Category Archives: Centers for Medicare and Medicaid Services (“CMS”)

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Dateline: Telehealth and COVID-19

Erica KrausBy Erica Kraus on Posted in Centers for Medicare and Medicaid Services ("CMS"), Coronavirus, Telehealth
CMS issued guidance this afternoon on expanded Medicare coverage of telehealth services during the COVID-19 outbreak. Under the guidance, Medicare will pay for office, hospital, and other visits furnished via telehealth across the country, including in patient’s places of residence, retroactive to March 6, 2020. CMS does not plan to enforce any requirement that visits … Continue Reading

Home Health Agencies and Dialysis Centers Take Note: CMS Provides Additional Guidance to Healthcare Providers to Stop the Spread of the Coronavirus

Melissa GertlerBy Melissa Gertler on Posted in Centers for Medicare and Medicaid Services ("CMS"), Coronavirus
On March 10, 2020, the Centers for Medicare & Medicaid Services (“CMS”) supplemented the guidance that we previously discussed in our March 6, 2020 blog post in order to provide additional guidance to healthcare providers, specifically home health agencies and dialysis facilities, in addressing the spread of the 2019 Novel Coronavirus (“COVID-19”).… Continue Reading

Medicare Advantage Plans, Medicare Prescription Drug Plans and FEHBP Carriers Take Note: CMS and OPM Announce Actions to Address the Threat of Coronavirus

Christine ClementsBy Christine Clements on Posted in Centers for Medicare and Medicaid Services ("CMS"), Coronavirus
The Centers for Medicare and Medicaid Services (CMS) and the Office of Personnel Management (OPM) issued guidance to their contracting carriers on various issues surrounding the novel coronavirus or COVID-19.  These guidance documents remind carriers of their contractual obligations as well as give carriers flexibility in the administration of their benefit plans during this crisis.… Continue Reading

Top 10 Provisions of CMS Proposed Rule: Medicare Advantage and Part D Programs for CY2021 and CY2022

Christine ClementsBy Christine Clements on Posted in Centers for Medicare and Medicaid Services ("CMS")
As promised, here is a summary of some key provisions in CMS’ proposed rule relating to the Medicare Advantage and Part D programs for contract years 2021 and 2022.  CMS is soliciting comments on a number of issues and we urge stakeholders to take the opportunity to submit comments.  The deadline for comments is April … Continue Reading

CMS Proposes Changes to the Medicare Advantage and Part D Programs for CY 2021 and 2022

Christine ClementsBy Christine Clements on Posted in Centers for Medicare and Medicaid Services ("CMS"), Medicare, Medicare Advantage, Prescription Drug Issues
In an evening email that is sure to ruin the weekend for many, CMS announced on February 5, 2020, that it is proposing changes to the Medicare Advantage and Part D Programs for CY 2021 and 2022. CMS will not issue a Call Letter for CY2021. The unpublished version of the proposed rule is available … Continue Reading

Health and Human Services Exchange Program Integrity Final Rule

Lynsey MitchelBy Lynsey Mitchel on Posted in Centers for Medicare and Medicaid Services ("CMS")
On December 20, 2019, the Centers for Medicare and Medicaid Services (CMS) issued a final rule on program integrity for Affordable Care Act (ACA) exchange plans.  This rule implements a number of provisions from the ACA, including the requirement that each state have the opportunity to establish an Exchange, as well as the steps the Secretary … Continue Reading

CMS Issues Long-Awaited Draft Guidance for Hospital Co-Location with Other Hospitals or Healthcare Facilities

Michael PaddockErica KrausTheresa ThompsonBy Michael Paddock, Erica Kraus and Theresa Thompson on Posted in Centers for Medicare and Medicaid Services ("CMS"), Medicare
On May 3, 2019, the Centers for Medicare and Medicaid Services (“CMS”) released long-awaited draft guidance (the “Guidance”), proposing to allow hospitals to co-locate with other hospitals or healthcare facilities in certain circumstances. In welcome news for the industry – particularly for hospitals that co-locate provider-based space with non-provider-based facilities – CMS has proposed that … Continue Reading

CMS Issues Proposed Rule on Modernizing Part D and Medicare Advantage to Lower Drug Prices and Reduce Out-of-Pocket Expenses

