Wendy Wright (US)

Subscribe to all posts by Wendy Wright (US)

CMS FY 2019 IPPS and LTCH PPS proposed rule targets interoperability, transparency and burden reductions

On April 24, the Centers for Medicare & Medicaid Services (CMS) released its fiscal year (FY) 2019 inpatient prospective payment system (IPPS) and long-term care hospital prospective payment system (LTCH PPS) proposed rule. CMS proposes to reduce regulatory burdens for inpatient hospitals and increase price transparency and better data sharing between hospitals and other providers … Continue reading

CHIP Program funding remains in limbo; Senators advocate reversal of 340B Drug Discount Program cuts; CMS reports on 2016 U.S. health expenditures

Payments under the Children’s Health Insurance Program (CHIP) remain uncertain in many states without an extension of federal funding to the program. CHIP provides insurance coverage for children whose parents earn too much for Medicaid but cannot afford other health insurance coverage. While the short-term spending bill signed into law on December 8 allows for … Continue reading

Senate tax bill would effectively repeal ACA individual mandate; House legislation to reverse 340B Drug Discount Program cuts; CMS addresses prescription drug costs and the opioid crisis

On November 14, Senate Finance Committee Chairman Orrin Hatch (R-UT) released the Chairman’s Mark to the Senate version of the Tax Cuts and Jobs Act. Hatch’s version of the tax plan effectively repeals the Affordable Care Act (ACA) individual mandate by reducing the associated penalty to $0. The ACA individual mandate requires individuals to buy … Continue reading

Senators Alexander and Murray release draft bill intended to stabilize the ACA marketplaces

On October 17, Senate Committee on Health, Education, Labor, and Pensions Chairman Lamar Alexander (R-TN) and Ranking Member Patty Murray (D-WA) announced a bipartisan proposal intended to stabilize Affordable Care Act (ACA) marketplaces and relax ACA State Innovation Waiver restrictions. On October 19, Chairman Alexander released the proposed health care bill known as the Bipartisan … Continue reading

CMS clarifies when hospitals are primarily engaged in inpatient care; U.S. Republican Senators introduce ACA repeal legislation while Democrats promote Medicare for all

The Centers for Medicare and Medicaid Services (CMS) recently issued Survey and Certification Letter 17-44, clarifying what it means for a facility to be “primarily engaged” in inpatient care for purposes of meeting the definition of a hospital and qualifying for reimbursement as a hospital under Medicare and Medicaid. A facility is primarily engaged in … Continue reading

CBO releases report on effects of terminating ACA cost-sharing reduction payments; CMS proposes to end two incentive payment models

On August 15, the Congressional Budget Office (“CBO”) released a report on the effects of terminating payments to insurers for cost-sharing reductions under the Affordable Care Act (“ACA”) in 2017. The CBO estimated that by 2018, insurance premiums for silver plans would increase by 20 percent and leave 5 percent of Americans living in areas … Continue reading

Senate Republican leadership plans vote to begin debate on health care reform legislation; House Budget Committee approves budget resolution; 340B program hearing held

Without enough votes to begin debate on the July 13th version of the “Better Care Reconciliation Act of 2017” on Monday, July 17, Republican leaders in the Senate called for the repeal of the Affordable Care Act (ACA) without an immediate plan to replace the ACA. According to a report issued by the Congressional Budget … Continue reading

Senate Republicans unveil health care reform bill; CMS proposes updates to the Quality Payment Program

On June 22, U.S. Senate Majority Leader Mitch McConnell unveiled the draft Senate health care reform bill, the Better Care Reconciliation Act of 2017. Earlier today, Senate Republican leadership released a new discussion draft. As of this afternoon, Republican leadership reportedly has firm commitments from less than the 50 Senators needed to approve the legislation … Continue reading

Senate Republicans consider options for ending Medicaid expansion, projected insurer participation in 2018 health insurance exchanges; MedPAC report to Congress

Republican Senators previously appointed by Senate GOP leadership reportedly are continuing to draft Senate health care legislation to repeal and replace the Affordable Care Act (ACA) without any scheduled committee hearings on the bill. While the text of the Senate health care bill remains undisclosed, Republican Senators have reportedly been working to reach a consensus … Continue reading

CMS proposes to remove a ban on pre-dispute arbitration agreements at long-term care facilities

On June 5, 2017, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule to revise requirements established by the Reform of Requirements for Long-Term Care Facilities final rule (2016 Final Rule). Specifically, the proposed rule would remove regulations prohibiting long-term care facilities from entering into pre-dispute arbitration agreements with residents or their … Continue reading

Centers for Medicare & Medicaid Services issues health care reform directives; Senate committee passes telehealth bill

