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Reporting Requirements Medicaid Centers for Medicare & Medicaid Services (CMS)

Hogan Lovells

HRSA issues notice regarding 340B Rebate Model Pilot Program, limited to drugs subject to a maximum fair price (MFP) for 2026

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On July 31, 2025, the Health Resources and Services Administration (HRSA) published a notice in the Federal Register (Rebate Model Notice) announcing a 340B Rebate Model Pilot Program (Pilot Program). Notably, the Pilot...more

Alston & Bird

Health Care Week in Review | CMS Finalizes FY 2026 Medicare Payment Rules, Senate Appropriations Committee Advances Labor-HHS...

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Below is Alston & Bird’s Health Care Week in Review, which provides a synopsis of the latest news in health care regulations, notices, and guidance; federal legislation and congressional committee action; reports, studies,...more

King & Spalding

CMS Reviews Quality Standards on Gender Transition Procedures

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CMS announced in a letter released on Tuesday, May 27, 2025 (CMS Letter) that it will ramp up financial oversight of states to detect misuse of federal Medicaid funds “[t]o ensure that federal money is not used to pay for or...more

McDermott+

CMS Requests Hospitals Submit Gender-Affirming Care Data- (UPDATED)

McDermott+ on

On May 28, 2025, the Centers for Medicare & Medicaid Services (CMS) sent a letter to “select hospitals” that provide gender-affirming care services, requesting information about how those hospitals adhere to quality standards...more

McDermott Will & Schulte

CMS Requests Hospitals Submit Gender-Affirming Care Data

On May 28, 2025, the Centers for Medicare & Medicaid Services (CMS) sent a letter to “select hospitals” that provide gender-affirming care services, requesting information about how those hospitals adhere to quality standards...more

Mintz - Health Care Viewpoints

PBM Legislation in the Reconciliation Bill is Far From Sweeping PBM Reform

Over the past few years, Congress has attempted to pass “federal PBM reform.” Members of Congress have held numerous hearings related to PBMs and introduced numerous bills seeking to regulate PBMs (we regularly track these...more

Ropes & Gray LLP

CMS Publishes Federal Fiscal Year 2026 Hospital Payment Proposed Rule

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On April 11, 2025, the Centers for Medicare & Medicaid Services (“CMS”) published its annual proposed rule for the federal fiscal year (“FFY”) 2026 inpatient prospective payment system (“IPPS”) and long-term care hospital...more

Bricker Graydon LLP

CMS Extends Mandatory SNF Off-Cycle Revalidations to August 1, 2025

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On April 17, 2025, the Centers for Medicare and Medicaid Services (CMS) formally announced an extension for the mandatory off-cycle revalidation deadline for skilled nursing facilities (SNFs)....more

Polsinelli

CMS Extends Revalidation Deadline for Skilled Nursing Facilities to August 1, 2025

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In its April 17 MLN Newsletter, the Centers for Medicare and Medicaid Services (CMS) once again extended the deadline for skilled nursing facilities (SNF) to submit their off-cycle revalidation from May 1 to August 1, 2025....more

Polsinelli

CMS Spring Provider Enrollment Updates

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Centers for Medicare & Medicaid Services (CMS) released several pieces of Medicare provider enrollment guidance this spring, both emphasizing current policy and requirements as well as providing guidance and clarification...more

Arnall Golden Gregory LLP

SNF Off-Cycle CMS-855A Reporting Delayed to August 1, 2025

Mandatory Medicare reporting for skilled nursing facilities (“SNFs”) has been delayed to August 1, 2025, to the relief of many in the industry. As a reminder, the Centers for Medicare & Medicaid Services (“CMS”) required the...more

Bricker Graydon LLP

The Mandatory SNF Provider Enrollment Revalidation Deadline is May 1, 2025

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The Centers for Medicare and Medicaid Services (CMS) has long required skilled nursing facilities (SNFs) enrolled in the Medicare and Medicaid programs to disclose information regarding organizational structure, governing...more

Epiq

How Plaintiff and Defense Attorneys Can Protect Beneficiaries’ Finances and Health Care in MMSEA Section 111 Reporting

