News & Analysis as of

Reimbursements Regulatory Requirements

Hogan Lovells

Payments: European Court of Justice (ECJ) rules on PSP liability for unauthorised transactions and late PSU notification

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The ECJ has confirmed that a payment service user (PSU) is deprived of the right to reimbursement for an unauthorised transaction under PSD1 if: they fail to notify without undue delay upon becoming aware of it; or...more

McGuireWoods LLP

From Delivery to Recovery: Unlocking Value in Postpartum Health

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Most maternal health complications happen after delivery, but for decades, postpartum care remained one of medicine’s most neglected phases of life. That is changing fast. The first 12 weeks after delivery, long overlooked,...more

Gardner Law

NTAP: How to Secure Supplemental Medicare Reimbursement in FY2027

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The New Technology Add-On Payment (NTAP) program remains one of the most powerful and underutilized tools for securing Medicare reimbursement for novel medical technologies. For eligible products, NTAP provides additional...more

McGuireWoods LLP

CMS Proposes Reimbursement Changes for Remote Patient Monitoring

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On July 14, 2025, the Centers for Medicare & Medicaid Services (CMS) issued the 2026 Medicare Physician Fee Schedule (PFS) Proposed Rule (PFS Proposed Rule). The PFS Proposed Rule proposes to reduce requirements for several...more

McDermott Will & Schulte

HRSA issues 340B rebate model pilot program guidance, requests comments

The Health Resources and Services Administration (HRSA) issued a notice announcing the application process for the 340B rebate model pilot program and requesting public comment. The notice sets the parameters of 340B rebate...more

Kohrman Jackson & Krantz LLP

Why More Employers Are Turning to ICHRA for Affordable Health Care Benefits

Many employers have faced the same “knot in the stomach” moment during insurance renewal season. We’re all too familiar with the stress of inexplicably rising health care costs, especially when group plan risk pools take an...more

Pullman & Comley - Connecticut Health Law

New Billing Codes for At-Home Acute Kidney Injury Renal Dialysis

Earlier this year, the Centers for Medicare and Medicaid Services (CMS) confirmed that, effective January 1, 2025, CMS will pay for acute kidney injury (AKI) renal dialysis treatments at-home at the daily rate based on...more

Orrick, Herrington & Sutcliffe LLP

Opportunities and Risks in Remote Patient Monitoring and Remote Therapeutic Monitoring for 2026

The Calendar Year 2026 Medicare Physician Fee Schedule (PFS) proposed rule (see Orrick’s analysis of the proposed rule here) contains important signals for the future of remote patient monitoring (RPM) and remote therapeutic...more

Cozen O'Connor

The State AG Report – 07.31.2025

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Here are curated AG and federal regulatory news stories highlighting key areas in which state and federal regulators’ decisions are having an impact across the US: • PetSmart in the Doghouse as Colorado Sues over Grooming...more

Foley & Lardner LLP

Remote Patient Monitoring (RPM) and Remote Therapeutic Monitoring (RTM): What You Need to Know About CMS’ Proposed Changes

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On July 14, 2025, the Centers for Medicare and Medicaid Services (CMS) proposed key changes to remote patient monitoring (RPM) and remote therapeutic monitoring (RTM) services reimbursed under the Medicare program. The...more

Ropes & Gray LLP

Proposed Changes to Medicare Payment Rules: What Life Sciences Companies Need to Know

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The Centers for Medicare & Medicaid Services (“CMS”) recently released two proposed updates to Medicare payment rules that, if implemented, could have a significant impact on life sciences companies. The Medicare proposed...more

Blank Rome LLP

Impact of Recent CMS Rule on Site Neutrality and 340B Programs—Implications for Oncology Services

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Overview - The Centers for Medicare & Medicaid Services (“CMS”) has finalized and proposed several significant changes affecting both site neutrality in Medicare payments and the 340B Drug Pricing Program. These changes...more

Hogan Lovells

Medicare proposed rules include government pricing surprises: ASP changes and maximum fair price, new bona fide service fee and...

