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Focus on Regulation

Tag Archives: Medicare

U.S. Senate passes bill requiring prescription drug ads to include prices

On Thursday, the U.S. Senate passed (85-7) the fiscal year 2019 minibus appropriations bill (H.R.6157) that would fund the Departments of Labor, Health and Human Services (HHS), and Education, attaching to it a large amendment package.  The bill includes S.Amdt. 3964, an amendment introduced by Sens. Richard Durbin (D-IL) and Chuck Grassley (R-IA) that provides

Medicare Inpatient Hospital Final Rule for Fiscal Year 2014 Released; Includes Changes to Inpatient Admission and Rebilling Policies

The Centers for Medicare & Medicaid Services released the Hospital Inpatient Prospective Payment System (IPPS) final rule for fiscal year (FY) 2014 on August 2, 2013.  The final rule addresses changes in payment rates for general acute care and long-term care hospitals effective October 1, 2013, as well as revisions to the Hospital Value-Based Purchasing

CMS Issues New Notice on Its National Coverage Determination Process

CMS has issued a notice announcing updates to the process it uses for opening, deciding, or reconsidering national coverage determinations (NCDs).  The notice provides further guidance on external requests and internal review for new or reconsidered NCDs.  Perhaps the most novel aspect of the notice is a new “expedited administrative process” to remove certain NCDs,

Medicare Inpatient Hospital Proposed Rule for Fiscal Year 2014 Released

The Centers for Medicare & Medicaid Services (CMS) released the Hospital Inpatient Prospective Payment System (IPPS) proposed rule for fiscal year (FY) 2014 on April 26, 2013.  The proposed rule addresses changes in payment rates for general acute care and long-term care hospitals effective October 1, 2013, as well as revisions to the Hospital Value-Based

Obama Releases Budget Proposal

On April 10, 2013, President Obama released his Fiscal Year (FY) 2014 budget proposal.  As reported widely in the days leading up to the budget’s release, it included numerous health proposals that would together generate approximately $400 billion in savings over the next 10 years. Many of these proposals also appeared in the President’s FY

CMS Innovation Center Launches New Medicare ESRD Shared Savings Program

The Centers for Medicare and Medicaid Services (CMS) recently announced the launch of the Comprehensive ESRD Care (CEC) Initiative to test an innovative Medicare payment model to improve care for Medicare beneficiaries with End Stage Renal Disease (ESRD), while decreasing costs to Medicare. CMS hosted a call to discuss the new initiative on February 5,

Supreme Court Reverses D.C. Circuit in Medicare Equitable Tolling Case

The Supreme Court issued a unanimous opinion today reversing a D.C. Circuit decision that held that the 180-day statutory deadline for providers to appeal reimbursement determinations to the Provider Reimbursement Review Board (PRRB) is subject to equitable tolling. In this case, the hospitals sought to challenge their disproportionate share hospital (DSH) payments ten years after

Going Over the Overpayment Cliff

Buried in the American Taxpayer Relief Act of 2012 (“ATRA”), the fiscal cliff legislation President Obama signed into law on January 2, 2013, is a seven-line provision amending the Social Security Act by extending the so-called “statute of limitations” for recovering Medicare overpayments. ATRA Section 638 appears to implement HHS-OIG’s May 2012 recommendation to CMS

CMS Releases New List of Potential NCD Topics

On November 27, 2012, the Centers for Medicare & Medicaid Services (CMS) released a new list of Potential National Coverage Determination (NCD) Topics.  This list was released more than a year after CMS had solicited public input on items and services that may be inappropriately used or provide minimal benefit or items and services that

CMS Announces First “Qualified Entities” To Receive Medicare Data under Affordable Care Act Program

As part of the Patient Protection and Affordable Care Act, Congress created a new program making certain Medicare data available to “qualified entities” for the “the evaluation of the performance of providers of services and suppliers.”  On December 7, 2011, CMS published a final rule implementing the data use program, which it refers to as

