Alexandra Shalom on Centers for Medicare & Medicaid Services (CMS)

Medicare Payment Model Trends and Economic Drivers – Awaiting Direction from Trump Administration

The Medicare program continues to face long term financial pressures associated with inflationary effects on health care costs and the growing wave of aging baby boomers. The Medicare Trust Fund, which is often viewed as a...more

2/28/2025 / Affordable Care Act , Centers for Medicare & Medicaid Services (CMS) , CMMI , Health Care Providers , Health Insurance , Healthcare Reform , Insurance Industry , Medicaid , Medicare , Medicare Advantage , Medicare Part A , Medicare Shared Savings Program , Value-Based Care

Risk Bearing Entity Requirements: An Introduction

Providers and provider organizations are increasingly contracting with payors to manage specific patient pools and diseases on a risk basis. They are taking new and increasing financial risk to better align with payors’...more

11/19/2024 / ACOs , Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Medicare Advantage Organizations (MAOs) , Payor Contracts , REACH , Risk Management

New HCPCS for Advanced Primary Care Management

The Center for Medicare & Medicaid Services (CMS) issued the display copy of the final Calendar Year 2025 Physician Fee Schedule on November 1, 2024, which included three new Healthcare Common Procedure Coding System (HCPCS)...more

11/5/2024 / Centers for Medicare & Medicaid Services (CMS) , Chronic Care Managment (CCM) , Consent , Continuity of Care , Department of Health and Human Services (HHS) , HCPCS

The No Surprises Act: A District Court’s Decision Results in Federal IDR Outage

Although the No Surprises Act was signed into law almost three years ago and has been in effect for the past year and a half, there have been numerous delays in implementation and execution due to the complexity of elements...more

8/15/2023 / Arbitration , Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Department of Labor (DOL) , Dispute Resolution , Health Care Providers , No Surprises Act (NSA) , Payor Contracts , U.S. Treasury

Payor/Provider Convergence and What It Means for You

Welcome to the Payor/Provider Convergence Series of the Health Care Law Today blog. This series is dedicated to exploring the intersection between payors and providers in the health care space; in particular, the evolving...more

5/4/2023 / Centers for Medicare & Medicaid Services (CMS) , CMMI , False Claims Act (FCA) , Fee-for-Service , Health Care Providers , Health Insurance , Healthcare , Knox Keene , Medicare Advantage , No Surprises Act (NSA) , Public Health Emergency

Key Takeaways from the Foley/PYA “Let’s Talk Compliance” 2-Day Virtual Conference

Session #1: State of the Healthcare Industry Effective Compliance Plans and Enforcement Trends - In their discussion of compliance program effectiveness and enforcement, attorneys Kolarik and Waltz and Ms. Sumner...more

2/23/2023 / Centers for Medicare & Medicaid Services (CMS) , Compliance , Consolidated Appropriations Act (CAA) , Coronavirus/COVID-19 , Department of Health and Human Services (HHS) , Department of Justice (DOJ) , Dispute Resolution , Enforcement , Health Care Providers , Healthcare , Medicaid , Medicare , Mental Health , No Surprises Act (NSA) , Physician Fee Schedule , Public Health Emergency , Risk Assessment

CMS Extends Delayed Enforcement of the Good Faith Estimate

On Friday, December 2, 2022, the Centers for Medicare & Medicaid Services (CMS) issued an FAQ regarding the Good Faith Estimate (GFE) and Convening Provider/Facility requirements in the Federal No Surprises Act. The issued...more

12/8/2022 / Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Enforcement Actions , Good Faith , Health Care Providers , Insurance Industry , No Surprises Act (NSA) , Uninsured Patients

CMS Reports Medicare Shared Savings Program Saved Medicare $1.66 Billion in 2021

On August 30, 2022, the Centers for Medicare & Medicaid Services (CMS) announced that the Medicare Shared Savings Program (MSSP) had saved the Medicare program $1.66 billion in 2021 as compared to spending targets, while...more

9/7/2022 / ACOs , Affordable Care Act , Centers for Medicare & Medicaid Services (CMS) , Medicare , Medicare Shared Savings Program

Proposed Revisions to Medicare Shared Savings Program: CMS Encourages Participation

The Centers for Medicare and Medicaid Services (CMS), as part of 2023 Physician Fee Schedule proposed rule, has proposed significant revisions to the Medicare Shared Savings Program (MSSP). The revisions to the MSSP in the...more

8/24/2022 / ACOs , Affordable Care Act , Centers for Medicare & Medicaid Services (CMS) , Medicare , Medicare Shared Savings Program , Physician Fee Schedule

Price Transparency Enforcement is Here – Hospitals Beware

On June 7, 2022, after months of written warnings, the U.S. Centers for Medicare & Medicaid Services (CMS) has levied its first fines nationwide on two affiliated Georgia hospitals for violations of CMS’ Hospital Price...more

7/6/2022 / Centers for Medicare & Medicaid Services (CMS) , Corrective Action Plans (CAPs) , Enforcement , Fines , Hospitals , Price Transparency

How does the Federal No Surprises Act Impact Telemedicine Providers? Part Two

In this second installment of this blog series on the No Surprises Act interim regulations (NSA) we discuss: i) notice and consent requirements for out of network providers providing services at participating health care...more

3/9/2022 / Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Disclosure Requirements , Health Care Providers , Interim Final Rules (IFR) , Out of Network Provider , Social Security Act , Surprise Medical Bills , Telemedicine

Sunshine Act Reporting Update: De Minimis Amounts

The Centers for Medicare & Medicaid Services (CMS) issued updated guidance on the thresholds that Applicable Manufacturers and Group Purchasing Organizations are required to report annually under the Sunshine Act (42 U.S.C. §...more

11/18/2020 / Centers for Medicare & Medicaid Services (CMS) , Civil Monetary Penalty , Consumer Price Index , Covered Recipients , Data Collection , Department of Justice (DOJ) , Group Purchasing Organizations (GPO) , Manufacturers , Nurse Practitioners , Open Payments , Physicians , Social Security Act , Sunshine Act

CMS Proposes Changes to Lower Drug Prices

On November 30, 2018, the Centers for Medicare & Medicaid Services (CMS) published 83 Fed. Reg. 62152, which proposes changes to Medicare Part D (prescription drug benefit) and drug plans offered by Medicare Advantage...more

12/7/2018 / Centers for Medicare & Medicaid Services (CMS) , Drug Pricing , Food and Drug Administration (FDA) , Gag Clauses , Medicare , Medicare Part D , Out-of-Pocket Expenses , Prescription Drugs , Proposed Regulation

CMS Continues to Tighten the Belt on Hospital Off-Campus Provider-Based Departments

Hospitals with off-campus provider-based departments (PBDs) may want to rethink their end of summer vacation plans in order to focus on a recent slate of proposed regulations from the Center for Medicare and Medicaid Services...more

8/17/2018 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Healthcare Facilities , Hospitals , Medicare , Outpatient Prospective Payment System (OPPS) , Outpatient Services , Physician Fee Schedule , Physician Medicare Reimbursements , Proposed Regulation

Alexandra Shalom

Foley & Lardner LLP

Popular Topics by This Author

Latest Posts › Centers for Medicare & Medicaid Services (CMS)