Lee Nutini on Centers for Medicare & Medicaid Services (CMS)

Biden Administration Taps Chiquita Brooks-LaSure to Lead CMS

On February 19, 2021, President Joe Biden nominated Chiquita Brooks-LaSure to serve as the Administrator for the Centers for Medicare and Medicaid Services (CMS). If confirmed by the Senate, Brooks-LaSure would be the first...more

2/25/2021 / Affordable Care Act , Biden Administration , Centers for Medicare & Medicaid Services (CMS) , Consumer Information , Department of Health and Human Services (HHS) , Nominations

CMS Releases Mid-Build Off-Campus Outpatient Department Audit Results

On January 19, 2021, CMS announced the results of its audit of off-campus outpatient departments claiming the “mid-build” exception following enactment of the 21st Century Cures Act (the Cures Act). Of the 334 providers that...more

1/28/2021 / 21st Century Cures Act , Audits , Centers for Medicare & Medicaid Services (CMS) , Outpatient Prospective Payment System (OPPS)

CMS Approves Nebraska Medicaid Expansion Program with Community Engagement and Wellness Requirements

On October 20, 2020, CMS approved Nebraska’s Medicaid expansion program – named the “Heritage Health Adult,” or HHA – under Section 1115 of the Social Security Act, creating a new two-tiered system of Medicaid benefits for...more

11/4/2020 / Centers for Medicare & Medicaid Services (CMS) , Coronavirus/COVID-19 , Department of Health and Human Services (HHS) , Medicaid Expansion , Mental Health , Wellness Programs

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

House Appropriations Draft Bill Targets Private Equity-Backed Healthcare Entities, Focuses on Pandemic Preparedness

On July 6, 2020, the House of Representatives Committee on Appropriations released its draft Fiscal Year (FY) 2021 funding bill for the Departments of Labor, Education, and HHS (the Bill), which includes several interesting...more

7/27/2020 / Advanced Payment Program , Biomedical Advanced Research and Development Authority (BARDA) , Centers for Disease Control and Prevention (CDC) , Centers for Medicare & Medicaid Services (CMS) , Coronavirus/COVID-19 , Department of Education , Department of Health and Human Services (HHS) , Department of Labor (DOL) , HRSA , Medicare , National Institute of Health (NIH) , Proposed Legislation

CMS Approves Emergency Medicaid Waivers for 34 States; More States to Come

Following President Trump’s declaration of a national emergency related to COVID-19 on March 13, 2020, CMS has been swiftly approving states’ requests for flexibilities for their Medicaid programs as they continue to battle...more

4/7/2020 / Centers for Medicare & Medicaid Services (CMS) , Coronavirus/COVID-19 , Medicaid , Medicare , Waivers

CMS Issues Final Rule for CY 2020 Home Health Payments, CY 2021 Home Infusion Therapy Benefit

On October 31, 2019, CMS issued a final rule with comment period (Final Rule), CMS-1711-FC, updating the payment rates for home health agencies (HHAs) for calendar year (CY) 2020...more

11/13/2019 / 21st Century Cures Act , Centers for Medicare & Medicaid Services (CMS) , Final Rules , Health Care Providers , Home Health Agencies , Medicare , Prospective Payment System (PPS) , Value-Based Purchasing

Federal Court Vacates CMS’s Medicare Advantage Overpayment Rule Due to “Crucial Data Mismatch” and Other Failings

On September 7, 2018, the United States District Court for the District of Columbia vacated CMS’s 2014 Overpayment Rule for Medicare Advantage insurers at 79 Fed. Reg. 29,844, 29,918-25 (the 2014 Overpayment Rule), ruling...more

9/11/2018 / Centers for Medicare & Medicaid Services (CMS) , False Claims Act (FCA) , Health Care Providers , Medicare , Medicare Advantage

CMS Revises Waiver Process for New Home Health Agencies and Non-Emergency Ambulance Suppliers in Six Moratorium States

On August 16, 2018, CMS announced that it is expanding the waiver application standards for new home health agency (HHA) and non-emergency ambulance suppliers in six states with a moratorium on Medicare enrollment. Providers...more

8/24/2018 / Ambulance Providers , Centers for Medicare & Medicaid Services (CMS) , Home Health Agencies

CMS Releases Proposed Rule for 2019 Hospital Outpatient Prospective Payment System, Includes Major Proposals on Site Neutrality

On July 25, 2018, CMS proposed a rule (Proposed Rule) revising factors for determining Medicare payment rates for the Hospital Outpatient Prospective Payment System (OPPS) and the Ambulatory Surgery Center (ASC) Payment...more

8/1/2018 / Centers for Medicare & Medicaid Services (CMS) , Hospitals , Medicare , Outpatient Prospective Payment System (OPPS) , Payment Systems

CMS Updates Rules for Reporting Adverse Legal Action

On June 1, 2018, CMS issued further guidance for reporting and reviewing final adverse legal actions (ALAs) in provider enrollment applications. In Transmittal 797, which replaces Transmittal 784 to the Medicare Program...more

6/22/2018 / Adverse Action , Centers for Medicare & Medicaid Services (CMS) , Change in Ownership , Exclusions , Health Care Providers , Hospitals , MACs , Medicare , Medicare Billing Privileges , PECOS , Physicians , Reporting Requirements , Revocation

Lee Nutini

King & Spalding

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