On August 1, 2024, CMS filed a display copy of its final rule for Fiscal Year (FY) 2025 pertaining to the Inpatient Prospective Payment Systems (IPPS) for general acute care hospitals and long-term care hospitals (LTCHs) (the...more
White House Expected to Sign Law Opening Competitive Bidding for Organ Procurement and Transplantation Network Activities On July 27, 2023, the U.S. Senate passed H.R. 2544 - Securing the U.S. Organ Procurement and...more
On July 7, 2023, CMS published its highly-anticipated proposed rule identifying its remedy to reimburse hospitals unpaid by its unlawful 340B drug payment policy (the Proposed Rule). While the Supreme Court found CMS’s 340B...more
On June 7, 2023, CMS issued a final rule retroactively re-adopting its policy requiring patient days attributable to Medicare Part C beneficiaries (Part C days) to be counted in the Medicare fraction of the disproportionate...more
On March 22, 2023, the Health Resources and Services Administration (HRSA), an HHS subagency, announced major reforms for the nation’s organ transplant system. Chief among the reforms is to increase competition and...more
On March 16, 2023, CMS issued Transmittal 11904, directing its contractors to adjust hospitals’ nursing and allied health education (NAH) payments associated with services furnished to Medicare Advantage (MA) enrollees. ...more
On February 24, 2023, CMS issued a proposed rule updating its Medicaid Disproportionate Share Hospital (DSH) program regulations as a result of legislative changes made by the Consolidated Appropriations Act (CAA) of 2021....more
On January 10, 2023, Judge Contreras of the United States District Court for the District of Columbia ruled that CMS’s 340B drug reimbursement rates dating back to January 1, 2018, were unlawful and underpaid affected...more
On October 13, 2022, CMS announced that it will revert to paying the statutory rate of average sales price (ASP) plus 6% for 340B-acquired drugs on a prospective basis. This announcement comes on the heels of a September 28,...more
On August 1, 2022, CMS issued its annual Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System Final Rule for FY 2023 (the Final Rule). In the Final Rule, CMS...more
8/10/2022
/ Affordable Care Act ,
Centers for Medicare & Medicaid Services (CMS) ,
DSH ,
Final Rules ,
Full-Time Employees ,
Graduate Medical Education ,
Inpatient Prospective Payment System (IPPS) ,
Long-Term Care ,
Medicare ,
Payment Rates ,
Rulemaking Process ,
Value-Based Purchasing ,
Wage Index
On July 15, 2022, the D.C. Circuit issued a decision in favor of the American Clinical Laboratory Association (ACLA) in American Clinical Laboratory Association v. Becerra. The decision is the latest chapter in long-pending...more
On June 15, 2022, the Supreme Court issued a unanimous ruling in American Hospital Assn. v. Becerra declaring that CMS’s 2018 and 2019 reimbursement outpatient drug rate cut to 340B hospitals was “contrary to the statute and...more
On April 18, 2022, CMS issued its annual Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System Proposed Rule for FY 2023 (the Proposed Rule). In the Proposed Rule,...more
4/27/2022
/ Affordable Care Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Hospitals ,
Inpatient Prospective Payment System (IPPS) ,
Long-Term Care ,
Medicare ,
Medicare Advantage ,
Payment Rates ,
Proposed Rules ,
Rulemaking Process ,
Wage Index
On February 24, 2022, CMS announced major changes to several of its innovation models, including the permanent cancellation of the Geographic Direct Contracting Model—a Trump-era model that tested whether a geographic-based...more
On January 25, 2022, the U.S. Court of Appeals for the Second Circuit affirmed a lower court ruling that the Secretary of HHS violated the due process rights of Medicare beneficiaries by failing to provide an administrative...more
On December 17, 2021, CMS issued a final rule with comment period addressing certain provisions of the fiscal year 2022 IPPS/LTCH PPS proposed rule that were designated to be addressed in “future rulemaking,” including...more
On November 8, 2021, the Eighth Circuit affirmed a district court order that denied an attempt to preliminarily block the Organ Procurement and Transplant Network’s (OPTN) policy changing the manner in which donor kidneys are...more
11/18/2021
/ Administrative Procedure Act ,
Appeals ,
Arbitrary and Capricious ,
Health Care Providers ,
Hospitals ,
Irreparable Harm ,
Notice and Comment ,
Organ Transplant Centers ,
Patients ,
Preliminary Injunctions ,
Rulemaking Process
On August 10, 2021, CMS notified Ohio, South Carolina, and Utah that it is withdrawing its prior approval of the Medicaid demonstration projects in these states, which had established work requirements as a condition for...more
On July 19, 2021, CMS published a proposed rule to update the payment policies, payment rates and other provisions for services furnished under the Medicare Outpatient Prospective Payment System (OPPS) and the Ambulatory...more
7/27/2021
/ Ambulatory Surgery Centers ,
Centers for Medicare & Medicaid Services (CMS) ,
Civil Monetary Penalty ,
Consumer Price Index ,
Food and Drug Administration (FDA) ,
Medicare ,
Patient Prospective Payment System ,
Price Transparency ,
Proposed Rules ,
Public Health Emergency ,
Reporting Requirements ,
Rural Health Care Providers ,
Social Security Act
On April 29, 2021, CMS issued a final rule extending the Comprehensive Care for Joint Replacement (CJR) bundled-payment model for an additional three performance years (the Final Rule). Originally slated to end September 30,...more
On March 29, 2021, Judge Margaret B. Seymour, in the United States District Court for the District of South Carolina, set aside a decision from CMS’s Provider Reimbursement Review Board (Board) denying reimbursement relating...more
On January 28, 2021, President Biden signed the “Executive Order on Strengthening Medicaid and the Affordable Care Act” which, among other things, ordered a special enrollment period (SEP) for the federal Health Insurance...more
On January 7, 2021, CMS issued a guidance letter to state health officials describing opportunities under Medicaid and the Children’s Health Insurance Program (CHIP) to address social determinants of health (SDOH). The...more
On December 7, 2020, the United States Supreme Court declined review of the U.S. Court of Appeals for the Fifth Circuit’s affirmation to dismiss a $61.8 million False Claims Act case alleging Medicare overbilling against a...more
On October 14, 2020, CMS added eleven (11) new services to its Medicare telehealth list that are payable during the COVID-19 public health emergency (PHE). This latest expansion of telehealth services is the first to use the...more
10/22/2020
/ Centers for Medicare & Medicaid Services (CMS) ,
Children's Health Insurance Program (CHIP) ,
Coronavirus/COVID-19 ,
Department of Health and Human Services (HHS) ,
Executive Orders ,
Interim Final Rules (IFR) ,
Medicaid ,
Medicare ,
Public Health Emergency ,
Rural Health Care Program ,
Telehealth