Topic: News from DC

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CMS Releases Final Rule on CY 2020 Physician Fee Schedule Updates and Implements Opioid Use Disorder Treatment Programs

On November 1, 2019, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that updates the Medicare Physician Fee Schedule (PFS) rates and policies for calendar year (CY) 2020 and expands Medicare coverage to opioid treatment programs (OTPs) that treat beneficiaries with opioid use disorder (OUD). In a fact sheet accompanying the … Continue reading

CY 2020 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Final Rule

On November 1, 2019, the Centers for Medicare & Medicaid Services (CMS) published its CY 2020 Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule.  The final rule implements a number of significant changes to payment policies and rates for services furnished to Medicare beneficiaries in hospital outpatient … Continue reading

U.S. District Court Upholds Ruling that CMS Exceeded Its Statutory Authority in Reducing Medicare Payments for Clinic Visit Evaluation and Management Services Furnished in Hospital Excepted Off-Campus Provider-Based Departments

On October 21, 2019, U.S. District Judge Rosemary M. Collyer denied the government’s request to modify the Court’s previous ruling on September 17, 2019, that the Centers for Medicare & Medicaid Services (CMS) exceeded its statutory authority when it reduced Medicare payment rates for clinic visit evaluation and management (E&M) services provided to Medicare patients … Continue reading

Republican Study Committee Releases Affordable Care Act Replacement plan

The Republican Party will soon be the party of health care. You watch. -President Donald J. Trump, March 23, 2019 Opening with the above quote from President Trump, the Republican Study Committee (RSC) released the first part of its healthcare plan entitled: A Framework for Personalized, Affordable Care. An accompanying press release from the RSC … Continue reading

CMS and OIG release sweeping proposals to modernize Stark Law and AKS regulations

On Thursday, October 17, 2019, the Centers for Medicare & Medicaid Services (CMS) and the Department of Health and Human Services (HHS) Office of Inspector General (OIG) will publish in the Federal Register two proposals to implement major changes to Stark Law and Anti-Kickback Statute (AKS) regulations. We have summarized a portion of those proposed … Continue reading

US regulators to align key health care regulations with transformation to value-based care system; CMS and OIG propose major overhaul of Stark Law and AKS regulations

On October 9, 2019, the Centers for Medicare & Medicaid Services (CMS) and the Department of Health and Human Services (HHS) Office of Inspector General (OIG) issued two sweeping proposals aimed at revising the Stark Law and Anti-Kickback Statute (AKS) regulations to adapt to and promote the US health care system’s transformation to value-based payment … Continue reading

Medicaid Update: D.C. Circuit Court of Appeals Reviews CMS Approval of Medicaid Work and Community Engagement Eligibility Requirements

Today, October 11, 2019, the United States Court of Appeals for the D.C. Circuit is hearing oral arguments in Stewart v. Azar (Case No. 19-5095), an appeal from the federal district court’s rulings invalidating three prior approvals of Section 1115 Waivers in Kentucky and Arkansas that would have implemented work and community engagement requirements as … Continue reading

President Trump signs executive order to make changes to Medicare Advantage

On Thursday, October 3, 2019, President Trump signed an executive order that aims to expand the Medicare Advantage program. Medicare Part C, commonly known as Medicare Advantage, is administered by private insurers in which CMS pays the health insurer  on a fee per beneficiary basis and the insurer in turn pays providers a negotiated rate … Continue reading

MEDICAID UPDATE: New Hampshire Work Requirements Vacated / Utah’s Partial Expansion Request

New Hampshire “We’ve all seen this movie before” – Judge James Boasberg, Philbrick v. Azar On July 29 HHS approval of work and community engagement requirements as a condition of eligibility for Medicaid was again found to be arbitrary and capricious.  This time Judge James Boasberg ruled that New Hampshire’s efforts to impose work requirements … Continue reading

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

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 2020 IPPS and LTCH Proposed Rule

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

MEDICAID ALERT: Work and community engagement requirements blocked by federal court

“As Opening Day arrives, the Court finds its guiding principle in Yogi Berra’s aphorism, “It’s déjà vu all over again.”” – Judge James Boasberg, Gresham v. Azar. On March 27, United States District Court for the District of Columbia Judge James Boasberg ruled that Department of Health & Human Services Secretary Azar’s approval of work … Continue reading

CMS rings in the new year with overhaul of MSSP ACOs

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

Judge declares ACA unconstitutional

On Friday, December 14, Judge Reed O’Connor of the Federal District Court in the Northern District of Texas issued a declaratory judgment holding the shared responsibility provision (also referred to as the “Individual Mandate”), and with it, the entire Affordable Care Act (“ACA”), to be unconstitutional. The case is Texas v. United States and California … Continue reading

Medicaid update: CMS again approves Kentucky HEALTH Medicaid demonstration

On November 20, 2018, the Centers for Medicare & Medicaid Services (“CMS”) again approved the Kentucky HEALTH 1115 demonstration.  Kentucky HEALTH  was the first Section 1115 demonstration that CMS approved with a work and community engagement requirement as a condition of eligibility for coverage under Medicaid.  The demonstration requires certain Medicaid beneficiaries to engage in … Continue reading

CMS significantly expands its Medicare site-neutral payment policy

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

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

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

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

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 opens new comment period for Kentucky HEALTH

“In light of the district court’s decision in Stewart v. Azar,” CMS has opened a new 30-day comment period for the Kentucky HEALTH demonstration project that would implement work or community engagement requirements as a condition of eligibility.  On June 29, 2018, Judge James E. Boasberg of the U.S. Federal District Court for the District … Continue reading

House Subcommittee on Health holds hearing on 340B program

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

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
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