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Thomas Dowdell (US)

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CMS rings in the new year with overhaul of MSSP ACOs

Thomas Dowdell (US)Joseph Keillor (US)By Thomas Dowdell (US) and Joseph Keillor (US) on Posted in News from DC
On December 21, 2018, CMS issued a mammoth 957 page “Pathways to Success” final rule, which overhauls shared savings/losses tracks for Medicare Shared Savings Program Accountable Care Organizations (MSSP ACOs) to push ACOs into shared risk models more quickly, among other program changes. Largely consistent with the proposed rule as we summarized here, the final … Continue reading

CMS significantly expands its Medicare site-neutral payment policy

Thomas Dowdell (US)By Thomas Dowdell (US) on Posted in News from DC
We previously summarized certain provisions of CMS’s CY 2019 OPPS/ASC final rule published on November 2. See here. In this final rule CMS significantly expands its Medicare site-neutral payment policy beginning January 1, 2019. As we previously described, CMS did not finalize its proposal that an excepted off-campus provider-based department (PBD) will be paid under … Continue reading

CMS publishes CY 2019 changes to hospital outpatient prospective payment and ambulatory surgical center payment systems and quality reporting programs final rule

Thomas Dowdell (US)By Thomas Dowdell (US) on Posted in News from DC
On November 2, CMS published its CY 2019 hospital outpatient prospective payment and ambulatory surgical center payment systems and quality reporting programs final rule. In the final rule CMS implements its proposal to pay clinic visit services performed in excepted off-campus provider-based departments (PBDs) a Medicare Physician Fee Schedule – equivalent payment rate. These services … Continue reading

CMS publishes CY 2019 Home Health and Home Infusion Therapy final rule

Thomas Dowdell (US)Sarah Jean Kilker (US)By Thomas Dowdell (US) and Sarah Jean Kilker (US) on Posted in News from DC
Earlier this summer the Centers for Medicare & Medicaid Services (CMS) published its Calendar Year (CY) 2019 home health agency (HHA) and home infusion therapy supplier payment updates proposed rule. On October 31, CMS published its CY 2019 final rule, which alters Medicare quality and payment reporting processes for HHAs under the Home Health Prospective … Continue reading

CMS proposes significant Medicare OPPS and ASC payment system changes for 2019

Thomas Dowdell (US)Jeff Wurzburg (US)By Thomas Dowdell (US) and Jeff Wurzburg (US) on Posted in Regulatory
On July 25, 2018, the Centers for Medicare & Medicaid Services published its 2019 Medicare hospital outpatient prospective payment system (OPPS) and ambulatory surgical center (ASC) payment system proposed rule.  A fact sheet describing the proposed rule is available here. The proposed rule can be accessed here. CMS proposes to update hospital OPPS payment rates … Continue reading

GAO releases report on the differences between 340B and non-340B hospitals

Thomas Dowdell (US)By Thomas Dowdell (US) on Posted in News from DC
On June 18, the United States Government Accountability Office (GAO) released a report on the 340B program, entitled “Drug Discount Program: Characteristics of Hospitals Participating and Not Participating in the 340B Program.” The 340B Drug Discount Program requires drug manufacturers to provide discounts on outpatient drugs to certain categories of eligible hospitals. Hospitals that serve … Continue reading

CMS issues CY 2019 home health proposed rule

Thomas Dowdell (US)By Thomas Dowdell (US) on Posted in Regulatory
On July 12, 2018, the Centers for Medicare & Medicaid Services (CMS) published its calendar year (CY) 2019 proposed rule for Medicare payment updates and proposed quality reporting changes for home health agencies (HHA) under the home health prospective payment system (HH PPS). CMS proposes certain changes to Medicare payment and quality reporting standards for … Continue reading

House Subcommittee on Health holds hearing on 340B program

Thomas Dowdell (US)By Thomas Dowdell (US) on Posted in News from DC
On July 11, the U.S. House of Representatives Energy and Commerce Subcommittee on Health held a hearing on the 340B program, entitled “Opportunities to Improve the 340B Drug Pricing Program.” In his opening statement, Subcommittee Chairman Michael Burgess (R-TX) stated that it is reasonable to review the 340B program because healthcare has “evolved significantly” since … Continue reading

