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D.C. Circuit Court Reinstates 2017 Final Rule Limiting Hospitals’ Medicaid Disproportionate Share Hospital (DSH) Funding

On August 13, 2019, the U.S. Court of Appeals for the District of Columbia Circuit overturned a district court ruling that CMS’s 2017 final rule on the Medicaid DSH program limit calculation violates the Medicaid Act, 42...more

Federal Court Says 2018 OPPS 340B Program Rate Cuts Unlawful, Orders Briefing to Avoid ‘Havoc’ on Medicare Program

On December 27, 2018, Judge Rudolph Contreras of the U.S. District Court for the District of Columbia ruled in favor of several associations and hospital plaintiffs, including the American Hospital Association (AHA)...more

OIG Advisory Opinion Rejects Pharma Company’s Proposed Free-Products-to-Hospitals Arrangement

On November 13, 2018, the Department of Health and Human Services Office of Inspector General (OIG) issued Advisory Opinion No. 18-14 advising a drug company that its proposal to provide a drug to inpatients without charge...more

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

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

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