Articles and Blogs

This is the first in a series of articles discussing the countdown to Phase 3 skilled nursing home compliance programs. To view other articles in this series, click here. Beginning on November 28, 2019, surveyors will use the requirements detailed 42 C.F.R. Section 483.85, the Requirements for States and Long-Term Care Facilities (“Final Regulations”)... READ MORE

The Centers for Medicare & Medicaid Services (“CMS”) recently published a final rule (“Final Rule”) revising the procedures that CMS uses to administer its Preclusion List. As outlined below, CMS now requires Medicare Advantage, Medicare Part D and other designated plans to deny payment for items or services provided by or prescribed by a... READ MORE

On April 22, 2019, the Centers for Medicare & Medicaid Services (“CMS”) announced a new set of value-based payment models for reimbursement of primary care services. CMS has coined the new models its “Primary Cares Initiative.” Although participation in the models is currently voluntary, CMS hopes the initiative will accelerate the nationwide transition of... READ MORE

In keeping with the trends of the commercial market, on April 22, 2019, the Centers for Medicare & Medicaid Services (“CMS”) announced opportunities to participate in new direct contracting models under Medicare’s Part A and Part B fee-for-service program. CMS intends to focus these models particularly on primary care coordination for medically complex and... READ MORE

On May 6, 2019, the United States District Court in Washington, D.C. issued its opinion on the appropriate remedy to address the invalidated payment cuts set forth in the 2018 and 2019 Outpatient Prospective Payment System final rules (“2018 and 2019 OPPS Rules”) for drugs purchased under the 340B drug discount program (“340B Program”).... READ MORE

On May 3, 2019, CMS released its long-awaited guidance on hospital co-location and shared service arrangements in the form of a draft survey memo (“Memo”), which is available here. The Memo clarifies how a hospital can co-locate with other health care entities without violating the Medicare Conditions of Participation (“CoPs”). CMS has been promising... READ MORE

Health Cost Reduction Package Slated for Summer Release Speaking on the Senate floor on Thursday, Sen. Lamar Alexander (R-TN), Chairman of the Health, Education, Labor, and Pensions (“HELP”) Committee, said he plans to move a wide-ranging legislative package through his panel seeking to curb health care costs. Sen. Alexander, along with HELP ranking member... READ MORE

It’s no April Fools’ joke. On April 1, 2019, the Health Resources & Services Administration Office of Pharmacy Affairs (“HRSA”) unveiled a long-awaited website that gives providers participating in the 340B drug pricing program (“340B Program”) direct access to information about the maximum amounts that pharmaceutical companies may charge for certain drugs. This moves... READ MORE

In a previous article, we reported on new billing edits that CMS is implementing, which will Return to Provider any hospital UB-04 claims that identify a service location that is not an exact match to a Medicare-enrolled location identified in Provider Enrollment, Chain and Ownership System (“PECOS”). Those edits were scheduled to be activated... READ MORE

Presidential Budget for 2020 Proposes Major Health Care Cuts President Trump released his administration’s fiscal year 2020 budget this week. While this proposal stands little chance of being implemented in its entirety, it is a good indicator of where the administration’s priorities stand for the next year, and some of the provisions, especially those... READ MORE