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Nursing Home Operators Wary of Steep Medicaid Cuts as "One Big Beautiful Bill" Moves to Senate

Even as long-term care providers celebrate a proposed 10-year moratorium on the nursing home staffing mandate[1], they are sounding the alarm over major Medicaid cuts included in the House-passed budget reconciliation bill...more

In Surprise Move, DHHS Appeals District Court Decision to Strike Down Long Term Care Staffing Mandates

On April 7, 2025, U.S. District Judge Matthew J. Kacsmaryk of the Northern District of Texas struck down the Biden administration’s final rule related to federally imposed minimum staffing requirements for long term care...more

Nursing Home Industry Cheers While Also Signaling a Continuing Need for Workforce Solutions

When the Biden administration issued its final rule related to federally imposed minimum staffing requirements for long-term care facilities (“Final Rule”) on April 22, 2024, it sought to mandate minimum levels of nursing...more

Federal Long Term Care Staffing Mandates:  Impacts on Facilities Across the Country and in Alabama

On May 10, 2024, the Centers for Medicare & Medicaid Services (CMS) published its controversial final rule imposing minimum staffing requirements for long term care facilities (the “Final Rule”). When it takes effect on June...more

Changing Hospice Certifying Physician Enrollment:  Starting in June, Physicians Must Be Enrolled or Opted-Out of Medicare for CMS...

On April 26, 2024, the Centers for Medicare and Medicaid Services (CMS) issued Questions and Answers concerning new hospice enrollment requirements for certifying physicians (CMS Q&As). In a nutshell, as of June 3, 2024, the...more

Federal Long Term Care Staffing Mandates:  Key Requirements, Compliance Dates, Hardship Exceptions, and Ongoing Controversy

On April 22, 2024, the Centers for Medicare & Medicaid Services (CMS) issued its controversial final rule related to the first federally imposed minimum staffing requirements for long term care facilities (“Final Rule”).[i] ...more

CMS Proposes to Dramatically Increase Amount of Civil Monetary Penalties Imposed During Nursing Home Surveys

With Nursing Homes Still Struggling to Rebuild After the COVID-19 Pandemic, is This Advisable? When The Centers for Medicare and Medicaid Services (CMS) posted the PPS and Consolidated Billing Updates for Skilled Nursing...more

CMS Allows for the Coverage of Marriage and Family Therapists and Mental Health Counselors Services

For the first time, Marriage and Family Therapists (MFTs) and Mental Health Counselors (MHCs) can enroll as Medicare providers under provisions established in the Consolidated Appropriations Act of 2023. MFTs and MHCs can...more

Billing Medicare or Medicaid? Understanding Your Audit Risk

If you are a healthcare provider enrolled with Medicare and Medicaid, it is imperative that you know the governmental agencies’ expectations for compliant billing and understand that the agencies constantly monitor and audit...more

Recent Legislation Green Lights H@H Programs

Until recently, the idea of hospitals providing acute-care hospital services to patients in their homes had been studied and implemented only in a limited manner in the United States. However, during the COVID-19 Public...more

CMS Announces New “SNF 5-Claim Probe & Educate Review”

On June 8, 2023, the Centers for Medicare & Medicaid Services (CMS) announced a new nationwide audit of all skilled nursing facilities (SNF) and Hospital swing bed providers that submit claims for reimbursement to Medicare...more

The End of PHE Flexibilities – How to Navigate Upcoming Changes in Healthcare

On January 30, 2022, President Biden announced that the Covid-19 Public Health Emergency (PHE) will finally end on May 11, 2023.[1] Since the PHE was declared on January 31, 2020, emergency declarations and waivers were...more

CMS Designates More Providers as “High Risk”

On November 23, 2022, the Department of Health and Human Services and the Center for Medicare and Medicaid Services (“CMS”) passed a final rule that drastically changed the risk categories for certain providers when they...more

OIG to Audit Nursing Home Services Rendered Prior to Inpatient Hospitalizations – Four Steps to Take to Prepare for the Increase...

Efforts to reduce avoidable inpatient hospitalizations among nursing facility residents have been ongoing for years. As an example of these initiatives, CMS ran a program from 2012 to 2020 focusing on long-stay long-term...more

CMS Directs Providers to “Prepare to Return to Normal”- Getting Ready for the

The current extension of the federal public health emergency declared as a result of the COVID-19 pandemic (“PHE”) will expire on October 15, 2022. As the need wanes for the waivers and flexibilities implemented due to the...more

State Abortion Laws v. EMTALA: Navigating Between a Rock and a Hard Place

The Centers for Medicare & Medicaid Services (“CMS”) issued updated guidance on July 11, 2022, reinforcing the federal Emergency Medical Treatment and Labor Act (“EMTALA”) obligations specific to patients who come to a...more

Understanding the CMS 2022 Strategic Plan:  Six Trends to Follow

The Centers for Medicare and Medicaid Services (“CMS”) issued its 2022 Strategic Framework (“CMS Strategic Framework”) on June 8, 2022. Although styled as an open letter and visionary plan, key trends affecting providers now...more

CMS Affirms Access to Reproductive Health Care on Same Day Supreme Court Strikes Down Roe v. Wade

Friday, June 24, 2022, began with the United States Supreme Court’s publication of its decision to overturn Roe v. Wade. In Dobbs v. Jackson Women’s Health Organization (19-1392), the Supreme Court held: “The Constitution...more

SMRC Targets for 2022: After Heavy Focus on Hospice, the SMRC Moves On to Home Health and Other Projects

The Supplemental Medical Review Contractor (“SMRC”) is a Centers for Medicare and Medicaid Services (“CMS”) contractor authorized to conduct nationwide medical reviews (Medicare Part A, Part B, and DME). As many in the...more

Increased Enforcement Means Need to Review Credit Balance Procedures

On December 10, 2021 a hospital in Illinois made the news when it was reported that Gibson Area Hospital had agreed to pay $292,000 to settle False Claims Act (“FCA”) allegations of failing to return overpayments received...more

TPE Audits Are Back: What Providers Need to Know

The Centers for Medicare and Medicaid Services (CMS) announced that Targeted Probe and Educate (TPE) audits would resume on September 1, 2021. TPE audits had been suspended by CMS during the public health emergency. Unlike...more

The Accelerating Movement Towards Hospital Care in the Home Setting

The next time you step into an emergency room, you may learn the hospital can provide you with hospital-level services to treat your illness in your home. Until recently, the idea of hospitals providing services to patients...more

SMRC Intensified Auditing in 2021: What is a Supplemental Medical Review Contractor and What Are They Auditing?

The year 2020 saw much less medical review auditing, including a CMS suspension of audits between March 30 and August 3 of 2020. However, with the lifting of the CMS suspension, the CMS Supplemental Medical Review Contractor...more

Health Care Reimbursement: Experience Matters. The Who, What, When, Where, and Why of Healthcare Reimbursement Coverage,...

The laws and policies surrounding the financial relationship between payors and healthcare providers is healthcare reimbursement law. Our attorneys and consultants have broad experience handling matters involving the full...more

CMS Releases Extensive Updated FAQs on Medicare COVID-19 Billing and Documentation Issues and Cares Act Provisions

On August 26, 2020, the Centers for Medicare & Medicaid Services (CMS) released extensive COVID-19 Frequently Asked Questions (FAQs) on Medicare Fee-for-Service Billing and certain provisions of the Coronavirus Aid, Relief,...more

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