Articles and Blogs

In 2023, nursing homes have seen increased citations by surveyors for noncompliance tied to their pre-dispute, binding agreements for binding arbitration with their residents. When used appropriately, these agreements can streamline conflict resolution processes, but operators must tread carefully to ensure compliance with the regulations. Regulations In 2019, the Centers for Medicare & Medicaid... READ MORE

On September 1, 2023, the Centers for Medicare & Medicaid Services (“CMS”) released a proposed rule (“Proposed Rule”) that calls for minimum staffing standards in long-term care facilities (“nursing homes”). If finalized, the changes in the Proposed Rule would be used to survey nursing homes for compliance and enforced as part of CMS’s existing survey,... READ MORE

Starting on August 1, 2023, Medicare validation edits will be activated to require service location addresses on the UB-04 hospital claim form to match exactly with the service location enrolled in Medicare’s Provider Enrollment, Chain, and Ownership System (“PECOS”). Background In a previous article, we reported on the Center for Medicare & Medicaid Services... READ MORE

In 2022, the Biden administration announced an initiative to increase the transparency of corporate and private equity ownership and operation of nursing homes. Recently, the Centers for Medicare & Medicaid Services (“CMS”) announced that it would include ownership and operatorship affiliation information on its Nursing Home Care Compare website and that it would publish... READ MORE

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