Articles and Blogs

On March 5, 2019, the Center for Clinical Standards and Quality/Survey & Certification Group released a memorandum titled “April 2019 Improvements to Nursing Home Compare and the Five-Star Rating System” (“Memorandum”). In the Memorandum, the Centers for Medicare & Medicaid Services (“CMS”) announced the end of the freeze on health inspection star ratings and added quality... READ MORE

On March 5, 2019, the Center for Clinical Standards and Quality/Survey & Certification Group released a memorandum titled “Revisions to Appendix Q, Guidance on Immediate Jeopardy” (“Memorandum”). The Memorandum’s revisions create a “Core Appendix Q” that will be used by surveyors of all provider and supplier types in determining when to cite immediate jeopardy.... READ MORE

Location, location, location – this will be the focus of a Medicare hospital claims processing requirement. Starting in April 2019, CMS will activate billing edits that will Return to Provider (“RTP”) any hospital UB-04 claims that identify a service location that is not an exact match to a Medicare enrolled location identified in Provider... READ MORE

House Democrats Unveil Single-Payor Legislation House Democrats introduced sweeping “Medicare for All” legislation, providing the most detailed plan to overhaul the current health care system by enrolling all U.S. residents in a single-payor, government-run health plan. It would cover a more expansive set of benefits than the current Medicare program and restructure payment for... READ MORE

Government Funded After Congress Borders on Another Shutdown Congressional negotiators have reached an agreement on a funding deal that avoids another partial government shutdown that would have occurred at midnight tonight. The measure would fund nine out of fifteen federal departments through September 30, 2019. President Trump is expected to sign the legislation into... READ MORE

Beginning April 1, 2019, Medicare Part C and D plans, PACE organizations and 1876 cost contract plans (“Plans”) will be required to deny payment for services rendered or prescriptions ordered by any provider on the new Centers for Medicare & Medicaid Services (“CMS”) Preclusion List. The Preclusion List, which was first made available to... READ MORE

HHS Previews 2019 Regulatory Agenda At a symposium on Tuesday, Deputy HHS Secretary Eric Hargan and CMS Administrator Seema Verma outlined the administration’s health care strategy for 2019, which includes advancing the use of technology, adjusting payments in rural areas and testing new ways to reward high-quality care and reforms to the Stark and... READ MORE

January 1, 2019 marked the start of a new data collection period for laboratories pursuant to the Medicare Clinical Diagnostic Laboratory Tests Payment System Final Rule (“CLFS Rule”).¹ The CLFS Rule establishes the Centers for Medicare & Medicaid Services’s (“CMS’s”) new private payor-based rate-setting system for clinical diagnostic laboratory tests (“CDLTs”) paid under the... READ MORE

On December 27, 2018, a federal judge ruled in favor of hospital associations and hospitals challenging the reduction in reimbursement for drugs purchased at a discount under the 340B Program established in the 2018 Outpatient Prospective Payment System final rule (“2018 OPPS Rule”). Judge Rudolph Contreras of the United States District Court in Washington,... READ MORE

On November 30, 2018, CMS issued a Memorandum to State Survey Agency Directors (QSO-19-02-NH), announcing its concerns about adequate registered nurse staffing in skilled nursing facilities and that it will provide CMS Regional Offices and State Survey Agencies with a list of facilities with potential staffing issues to support survey activities for evaluating sufficient staffing and... READ MORE