On April 16, 2025, the Committee on Ways and Means in the U.S. House of Representatives issued a letter to the public requesting information regarding Organ Procurement Organizations (OPOs)—the nonprofit, tax-exempt entities...more
On October 11, 2024, CMS issued a final rule establishing a new appeals process for Medicare beneficiaries who were initially admitted to a hospital as an inpatient but are later reclassified as an outpatient receiving...more
On August 1, 2024, CMS filed a display copy of its final rule for Fiscal Year (FY) 2025 pertaining to the Inpatient Prospective Payment Systems (IPPS) for general acute care hospitals and long-term care hospitals (LTCHs) (the...more
On June 7, 2023, CMS issued a final rule retroactively re-adopting its policy requiring patient days attributable to Medicare Part C beneficiaries (Part C days) to be counted in the Medicare fraction of the disproportionate...more
On October 13, 2022, CMS announced that it will revert to paying the statutory rate of average sales price (ASP) plus 6% for 340B-acquired drugs on a prospective basis. This announcement comes on the heels of a September 28,...more
On August 1, 2022, CMS issued its annual Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System Final Rule for FY 2023 (the Final Rule). In the Final Rule, CMS...more
8/10/2022
/ Affordable Care Act ,
Centers for Medicare & Medicaid Services (CMS) ,
DSH ,
Final Rules ,
Full-Time Employees ,
Graduate Medical Education ,
Inpatient Prospective Payment System (IPPS) ,
Long-Term Care ,
Medicare ,
Payment Rates ,
Rulemaking Process ,
Value-Based Purchasing ,
Wage Index
On July 15, 2022, the D.C. Circuit issued a decision in favor of the American Clinical Laboratory Association (ACLA) in American Clinical Laboratory Association v. Becerra. The decision is the latest chapter in long-pending...more
On June 15, 2022, the Supreme Court issued a unanimous ruling in American Hospital Assn. v. Becerra declaring that CMS’s 2018 and 2019 reimbursement outpatient drug rate cut to 340B hospitals was “contrary to the statute and...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 February 24, 2022, CMS announced major changes to several of its innovation models, including the permanent cancellation of the Geographic Direct Contracting Model—a Trump-era model that tested whether a geographic-based...more
On December 17, 2021, CMS issued a final rule with comment period addressing certain provisions of the fiscal year 2022 IPPS/LTCH PPS proposed rule that were designated to be addressed in “future rulemaking,” including...more
On July 19, 2021, CMS published a proposed rule to update the payment policies, payment rates and other provisions for services furnished under the Medicare Outpatient Prospective Payment System (OPPS) and the Ambulatory...more
7/27/2021
/ Ambulatory Surgery Centers ,
Centers for Medicare & Medicaid Services (CMS) ,
Civil Monetary Penalty ,
Consumer Price Index ,
Food and Drug Administration (FDA) ,
Medicare ,
Patient Prospective Payment System ,
Price Transparency ,
Proposed Rules ,
Public Health Emergency ,
Reporting Requirements ,
Rural Health Care Providers ,
Social Security Act
On March 29, 2021, Judge Margaret B. Seymour, in the United States District Court for the District of South Carolina, set aside a decision from CMS’s Provider Reimbursement Review Board (Board) denying reimbursement relating...more
On December 7, 2020, the United States Supreme Court declined review of the U.S. Court of Appeals for the Fifth Circuit’s affirmation to dismiss a $61.8 million False Claims Act case alleging Medicare overbilling against a...more
On October 14, 2020, CMS added eleven (11) new services to its Medicare telehealth list that are payable during the COVID-19 public health emergency (PHE). This latest expansion of telehealth services is the first to use the...more
10/22/2020
/ Centers for Medicare & Medicaid Services (CMS) ,
Children's Health Insurance Program (CHIP) ,
Coronavirus/COVID-19 ,
Department of Health and Human Services (HHS) ,
Executive Orders ,
Interim Final Rules (IFR) ,
Medicaid ,
Medicare ,
Public Health Emergency ,
Rural Health Care Program ,
Telehealth
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
On July 24, 2020, OIG issued an Advisory Opinion (AO), AO 20-04, regarding whether an arrangement where a charitable organization purchases or receives donations of unpaid medical debt from health care providers, and then...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 October 9, 2019, President Trump issued an Executive Order aimed to curb agencies, such as CMS, from using informal guidance documents as de facto rules that have the binding effect of law. In a press conference...more
10/16/2019
/ Administrative Procedure Act ,
Azar v Allina Health Services ,
Centers for Medicare & Medicaid Services (CMS) ,
Corporate Counsel ,
Executive Orders ,
Health Care Providers ,
Medicare ,
New Guidance ,
Notice and Comment ,
Rulemaking Process ,
Trump Administration
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 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 August 13, 2018, the United States District Court for the Eastern District of Washington decided Empire Health Foundation v. Price by vacating the Secretary’s policy of counting exhausted patient days and Medicare...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
Physical therapy providers are the target of a recent HHS Office of Inspector General (OIG) report that identified millions of dollars in overpayments for improperly billed Medicare services. The OIG selected a stratified...more