Articles and Blogs

On October 3, 2024, the Centers for Medicare & Medicaid Services (“CMS”) published an interim final rule that eliminated the low wage index hospital policy and related budget neutrality adjustments. This action was prompted by the D.C. Circuit Court of Appeals’ decision to vacate the policy in Bridgeport Hospital v Becerra (“Bridgeport“) concluding that the... READ MORE

On July 10, 2024, the Centers for Medicare & Medicaid Services (“CMS”) issued its calendar year 2025 Medicare Physician Fee Schedule (“MPFS”) proposed rule (“Proposed Rule”), to implement certain payment updates effective January 1, 2025. Several major proposals are summarized below and the fact sheet accompanying this Proposed Rule may be found here. Telehealth... READ MORE

The Centers for Medicare & Medicaid Services (“CMS”) will publish the 2025 Inpatient Prospective Payment System (“IPPS”) Final Rule (“Final Rule”) in the Federal Register on August 28 with an effective date of October 1, 2024. Along with increasing IPPS payments for FY 2025, the Final Rule introduces a new alternative payment model, funds... READ MORE

On July 3, 2024, a federal court in Texas (“the Court”) issued a stay related to certain provisions of CMS’s Contract Year 2025 Medicare Advantage and Part D (“MAPD”) Final Rule (“2025 Final Rule”), which would change how agents and brokers are paid by Medicare Advantage (“MA”) and Part D plans. Specifically, the Court... READ MORE

On June 24, 2024, the Department of Health and Human Services (“HHS”) released a final rule implementing disincentives for health care providers who are found by the Office of Inspector General (“OIG”) to have engaged in information blocking practices as defined under the 21st Century Cures Act. This rule establishes a framework for the... READ MORE

On June 10, 2024, the Supreme Court of the United States (“Supreme Court”) agreed to consider an appeal on behalf of more than 200 hospitals* in Advocate Christ Medical Center, et al v. Becerra, challenging the manner in which the Centers for Medicare and Medicaid Services (“CMS”) calculates a hospital’s Disproportionate Share Hospital (“DSH”) payments.... READ MORE

On April 10, 2024, the Centers for Medicare & Medicaid Services (“CMS”) announced its plan to implement the Transforming Episode Accountability Model (“TEAM”), a new mandatory alternative payment model unveiled as part of the 2025 Hospital Inpatient Prospective Payment System proposed rule. TEAM is an episode-based payment model in which selected acute care hospitals... READ MORE

On April 1, 2024, the U.S. Department of Health and Human Services (“HHS”), through the Centers for Medicare & Medicaid Services (“CMS”) released a memorandum to state survey agency directors highlighting revisions and clarification to the Hospital Interpretive Guidelines for Informed Consent (the “Guidance”). The Guidance clarifies informed consent requirements for the performance of... READ MORE

On April 10, 2024, the Centers for Medicare & Medicaid Services (“CMS”) released the 2025 Inpatient Prospective Payment System (“IPPS”) Proposed Rule (“Proposed Rule”). The Proposed Rule brings a significant change in that it confirms CMS will adopt updated labor market area delineations based on the 2020 Census, taking effect on October 1, 2024.... READ MORE

The Centers for Medicare & Medicaid Services (“CMS”) recently announced the ACO Primary Care Flex Model (“Flex Model”), a new voluntary model within MSSP for low-revenue ACOs, that begins January 1, 2025. The Flex Model will utilize a prospective primary care payment option to increase flexibility for low-revenue ACOs to increase access to high-quality... READ MORE