Articles and Blogs

In an interim final rule published in the Federal Register on April 21 (“Rule”), the Centers for Medicare & Medicaid Services (“CMS”) amended its regulations to allow PPS hospitals located in urban areas to obtain a “412.103” urban to rural reclassification and also be reclassified for wage index purposes by the Medicare Geographic Classification Review…Read More

On May 6, 2016, CMS will publish its new Medicaid managed care rule, which will permit states to require Medicaid MCOs1 to make enhanced payments to targeted hospitals, physicians and nursing facilities for a limited number of years. This is a departure from current practice in which states are prohibited from directing a Medicaid MCO’s…Read More

On April 19, 2016, the U.S. Department of Health and Human Services Office for Civil Rights (“OCR”) reached a settlement in the amount of $755,000 with a North Carolina orthopedic clinic (“Clinic”) for failing to execute a business associate agreement with a third-party vendor. This is OCR’s second settlement this year related to business associate…Read More

On April 5, 2016, a district court in Massachusetts dismissed a Title VII case against a hospital where the employee was terminated for refusing vaccinations on religious grounds. Robinson v. Children’s Hospital Boston, 2016 WL 1337255. While this order is not binding precedent, we wanted to report on this case because vaccination refusal is an…Read More

On April 18, 2016, the Centers for Medicare & Medicaid Services (“CMS”) released its Hospital Inpatient Prospective Payment System and Long Term Acute Care Hospital Proposed Rule Issues for Fiscal Year 2017, which are set to be published on April 27, 2016. CMS included a proposed rule for implementing the Notice of Observation Treatment and…Read More

CMS Releases IPPS and LTCH Proposed Payment Rule that Ends Negative Payment Impact from Two-Midnight Policy On April 18, CMS issued its proposed payment rule covering inpatient hospital stays and long-term acute care hospitals. The inpatient hospital measure would increase rates by 0.85 percent in FY 2017, compared to FY 2016, after accounting for inflation…Read More

This week, the Centers for Medicare & Medicaid Services (“CMS”) announced that it is extending participation in the Bundled Payments for Care Improvement (“BPCI”) initiative through September 30, 2018. Awardees in the BPCI initiative can now extend their participation in Models 2, 3 and 4 until that date. Originally, awardees that began in October 2013…Read More

In the proposed Inpatient Prospective Payment System (“IPPS”) rule for FFY 2017, hospitals will benefit from the restoration of payments CMS has taken away from hospitals since FFY 2014, related to implementation of the Two-Midnight Rule that redefined the definition of inpatient admissions. Not only will there be no 0.2 percent decrease in IPPS payments in…Read More

On April 15, 2016, the Food and Drug Administration (“FDA”) issued three important draft guidance documents that clarify the standards under Sections 503A and 503B of the federal Food Drug & Cosmetic Act (“the Act”) applicable to compounding activities carried out by prescription drug compounders. These compounders include hospital pharmacies, non-hospital pharmacies (including retail pharmacies)…Read More

Secondary Payer Refunds, Overpayments and Obligations CMS’s new rule regarding the reporting and returning of Medicare overpayments (effective March 14, 2016) makes clear that secondary payer refunds owed by health care providers to Medicare may become overpayments for purposes of the new rule. Without sufficient oversight, such overpayments may expose a health care provider to liability…Read More