On July 7, 2023, CMS published its highly-anticipated proposed rule identifying its remedy to reimburse hospitals unpaid by its unlawful 340B drug payment policy (the Proposed Rule). While the Supreme Court found CMS’s 340B...more
On March 16, 2023, CMS issued Transmittal 11904, directing its contractors to adjust hospitals’ nursing and allied health education (NAH) payments associated with services furnished to Medicare Advantage (MA) enrollees. ...more
On February 24, 2023, CMS issued a proposed rule updating its Medicaid Disproportionate Share Hospital (DSH) program regulations as a result of legislative changes made by the Consolidated Appropriations Act (CAA) of 2021....more
On April 18, 2022, CMS issued its annual Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System Proposed Rule for FY 2023 (the Proposed Rule). In the Proposed Rule,...more
4/27/2022
/ Affordable Care Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Hospitals ,
Inpatient Prospective Payment System (IPPS) ,
Long-Term Care ,
Medicare ,
Medicare Advantage ,
Payment Rates ,
Proposed Rules ,
Rulemaking Process ,
Wage Index
On November 8, 2021, the Eighth Circuit affirmed a district court order that denied an attempt to preliminarily block the Organ Procurement and Transplant Network’s (OPTN) policy changing the manner in which donor kidneys are...more
11/18/2021
/ Administrative Procedure Act ,
Appeals ,
Arbitrary and Capricious ,
Health Care Providers ,
Hospitals ,
Irreparable Harm ,
Notice and Comment ,
Organ Transplant Centers ,
Patients ,
Preliminary Injunctions ,
Rulemaking Process
On April 29, 2021, CMS issued a final rule extending the Comprehensive Care for Joint Replacement (CJR) bundled-payment model for an additional three performance years (the Final Rule). Originally slated to end September 30,...more
On July 31, 2020, the U.S. Court of Appeals for the District of Columbia Circuit reversed a district court decision that had found unlawful Medicare’s nearly 30 percent rate cut for separately payable outpatient drugs...more
Last week CMS issued a new round of regulatory waivers and rule changes in response to the COVID-19 public health emergency, including its Interim Final Rule with comment period, CMS-5531-IFC. The key changes relax certain...more
5/8/2020
/ ACOs ,
Ambulatory Surgery Centers ,
Centers for Medicare & Medicaid Services (CMS) ,
Coronavirus/COVID-19 ,
Food and Drug Administration (FDA) ,
Home Health Agencies ,
Hospice ,
Hospitals ,
Inpatient Rehab Facilities ,
Long Term Care Facilities ,
Medicare ,
Pharmacies ,
Public Health Emergency ,
Skilled Nursing Facility ,
Telehealth ,
Virus Testing ,
Waivers
On Thursday, February 20, 2020, hospitals represented by King & Spalding that operate excepted off-campus provided-based outpatient departments (PBDs) filed their brief in federal appeals court to preserve the victory they...more
On September 26, 2019, CMS issued a Final Rule that CMS intends will reform certain Medicare regulations related to standards and certifications that CMS identified as “unnecessary, obsolete, or excessively burdensome.” CMS...more
10/3/2019
/ Ambulatory Surgery Centers ,
Centers for Medicare & Medicaid Services (CMS) ,
Emergency Management Plans ,
Final Rules ,
Health Care Providers ,
Healthcare Facilities ,
Home Health Care ,
Hospice ,
Hospitals ,
Medicare ,
Mental Health ,
Organ Transplant Centers ,
Regulatory Standards
On July 29, 2019, CMS published a proposed rule revising the factors for determining Medicare payment rates under the Hospital Outpatient Prospective Payment System (OPPS) and the Ambulatory Surgery Center (ASC) Payment...more
8/7/2019
/ Centers for Medicare & Medicaid Services (CMS) ,
Comment Period ,
Hospitals ,
Innovative Technology ,
Inpatient Quality Reporting ,
Medicare ,
Outpatient Prospective Payment System (OPPS) ,
Price Transparency ,
Proposed Rules ,
Rural Health Care Program ,
Section 340B ,
Surgical Center Requirements
On June 19, 2019, the Senate Committee on Health, Education, Labor and Pensions (HELP), in the latest effort to curb “surprise billing,” released the “discussion draft” of its proposed “surprise billing” legislation. The...more
On April 23, 2019, CMS issued its annual Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System Proposed Rule for FY 2020 (the Proposed Rule), which will affect...more
4/30/2019
/ Centers for Medicare & Medicaid Services (CMS) ,
Comment Period ,
Graduate Medical Education ,
Health Care Providers ,
Healthcare ,
Hospitals ,
Inpatient Prospective Payment System (IPPS) ,
Long Term Care Facilities ,
Medicare ,
Proposed Rules ,
Quality Payment Program (QPP) ,
Regulatory Requirements
On January 18, 2019, a group of nearly 40 hospitals filed a lawsuit in the United States District Court for the District of Columbia challenging CMS’s rate cut to evaluation and management (E/M) services furnished by excepted...more
On August 25, 2018, the U.S. District Court for the District of New Hampshire in New Hampshire Hospital Association v. Azar gavehospitals another victory in their claims that CMS unlawfully reduces Medicaid Disproportionate...more
On June 29, 2018, the U.S. District Court for the District of Columbia decided Stringfellow Memorial Hospital et al. v. Azar by granting summary judgment to the Secretary of HHS in his defense of the FY 2005 Inpatient...more
On May 2, 2018, Georgia Governor Nathan Deal signed into law a bill allowing failed rural hospitals to be converted into “micro-hospitals.” The law comes as a response to a recent string of rural hospital closures and a...more
On February 20, 2018, the Trump administration announced a proposed rule to allow insurers to offer short-term, limited-duration insurance plans that provide coverage for a period of up to twelve months. The limit for this...more