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Every July, the Centers for Medicare & Medicaid Services (CMS) publishes two proposed rules relating to how it plans to administer the Medicare Part B program for the next calendar year: the physician fee schedule (PFS)...more

Nelson Mullins Riley & Scarborough LLP

New Jersey Poised to Adopt Unique Warranty Time Multiplier: Latest Development In Statutory Warranty Reimbursement Requirements

New Jersey appears poised to adopt a unique “average retail labor time allowance” multiplier to the compensation OEMs must pay dealers for warranty service, after both houses of that state’s Legislature voted on June 30, 2025...more

Husch Blackwell LLP

Hospice Insights Podcast - Election Inspection: Be Proactive to Avoid Costly Election Statement Denials

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In an audit, election statement deficiencies can be costly. Auditors deny all claims covered by the problematic election statement, and those costs can multiply if more than one patient was affected. In this episode, Husch...more

A&O Shearman

PSR consolidated policy statement on APP scams reimbursement requirement

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The UK Payments Systems Regulator (PSR) has published a consolidated policy statement (PS25/5) concerning the authorised push payment (APP) fraud reimbursement requirement within the Faster Payments system, which came into...more

Proskauer - Health Care Law Brief

CMS to Immediately Begin Auditing Medicare Advantage Plans in Significant Expansion of Enforcement Efforts

On May 21, 2025, the Centers for Medicare and Medicaid Services (“CMS”) announced a significant expansion of its auditing efforts with respect to Medicare Advantage (“MA”) plans....more

McDermott Will & Schulte

Food as Medicine: A Deep Dive Into Reimbursement

The topic of “food as medicine” has gained increased attention recently, driven by a growing recognition of the role nutrition plays in preventing and managing chronic diseases. This article provides a high-level overview of...more

Dentons

Ep. 59 – Treating Medicare Beneficiaries as a Cash-Based Practice

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Cash-based practices, or providers who neither participate with nor bill insurers, are becoming increasingly common, especially in certain specialties such as primary care, women’s health, and mental health. While providers...more

Holland & Knight LLP

CMS Releases Fiscal Year 2026 IPPS and LTCH Proposed Rule

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The Centers for Medicare & Medicaid Services (CMS) on April 11, 2025, issued the proposed fiscal year (FY) 2026 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Acute Care Hospital (LTCH) Rule...more

McDermott Will & Schulte

CMS Poised for Medicare, Medicaid Integrity Enforcement Actions

The Trump administration and 119th Congress are preparing to reduce federal expenditures by targeting Medicare and Medicaid fraud, waste, and abuse. Medicare enrollment revocations, Medicaid enrollment terminations, and...more

Marshall Dennehey

Reimbursement of Pennsylvania Department of Human Services Lien Is Found Not Automatic by Pennsylvania Commonwealth Court

Marshall Dennehey on

Key Points: No formal liability for payment of work-related medical expenses is triggered on the part of the employer/insurer until such expenses are properly submitted in accordance with the terms and provisions of the...more

Holland & Knight LLP

New York Court Strikes Down CDPAP Reimbursement Changes

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In a significant development for fiscal intermediaries (FIs) and the Consumer Directed Personal Assistance Program (CDPAP), a New York Supreme Court Justice ruled on March 20, 2025, that the New York State Department of...more

Bond Schoeneck & King PLLC

Albany Supreme Court Decision Overturns Health Care Rate Reduction; Requires Rule-Making for Reimbursement Methodology Change

In a case brought by Bond, Schoeneck & King, the Albany County Supreme Court has overturned hundreds of millions of rate cuts implemented at the direction of the New York State Department of Health. The court, fully adopting...more

McDermott Will & Schulte

Trending in Telehealth: February 2025

Trending in Telehealth highlights monthly state legislative and regulatory developments that impact the healthcare providers, telehealth and digital health companies, pharmacists and technology companies that deliver and...more

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