Articles and Blogs

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

CMS recently issued a final rule to require health care payers to improve communications between the payers, providers and patients and to improve the prior authorization processes (“Final Rule”). The Final Rule aims to improve electronic exchange of health care data with a particular focus on improving the prior authorization process through the implementation... READ MORE

On January 30, 2024, the Centers for Medicare and Medicaid Services (“CMS”) issued a Request For Information (“RFI”) seeking input from interested parties regarding Medicare Advantage (“MA”) data. CMS’s goals for the RFI are to enhance data capabilities “to have better insight into [MA] programs, consider areas to increase MA data transparency, and propose... READ MORE

In the FY 2024 IPPS Final Rule (the “Final Rule”), the Centers for Medicare & Medicaid Services (“CMS”) incorporated certain social risk factors into the Hospital Value-Based Purchasing (“VBP”) Program (“the Program”). Set to begin in the FFY 2026 payment year, CMS will be using data on inpatient stays from January 1, 2024 through... READ MORE

CMS introduced an updated Medicare Cost Report e-Filing system (“MCReF”) and related templates to allow Medicare Part A providers the ability to electronically file to their Medicare contractor supporting documentation in addition to their cost report for fiscal years ending on or after December 31, 2017. This allows the contractor to receive successful MCReF... READ MORE