Epiq on

Insufficient collaboration between plaintiff and defense attorneys regarding Medicare, Medicaid, and SCHIP Extension Act (MMSEA) Section 111 reporting requirements creates administrative complications which can negatively...more

Parker Poe Adams & Bernstein LLP

How the Centers for Medicare and Medicaid Services 2025 Payment System Final Rule Impacts Ambulatory Surgical Centers

On November 1, 2024, the Centers for Medicare & Medicaid Services (CMS) issued the 2025 hospital outpatient prospective payment system and ambulatory surgical centers (ASC) rule. The rule updates Medicare payment rates for...more

McDermott Will & Schulte

New York Executive Budget Proposes Amendments to MCO Provider Tax

The New York State Executive Budget for Fiscal Year (FY) 2026 proposes significant updates to the managed care organization (MCO) provider tax, aiming to enhance Medicaid funding through innovative financial strategies. The...more

Woodruff Sawyer

Reminder: RxDC Reporting Due June 1st

Woodruff Sawyer on

With the 2024 reference year RxDC reporting deadline approaching in June, plan sponsors should re-familiarize themselves with the reporting requirements. The 2024 reference year RxDC Reporting Instructions have been released,...more

Goodell, DeVries, Leech & Dann, LLP

Understanding CMS “Immediate Jeopardy” Investigations in Healthcare Facilities

When it comes to ensuring patient safety, healthcare facilities operate under a complex regulatory framework, including oversight from the Centers for Medicare & Medicaid Services (CMS). One of the more intense processes CMS...more

Burr & Forman

Failure to Return Credit Balances (Especially to Medicare and Medicaid) Can Create Significant Liability

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Every health care provider has “credit balances,” which occur when a provider receives more money than it is owed for services rendered. Credit balances can be caused by a number of factors, including incorrect coding,...more

Nelson Mullins Riley & Scarborough LLP

Attention SNFs: Enhanced 855A Disclosure Requirements Have Arrived

Against the backdrop of increasing regulatory scrutiny of private equity ownership in the healthcare space, Medicare skilled nursing and Medicaid nursing facilities (“SNF”) and private equity companies looking to acquire SNFs...more

Holland & Knight LLP

Significant Changes to SNF Disclosure Requirements Prompt Need for Regulatory Review

Holland & Knight LLP on

To enhance quality of operations and increase transparency in ownership within skilled nursing facilities (SNFs), the Centers for Medicare & Medicaid Services (CMS) issued its Final Rule for ownership disclosures for Medicare...more

Arnall Golden Gregory LLP

CMS Issues Final Rule Mandating New Minimum Staffing Standards for Long-Term Care Facilities

On April 22, 2024, The Centers for Medicare & Medicaid Services (“CMS”) issued the “Medicare and Medicaid Programs; Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency...more

Foley & Lardner LLP

Medicaid: CMS Final Rules Aim to Expand Access, Provide Parity with Commercial Markets

Foley & Lardner LLP on

The Centers for Medicare & Medicaid Services (CMS) published two significant updates to its Medicaid regulations on May 10, 2024. The two Final Rules, a Medicaid Access Rule and a Medicaid Managed Care Rule, impose new...more

King & Spalding

CMS Issues Interim Final Rule for CMS Enforcement of State Compliance with Reporting and Federal Medicaid Renewal Requirements

King & Spalding on

On December 4, 2023, CMS issued an interim final rule (the Interim Rule) (RIN 0938-AV26) to implement new enforcement authorities that CMS may use if states fail to comply with new reporting requirements or with federal...more

Rivkin Radler LLP

New HHS Rule for Nursing Home Ownership and Manager Disclosure

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A new rule will require nursing homes enrolled in Medicare or Medicaid to make disclosures about certain facility ownership, management and other operational information. The U.S. Department of Health and Human Services (HHS)...more

Venable LLP

Looming CTA Disclosure Requirements and Healthcare Providers

Venable LLP on

The Federal Corporate Transparency Act (the CTA), 31 U.S.C. §5336, will soon require certain entities to disclose to the U.S. Treasury's Financial Crimes Enforcement Network (FinCEN) certain pieces of identifying information...more

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