Christopher Kenny on Medicare

The One Big Beautiful Bill Act Explained: A Detailed Review of Key Changes for the Healthcare Industry

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

7/25/2025 / Affordable Care Act , Compliance , Federal Funding , Insurance Industry , Legislative Agendas , Medicaid , Medicare , New Legislation , Regulatory Requirements

CMS Issues Guidance for Medicare Contractors to Pay For Section 1115 Day

On March 16, 2023, CMS issued Change Request 12669, which contains instructions for Medicare Administrative Contractors (MACs) to begin the process of retroactively reimbursing DSH hospitals for inpatient days attributable to...more

3/22/2023 / Centers for Medicare & Medicaid Services (CMS) , Medicaid , Medicare , Medicare Administrative Contractors (MAC) , New Guidance

CMS Proposes for the Third Time to Exclude Section 1115 Uncompensated Care Pool Days from Medicare DSH

On February 24, 2023, CMS issued a proposed rule that would modify the Medicare Disproportionate Share Hospital (DSH) payment regulation to limit the universe of Section 1115 demonstration beneficiaries who can be “regarded...more

3/1/2023 / Appeals , Centers for Medicare & Medicaid Services (CMS) , DSH , EHB , Insurance Industry , Medicaid , Medicare , Proposed Rules

CMS Proposes Quality Program Changes, Increased OPPS and ASC Medicare Payments for 2021

On August 4, 2020, CMS proposed its annual rule adjusting the Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System, as well as changes to quality reporting...more

8/20/2020 / Ambulatory Surgery Centers , Centers for Medicare & Medicaid Services (CMS) , Critical Access Hospitals , Inpatient Prospective Payment System (IPPS) , Medicare , Outpatient Prospective Payment System (OPPS) , Payment Systems , Proposed Rules

CARES Act: Medicare Advanced Payment Protocol

The federal government has implemented a number of relief programs in response to the COVID-19 public health emergency. Many borrowers in the healthcare industry may be seeking funds under the recently-expanded Medicare...more

4/17/2020 / Advanced Payment Program , CARES Act , Centers for Medicare & Medicaid Services (CMS) , Coronavirus/COVID-19 , Medicare

CMS to Repay Hospitals for 2019 Off-Campus Clinic Visit Services

CMS and its contractors have announced that beginning January 1, 2020, the agency will repay hospitals for underpaid evaluation and management (E/M) services provided in excepted off-campus provider-based departments during...more

12/24/2019 / Appeals , Centers for Medicare & Medicaid Services (CMS) , Hospitals , Medicare , Notice of Intent , Off-Campus Departments , Outpatient Prospective Payment System (OPPS)

CMS Extends Timeline to Finalize Updated Medicare Rules for Hospitals to June 2020

In 2016, CMS issued a proposed rule to update the requirements that hospitals and critical access hospitals must meet to participate in Medicare and Medicaid programs....more

6/12/2019 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Medicaid , Medicare , Proposed Rules , Time Extensions

D.C. Circuit Clears the Way for Hospitals to Challenge Base-Year Factual Determinations

The United States Court of Appeals for the District of Columbia Circuit recently held in Saint Francis Medical Center v. Azar that Medicare’s reopening regulation, which prohibits providers from seeking to revise payment...more

7/30/2018 / Appeals , Centers for Medicare & Medicaid Services (CMS) , Hospitals , Medicare

Christopher Kenny

King & Spalding

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