Articles and Blogs

Review of the New Home Health Conditions of Participation – Release of Patient Identifiable OASIS information, Reporting OASIS Information and Comprehensive Assessment of Patients; and Care Planning, Coordination of Services and Quality of Care. This is the second article in a series discussing CMS’s Final Revised Home Health Conditions of Participation (“Final CoPs”). With... READ MORE

On December 20, 2016, the Centers for Medicare & Medicaid Services (“CMS”) published a Final Rule that included several changes to the recently implemented Comprehensive Care for Joint Replacement (“CJR”) program. The CJR Model is a retrospective bundled payment program limited to lower extremity joint replacement (“LEJR”) procedures and is designed to encourage hospitals... READ MORE

Background On December 20, 2016, the Centers for Medicare & Medicaid Services (“CMS”) published a final rule (the “Final Rule”)1 creating three new episode payment models (“EPMs”) covering services provided to Medicare beneficiaries admitted to certain Inpatient Prospective Payment System (“IPPS”) hospitals for heart attacks, coronary bypass surgery or surgical treatment of hip or... READ MORE

Review of the New Quality Assessment and Performance Improvement Condition This is the first article in a series discussing CMS’s pre-publication copy of the Final Revised Home Health Conditions of Participation (“Final CoPs”). With the release of the Final CoPs, CMS is finalizing, with only a few changes, the significant changes they proposed to... READ MORE

This time things are really going to change. On January 9, 2017, the Centers for Medicare & Medicaid Services (“CMS”) released a pre-publication copy of the Final Revised Home Health Conditions of Participation (“Final CoPs”). With the release of the Final CoPs, CMS is finalizing, with only a few changes, the significant changes they proposed to... READ MORE

Pursuant to its recently issued final rule (“Rule”), CMS is implementing two cardiac-related episode payment models (“EPMs”). One of the EPMs pertains to episodes of care surrounding an acute myocardial infarction (“AMI EPM”); the other EPM pertains to episodes of care surrounding a coronary artery bypass graft (“CABG EPM”). Generally, participation in the AMI... READ MORE

On July 22, 2016, the Center for Clinical Standards and Quality/Survey & Certification Group released a memorandum that revised Chapter 7 of the State Operations Manual (“SOM”) and provided guidance on its policy to immediately impose federal remedies when a deficiency of a certain type is cited. The remedies are in addition to a... READ MORE

CMS has released its final 60-Day Overpayment Rule, providing clarity to the 2010 Affordable Care Act (“ACA”) amendment to the False Claims Act (“FCA”) that created FCA liability for failure to repay identified overpayment within 60 days. This is a long-awaited rule that provides essential clarity to an amendment that, until now, has vastly... READ MORE

A recent court decision had highlighted two issues on the cutting edge of health care and False Claims Act (“FCA”) law. Both address what happens in the transition from health care advice to health care litigation. The first is the application of the attorney client privilege and the advice of counsel defense. The second is... READ MORE

Subject to various exceptions, a covered skilled nursing facility (“SNF”) stay must initiate within 30 days of a qualifying hospital stay.  In some cases where it is medically predictable that an individual will require a covered level of SNF care within a determinable time frame, that same individual may also have a need for a covered... READ MORE