news and updates
MACPAC, GAO Recommend Oversight Changes for Managed Care Directed Payments
Both The Medicaid and CHIP Access and Payment Commission and the Government Accountability Office have recently published recommendations for increasing transparency of managed care directed payment programs to facilitate closer evaluation of direct payment programs....
Supreme Court Rules Medicare Cuts to 340B Hospitals Unlawful
The Supreme Court issued a unanimous opinion in American Hospital Association v. Becerra on June 15, 2022, concluding in a "straightforward" decision that the Medicare reimbursement cuts for certain separately-payable outpatient drugs implemented in the 2018 and 2019...
CMS Issues Proposed IPPS Rule
The Centers for Medicare & Medicaid Services (CMS) has released its proposed inpatient prospective payment system (IPPS) rule for fiscal year 2023, with changes that would impact reporting used to calculate Medicare disproportionate share hospital (DSH) payments,...
FMAP-Enhanced DSH Allotments Announced
CMS published a Federal Register Notice on March 16, 2022 implementing a congressionally-mandated increase in Medicaid Disproportionate Share Hospital (DSH) allotments for FYs 2020 and 2021 to account for the enhanced federal Medicaid matching rates during the public...
Avoid Unexpected Medicaid DSH Recoupments Under New Hospital-Specific Limit Rules
The rules governing how to treat costs and revenues for hospital services provided to dually-eligible Medicaid patients for purposes of calculating the limit on Medicaid disproportionate share hospital (DSH) payments to a particular hospital have been repeatedly...
CMS Approves California Advancing & Innovating Medi-Cal (CalAIM) Waivers, Including Provisions to Address Social Determinants of Health
In December, CMS approved some of California’s CalAim proposals through extensions of its 1115 demonstration and 1915(b) managed care waivers. California is transitioning significant programs under its prior 1115 waiver into its 1915(b) waiver, and working to sustain...
CMS Finalizes Medicare Graduate Medical Education Policies, including Process for Allocating 1,000 New Resident Slots
On December 27, 2021, CMS finalized several Medicare graduate medical education (GME) policies, implementing changes required by the Consolidated Appropriations Act of 2021 (CAA). Importantly, the rule establishes the process CMS will use to award 1,000 new resident...
Congress Further Delays Medicare Sequestration and Statutory Pay-As-You-Go Cuts
On December 10, 2021, President Bident signed into law legislation further delaying steep Medicare cuts that were slated to take effect in the new year. Specifically, the moratorium on 2% Medicare sequestration cuts has been extended until April 1, 2022; cuts will be...
CMS Releases State Medicaid Director Letter with Guidance on Implementation of Supplemental Payment Reporting and DSH Limit Provisions in Consolidated Appropriations Act of 2021
In a State Medicaid Director Letter (SMDL) dated December 10, 2021, the Centers for Medicare & Medicaid Services (CMS) issued guidance on how the agency will implement several Medicaid-related provisions from the Consolidated Appropriations Act of 2021 (CAA). As...
CMS Releases Final Outpatient Prospective Payment System and Physician Fee Schedule Rules
The Centers for Medicare & Medicaid Services (CMS) has finalized its outpatient prospective payment system (OPPS) and physician fee schedule rules for calendar year 2022. In the final OPPS rule, as proposed, CMS continued controversial reimbursement cuts of 30%...
CMS Revises Co-Location Guidance Adding Flexibilities for Hospitals
The Centers for Medicare & Medicaid Services (CMS) has released long-awaited guidance increasing flexibility for hospitals to enter into co-location arrangements. Historically, CMS disapproved of co-location arrangements, contending that they rendered hospitals...
CMMI Releases New Strategic Objectives Focused On Health Equity
The Center for Medicare and Medicaid Innovation (or “Innovation Center”) has released a white paper outlining the Center’s strategic objectives for its second decade, with the goal of achieving equitable outcomes through high-quality, affordable, person-centered care....
CMS Issues Interim Final Rule on Surprise Billing Dispute Resolution Process
The Centers for Medicare & Medicaid Services (CMS) has released an interim final rule (IFR) establishing the independent dispute resolution (IDR) process for surprise billing disputes and a similar process for uninsured/self-pay patients, as required by the No...
HRSA Notifies Six Drug Manufacturers of Referral to OIG for Possible Penalties
The Health Resources and Services Administration (HRSA) has taken additional steps to require 340B drug discounts when drugs are dispensed through contract pharmacies. On September 22, HRSA followed up on earlier letters to six manufacturers refusing contract pharmacy...
HHS Announces New $25.5B Round of COVID-19 Provider Funding Targeting Those Serving Vulnerable Communities
The Department of Health and Human Services (HHS) has announced the release of $25.5 billion in new COVID-19 funding for providers, including $17 billion to be distributed as Phase 4 of the Provider Relief Fund (PRF) and $8.5 billion in American Rescue Plan (ARP)...
CMS Releases Proposed Outpatient Prospective Payment System Rule, Continuing Several Controversial Policies
The Centers for Medicare & Medicaid Services (CMS) has released its proposed outpatient prospective payment system (OPPS) rule for calendar year 2022. To the disappointment of many in the hospital industry, the rule proposes to continue a pair of controversial...
CMS Releases Proposed Physician Fee Schedule Rule
On July 13, 2021, the Centers for Medicare & Medicaid Services (CMS) released its proposed physician fee schedule rule for calendar year 2022, which includes provisions extending and expanding certain telehealth flexibilities, delaying the penalty phase of the...
HRSA Withdraws Contract Pharmacy Advisory Opinion But Will Continue Enforcement of Statute, Including Pursuant to May 17 Letters
The Health and Resource Service Administration (HRSA) announced June 18, in connection with the ongoing AstraZeneca case, that is withdrawing its December 2020 contract pharmacy Advisory Opinion “to avoid confusion and unnecessary litigation.” Despite withdrawal of...