Articles and Blogs

On July 30, 2026, the Centers for Medicare & Medicaid Services (“CMS”) issued its final rule updating Medicare payment policies and rates for skilled nursing facilities (“SNFs”) under the Skilled Nursing Facility Prospective Payment System (“SNF PPS”) for federal fiscal year (“FY”) 2027. The final rule also includes significant revisions to the Skilled Nursing... READ MORE

On July 27, 2026, the U.S. District Court for the Northern District of Texas in Covenant Medical Center v. Kennedy (“Covenant”) once again vacated a 2023 Centers for Medicare & Medicaid Services (“CMS”) regulation that excluded inpatient days covered by an uncompensated care funding pool when counting Medicaid Days in the Disproportionate Share Hospital... READ MORE

On May 13, 2026, as part of its ongoing effort to address home health and hospice fraud, the Trump administration announced a 6-month moratorium on new Home Health and Hospice enrollment, effective immediately. The federal register notice for home health and hospice is set to be published on May 15, 2026. In general, the... READ MORE

The first nationwide test of a mandatory episode-based payment model has been unveiled. In the Fiscal Year (“FY”) 2027 Inpatient Prospective Payment System (“IPPS”) Proposed Rule, the Centers for Medicare & Medicaid Services (“CMS”) proposes resurrecting and expanding the original Comprehensive Care for Joint Replacement (“CJR”) Model to establish a mandatory, nationwide episode-based payment model for most hospitals paid under... READ MORE

On December 15, 2025, the Office of Inspector General (“OIG”) issued Advisory Opinion No. 25‑11 (“Advisory Opinion”) and concluded it would not impose administrative sanctions under the federal Anti‑Kickback Statute (“AKS”) on a biopharmaceutical manufacturer for a series of discounts and rebates offered on multiple vaccines. Although portions of the arrangement failed to meet... READ MORE

On February 3, 2026, after years of false starts, federal regulation of pharmacy benefit managers (“PBMs”) became reality when the Consolidated Appropriations Act, 2026 (the “Act”) was signed into law by President Trump. For the first time, the Act imposes federal requirements on PBMs related to compensation, transparency, reporting and other matters to be... READ MORE

On June 26, 2025, the Department of Justice (“DOJ”) announced that a Remote Patient Monitoring (“RPM”) provider (“Company”) and its physician owner, paid $1.29 million to settle allegations of submitting false claims to Medicare under the False Claims Act (“FCA”). This settlement highlights the increased growth in RPM services, while noting the government’s scrutiny... READ MORE

The Centers for Medicare & Medicaid Services (“CMS”) recently issued its calendar year (“CY”) 2026 Outpatient Prospective Payment System (“OPPS”) proposed rule (“Proposed Rule”). The following summarizes several major proposals of the Proposed Rule, and the corresponding fact sheet can be found here. For interested parties and stakeholders, comments should be submitted by September... READ MORE

On April 30, 2025, the Centers for Medicare & Medicaid Services (“CMS”) released the FFY 2026 Inpatient Prospective Payment System (“IPPS”) Proposed Rule (“Proposed Rule”) to update IPPS payment rates, change DSH payments, increase uncompensated care payments and request input on ways to streamline Medicare regulations and reduce provider burden. Increase to Payment Rates... READ MORE

As the NCAA March Madness tournaments heat up, lawmakers and the Trump administration are making their own plays on key federal telehealth policy issues. On March 15, the President signed the Full-Year Continuing Appropriations and Extensions Act, 2025 (“Continuing Resolution”) to fund the federal government through September 30. The Continuing Resolution extends several key... READ MORE