Taylor Whitten on Centers for Medicare & Medicaid Services (CMS)

CMS Will Likely Stop Funding Certain State Medicaid Programs

CMS announced this month that it does not anticipate using federal funds to match state funds for designated state health programs (DSHP) and designated state investment programs (DSIP) under its section 1115 demonstration...more

5/5/2025 / Centers for Medicare & Medicaid Services (CMS) , Federal Funding , Government Agencies , Healthcare , Healthcare Reform , Medicaid , Regulatory Oversight , State and Local Government , State Medicaid Programs , Telehealth

CMS Issues Fiscal Year 2025 Final Rule for Skilled Nursing Facilities

On July 31, 2024, CMS issued a final rule (the Final Rule) for fiscal year (FY) 2025 updating Medicare payment policies and rates for skilled nursing facilities (SNFs) under the SNF Prospective Payment System (PPS). Under the...more

8/8/2024 / CBAs , Centers for Medicare & Medicaid Services (CMS) , Enforcement , Final Rules , Inpatient Quality Reporting , Medicare , Patient-Driven Payment Model (PDPM) , Payment Systems , Skilled Nursing Facility , Value-Based Purchasing

CMS Makes Several Updates to the Federal Independent Dispute Resolution (IDR) Process

Over the past month, CMS announced several updates to the Federal No Surprises Act IDR Process. On December 15, 2023, the Federal IDR portal was re-opened for all remaining disputes. The portal is now open for all disputes...more

1/8/2024 / Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Department of Labor (DOL) , Dispute Resolution , Final Rules , No Surprises Act (NSA) , Portal , U.S. Treasury

CMS Issues New Policy in Letter to State Health Officials that Medicaid and CHIP Will Pay Specialists for Interprofessional...

CMS announced on January 5, 2023, that Medicaid and CHIP will pay specialists who provide interprofessional consultations to other providers. Previously, CMS did not provide coverage for most interprofessional consultations...more

1/16/2023 / Centers for Medicare & Medicaid Services (CMS) , Children's Health Insurance Program (CHIP) , Coronavirus/COVID-19 , Medicaid , Mental Health , Specialty Healthcare

California DMHC Takes Position that Additional California Law Constitutes “Specified State Law” Under the No Surprises Act

Last week, the California Department of Managed Health Care (DMHC) issued an All-Plan Letter (APL) stating that California case law and the Knox-Keene Health Care Service Plan Act of 1975 (the Knox-Keene Act) constitute...more

4/1/2022 / California , Centers for Medicare & Medicaid Services (CMS) , Knox Keene , Out of Network Provider , Surprise Medical Bills

CMS Issues Outpatient Prospective Payment System Final Rule for CY 2022

On November 2, 2021, CMS published the final rule to update the payment policies and rates for services furnished under the Medicare Outpatient Prospective Payment System (OPPS) and the Ambulatory Surgery Center (ASC) Payment...more

11/15/2021 / Ambulatory Surgery Centers , Centers for Medicare & Medicaid Services (CMS) , Civil Monetary Penalty , Coronavirus/COVID-19 , Medicare , Medicare Advantage , Outpatient Prospective Payment System (OPPS) , Payment Systems , Price Transparency , Public Health Emergency

D.C. Circuit Rejects UnitedHealthcare’s Challenge to the Medicare Advantage 60-Day Overpayment Rule

The D.C. Circuit Court overturned UnitedHealthcare’s victory in the lower court that resulted in vacatur of the Medicare Advantage 60-day overpayment rule (the Overpayment Rule). Last week, the D.C. Circuit Court held that...more

8/19/2021 / Affordable Care Act , Centers for Medicare & Medicaid Services (CMS) , False Claims Act (FCA) , Medicare , Medicare Advantage , Overpayment , United Healthcare Insurance Co.

California Medicaid Set to Lose $200 Million in Funding Next Quarter for its Universal Abortion Coverage Mandate

On December 16, 2020, the U.S. Department of Health and Human Services (HHS), Office for Civil Rights (OCR), announced that the Centers for Medicare & Medicaid (CMS) will disallow $200 million in federal Medi-Cal funding next...more

12/29/2020 / Abortion , California , Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Knox Keene , Medicaid , OCR

CMS Amends Medicare Loan Terms Allowing Providers More Time to Make Payments

During the COVID-19 pandemic, CMS has issued approximately $106 billion in loans to providers who were struggling with cash flows and financing in the early stages of the pandemic. This month, the Continuing Appropriations...more

10/16/2020 / Accelerated Payments , Centers for Medicare & Medicaid Services (CMS) , Continuing Appropriations Act 2018 , Coronavirus/COVID-19 , Medicare , Medicare Part A , Medicare Part B , Provider Relief Fund

Executive Order Looks to Extend Access to Telemedicine Beyond the Pandemic and Increase Access to Care in Rural Communities

On August 3, 2020, President Trump signed an Executive Order that could potentially extend the easing of restrictions on telemedicine that were put in place during the COVID-19 public health emergency (PHE) beyond the...more

8/24/2020 / Centers for Medicare & Medicaid Services (CMS) , Coronavirus/COVID-19 , Department of Health and Human Services (HHS) , Executive Orders , FCC , Medicare , Public Health Emergency , Rural Health Care Program , Social Security Act , Telemedicine

Taylor Whitten

King & Spalding

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