On August 4, 2025, CMS issued a final rule (Final Rule) updating payment rates, policies, and quality programs for Skilled Nursing Facilities (SNFs) under the Medicare Prospective Payment System (SNF PPS) for Fiscal Year (FY)...more
8/13/2025
/ Appeals ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
Final Rules ,
Healthcare ,
Healthcare Facilities ,
Medicare ,
Patient-Driven Payment Model (PDPM) ,
Prospective Payment System (PPS) ,
Reimbursements ,
Reporting Requirements ,
Skilled Nursing Facility ,
Value-Based Payments
To offset the cost of other provisions in the bill, the One Big Beautiful Bill Act (OBBBA) includes significant reforms to Medicaid, Medicare, and Affordable Care Act (ACA) premium tax credits that are expected to result in...more
CMS announced in a letter released on Tuesday, May 27, 2025 (CMS Letter) that it will ramp up financial oversight of states to detect misuse of federal Medicaid funds “[t]o ensure that federal money is not used to pay for or...more
On January 10, 2025, OIG posted a favorable advisory opinion approving a proposed program (Program) to provide patients who meet certain financial need criteria with free access to a pharmaceutical product that has limited...more
1/28/2025
/ Anti-Kickback Statute ,
Compliance ,
Drug Pricing ,
Federal Health Care Programs (FHCP) ,
Healthcare Fraud ,
Incentives ,
Medicaid ,
Medicare ,
OIG ,
Pharmaceutical Industry ,
Prescription Drugs ,
Reimbursements
On July 10, 2024, CMS issued a proposed rule with updates to the Medicare payment rates for the Hospital Outpatient Prospective Payment System (OPPS) and the Medicare Ambulatory Surgical Center (ASC) payment system for...more
On April 10, 2024, CMS issued its annual Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) Proposed Rule for Fiscal Year (FY) 2025 (the Proposed Rule). In...more
4/17/2024
/ Centers for Medicare & Medicaid Services (CMS) ,
Consolidated Appropriations Act (CAA) ,
Food and Drug Administration (FDA) ,
Graduate Medical Education ,
Inpatient Prospective Payment System (IPPS) ,
Long Term Care Facilities ,
Manufacturers ,
Medicare ,
Payment Systems ,
Proposed Rules ,
Prospective Payment System (PPS) ,
Provider Reimbursement Review Board ,
Supply Chain ,
Supply Shortages
On December 21, 2023, the OIG issued a favorable advisory opinion (Advisory Opinion 23-11) regarding the proposed subsidization of certain Medicare cost-sharing obligations in the context of a clinical trial.
The...more