Articles and Blogs

Last week, the United States Court of Appeals for the Seventh Circuit (“Court of Appeals”) released an opinion that confirmed a Centers for Medicare & Medicaid Services (“CMS”) assessment of an immediate jeopardy citation and an $83,800 civil money penalty against a nursing home for inadequately addressing sexual interactions between cognitively impaired nursing home... READ MORE

This is another article in a series discussing the complete overhaul of Part 483 to Title 42 of the Code of Federal Regulations the Requirements for States and Long-Term Care Facilities (“Final Regulations”) by the Centers for Medicare & Medicaid Services (“CMS”). To view other articles in this series, click here. Beginning on November 28,... READ MORE

The Centers for Medicare & Medicaid Services (“CMS”) recently issued a proposed rule (“Proposed Rule”) that would require pharmaceutical manufacturers to disclose the list price for a typical course of treatment of prescription drugs and biologics covered by Medicare or Medicaid in direct-to-consumer television advertisements. This policy development comes just two months after the... READ MORE

The Centers for Medicare & Medicaid Services (“CMS”) Center for Medicare and Medicaid Innovation proposed to lower the cost of Medicare Part B outpatient prescription drugs by establishing their prices based on lower drug prices of other advanced industrial nations as compiled in an “international price index” (“IPI”) and changing the way the current drug... READ MORE

On November 8, 2018, CMS released a letter to clinicians regarding E/M documentation and coding reform. This follows the CY 2019 Medicare Physician Fee Schedule Final Rule intentions to reduce burden on clinicians in furtherance of the agency’s “Patients Over Paperwork” initiative. Effective January 1, 2019, CMS will: Simplify the documentation of history and exam... READ MORE

On July 12, 2018, the Centers for Medicare & Medicaid Services (“CMS”) released its proposed rule for the Calendar Year (“CY”) 2019 Medicare Physician Fee Schedule (“Proposed Rule”). Among many other changes, CMS proposed numerous modifications to the required documentation for evaluation and management (“E/M”) visits in order to alleviate the administrative burden on practitioners and... READ MORE

On August 7, 2018, the Centers for Medicare & Medicaid Services (“CMS”) issued a Memorandum (“Memorandum”) announcing a policy change to allow Medicare Advantage (“MA”) plans to implement step therapy programs for physician-administered and other Part B drugs. Step therapy is a type of prior authorization for drugs in which a health plan requires... READ MORE

On January 13, 2017, CMS published the revised Conditions of Participation (“CoPs”) for home health agencies, 42 CFR 484, Subparts A, B, and Subpart C. The CoPs became effective on January 13, 2018. On August 31, 2018, the Centers for Medicare & Medicaid Services (“CMS”) issued a Memorandum to State Survey Agency Directors (QSO-18-25-HHA) that... READ MORE

On August 17, 2018, the Centers for Medicare & Medicaid Services (“CMS”) issued a Memorandum to State Survey Agency Directors (QSO-18-24-ESRD) outlining additional survey activities that address dialysis services provided by an end-stage renal disease (“ESRD”) facility to residents in a long-term care facility. The survey process for evaluating home dialysis in nursing homes consists... READ MORE

On July 31, 2018, the Centers for Medicare & Medicaid Services (“CMS”) issued a final rule (CMS-1696-F) outlining Fiscal Year (“FY”) 2019 Medicare payment updates and quality program changes for skilled nursing facilities (“SNF”)(“Final Rule”). The Final Rule finalized the value-based purchasing payments that start October 1, 2018, updated several SNF Quality Reporting Program... READ MORE