Articles and Blogs

On March 4, 2020, the Quality, Safety & Oversight Group at the Centers for Medicare & Medicaid Services (“CMS”) issued a memorandum entitled “Suspension of Survey Activities” (“QSO Memo”) to announce that it is suspending non-emergency inspections across the United States so that inspectors may focus on infectious diseases and abuse. CMS states this... READ MORE

Most skilled nursing facilities are not correctly complying with life safety requirements or emergency preparedness requirements, according to three recent reports by the Office of the Inspector General (“OIG”) of the U.S. Department of Health and Human Services. OIG recently issued three reports on its audits of life safety requirements or emergency preparedness requirements:... READ MORE

On November 1, 2019, the Centers for Medicare & Medicaid Services (“CMS”) released its final rule for the Calendar Year (“CY”) 2020 Hospital Outpatient Prospective Payment System (“Final Rule”). Among many other changes, CMS finalized three key payment policy updates impacting hospital outpatient departments, including: (1) reducing payments for clinic visits at off-campus provider-based departments (“PBDs”);... READ MORE

With the October 1, 2019 beginning date now past for Patient Driven Payment Model (“PDPM”), the new skilled nursing case-mix classification mode under the Skilled Nursing Facility Prospective Payment System (“SNF PPS”) for classifying SNF patients in a covered Medicare Part A stay, providers need to consider several key legal and compliance program considerations... READ MORE

Beginning on November 28, 2019, surveyors will use the requirements detailed in 42 C.F.R. Section 483.80 of the Code of Federal Regulations Requirements for States and Long-Term Care Facilities (“Final Regulations”) to determine whether a skilled nursing facility (“Facility”) has an infection preventionist on staff who is a primary professional trained in nursing, medical... READ MORE

CMS was dealt a blow from the D.C. District Court on September 17, 2019 when the court determined the agency’s “site neutral” payment policy in the CY 2019 Outpatient Prospective Payment System (“OPPS”) Final Rule exceeded its statutory authority to adjust payments under the OPPS. Refusing to accept the government’s argument that the plaintiffs... READ MORE

The Bankruptcy Court for the District of Delaware analyzed whether CMS could suspend payments to a health care organization once the organization seeks bankruptcy court protection. The question centered on whether such payments are considered estate property within the scope of the automatic stay rule, 11 U.S.C. § 362. This case highlights the limits... READ MORE

On June 24, 2019, the Trump administration changed the game for the health care industry through the release of an executive order on price transparency. Entitled “Improving Price and Quality Transparency in American Healthcare to Put Patients First,” the executive order is aimed primarily at giving patients access to price and quality information about... READ MORE

The Centers for Medicare & Medicaid Services (“CMS”) could revoke or deny a provider’s or supplier’s Medicare enrollment if it determines that any of its affiliations pose an “undue risk” under a Final Rule announced on September 5, 2019 (“Enrollment Rule”). Also under the Enrollment Rule, providers and suppliers (“Providers”) selected by CMS will... READ MORE

CMS recently posted reminders regarding the availability of MIPS final scores and the deadline to request review if an error has been made: “If you participated in the Merit-based Incentive Payment System (MIPS) in 2018, your performance feedback, which includes your MIPS final score and payment adjustment factor(s), are available for review on the Quality... READ MORE