news and updates
CMS Proposes Changes to Medicaid Managed Care Rules, Including on State Directed Payments
On Thursday, April 27, the Centers for Medicare & Medicaid Services (CMS) issued a long-anticipated proposed rule related to Medicaid and CHIP managed care programs. Of particular importance for many of our clients across the country, CMS continued its practice of...
CMCS Releases Informational Bulletin Clarifying Hold-Harmless Policy
CMS’ Centers for Medicaid and CHIP Services (CMCS) has released an Informational Bulletin stating its interpretation of federal laws related to Medicaid payments where the state share is derived from a provider tax. The bulletin specifically addresses private...
CMS Issues Proposed Rule Implementing Disproportionate Share Hospital Third-Party Payer Law
The Centers for Medicare & Medicaid Services (CMS) has released its proposed rule implementing Section 203 of the Consolidated Appropriations Act of 2021, which altered the calculation of the Medicaid hospital-specific DSH limit to exclude costs and payments...
Third Circuit Issues Unfavorable Decision Allowing Drug Manufacturers to Continue Restrictive Contract Pharmacy Policies
The first of three federal circuits to consider the authority of the Health Resources and Services Administration (HRSA) to prohibit drug manufacturer contract pharmacy restrictions issued an unfavorable decision for hospitals, ruling that the federal 340B statute is...
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...