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HHS Continues the “Sprint to Coordinated Care”

September 28, 2018 | Blog | By Daryl Berke

On August 27, 2018 the Office of the Inspector General (OIG) of the Department of Health and Human Services (HHS) issued a request for information (RFI) seeking comment on the anti-kickback statute (AKS) and the beneficiary inducement prohibition to the civil monetary penalties (CMP) as potential barriers to coordinated and value-based care. The August 27 RFI was the second RFI issued as part of HHS’s “Regulatory Sprint to Coordinated Care,” an ongoing effort to accelerate the transition from fee for-service to a value-based system that emphasizes care coordination.
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CMS Proposes to Overhaul the Medicare Shared Savings Program

August 23, 2018 | Blog

On August 9, 2018, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule to overhaul the Medicare Shared Savings Program (MSSP).
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CMS Focuses on a Modern Medicare

July 23, 2018 | Blog | By Bridgette Keller

Earlier this month, CMS proposed changes to the Medicare Physician Fee Schedule and Quality Payment Program with the goal of “modernizing Medicare and restoring the doctor-patient relationship.”
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Opioids Have Our Attention

June 21, 2018 | Blog | By Bridgette Keller

The government is focusing on opioids.  Whether it be program policies, enforcement, or legislation, combating the opioid epidemic continues to be a major focus for government officials.  It is also a major piece of the health care legislation moving in both the House and the Senate.
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ML Strategies Health Care Preview - Week of April 16th

April 16, 2018 | Blog

Congress will continue its work in addressing the opioid crisis this week with a hearing in the Senate Finance Committee. There were reports last week that Congress will also consider legislation around telemedicine, which is sure to capture stakeholders attention.
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MedPAC Recommends Significant Changes to MACRA

April 5, 2018 | Blog

In March, the Medicare Payment Advisory Commission (MedPAC) released its biannual report to Congress on matters affecting the Medicare program. MedPAC is an independent congressional agency that advises Congress on issues relating to Medicare.
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Hospitals and Others Respond to "Red Tape Relief Project" Requests

August 30, 2017 | Blog

Last week, a number of health care industry associations sent letters to Congress detailing ways in which the government could relieve them of the burdens associated with "red tape." The letters are in response to the first stage of a House initiative dubbed the "Medicare Red Tape Relief Project," which was announced earlier this summer by the House Committee on Ways and Means' Subcommittee on Health.
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CMS Proposes to Cancel Bundled Payment and Incentive Models

August 21, 2017 | Blog

The U.S. Centers for Medicare & Medicaid Services (CMS) published a proposed rule last week regarding the cancellation of three bundled payment models and an incentive payment model while also reducing the scope of a third type of payment model.
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CBO Greenlights Telehealth Provisions in Senate’s CHRONIC Care Act

May 25, 2017 | Blog | By Carrie Roll

Last week, the Congressional Budget Office (CBO) concluded that a key piece of telehealth legislation, the CHRONIC Care Act of 2017, would not, overall, increase or decrease Medicare spending.
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Insiders Say New MACRA Rule Likely as Providers Look to Sec. Price to Ease Burden

May 2, 2017 | Blog

The Trump administration is considering releasing a rule to ease the burden that small practices are facing in trying to comply with the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), according to a recent report in The Hill.
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Changes Needed to Stark Law Advisory Opinion Process

March 29, 2017 | Blog

The Stark Law has caused angst for many a physician and many a health care lawyer over the years. The Stark Law has also troubled hospital and health system CEOs looking for ways to align incentives with physicians. Some stakeholders say Congress should do away with the myriad statutes and regulations that comprise the strict liability federal law banning physician self-referral.
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Pharmaceutical Manufacturers and Healthcare Leaders cite Fraud and Abuse Laws as Obstacle to Value-Based Arrangements

March 15, 2017 | Blog | By Theresa Carnegie, Lauren Moldawer

As the healthcare industry moves towards value-based purchasing, pay-for-performance, and other payment reform models, industry leaders have identified federal fraud and abuse laws as a barrier to full implementation of such models.
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Medicare Advisors Debate Part B Drug Payment Reforms

March 10, 2017 | Blog | By Carrie Roll

Last week, the Medicare Payment Advisory Commission (the “Commission”) debated a package of policy reforms that would change the way Medicare reimburses physicians for Medicare Part B drugs.
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Massachusetts Determination of Need Program – Final Regulations

January 23, 2017 | Blog | By Daria Niewenhous

The Massachusetts Department of Public Health (DPH) Determination of Need (DoN) Program has promulgated final DoN regulations.
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OIG Report Offers Glimpse into CMS Progress Towards MACRA Implementation

December 28, 2016 | Blog

Last week, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services released a report analyzing CMS' readiness to implement major parts of the Medicare Access and CHIP Reauthorization Act  of 2015 (MACRA).
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The Medicare Part B Demo May be Dead, but Drug Pricing Concerns Still Linger

December 16, 2016 | Blog | By Lauren Moldawer

The Centers for Medicare & Medicaid Services (CMS) has withdrawn its controversial rule implementing the Medicare Part B payment demonstration. The agency stated that after consideration of the comments, it will not move forward with the demo.
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The Future of the Medicare Part B Payment Demo under a Republican-held Congress

November 29, 2016 | Blog | By Theresa Carnegie, Lauren Moldawer

There has been much controversy over the Medicare Part B payment demonstration proposed by the Center for Medicare and Medicaid Innovation (CMMI) in March 2016.
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Promise to Repeal the ACA Poses Threat to MACRA Implementation

November 21, 2016 | Blog

Most of the post-election discussion of the ACA has focused on how promises to repeal the law could impact the newly insured. But one priority area of the ACA that has received very little discussion is the federal government's strategy to try to reign in health care costs by reducing volume and promoting quality.
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Will Republicans Embrace CMMI’s Authority?

November 18, 2016 | Blog | By Lauren Moldawer

The Affordable Care Act (ACA) and the Medicare and CHIP Reauthorization Act (MACRA) provided the Centers for Medicare & Medicaid Services (CMS) and the newly created Center for Medicare and Medicaid Innovation (CMMI) tremendous authority.  With Republicans set to take control of both the White House and Congress, the future of that authority is very much in question.
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2017 OIG Work Plan: For Medicare Plans

November 16, 2016 | Blog | By Tara E. Dwyer

Last week, the OIG posted its Work Plan for 2017.  In it, the OIG announced many goals touching on programs including, but not limited to, Medicare, Medicaid, Insurance Marketplace (Health Exchanges), Indian Health Service, TANF and Head Start.  Below are some of the OIG’s action items that Medicare Advantage and Part D plans should be aware of.
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