Status of Medicaid reform in Kentucky, Mississippi and Maine

Thomas Dowdell (US)By Thomas Dowdell (US) on Posted in News from DC
On January 11, 2018, the Centers for Medicare & Medicaid Services (CMS) sent a letter to State Medicaid Directors that signaled their support of section 1115 demonstration projects that include work or community engagement requirements, as previously summarized in the Health Law Pulse. CMS prompted State Medicaid Directors to respond to this letter with proposals … Continue reading

Coalition of conservative groups release outline of plan to repeal and replace the Affordable Care Act

Thomas Dowdell (US)By Thomas Dowdell (US) on Posted in News from DC
On June 19, the Health Policy Consensus Group, a coalition of conservative groups including the Heritage Foundation, the Galen Institute and the Hoover Institution, released an outline of a new proposal to repeal and replace the Affordable Care Act (ACA).  The plan is similar to the Graham-Cassidy bill that Congress failed to enact last year.  … Continue reading

MedPAC recommends to Congress a 30 percent reduction in Medicare payment rates for services provided in certain hospital off-campus emergency departments

Thomas Dowdell (US)By Thomas Dowdell (US) on Posted in News from DC
In its June 2018 Report to the Congress the Medicare Payment Advisory Commission (MedPAC) recommends that Congress reduce Medicare Type A emergency department payment rates by 30 percent for services furnished in hospital off-campus emergency departments that are located within six miles of a hospital on-campus emergency department.  MedPAC also recommends that Congress should enable … Continue reading

Budget Act codifies Stark liberalizations

Thomas Dowdell (US)Joseph Keillor (US)By Thomas Dowdell (US) and Joseph Keillor (US) on Posted in News from DC, Regulatory
As we previously reported, on February 9, the U.S. Senate and House of Representatives approved the Bipartisan Budget Act of 2018 (the “Act”) and President Trump subsequently signed the bill into law.  Section 50404 of the Act includes several amendments to the Stark Law.  Specifically, Section 50404 endorses recent liberalizations of the Stark Law requirements … Continue reading

US Congress agrees to and President Trump signs budget deal that includes health care provisions

Thomas Dowdell (US)By Thomas Dowdell (US) on Posted in News from DC
Early this morning, Friday, February 9, the US Senate voted 71 – 28 to approve a budget proposal.  Subsequently, the House of Representatives passed by a 240 – 186 vote the budget package and President Trump has signed the bill into law.  The legislation reportedly:  (i) funds federal agencies until March 23; (ii) includes US$89.3 … Continue reading

U.S. Senate passes tax bill eliminating penalties for failure to comply with ACA individual health insurance mandate

Thomas Dowdell (US)By Thomas Dowdell (US) on Posted in News from DC
On December 2, the U.S. Senate passed a tax bill by a 51-49 vote.  The legislation would not repeal the Affordable Care Act (ACA) individual health insurance mandate but instead would eliminate tax penalties for con-compliance with the mandate.  Senator Susan Collins (R-ME) announced her support for the bill in a press release in which … Continue reading

340B drug discount program payment reductions challenged; Alex Azar nominated as next HHS Secretary

Thomas Dowdell (US)By Thomas Dowdell (US) on Posted in News from DC
On November 13, the American Hospital Association, Association of American Medical Colleges, America’s Essential Hospitals, Eastern Maine Healthcare Systems, Henry Ford Health System, and Fletcher Hospital filed a lawsuit in United States District Court for the District of Columbia seeking declaratory and injunctive relief, including a preliminary injunction preventing the reduction in payments for 340B … Continue reading

CMS issues 2018 Medicare physician fee schedule final rule and MACRA physician QPP final rule

Thomas Dowdell (US)By Thomas Dowdell (US) on Posted in News from DC
On November 2, 2017, the Centers for Medicare & Medicaid (CMS) Services issued its Calendar Year (CY) 2018 Medicare Physician Fee Schedule (MPFS) final rule.  The overall update to payments under the MPFS in 2018 will be +0.41 percent.  The 2018 MPFS conversion factor will be $35.99, an increase from $35.89 in 2017.  MPFS payment … Continue reading

