news and updates
Texas Files Suit Against HHS Seeking Reversal of $25 Million Disallowance
On December 2, 2019, the Texas Health and Human Services Commission filed suit against HHS seeking reversal of an August 2018 DAB decision that upheld a $25 million disallowance against the state. The complaint, filed in D.C District Court, argues that the standard...
Trump Administration Releases Transparency Rules for Hospitals and Insurers
On Friday November 15, the Trump administration released a set of rules aimed at increasing transparency in the hospital and health insurance industries. A proposed rule targeting both exchange and employer-sponsored health plans would require insurers to disclose...
CMS Proposes Sweeping Medicaid Financing Changes through Fiscal Accountability Rule
On November 12, 2019, CMS issued a proposed rule that, if finalized, would have a sweeping impact on Medicaid programs across the country. The 222-page “Medicaid Fiscal Accountability Regulation” seeks to implement significant policy changes to some of the key...
CMS Releases 2019 OPPS Final Rule
On November 1, 2019, CMS issued its FY 2019 Outpatient Prospective Payment Systems (OPPS) Final Rule.
Three Federal District Courts Block DHS Public Charge Rule
Federal district courts in Washington, New York, and California have blocked the Trump Administration's public charge rule from going into effect. The Southern District of New York's ruling applies on a nationwide basis, with the other two rulings limited to the...
President Trump Issues Executive Order Curbing Agency use of Informal Guidance
On October 9, 2019, President Trump issued an executive order on agency reliance on informal guidance documents. The order seeks to curb what the Administration believes to be a “back-door” practice of regulation that allows agencies to improperly bypass the formal...
Trump Administration Issues Proposed Rules to Revamp Fraud and Abuse Laws
On October 9, 2019, the Trump administration released two proposed rules seeking to revamp current fraud and abuse regulations to support the transition to value-based payment. The first would amend regulations implementing the anti-kickback statute and civil monetary...
President Trump Issues Proclamation Requiring Health Insurance for Immigrants
On October 4, 2019, President Trump issued a proclamation requiring immigrants seeking entry into the U.S. to prove that they will obtain health insurance within 30 days of entering the United States or have the resources to pay for “reasonably foreseeable medical...
President Trump Issues Executive Order Promoting Medicare Advantage
On October 3, 2019, President Trump issued an executive order requiring the Medicare program to implement more market-based policies—some which were included in his October 2017 executive order—and support the Medicare Advantage program. Specifically, the order calls...
Senate Approves Temporary Delay in DSH Cuts
On September 26, 2019, the Senate approved a bipartisan continuing resolution to temporarily delay $4 billion in cuts to Medicaid disproportionate share hospital (DSH) payments. The cuts, originally set to take place on October 1, will now take effect on November 22nd.
CMS Issues Final Rule on DSH Cut Methodology
On September 23, 2019, CMS issued a final rule implementing its Disproportionate Share Hospital (DSH) reduction methodology. The DSH payment cuts were part of the Affordable Care Act (ACA) and are currently scheduled to begin in 2020 after a series of two-year delays....
Federal Judge Overturns CMS Site Neutral Policy
On September 18, 2019, the D.C. District Court ruled that CMS exceeded its authority when it extended site-neutral payment to certain services in grandfathered clinics. The policy, issued as part of the November 2018 Outpatient Prospective Payment System (OPPS) Final...
Tennessee Releases Draft Medicaid Block Grant Proposal
On September 17, 2019, Tennessee released a draft amendment proposal to its 1115 “TennCare” waiver that would restructure its Medicaid program into a block grant. Though this option has been discussed in various states, and encouraged by CMS under Administrator Seema...
Despite Early Success for Providers, August 2019 Appellate Court Decision Leaves Future Uncertain for Medicaid DSH Third-Party Payer Policy
Over the last several years, courts in various jurisdictions have issued rulings in lawsuits challenging the Centers for Medicare & Medicaid Services’ (CMS’) policy requiring the inclusion of Medicare and commercial payments in the calculation of the Medicaid...
CMS Releases 2019 IPPS Final Rule
On August 16, 2019, CMS issued its FY 2019 Inpatient Prospective Payment Systems (IPPS) Final Rule.
DHS Issues Final Rule on Public Charge
On August 14, 2019, the Department of Homeland Security (DHS) issued a final rule expanding the types of public benefits that may be considered when assessing whether an individual is a “public charge” for purposes of altering their immigration status. The rule allows...
D.C. Circuit Reverses Lower Court’s Ruling in DSH Litigation
On August 13, 2019, the D.C. Circuit issued its highly-anticipated decision in a lawsuit brought by the Children’s Hospital Association of Texas (CHAT) and others, challenging the legality of CMS’ 2017 Medicaid DSH third-party payer final rule that was set to take...
CMS Releases 2019 OPPS Proposed Rule
On August 9, 2019, CMS issued its FY 2019 Outpatient Prospective Payment Systems (OPPS) Proposed Rule.