Thomas Dowdell (US)

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Allina Update: Supreme Court holds Medicare statute requires notice and comment for DSH payment change

By Yvonne Puig (US), Thomas Dowdell (US), Frances Morgan (US) and Jeff Wurzburg (US) on June 4, 2019 Posted in News from DC

In a decision with potentially far reaching implications for Medicare hospital reimbursement, on June 3 the U.S. Supreme Court ruled 7-1 against the U.S. Department of Health and Human Services (“HHS”) in Azar v. Allina Health Services. The Court affirmed the U.S. Court of Appeals for the D.C. Circuit decision that vacated a rate calculation … Continue reading

CMS publishes draft “Guidance for Hospital Co-location with Other Hospitals or Healthcare Facilities”

By Thomas Dowdell (US) on May 6, 2019 Posted in Regulatory

On May 3, the Centers for Medicare & Medicaid Services (CMS) published its long-awaited draft “Guidance for Hospital Co-location with Other Hospitals or Healthcare Facilities.” The draft guidance is specific to compliance with the general Conditions of Participation for hospitals (CoPs) and does not address the specific location and separateness requirements that apply to other … Continue reading

CMS publishes 2020 IPPS and LTCH Proposed Rule

By Thomas Dowdell (US) on April 24, 2019 Posted in News from DC

On Tuesday, April 23, the Centers for Medicare & Medicaid Services (CMS) published its Fiscal Year (FY) 2020 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long Term Acute Care Hospital (LTCH) Prospective Payment System Proposed Rule and Request for Information. The proposed rule is available here. A CMS Fact Sheet describing the final rule … Continue reading

CMS rings in the new year with overhaul of MSSP ACOs

By Thomas Dowdell (US) and Joseph Keillor (US) on January 3, 2019 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

By Thomas Dowdell (US) on November 5, 2018 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

By Thomas Dowdell (US) on November 5, 2018 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

By Thomas Dowdell (US) and Sarah Jean Kilker (US) on November 2, 2018 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

By Thomas Dowdell (US) and Jeff Wurzburg (US) on July 26, 2018 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

By Thomas Dowdell (US) on July 26, 2018 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

By Thomas Dowdell (US) on July 26, 2018 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

By Thomas Dowdell (US) on July 18, 2018 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

By Thomas Dowdell (US) on July 12, 2018 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

By Thomas Dowdell (US) on June 20, 2018 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

By Thomas Dowdell (US) on June 18, 2018 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

By Thomas Dowdell (US) and Joseph Keillor (US) on February 20, 2018 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

By Thomas Dowdell (US) on February 9, 2018 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

By Thomas Dowdell (US) on December 4, 2017 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

By Thomas Dowdell (US) on November 14, 2017 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

By Thomas Dowdell (US) on November 3, 2017 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

By Thomas Dowdell (US) on November 2, 2017 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

By Thomas Dowdell (US) on October 30, 2017 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

By Thomas Dowdell (US) on October 17, 2017 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

By Thomas Dowdell (US) on October 2, 2017 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

By Thomas Dowdell (US) on September 25, 2017 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