While the Senate continues to work on its version of health care reform legislation, the American Health Care Act of 2017 (AHCA), the Centers for Medicare and Medicaid Services (CMS) has been busy streamlining and de-regulating current processes under the Affordable Care Act (ACA). On May 16, CMS released a Checklist for Section 1332 Innovation … Continue reading

CBO releases assessment on American Health Care Act; FDA fees double under President Trump budget proposal

On Monday, March 13, 2017, the Congressional Budget Office (CBO) and the Joint Committee on Taxation (JCT) released an assessment on the impact of the American Health Care Act (AHCA), the Republican proposed legislation to repeal and replace the Affordable Care Act. The assessment evaluated the impact of the AHCA on the federal budget and … Continue reading

CMS proposes rule to stabilize health insurance market

On February 15, 2017, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule to stabilize the individual and small group health insurance market by increasing incentives for individuals to maintain enrollment in health plans, decreasing incentives to enroll in coverage only after healthcare services are needed, and reducing the regulatory burdens for … Continue reading

Government agencies finalize updates to Common Rule to protect human research subjects

On January 19, the U.S. Department of Health and Human Services (HHS) and 15 other government agencies published a final rule updating regulations governing the protection of human research subjects, which is commonly referred to as the “Common Rule.” As described in our September 4 post, these revisions are intended to enhance the current system … Continue reading

CMS Issues CY 2017 Final Rule

On November 1, 2016, CMS issued its Calendar Year (CY) 2017 Outpatient Prospective Payment System (OPPS) final rule with comment period. CMS also issued an interim final rule with comment period that establishes Medicare Physician Fee Schedule (MPFS) rates for certain items and services furnished by certain hospital off-campus outpatient departments. Significant provisions of the … Continue reading

MACRA: Advanced APMs and MIPS Replace SGR Effective January 2017

On October 14, 2016, CMS issued the “Merit-based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive under the Physician Fee Schedule, and Criteria for Physician-Focused Payment Models” final rule with comment period. MIPS and Advanced APMs are the two ways for health care providers to participate in the CMS Quality Payment Program that … Continue reading

FDA draft guidance to assist CMS with coverage decisions for Medicare payment

On June 1, 2016, the US Food and Drug Administration (FDA) published in the Federal Register (81 Federal Register 35032) a draft guidance for sponsors, clinical investigators, industry, IRBs, and FDA staff regarding categorization of Investigational Device Exemption (IDE) devices as either a Category A or Category B device to assist the Centers for Medicare and … Continue reading

House bill addresses reduced payments to new off-campus hospital outpatient departments

On May 18, 2016, the U.S. House of Representatives Ways and Means Committee introduced the Helping Hospitals Improve Patient Care Act of 2016 (Act) to exempt certain newly-enrolled provider-based, off campus hospital outpatient departments (HOPDs) from reduced payments under the Bipartisan Budget Act of 2015 (BBA).… Continue reading

FY 2017 Medicare Acute Care Hospital IPPS and LTCH PPS proposed rule policy highlights

On April 27, 2016, CMS published the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital Prospective Payment System (LTCH PPS) proposed rule for fiscal year (FY) 2017 in the Federal Register. Highlights from the proposed rule are explained in further detail below. Completion of Medicare Severity-Diagnosis Related Group (MS-DRG) $11 Billion Overpayment Recoupment … Continue reading

CMS issues FY 2017 Medicare Acute Care Hospital IPPS and LTCH PPS proposed rule

On April 18, 2016, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to implement Medicare payment policy changes and rates for hospitals under the acute care hospital Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital Prospective Payment System (LTCH PPS). CMS’s proposed rule continues to shift Medicare payments from … Continue reading

FDA issues guidance on screening blood and tissue donors for the Zika Virus

On March 1, 2016, the U.S. Food and Drug Administration (FDA) issued guidance on screening donors of human cells, tissues, and cellular and tissue-based products for risk of evidence of infection with Zika virus. The FDA’s guidance identifies Zika virus as a relevant communicable disease agent or disease (RCDAD) and provides recommendations for reducing the … Continue reading

CMS increases Medicare enrollment screening for providers and suppliers

On February 22, the Centers for Medicare and Medicaid Services (CMS) announced its intention to further enhance CMS’s ability to screen providers and suppliers enrolling or currently enrolled in Medicare for compliance with Medicare enrollment requirements. Specifically, CMS will strengthen existing screening measures by increasing the number of site visits to Medicare enrolled providers and … Continue reading

CMS issues final rule requiring face-to-face encounters for Medicaid home health services

On January 27, 2016, the Centers for Medicare and Medicaid Services (CMS) issued a final rule requiring documentation of face-to-face encounters for physicians ordering home health services and certain medical equipment for Medicaid beneficiaries as required by the Patient Protection and Affordable Care Act of 2010. While the final rule becomes effective on July 1, … Continue reading