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Healthcare › Centers for Medicare & Medicaid Services (CMS) › Beneficiaries

Bass, Berry & Sims PLC

CMS Finalizes CY 2025 Medicare Advantage Rule, Confirming Continued Focus on Marketing Practices and Health Equity

Bass, Berry & Sims PLC on

On April 4, the Centers for Medicare & Medicaid Services (CMS) issued the Contract Year (CY) 2025 Medicare Advantage (MA) Final Rule (Final Rule), which will have significant implications for MA plans and other industry...more

Mintz - Health Care Viewpoints

CMS Announces New Model for the Delivery of Integrated Behavioral and Physical Health Care

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With the goal of enhancing health care quality and outcomes for individuals with moderate to severe behavioral health conditions and substance use disorders (SUD), the Centers for Medicare & Medicaid Services (CMS) recently...more

Foley Hoag LLP - Medicaid and the Law

CMS Issues Rule Implementing Medicaid Redetermination Policies

Foley Hoag LLP - Medicaid and the Law on

We’ve written recently about the process that states are undertaking to begin to wind down the Medicaid enrollment expansion that was necessitated by the enactment of the Families First Coronavirus Response Act in March of...more

Foley & Lardner LLP

Medicare Advantage Agent and Broker Compensation: Commissions, Administrative Payments, and Referral Fees under 42 C.F.R. §...

Foley & Lardner LLP on

A common question in the context of Medicare Advantage (“MA”) distribution and compensation is how agents and brokers may be compensated for commissions and administrative payments and whether, and to what extent, referral...more

King & Spalding

OIG Recommends Improvements to Skilled Nursing Facility Billing Policies Regarding Changes in Therapy

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The Department of Health and Human Services Office of Inspector General (OIG) recently issued a report that calls for CMS to accelerate its efforts to implement a new method for paying for changes in skilled nursing facility...more

McDermott Will & Emery

CMS Proposes Value-Based Purchasing Model, Other Updates to the 2016 Home Health Prospective Payment System

McDermott Will & Emery on

The U.S. Department of Health and Human Services (HHS) Centers for Medicare & Medicaid Services (CMS) published its proposed update to the home health prospective payment system (HHPPS) for calendar year (CY) 2016 in the July...more

Arnall Golden Gregory LLP

CMS Proposes to Establish Separate Payment for End of Life Planning Services

Arnall Golden Gregory LLP on

On July 8, 2015, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that updates payment rates and related reimbursement and quality policies for physician services furnished under the Medicare...more

Mintz - Health Care Viewpoints

Delivery System Reform 2.0: Scaling Alternative Payment Models is the New Normal

Mintz - Health Care Viewpoints on

For some health care providers, a pair of recent announcements made by the Obama Administration to implement mandatory alternative payment models (APMs) for home health value-based purchasing and bundled payments for hip and...more

Foley & Lardner LLP

Beneficiary Assignment Under the MSSP Final Rule

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This is the fourth post in Health Care Law Today’s series on the final rule. This post addresses how CMS assigns beneficiaries to an ACO participating in the MSSP. In the MSSP ACO Final Rule, CMS finalized new...more

Foley & Lardner LLP

Beneficiary Assignment in the Proposed Revised Medicare Shared Savings Program Regulations

Foley & Lardner LLP on

This post addresses the changes that the rule would make to how CMS assigns beneficiaries to an ACO participating in the MSSP. The Proposed Rule places a renewed emphasis on primary care for beneficiary assignment. Section...more

King & Spalding

OIG Reports Limited Compliance with Face-to-Face Certification Requirement for Home Health

King & Spalding on

The OIG recently released a report summarizing the details of its study regarding compliance with the requirement that physicians (or certain practitioners working with them) who certify beneficiaries as eligible for Medicare...more

Mintz - Health Care Viewpoints

Government Imposes Moratorium on Medicare Hearings and Appeals

Mintz - Health Care Viewpoints on

The Federal Office of Medicare Hearings and Appeals (OMHA) was established in July 2005 to administer the Medicare appeals program. OMHA adjudicates appeals regarding Medicare entitlement and Medicare provider reimbursement....more

King & Spalding

CMS Issues Guidance On Medicare Coverage of Items and Services Furnished to Beneficiaries in Custody Under a Penal Authority

King & Spalding on

In October 2013, CMS issued a Fact Sheet outlining its policy regarding beneficiaries who are incarcerated or in custody. Pursuant to 42 C.F.R. §§ 411.4, 411.6 and 411.8, where a beneficiary is in custody on the date items or...more

Sheppard Mullin Richter & Hampton LLP

A Review of CMS' Approach to $125 Million Recoupment of Payments to Providers for Services to Incarcerated / Unlawfully Present...

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CMS seeks to recover from providers $125 million in alleged overpayments for services to beneficiaries who are belatedly identified as ineligible (incarcerated/unlawfully present). In this post, Sheppard Mullin examines the...more

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