Articles and Blogs

Over the last 12 months, the Centers for Medicare & Medicaid Services (“CMS”) has received many reports of hospice fraud. In addition, CMS has seen the number of enrolled hospices increase significantly in Arizona, California, Nevada and Texas, raising concerns about market oversaturation.  On July 12, 2023, CMS released a Medicare Learning Network article (the “CMS Oversight Policy”)... READ MORE

On Friday, June 20, 2023, the Centers for Medicare & Medicaid Services (“CMS”) posted a pre-publication copy of the Calendar Year (“CY”) 2024 Home Health Prospective Payment System Rate Update (“PPS Rule”), which has since been published in the Federal Register and is currently open for comment. The PPS Rule usually only impacts the... READ MORE

On June 7, 2023, the Food and Drug Administration’s (“FDA”) Office of Prescription Drug Promotion (“OPDP”) issued its first Untitled Letter of the year regarding violative promotional materials for a prescription drug indicated for the treatment of endogenous hypercortisolemia (high cortisol) in adults with Cushing’s syndrome. Specifically, OPDP alleged that a website promoting the... READ MORE

On July 10, 2023, the Centers for Medicare & Medicaid Services (“CMS”) published a proposed rule (“Proposed Rule”) that would create an informal dispute resolution process for some hospice citations, begin the hospice special focus program and create additional restrictions and steps for certain transfers of hospice ownership interests.  Proposed Informal Dispute Resolution Program In the... READ MORE

The Centers for Medicare & Medicaid Services (“CMS”) just released its Proposed Rule for repaying hospitals that were affected by the 340B OPPS payment cuts from 2018 through 2022. CMS has proposed that 340B hospitals will receive a one-time lump sum payment at the end of 2023 or beginning of 2024. Each hospital’s payment... READ MORE

On June 30, 2023, CMS released the CY 2024 Proposed Rule that would increase the payment rates for freestanding End Stage Renal Disease (“ESRD”) facilities and hospital-based facilities by 1.6% and 2.6%, respectively, and the ESRD Prospective Payment System (“PPS”) base rate to $269.99. For the CY 2024 wage index update, CMS intends to... READ MORE

In the latest effort to increase price transparency and lower prescription drug costs, the Centers for Medicare & Medicaid Services (“CMS”) issued a proposed rule (“Proposed Rule”) that, in part, intends to reveal the actual cost of drugs covered by Medicaid. The Proposed Rule includes two new initiatives: A Medicaid managed care organization (“MCO”)... READ MORE

On June 8, 2023, the Centers for Medicare & Medicaid Services (“CMS”) announced the Making Care Primary Model (“Model”), a new multi-payor, voluntary primary care model tested by the Center for Medicare and Medicaid Innovation (“CMMI”) and aimed at strengthening the primary care infrastructure for Medicare and Medicaid patients. The Model focuses on primary... READ MORE

On June 7, CMS issued a much-anticipated Final Rule addressing the placement of Medicare Advantage patient days within the Medicare DSH calculation. The Final Rule adopts a retroactive policy that will place Medicare Advantage days in the Medicare Fraction of the DSH calculation for discharges before October 1, 2013. The numerator of that fraction... READ MORE

Could it be that CMS is implementing changes in the Medicare Communications and Marketing standards that will change the content and tone of the omnipresent television and radio advertisements targeted at potential enrollees? On the heels of publishing a final rule modifying the regulations for Medicare communications and marketing in April, on May 10,... READ MORE