Taylor Whitten on Medicare

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

$413 Million Distributed in Phase 4 Provider Relief Fund Payments

On March 22, 2022, HHS announced that it had distributed more than $413 million in Provider Relief Fund (PRF) payments to more than 3,600 health care providers impacted by the COVID-19 pandemic. HHS directed its disbursement...more

3/31/2022 / American Rescue Plan Act of 2021 , Children's Health Insurance Program (CHIP) , Coronavirus/COVID-19 , Department of Health and Human Services (HHS) , HRSA , Medicaid , Medicare , Provider Relief Fund

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.

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

CMS Issues New Section 1135 Waivers to Assist Healthcare Providers Combatting the COVID-19 Pandemic

Using its authority granted under Section 1812(f) of the Social Security Act, CMS has issued several new Section 1135 blanket waivers to waive or modify certain Medicaid, Medicare, CHIP, or HIPAA requirements when a federal...more

4/22/2020 / Centers for Medicare & Medicaid Services (CMS) , Medicaid , Medicare

Coronavirus Update: CMS Guidance Issued this Month

As the number of coronavirus cases across the country continue to rise, CMS has issued several coronavirus-specific memorandums to healthcare providers and laboratories. In the past two weeks, CMS has issued disease-specific...more

3/20/2020 / Centers for Medicare & Medicaid Services (CMS) , Coronavirus/COVID-19 , Cost-Sharing , Diagnostic Tests , Emergency Rooms , EMTALA , Health Care Providers , Hospitals , Medicaid , Medicare , Medicare Part C , Medicare Part D

Federal Government Funded for Fiscal Year 2020; Surprise Billing and Comprehensive Drug Pricing Legislation Postponed Until 2020

Last Friday, President Trump signed into law two bipartisan legislative packages that included all twelve Fiscal Year 2020 funding bills. Comprehensive surprise billing and drug pricing legislation were not included in the...more

12/31/2019 / Affordable Care Act , Appropriations Bill , Cadillac Tax , Community Health Systems , Congressional Committees , Drug Pricing , Federal Budget , Federal Funding , Health Insurance , Medicaid , Medicare , Pharmaceutical Industry , Surprise Medical Bills

Taylor Whitten

King & Spalding

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