Articles and Blogs

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

As skilled nursing facilities work and provide health care services after the May 11, 2023, end of the Public Health Emergency, questions and concerns about visitation at these facilities will likely continue to arise. The Centers for Medicare & Medicaid Services (“CMS”) recently released revisions and additional clarifications to prior CMS guidance on many... READ MORE

The FFY 2024 IPPS Proposed Rule (“Proposed Rule”) was released on April 10, 2023, and CMS published the associated tables on its website.  The Proposed Rule is expected to be published in the Federal Register on May 1st.  This year CMS is proposing to implement a change to its rural floor wage index policy... READ MORE

March 17, 2023, was the transition period deadline for full state compliance with the Home and Community-Based Services (“HCBS”) Final Regulation.  As part of the steps to get ready for this deadline, in late 2022, the Centers for Medicare & Medicaid Services (“CMS”) visited several settings in multiple states that were identified by the... READ MORE

On December 27, 2022, the Centers for Medicare & Medicaid Services (“CMS”) published a proposed rule that could potentially have a significant impact on enrollees’ obligations under the “60-day” overpayment rule. The original overpayment rule, which was signed into law in 2014 with the Affordable Care Act and expanded to Medicare Parts A and... READ MORE

The Centers for Medicare and Medicaid Services (“CMS”) published a recent Memo reminding hospitals and other Medicare certified health care entities of their regulatory obligation to maintain a safe setting for patients, residents and staff. CMS’s action comes at a time when violence in health care settings is on the rise. Although the Memo... READ MORE

The Centers for Medicare & Medicaid Services (“CMS”) intends to increase its oversight and scrutiny of skilled nursing facilities in its Special Focus Facility (“SFF”) program. CMS is revising the SFF program to protect and improve the quality of care that residents living in these skilled nursing facilities receive. This action is being taken... READ MORE