Christine ClementsBy Christine Clements on Posted in Centers for Medicare and Medicaid Services ("CMS")
The Centers for Medicare and Medicaid Services (“CMS”) released the much-anticipated proposed rule to lower Part D and Medicare Advantage (“MA”) drug prices and beneficiary out-of-pocket expenses on November 26, 2018 (the “Proposed Rule”). According to CMS, the primary purposes of the Proposed Rule are to revise the MA and Part D regulations to support … Continue Reading

Blog Series Part 7: CMS Proposed Rule on Policy and Technical Changes to the Medicare Advantage, Medicare Prescription Drug Benefit, Medicaid Fee-For-Service, and Medicaid Managed Care Programs for 2020 and 2021

Kim LeBy Kim Le on Posted in Centers for Medicare and Medicaid Services ("CMS"), Healthcare Legislation and Rulemaking, Medicare Advantage
Part C and Part D Quality Rating System The November 1, 2018 proposed rule issued by the Centers for Medicare & Medicaid Services (“CMS”) includes enhancements and substantive changes to the Star Rating System in order to increase the stability and predictability of the Medicare Advantage program (aka “Part C”) and the Medicare Prescription Drug … Continue Reading

Blog Series Part 6: CMS Proposed Rule on Policy and Technical Changes to the Medicare Advantage, Medicare Prescription Drug Benefit, Medicaid Fee-For-Service and Medicaid Managed Care Programs for Years 2020 and 2021

Lynsey MitchelBy Lynsey Mitchel on Posted in Centers for Medicare and Medicaid Services ("CMS"), Healthcare Legislation and Rulemaking, Medicare Advantage
Dual Special Needs Plans This part 6 of our 7 part series focuses on the provisions regarding dual special needs plans (“D-SNPs”) released by the Centers for Medicare and Medicaid Services (“CMS”) in the proposed rule issued on November 1, 2018 (the “Proposed Rule”). D-SNPs enroll individuals who are entitled to both Medicare and medical … Continue Reading

Blog Series Part 5: CMS Proposed Rule on Policy and Technical Changes to the Medicare Advantage, Medicare Prescription Drug Benefit, Medicaid Fee-For-Service, and Medicaid Managed Care Programs for 2020 and 2021

Sean M. CuddihyBy Sean M. Cuddihy on Posted in Centers for Medicare and Medicaid Services ("CMS"), Healthcare Legislation and Rulemaking, Medicare Advantage
Part D Plan Sponsors’ Access to Medicare Parts A and B Claims Data Extracts As detailed in previous posts in this series, one major objective that the Centers for Medicare and Medicaid Services (“CMS”) addressed in a proposed rule issued November 1, 2018 (the “Proposed Rule”), was to implement new Social Security Act provisions that … Continue Reading

Blog Series Part 4: CMS Proposed Rule on Policy and Technical Changes to the Medicare Advantage, Medicare Prescription Drug Benefit, Medicaid Fee-For-Service, and Medicaid Managed Care Programs for Years 2020 and 2021

Kathleen StrattonBy Kathleen Stratton on Posted in Centers for Medicare and Medicaid Services ("CMS"), Healthcare Legislation and Rulemaking, Medicare Advantage
Quality Improvement Programs The proposed rule issued November 1, 2018 (the “Proposed Rule”) by the Centers for Medicare and Medicaid Services (“CMS”) includes two technical changes to 42 C.F.R. Part 422. The first change involves a clarification regarding the accreditation “deeming” standard for Medicare Advantage (“MA”) quality improvement programs. The second change, also related to … Continue Reading

Blog Series Part 2: CMS Proposed Rule on Policy and Technical Changes to the Medicare Advantage, Medicare Prescription Drug Benefit, Medicaid Fee-For-Service, and Medicaid Managed Care Programs for Years 2020 and 2021

Theresa ThompsonBy Theresa Thompson on Posted in Centers for Medicare and Medicaid Services ("CMS"), Healthcare Information Technology, Medicare Advantage
Requirements for MA Plans Offering Additional Telehealth Benefits As part of the proposed rule issued November 1, 2018 by the Centers for Medicare and Medicaid Services (“CMS”) regarding updates to the Medicare Advantage (“MA”) and Medicare prescription drug benefit programs, CMS addressed expanding the ability of MA plans to offer telehealth benefits to their enrollees. … Continue Reading