CMS issues 2018 hospital OPPS and home health PPS final rules

Thomas Dowdell (US)By Thomas Dowdell (US) on Posted in News from DC
On November 1, 2017, the Centers for Medicare & Medicaid Services (CMS) issued its final hospital outpatient prospective payment system (OPPS) and ambulatory surgical center (ASC) payment system final rule for Calendar Year (CY) 2018.  On the same day CMS also issued its home health prospective payment system 2018 final rule.      OPPS payment rates will … Continue reading

Federal judge rejects preliminary injunction mandating ACA cost-sharing reduction payments; CBO estimates $3.8 billion deficit reduction from bipartisan ACA bill

Thomas Dowdell (US)By Thomas Dowdell (US) on Posted in News from DC
On Wednesday, October 25, Judge Vince Chhabria, federal district court in San Francisco, rejected a request for a  preliminary injunction by 18 states and the District of Columbia to compel the Trump Administration to continue to pay cost-sharing reduction (CSR) payments to health insurance companies.  Judge Chhabria concluded:  (i) States have been preparing for months … Continue reading

President Trump announces end of cost-sharing reduction payments to insurers; President signs executive order promoting association health plans

Thomas Dowdell (US)By Thomas Dowdell (US) on Posted in News from DC
On October 12, President Trump announced in a filing by the Department of Justice in the ongoing litigation challenging the cost-sharing reduction (CSR) payments that such payments will no longer be made to insurers. CSR payments help offset deductibles and other out-of-pocket expenses for Affordable Health Care Act (ACA) exchange health insurance coverage for approximately … Continue reading

U.S. Senate Republican leadership decides against full Senate vote on Graham-Cassidy ACA repeal and replace legislation; HHS Secretary Tom Price resigns under pressure from the White House

Thomas Dowdell (US)By Thomas Dowdell (US) on Posted in News from DC
On Tuesday, September 26, Senate Republican leadership decided not to hold a full Senate vote on the Graham-Cassidy Affordable Care Act (ACA) repeal and replace legislation. The previous day, Monday, September 25, the Senate Finance Committee held a hearing on the Graham-Cassidy bill. Following the hearing, Senator Susan Collins (R-ME) announced her opposition to the … Continue reading

US Senators Graham and Cassidy revise Affordable Care Act repeal legislation prior to Finance Committee hearing; AHA requests CMS guidance on hospital co-location and shared space arrangements

Thomas Dowdell (US)By Thomas Dowdell (US) on Posted in News from DC
On Sunday evening, September 24, U.S. Senators Lindsey Graham (R-South Carolina) and Bill Cassidy (R-Louisiana) released a revised version of their Affordable Care Act (ACA) repeal legislation in advance of the Senate Finance Committee hearing scheduled for Monday, September 25, at 2 PM EST. The amended bill is similar to the legislation previously released in … Continue reading

U.S. Senators continue ACA stabilization and repeal efforts

Thomas Dowdell (US)By Thomas Dowdell (US) on Posted in News from DC
The Senate Health, Education, Labor and Pensions (HELP) Committee has held three hearings in the past few days attempting to reach a bipartisan agreement on stabilizing the Affordable Care Act (ACA) insurance markets and will hold a fourth hearing later this week.  HELP Committee Chairman Lamar Alexander (R-TN) and Ranking Minority Member Patty Murry (D-WA) … Continue reading

CMS issues blanket waivers as a result of Hurricane Harvey; health care reform efforts continue

Thomas Dowdell (US)By Thomas Dowdell (US) on Posted in News from DC
The Centers for Medicare & Medicaid Services (CMS) has issued several blanket waivers of Medicare requirements as a result of Hurricane Harvey.  Examples of requirements that CMS may waive include those relating to conditions of Medicare participation or certification, preapproval requirements, EMTALA requirements, Stark Law self-referral sanctions, and performance deadlines.  Providers do not need to … Continue reading

CMS extends deadline for health insurers to file 2018 rate requests; bipartisan group of experts advocates certain health reform initiatives

Thomas Dowdell (US)By Thomas Dowdell (US) on Posted in Regulatory
On August 11, the Centers for Medicare & Medicaid Services sent a memorandum to insurers announcing an extension of the deadline by almost three weeks until September 5 for insurers to file their 2018 rate requests.  Insurers are wrestling with whether to participate in the Affordable Care Act exchanges/marketplaces in 2018, and if so, the … Continue reading
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