarding the...more
Last week, the FTC issued a policy paper addressing certificate of public advantage (COPA) laws, which have been enacted in nineteen states to shield certain hospital mergers and acquisitions from federal antitrust review....more
Earlier this month, CMS issued a pair of proposed rules to update reimbursement for home health and end-stage renal disease services. The CY 2023 Home Health Prospective Payment System (HH PPS) rate update proposed rule (the...more
On February 14, 2022, OIG issued Advisory Opinion No. 22-03 analyzing a proposed arrangement under which home health agency (HHA) owners would pay tuition costs of nurse aid certification programs for new employees who are...more
n January 6, 2022, CMS published a proposed rule (Proposed Rule) which would revise Medicare Advantage (Part C) and Medicare Prescription Drug Benefit (Part D) regulations. CMS simultaneously released a fact sheet (Fact...more
The House and Senate voted last week, and President Biden signed into law on December 10, 2021, a bill to delay looming reduction in Medicare rates set to take effect in 2022. The bill, the Protecting Medicare and American...more
Last week, President Biden presented an outline of a $1.75 trillion Build Back Better (BBB) social spending reconciliation framework resulting from months of negotiations with House and Senate Democrats. Congressional...more
11/3/2021
/ Affordable Care Act ,
Biden Administration ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
Department of Veterans Affairs ,
Federal Poverty Line ,
FMAP ,
Healthcare ,
Healthcare Reform ,
Home and Community Based Services (HCBS) ,
Long Term Care Facilities ,
Medicaid ,
Medicare ,
Mental Health ,
Nursing Homes
On September 29, 2021, OIG issued Advisory Opinion No. 21-13 analyzing a proposal for a clinical study that would involve subsidizing Medicare beneficiaries’ cost-sharing obligations in connection with a clinical study...more
A research study published September 20, 2021 in JAMA Network Open found that mergers and acquisitions of rural hospitals are associated with better mortality outcomes for certain conditions as compared to rural hospitals...more
On September 15, 2021, CMS published a proposed rule to repeal a final rule that would have allowed Medicare to automatically cover certain medical devices as soon as they receive FDA approval (the Proposed Rule). The final...more
On January 20, 2021, the White House issued a memorandum to the heads of federal executive departments and agencies requesting a freeze on federal rulemaking activity (the Memorandum). The Memorandum directs agencies not to...more
On Friday of last week, HHS published two long-awaited final rules implementing significant changes to the regulations under the Stark Law and Anti-Kickback Statute (AKS). The two final rules are: (i) Revisions to the Safe...more
11/30/2020
/ Anti-Kickback Statute ,
Centers for Medicare & Medicaid Services (CMS) ,
Cybersecurity ,
Department of Health and Human Services (HHS) ,
DMEPOS ,
Electronic Health Record Incentives ,
Fee-for-Service ,
Final Rules ,
Medical Devices ,
OIG ,
Popular ,
Safe Harbors ,
Self-Referral ,
Stark Law ,
Value-Based Care
On September 18, 2020, OIG issued Advisory Opinion No. 20-05 analyzing a pharmaceutical manufacturer’s proposal to offer direct cost-sharing assistance to Medicare beneficiaries prescribed certain of the manufacturer’s new...more
Last week, HHS and DOJ issued the Health Care Fraud and Abuse Control (HCFAC) Program FY 2019 Annual Report detailing federal enforcement activities and results during the federal fiscal year (FY) 2019, which ran from October...more
In a letter dated June 11, 2020, Senate Finance Committee Chairman Charles Grassley (R-Iowa) and Ranking Member Ron Wyden (D-Ore.) urged HHS Secretary Alex Azar to take measures to increase transparency around funds...more
With certain public health officials, including Dr. Anthony Fauci, cautiously optimistic the COVID-19 curve is beginning to flatten, government leaders and employers are beginning to turn their attention to the steps...more
OIG recently released the results of a survey conducted from March 23-27 in which OIG asked hospital administrators from 323 hospitals across the U.S. to opine on the most significant challenges relating to the current...more
President Trump signed the Families First Coronavirus Response Act, H.R. 6201, on March 18th, 2020 after it passed in the Senate without amendment. The Act, Public Law 116-127, has become known as “Phase II” of the...more
n November 1, 2019, CMS posted the final rule establishing the payment rates for the Hospital Outpatient Prospective Payment System (OPPS) and the Ambulatory Surgery Center (ASC) Payment System for calendar year (CY) 2020...more
11/15/2019
/ Ambulatory Surgery Centers ,
Appeals ,
Centers for Medicare & Medicaid Services (CMS) ,
Final Rules ,
Food and Drug Administration (FDA) ,
Health Care Providers ,
Hospitals ,
Inpatient Prospective Payment System (IPPS) ,
Lack of Authority ,
Medical Devices ,
Medicare ,
Off-Campus Departments ,
Outpatient Prospective Payment System (OPPS) ,
Payment Rates ,
Prescription Drugs ,
Price Transparency ,
Prior Authorization ,
Provider Payments ,
Rural Health Care Providers ,
Section 340B
On August 22, 2019, the United States District Court for the District of Columbia held that CMS had unlawfully changed its “must-bill” policy, without going through notice-and-comment rulemaking, when it denied bad-debt...more
n a motion filed last week in Alexander v. Azar, No. 3:11-cv-1703-MPS (D. Conn.), HHS argued that it cannot be sued by Medicare beneficiaries objecting to a hospital’s decision to admit them as inpatients instead of placing...more