Medicare Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center Final Rule

CMS released a single final rule addressing calendar year (CY) 2013 Medicare payments for hospital outpatient departments and ambulatory surgical centers (ASCs). Under the final rule, Medicare’s payment rates for hospital outpatient services will increase 1.8% overall.  CMS also plans to increase by 0.6% the payment rate to ASCs. CMS estimates that CY 2013 payments to hospitals

CMS Releases Final Rules on Home Health, Primary Care and Dialysis Facility Payments

In a busy week leading up to the election, CMS released several final rules, including final rules pertaining to the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS), Medicaid payments made to certain primary care physicians and the Home Health Prospective Payment System. ESRD PPS Final Rule In a final rule released on November 2nd, CMS

Obama Administration Releases Report on Sequestration

Many questions about the effects of the anticipated mandatory reductions in federal spending required by the Budget Control Act (BCA) remain unanswered after the Obama Administration released a report required by the Sequestration Transparency Act of 2012.  The report, released on September 14, 2012, provides preliminary estimates of the reductions required to 1,200 accounts in

Medicare Inpatient Hospital Rule for Fiscal Year 2013 Finalized

The Centers for Medicare & Medicaid Services (CMS) finalized the Hospital Inpatient Prospective Payment System (IPPS) rule for fiscal year (FY) 2013 on August 1, 2012.  The final rule addresses changes in payment rates for acute care and long-term care hospitals effective October 1, 2012, as well as revisions to the Hospital Value-Based Purchasing Program and

Seeing Green: CMMI Announces More Money for State Innovation

CMS’s Center for Medicare and Medicaid Innovation (CMMI) announced on July 19 $275 million in new federal grant money for states interested in designing and testing new approaches to delivering health care in order to “bolster health care quality and decrease costs.”  CMS expects that states participating in this “State Innovation Models Initiative” will work

Money! Money! Money!

CMS released three proposed rules addressing Medicare payment changes for calendar year (CY) 2013 for physicians, hospital outpatient departments and ambulatory surgical centers and home health agencies on Friday, July 6, 2012. The proposed rules will be published in the Federal Register on July 30, 2012, and comments for all three proposed rules are due

Holiday Reading for the Dialysis Industry – CMS Proposed Rule on 2013 Dialysis Payment System

Just in time for the 4th of July holiday, CMS released its proposed rule addressing the End-Stage Renal Disease (ESRD) prospective payment system (PPS) for calendar year 2013.  Calendar year 2013 represents the third year of a transition period, in which some dialysis facilities are paid based on a combination of 75% of the ESRD PPS amounts and 25% of

Is Inherent Reasonableness Coming Back to CMS?

Six and a half years after CMS promulgated regulations for the use of “inherent reasonableness” authority to alter a payment rate, CMS is considering applying this little used authority to Medicare payment levels for non-mail order diabetic testing supplies. In 2011, a competitive bidding process for the mail order equivalent of such supplies resulted in an

MEDCAC Discusses Future of Coverage with Evidence Development

The Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) held a day-long meeting on May 16, 2012 to discuss Coverage with Evidence Development (CED). This meeting is part of a larger effort by CMS to reconsider its use of CED, a Medicare policy in which an item or service that would not otherwise be considered

Rules Reducing Provider Burden Could Save Them More than $1.1 Billion

The Centers for Medicare & Medicaid Services (CMS) finalized two rules that together are expected to reduce costs for hospitals and other health care providers by over $1.1 billion.  The rules come in response to President Obama’s January 18 Executive Order 13563, which called upon agencies to review existing regulations and to “modify, streamline, expand,

Medicare Inpatient Hospital Rule for Fiscal Year 2013 Released

The Centers for Medicare & Medicaid Services (CMS) released the Hospital Inpatient Prospective Payment System (IPPS) proposed rule for fiscal year (FY) 2013 on April 24, 2011.  The proposed rule addresses changes in payment rates for acute care and long-term care hospitals effective October 1, 2012, as well as revisions to the Hospital Value-Based Purchasing