News & Analysis as of

Healthcare Reform Alternative Payment Models (APM) Medicare

Bass, Berry & Sims PLC

CMS Proposes Mandatory Two-Sided Risk Model for Specialists Treating Heart Failure and Low Back Pain

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On July 16, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule for the Ambulatory Specialty Model (ASM), a mandatory, five-year alternative payment model for select specialists who regularly treat...more

Sheppard Mullin Richter & Hampton LLP

Takeaways from the America’s Physician Groups’ Spring Conference: Turbulent Times Call for Change and Innovation

“Kicking Off Accountable Care” served as the theme for this year’s America’s Physician Groups’ (“APG”) Spring Conference, a three-day event packed with compelling speakers and breakout sessions focused on the state of...more

Bass, Berry & Sims PLC

CMMI Announces New Strategy

Bass, Berry & Sims PLC on

After months of signaling that a new strategy was in the works, on May 13, 2025, the Centers for Medicare & Medicaid Services (CMS) released a new strategic direction for the CMS Center for Medicare and Medicaid Innovation...more

Mintz - Health Care Viewpoints

What to Take Away from CMMI’s Early Termination of Four Demonstration Models

On March 12, 2025, in one of the Trump Administration’s first actions with respect to the Center for Medicare and Medicaid Innovation (CMMI), CMMI announced that it would prematurely terminate four alternative payment model...more

Whiteford

Navigating Value-Based Care in Anesthesia: Enhancing Patient Outcomes Amid Legal Complexities

Whiteford on

Value-based care (VBC) is a healthcare delivery model that prioritizes patient outcomes over the volume of services provided. This approach aims to enhance the quality of care while controlling costs by incentivizing...more

McDermott+

No Doc Fix or Advanced APM Bonus: What Happens Next?

McDermott+ on

Here we go again! For the second year in a row, we enter the new year without Congress enacting a doc fix or Advanced Alternative Payment Model (APM) bonus extension. While Congress did act last year on both counts (through...more

McDermott+

ACO REACH: What Recent Performance Results Could Mean for the Model’s Future

McDermott+ on

Decisions, decisions, decisions. The Centers for Medicare & Medicaid Services (CMS) under the Trump Administration will have its hands full making decisions about Center for Medicare and Medicaid Innovation (CMMI) models...more

Jones Day

California Health Care Providers to Face Greater Headwinds as State Implements Health Care Cost Targets

Jones Day on

Pursuant to California's Health Care Quality and Affordability Act (the "HCQA"), the newly created Office of Health Care Affordability ("OHCA") recently proposed statewide health care cost targets and standards and goals for...more

Hall Benefits Law

Health Care Stakeholders Support Passage of The Value in Health Care Act

Hall Benefits Law on

Seventeen healthcare stakeholder groups have come together to support The Value in Health Care Act, a bill that a bipartisan coalition reintroduced in Congress this summer. The bill supports a shift in the medical care...more

McDermott+

House Holds Hearing on MACRA Challenges, but Meaningful Reform is Unlikely

McDermott+ on

On June 22, 2023, the US House of Representatives Committee on Energy and Commerce Subcommittee on Oversight and Investigations held a hearing titled “MACRA Checkup: Assessing Implementation and Challenges that Remain for...more

Proskauer - Health Care Law Brief

CMS releases guidance on Expanded Home Health Value-Based Purchasing (“HHVBP”) Model

On November 2, 2021, the Centers for Medicare & Medicaid Services (“CMS”) issued a final rule (“Final Rule”) that advances the shift from paying for Medicare home health services based on volume to a system that pays based on...more

Sheppard Mullin Richter & Hampton LLP

Global and Professional Options Direct Contracting Model RFA and LOI Now Active

On April 21, 2019, the Center for Medicare and Medicaid Innovation (“CMMI”) announced the CMS Primary Cares Initiative – a voluntary, risk-based initiative to transform the Medicare program’s reimbursement of primary care...more

Mintz - Health Care Viewpoints

Promise to Repeal the ACA Poses Threat to MACRA Implementation

Most of the post-election discussion of the ACA has focused on how promises to repeal the law could impact the newly insured. But one priority area of the ACA that has received very little discussion is the federal...more

Troutman Pepper Locke

The New Era of Health Care Reform

Troutman Pepper Locke on

Welcome to the inaugural edition of The New Era of Health Care Reform which highlights important developments in health care reform under the Trump Administration. A FIRST LOOK AT HEALTH CARE PRIORITIES OF...more

McDermott Will & Schulte

Briefing Points for the Board: The Election and the 2017 Health Policy Agenda

McDermott Will & Schulte on

It is vitally important for the health system board, as well as certain of its key committees, to receive an introductory briefing as soon as possible on the health policy implications of last week’s Presidential and...more

Foley & Lardner LLP

Top Three Reasons ACOs Should Use Telehealth and Telemedicine

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Accountable Care Organizations (ACOs) can share costs of telehealth and remote patient monitoring services among their hospitals, providers/suppliers, and other ACO participants, according to federal regulations under the...more

King & Spalding

Also In The News - Health Headlines - October 2015 #3

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CMS Announces Part D Enhanced Medication Therapy Management Model Demonstration – On September 28, 2015, CMS announced a Part D Enhanced Medication Therapy Management Model (Enhanced MTM Model) that is designed to assess...more

Mintz - Health Care Viewpoints

Medicare to Permit Value-Based Insurance Design in Medicare Advantage Plans

The Centers for Medicare & Medicaid Services (“CMS”) recently announced that, beginning January 1, 2017, Medicare Advantage plans in Arizona, Indiana, Iowa, Massachusetts, Oregon, Pennsylvania and Tennessee will be permitted...more

Mintz - ML Strategies

Health Care Update - August 2015

Mintz - ML Strategies on

CMS Releases Final Payment Rules (IPPS, IRF, LTCHs, Hospice, and Psych): At the end of last week, the Centers for Medicare and Medicaid Services (CMS) released a set of final 2016 payment rules affecting acute care hospitals...more

King & Spalding

CMS Proposes to Revise Payment System for Joint Replacements

King & Spalding on

On July 9, 2015, CMS released a proposed rule to revise how it pays for joint replacement procedures like hip and knee replacements, also known as lower extremity joint replacements (LEJR). This payment structure, called the...more

Mintz - Health Care Viewpoints

Delivery System Reform 2.0: Scaling Alternative Payment Models is the New Normal

For some health care providers, a pair of recent announcements made by the Obama Administration to implement mandatory alternative payment models (APMs) for home health value-based purchasing and bundled payments for hip and...more

Mintz - ML Strategies

Health Care Update - July 2015 #1

Mintz - ML Strategies on

In This Issue: - Recent Mandatory APMs Signal Evolution in Delivery Reform Efforts - Implementation of the Affordable Care Act - Federal Regulatory Initiatives - Congressional Initiatives - Upcoming...more

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