CMS Continues to Push for Hospital Price Transparency in Final Rule

Matthew GoldmanJordan GrushkinCody FierroBy Matthew Goldman, Jordan Grushkin and Cody Fierro on Posted in Centers for Medicare and Medicaid Services ("CMS")
As discussed in our previous blog, “CMS Pushes for Hospital Price Transparency in Proposed Rule”, on April 24, 2018, the Centers for Medicare & Medicaid Services (“CMS”) announced a proposed rule (CMS-1694-P) aimed at empowering patients through better access to hospital charge information. In an effort to fulfill the proposed rule’s objective, CMS suggested an … Continue Reading

CMS Pushes for Hospital Price Transparency in Proposed Rule

Matthew GoldmanJordan GrushkinCody FierroBy Matthew Goldman, Jordan Grushkin and Cody Fierro on Posted in Centers for Medicare and Medicaid Services ("CMS")
On April 24, 2018, the Centers for Medicare & Medicaid Services (“CMS”) announced a new proposed rule (CMS-1694-P) (“Proposed Rule”). In an attempt to “empower patients through better access to hospital price information,” CMS plans to alter the requirements previously established by Section 2718(e) of the Affordable Care Act.[1] Under Section 2718(e), “each hospital operating … Continue Reading

CMS Proposes “Wind Down” Plan for Federal Exchanges

Cody FierroMatthew GoldmanJordan GrushkinBy Cody Fierro, Matthew Goldman and Jordan Grushkin on Posted in Affordable Care Act (ACA), Centers for Medicare and Medicaid Services ("CMS")
Despite the Trump Administration’s unsuccessful attempts to fully repeal and replace the Affordable Care Act (the “ACA”), the Administration has continued to target the ACA. In the Administration’s latest salvo, the Centers for Medicare & Medicaid Services (“CMS”) announced in its Fiscal Year 2019 Performance Budget (the “Budget”)[1] – as released by the federal Office … Continue Reading

Take-Aways from CMS’ Recent Listening Session Regarding E/M Services: Documentation Guidelines and Burden Reduction

Lynsey MitchelBy Sheppard Mullin and Lynsey Mitchel on Posted in Centers for Medicare and Medicaid Services ("CMS")
On March 21, 2018, a representative from the Hospital and Ambulatory Policy Group at the CMS, held a listening session regarding proposed updates to documentation guidelines for Evaluation and Management (“E/M”) Services. The purpose of this listening session was for the agency to obtain stakeholder feedback in order to develop policy proposals for upcoming notice … Continue Reading

CMS Aims to Nix Obama-Era Payment Models

Aytan DahukeyMatthew GoldmanJordan GrushkinBy Aytan Dahukey, Matthew Goldman and Jordan Grushkin on Posted in Centers for Medicare and Medicaid Services ("CMS"), Medicare
In a proposed rule published Tuesday, August 15, 2017, the Centers for Medicare & Medicaid Services (CMS) announced its intention to roll back a handful of payment models introduced under the Obama Administration. If implemented, the rule would cancel the Episode Payment Models (EPMs) and Cardiac Rehabilitation (CR) Incentive Payment Model, each currently set to … Continue Reading

CMS Delays Implementation of New Payment Models (Again)

Kenneth YoodBy Kenneth Yood on Posted in Centers for Medicare and Medicaid Services ("CMS")
On March 21, 2017, the Centers for Medicare and Medicaid Services (“CMS”) published an interim final rule (“Interim Final Rule”) delaying (i) the effective date of several new Medicare payment models developed by the CMS Innovation Center to advance care coordination, and (ii) the implementation of updates to an additional existing model.… Continue Reading

Medicaid Demonstration Waivers: A Shorter Path to Increasing State Control Over Healthcare Policy?

Steven ChananieBy Steven Chananie on Posted in Affordable Care Act (ACA), Centers for Medicare and Medicaid Services ("CMS")
Seema Verma’s nomination to head the Centers for Medicare and Medicaid Services (CMS) places Section 1115 Medicaid demonstration waivers into increasing spotlight. This article explores some of the current applications of waiver authority and the role it may play in the new administration.… Continue Reading

House Republicans Push Back on Medicare’s New Mandatory Bundled Payment Models

Kenneth YoodBy Kenneth Yood and Katherine Fragoso on Posted in Centers for Medicare and Medicaid Services ("CMS"), Medicaid, Medicare
On July 25, 2016, the Centers for Medicare & Medicaid Services (CMS) announced a proposed rule that promises to deliver coordinated, high-quality care for Medicare beneficiaries. The proposed rule (effective July 1, 2017) establishes a mandatory bundled payment program for cardiac care and expands the existing hip and knee bundled payment initiative that launched earlier … Continue Reading
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