Tag archives: CMS

CMS Releases Block Grant Guidance to States

In a State Medicaid Director Letter issued on January 30, 2020, CMS released its long anticipated guidance to states on implementing block grants as a mechanism of Medicaid financing.  State Medicaid Director Letter 20-001 announced the “Healthy Adult Opportunity” initiative (“HAO”) that will allow states to receive block grant funding for non-disabled adults under the … Continue reading

CMS Publishes Notice of Benefit and Payment Parameters for 2021 Proposed Rule

On January 31, 2020, CMS issued the Notice of Benefit and Payment Parameters for 2021 proposed rule (“Payment Notice”).  The proposed rule introduces updates to the “regulatory and financial standards applied to issuers and Exchanges” and also proposes parameters for the risk adjustment program.  The proposed payment rule is available here.  CMS also issued the … Continue reading

CMS Agrees to Pay for Clinic Visit Services Furnished in Excepted Off-Campus Provider-Based Departments at the Full OPPS Rate

CMS has announced that it will reimburse hospitals for clinic visit services furnished in excepted off-campus provider-based departments at the full OPPS rate without the payment reduction set forth in the agency’s CY 2019 OPPS final rule. CMS explains that it has installed a revised OPPS Pricer to update the payment rates applied to claim … Continue reading

CMS Proposes Major Changes in Medicaid Fiscal Accountability Rule

On November 12, 2019, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule for public inspection entitled Medicaid Fiscal Accountability Regulation. CMS states that the intent of the proposed rule is to ensure that state supplemental payments and financing arrangements under the Medicaid program are consistent with federal statutory requirements. In a … 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

CMS requests comments on the use of new technologies in the Medicare and Medicaid programs

On Monday, October 21, 2019, the Centers for Medicare & Medicaid Services (CMS) posted a request for information (RFI) soliciting comments on the use of new technologies in the Medicare and Medicaid programs. In a blog post accompanying the release of the RFI, CMS Administrator Seema Verma referenced the Government Accountability Office’s designation of “Medicare … 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

CMS releases FY 2020 IPPS and LTCH PPS final rule

On August 2, 2019, 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 (PPS) final rule (CMS-1716-F). The final rule is scheduled to be published in the Federal Register on August 16, 2019. … Continue reading

CMS Publishes FY 2020 Medicare Hospital IPPS and LTCH PPS Final Rule

On August 2, 2019, the Centers for Medicare & Medicaid Services (CMS) published its Fiscal Year (FY) 2020 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long Term Care Acute Care Hospital (LTCH) Prospective Payment System (PPS) final rule (CMS-1716-F). The final rule is scheduled to be published in the Federal Register on August 16, … Continue reading

CMS Publishes CY 2020 Proposed Rules for Hospital OPPS and ASC, MPFS, and ESRD and DMEPOS Policies and Payments

On July 29, the Centers for Medicare & Medicaid Services (CMS) published three proposed rules for Calendar Year (CY) 2020: Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Proposed Rule; Proposed Policy, Payment, and Quality Provisions Changes to the Medicare Physician Fee Schedule (MPFS); and End State Renal Disease … Continue reading

CMS releases 2018 Open Payments data

The U.S. Centers for Medicare and Medicaid Services (CMS) released Open Payments data reflecting payments and transfers of value from drug and medical device companies to physicians and teaching hospitals in 2018, totaling approximately $9.35 billion in payments and more than 11.4 million payment records. This represents a 4.3% increase from the $8.4 billion reported … 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 draft “Guidance for Hospital Co-location with Other Hospitals or Healthcare Facilities”

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

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

Hospital alert: CMS hospital transparency requirements in effect January 1, 2019

On January 1, 2019, all hospitals are required to make public a list of their standard charges.  As a reminder, Section 2718(e) of the Public Health Service Act, as enacted by the Affordable Care Act, requires: “each hospital operating within the United States” to “make public (in accordance with guidelines developed by the Secretary) a … 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 publishes CY 2019 physician fee schedule final rule

On November 2, 2018, CMS published its CY 2019 physician fee schedule final rule.  The final rule implements a number of significant changes to the way practitioners receive reimbursement for items and services provided to Medicare beneficiaries, including: Eliminating the requirement for a practitioner to document the medical necessity of a home visit in lieu … Continue reading
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