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

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CMS Issues the 2022 Medicare Advantage Advance Notice Part I – Risk Adjustment

Christine ClementsBy Christine Clements on Posted in Centers for Medicare and Medicaid Services ("CMS")
On September 14, 2020, the Centers for Medicare & Medicaid Services (“CMS”) issued the Advance Notice of Methodological Changes for Calendar Year (CY) 2022 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies – Part I, CMS-HCC Risk Adjustment Model (the “Advance Notice”).  CMS is issuing the Advance Notice in … Continue Reading

HHS OIG Issues Report Critical of Medicare Advantage Risk Adjustment Practices

Christine ClementsSusan IngargiolaBy Christine Clements and Susan Ingargiola on Posted in Centers for Medicare and Medicaid Services ("CMS"), Medicare
Earlier this month, the U.S. Department of Health and Human Services Office of the Inspector General (the “OIG”) released a report highlighting concerns about the extent to which Medicare Advantage Organizations (“MAOs”) are using health risk assessments (“HRAs”) to improve care and health outcomes under the Medicare Advantage Program (“MA”), as intended, and about the … Continue Reading

Nursing Home Liability Waivers and Nursing Home Investigations and Enforcement: A Delicate Balance During the COVID-19 Pandemic

Kenneth YoodTheresa ThompsonBy Kenneth Yood and Theresa Thompson on Posted in Centers for Medicare and Medicaid Services ("CMS"), Coronavirus
As we discussed in our April 27, 2020 blog post, nursing homes have become the focus of significant attention during the COVID-19 crisis.  In many respects, the attention is well deserved: Nursing homes traditionally serve seniors who often struggle with chronic health conditions. As a result, nursing home residents are particularly vulnerable to coronavirus infection … Continue Reading

CMS Updates Waivers, Provides More Flexibility for Providers Responding to COVID-19

Michael PaddockErica KrausBy Michael Paddock and Erica Kraus on Posted in Centers for Medicare and Medicaid Services ("CMS"), Coronavirus, Medicare, Telehealth
As the COVID-19 emergency continues to heavily impact the U.S. and its health care system, CMS has issued additional flexibilities for providers and payors seeking to respond to the pandemic.  These new flexibilities are described both in revisions to CMS’ blanket waivers and in a new Interim Final Rule with comment period, both issued on … Continue Reading

Even in a Crisis, Stark Law Compliance Demands Attention: CMS Issues Explanatory Guidance on Stark Law Blanket Waivers

Michael PaddockErica KrausTheresa ThompsonBy Michael Paddock, Erica Kraus and Theresa Thompson on Posted in Centers for Medicare and Medicaid Services ("CMS"), Coronavirus
On April 21, 2020, the Centers for Medicare and Medicaid Services (“CMS”) released “Explanatory Guidance” related to the March 30, 2020 Blanket Waivers of Section 1877(g) of the Social Security Act (information about those waivers available in our previous blog post here), applicable during the COVID-19 public health emergency (“PHE”). The Explanatory Guidance clarifies the … Continue Reading

CMS Issues COVID-19 Prevention Guidance for PACE Organizations

Matthew GoldmanJordan GrushkinMelissa GertlerBy Matthew Goldman, Jordan Grushkin and Melissa Gertler on Posted in Centers for Medicare and Medicaid Services ("CMS"), Coronavirus
On March 17, 2020, the Centers for Medicare & Medicaid Services (“CMS”) issued a memorandum to provide information to organizations that participate in the Programs of All-Inclusive Care for the Elderly (“PACE”) program in furtherance of preventing the spread of the 2019 Novel Coronavirus (“COVID-19”).… Continue Reading

CMS “Hospitals Without Walls” Waiver: Looking To ASCs to Provide Relief

Steven ChananieMichael McKinnonMichael PaddockBy Steven Chananie, Michael McKinnon and Michael Paddock on Posted in Centers for Medicare and Medicaid Services ("CMS"), Coronavirus
On March 30, 2020, CMS through its blanket 1135 waiver authority[1] implemented a “Hospital without Walls” policy to allow hospitals to provide and bill for hospital services in other healthcare facilities and sites, such as ambulatory surgery centers (“ASCs”).  The waiver is intended to ensure that local hospitals and health systems have the capacity to … Continue Reading

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
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