Articles and Blogs

The Centers for Medicare & Medicaid Services (“CMS”) is reinforcing its emphasis on hospice quality of care and identifying fraud. On November 13, 2024, CMS issued a QSO Memo, “Ensuring Consistency in the Hospice Survey Process to Identify Quality of Care Concerns and Potential Fraud Referrals” (the “CMS Memo”), addressing the importance of consistency in... READ MORE

The United States Department of Justice (“DOJ”) recently settled part of a qui tam lawsuit under the False Claims Act for alleged violations of the Medicare “14-Day Rule” for $388,667. From March 2012 to November 2023, a laboratory and health system allegedly delayed submitting physician orders for certain laboratory testing until 14 days after patients’ hospital... READ MORE

On January 10, 2025, Secretary Becerra of the U.S. Department of Health and Human Services (“HHS”) issued a determination titled “Determination That A Public Health Emergency Exists” (the “California PHE Determination”), that decided a public health emergency exists and has existed since January 7, 2025, in the State of California (“California Public Health Emergency”). Blanket Waivers... READ MORE

On November 26, 2024, the Centers for Medicare & Medicaid Services (“CMS”) released a proposed rule that revises the Medicare Advantage (“MA”) Program, Medicare Prescription Drug Benefit Program (“Part D”), Medicare Cost Plan Program and Programs of All-Inclusive Care for the Elderly for the Contract Year 2026 (“Proposed Rule”). The Proposed Rule clarifies the... READ MORE

On December 31, 2024, the Centers for Medicare & Medicaid Services (“CMS”) released a memo titled “Long-Term Care (LTC) Facility Acute Respiratory Illness Reporting Requirements” (“Memo”) to state survey agency directors providing survey guidance related to requirements for long-term care reporting through the National Healthcare Safety Network (“NHSN”) as COVID-19 data reporting requirements ended... READ MORE

On November 21, 2024, the Centers for Medicare & Medicaid Services (“CMS”) issued revised guidance under QSO-25-09-ALL, updating Core Appendix Q of the State Operations Manual regarding findings of immediate jeopardy. These updates are intended to enhance transparency, standardize immediate jeopardy determinations and improve communication with providers, suppliers and laboratories. These revisions apply to... READ MORE

The following is our summary of significant nursing home legal and regulatory developments during 2024 of interest to nursing home providers and operators. 1. Staffing Mandate Rule. The “Minimum Staffing Standards for Long Term Care Facilities” final rule was published in the Federal Register on May 10, 2024, establishing a phased implementation of a... READ MORE

On December 13, 2024, the Centers for Medicare & Medicaid Services (“CMS”) continued revisions to its “Guidance for SNF Attachment on Form CMS-855A” (“Guidance”). The Guidance is CMS’s subregulatory advice and FAQs to skilled nursing facilities on the completion and submission of the new Form CMS-855A SNF Disclosures Attachment (“SNF Attachment”) for every skilled... READ MORE

The Centers for Medicare & Medicaid Services (“CMS”) provided additional details and information related to CMS provider enrollment site visits. On November 4, 2024, CMS issued a Quality and Safety Special Alert memo (“QSSAM”), “Clarification of CMS’ Provider Enrollment Visits (all providers and suppliers) and Specific Disclosure Requirements for SNFs and NFs.” CMS provides... READ MORE

On November 7, 2024, the Centers for Medicare & Medicaid Services (“CMS”) published a final rule (“Final Rule”) that added a new condition of participation for home health agencies (“HHA”) to participate in Medicare under the “Medicare Program; Calendar Year (“CY”) 2025 Home Health Prospective Payment System (“HH PPS”) Rate Update” for the calendar... READ MORE