On November 12, 2021, the Centers for Medicare & Medicaid Services (“CMS”) issued its final guidance for hospitals to clarify how CMS and state agency surveyors will evaluate space-sharing or contracted staff and service arrangements with other hospitals or healthcare providers for compliance with the Medicare Conditions of Participation (“CoPs”). According to CMS, “[c]o-location occurs … Continue reading
President Trump signed a controversial Executive Order on September 13, 2020 entitled Executive Order on Lowering Drug Prices by Putting America First with the intention of tying drug costs paid by the Medicare program to the costs borne by countries that have national health systems. The Executive Order provides that “[i]t is the policy of … Continue reading
On Friday, July 24, 2020, President Trump issued three executive orders, and announced a potential fourth executive order, with the stated intention of lowering the cost of prescription drugs in the United States. The general consensus among legal commentators is that the executive orders are not self-executing and implementation of the policies therein will, therefore, … Continue reading
On Wednesday, July 15, 2020, Administrator of the Centers for Medicare & Medicaid Services (CMS), Seema Verma, published a blog post on the Health Affairs Blog discussing CMS’ efforts to expand telehealth for Medicare beneficiaries during the COVID-19 pandemic and reviewing the potential of adopting some flexibilities as permanent measures. Historically Medicare has covered telehealth … Continue reading
Today, the Centers for Medicare & Medicaid Services (CMS) released an additional round of regulatory waivers and rule changes to support the healthcare system during the COVID-19 pandemic. The changes include new rules to expand COVID-19 diagnostic testing, increase care capacity and the healthcare workforce, and further promote telehealth services. Medicare no longer requires an … Continue reading
On Friday morning April 10, the U.S. Department of Health and Human Services (“HHS”) released details regarding the first $30 billion in payments under the CARES Act. The CARES Act provides a total of $100 billion in relief funds to providers “to support healthcare-related expenses or lost revenue attributable to COVID-19 and to ensure uninsured … Continue reading
The United States Senate has passed a $2 trillion phase three emergency package, the Coronavirus Aid, Relief, and Economic Security Act (CARES Act). The Senate approved the CARES Act on a unanimous vote of 96-0, with three Senators in self-quarantine and another returning home out of an abundance of caution. The CARES Act, assuming it … Continue reading
On Tuesday, March 17, 2020, the Trump administration announced that it will immediately expand access to telehealth services for all Medicare beneficiaries during the COVID-19 outbreak. In coordination with this announcement, the Office for Civil Rights at the Department of Health & Human Services (HHS) released a notification stating that HHS has temporarily suspended certain … Continue reading
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
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
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
On February 14, 2019, the Center for Medicare and Medicaid Innovation (CMMI) announced the Emergency Triage, Treat, and Transport (ET3) Model that aims to transform the ambulance system. Medicare-enrolled ambulance service suppliers and hospital-owned ambulance providers will participate in the model. CMMI believes this model will improve quality and lower costs by reducing hospitalizations and … Continue reading
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
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
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
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
On July 12, 2018, CMS included three proposed changes to telehealth reimbursements within the CY 2019 Physician Fee Schedule (the “Proposed Rule”). Currently, subject to certain exceptions, Medicare reimbursements for certain telehealth services are statutorily limited by the type of health care professional providing the service, and the geographic location of the patient (namely, the … Continue reading
On July 12, 2018, CMS included within the CY 2019 Physician Fee Schedule (the “Proposed Rule”) two revisions to Stark Law regulations aimed at further clarifying any actual or perceived differences between current regulations and the recently enacted Bipartisan Budget Act of 2018 (“2018 BBA”). As we previously reported, Section 50404 of the 2018 BBA … Continue reading
On August 9, 2018, CMS published the long-awaited Pathways to Success proposed rule. CMS Administrator Seema Verma published a related article on the Health Affairs Blog. The proposed rule would usher in significant changes for Accountable Care Organizations (ACOs). Groups of providers, such as doctors and hospitals, can join together to form an ACO and … Continue reading
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
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
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
Last week, the U.S. Department of Justice announced charges against 601 individuals for their alleged participation in healthcare fraud schemes. According to the announcement, the alleged fraud is estimated to have resulted in more than $2 billion in losses to federal healthcare programs. This national healthcare fraud takedown is the largest in U.S. history, surpassing … Continue reading
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