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CMS Adopts 2019 ACA Health Plan Policies
CMS has released its final rule updating policies applying to qualified health plans (QHPs) offered on Affordable Care Act (ACA) Exchanges for 2019.
Reed Smith
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CMS Announces Acute Hospital Care At Home Program To Accommodate COVID-19 Surge
On November 25, 2020, the Centers for Medicare & Medicaid Services (CMS) announced an Acute Hospital Care At Home program designed to increase hospital capacity during the COVID-19 surge.Wyatt, Tarrant & Combs - Article
CMS Cancels Two Bundled Payment Models & Announces More Voluntary Bundles
On November 30, 2017, the Centers for Medicare and Medicaid Services ("CMS") canceled mandatory hip fracture and cardiac bundled payment models and implemented changes to the Comprehensive Care for Joint Replacement ("CJR") model.Carlton Fields - Article
CMS Considering New Medicare Advantage Payment Arrangement Incentive (MAQI) Demonstration
CMS is planning a new "Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) Demonstration" that would allow clinicians who participate in certain Medicare Advantage (MA) ...Reed Smith - Article
CMS Declines to Adopt National Coverage Policy on Gender Reassignment
On June 2, the Centers for Medicare & Medicaid Services (CMS) published a proposed decision memo on gender dysphoria and gender reassignment surgery which continues the existing policy of allowing local Medicare contractors to determine coverage on an individual basis.Day Pitney LLP - Article
CMS Delays Enforcement Date for Prescriber Enrollment in Medicare Part D - Again
The Centers for Medicare & Medicaid Services (CMS) announced through a fact sheet released on October 31 that it is again delaying the new Medicare Part D rule requiring physicians and other prescribers to enroll in Medicare before prescribing drugs under Medicare Part D.Day Pitney LLP - Article
CMS Extends Medicare Prior Authorization Program For Repetitive Scheduled Non-Emergent Ambulance Transport
CMS is extending for another year the Medicare prior authorization program for repetitive, scheduled non-emergent ambulance transport services rendered by ambulance providers in selected states.Reed Smith - Article
CMS Finalizes Changes To Medicare Shared Savings Program/ACO Benchmark Rebasing Rules
CMS has published a final rule that revises the methodology CMS uses to measure the performance of accountable care organizations (ACOs) in the Medicare Shared Savings Program.Reed Smith - Article
CMS Guidance on Off-Campus Provider-Based Department Policy Changes
CMS recently released guidance on how hospitals can request from their CMS Regional Office a relocation exception from site-neutral payment rates for an excepted off-campus department of a provider due to an extraordinary circumstance, in conformance with the 2017 Medicare Outpatient Prospective Payment System Final RuleReed Smith - Article
CMS Issues Preliminary 2017 Medicare Clinical Lab Payment Determinations, Final 2016 Gap Fill Amounts
CMS has released the preliminary 2017 Medicare clinical laboratory fee schedule (CLFS) payment determinations for new and reconsidered test codes, including determinations regarding whether CMS will use crosswalking or gapfilling to establish payment rates for specific tests.Reed Smith - Article
CMS Posts Corrections To July 2016 DMEPOS Fee Schedule Rates
CMS has identified errors in its July 2016 update to Medicare durable medical equipment prosthetic orthotics and supplies fee schedule amounts for certain items in non-competitive bidding areas.Reed Smith - Article
CMS Proposes Changes to Bundled Payment Initiatives
The Centers for Medicare and Medicaid Services (CMS) has proposed the elimination of bundled payment program initiatives whose implementation has already been twice delayed, as previously discussed here.Day Pitney LLP - Article
CMS Proposes Extension Of Medicare Self-Referral Disclosure Protocol Lookback Period To Six Years
Under the currently-approved process, a party must provide a financial analysis of overpayments arising from actual or potential violations of the Stark Act based on a 4-year lookback period.Reed Smith - Article
CMS Proposes Updates To ACA Exchange Plan Policies For 2021
The Centers for Medicare & Medicaid Services (CMS) has proposed updates to its standards for health plan issuers offering plans ...Reed Smith - Article
CMS Revises Enforcement Guidance—Again
After the publication of our Legal Alert on the Supreme Court decision lifting the stay on the Omnibus COVID-19 Health Care Staff Vaccination Interim Final Rule (the "Rule")...Snell & Wilmer - Article
CMS Selects Regions For Primary Care Innovation Model
CMS has opened the application period for physician practices interested in participating in its new primary care model, Comprehensive Primary Care Plus (CPC+), ..Reed Smith - Article
CMS Update On Temporary "Two Midnight" QIO Review Pause
CMS has temporarily "paused" Beneficiary and Family Centered Care (BFCC) Quality Improvement Organizations' (QIOs) performance of initial patient status reviews under CMS's "two-midnight policy" for short hospital stays.Reed Smith - Article
Expansive New CMS Enrollment And Participation Rules Set To Go Live November 4, Although Comments Still Being Accepted
The Centers for Medicare & Medicaid Services (CMS) has published a final rule with comment period establishing sweeping disclosure and monitoring obligations for providersReed Smith - Article
New Medicare Coverage for Alzheimer's Disease Drugs
Centers for Medicare & Medicaid Services (CMS) recently announced that Medicare will cover drugs that could slow the progression of Alzheimer's disease, if the Food and Drug Administration (FDA) grants...Katten - Article
Newest CMS Innovation Model Targets Medicare Payment For Emergency Ambulance Services
The Centers for Medicare & Medicaid Services (CMS) plans to test a new voluntary emergency ambulance service innovation model that seeks promote "the most appropriate level of careReed Smith