On September 10, the Biden-Harris Administration, in conjunction with the Department of Health and Human Services (HHS), announced that $25.5 billion in relief funds will be distributed to healthcare providers through the Health Resources and Services Administration (HRSA). The American Rescue Plan (ARP) will provide $8.5 billion in funding and an additional $17 billion will be distributed as Phase 4 Provider Relief Funds (PRF).
Continue Reading Healthcare Providers to Receive $25.5 Billion in Relief Funds

By October 1, 2021, hospices will need to update their election addendum form to address a change made by the Centers for Medicare & Medicaid Services (CMS) in the final rule. The government has provided much-needed clarification and flexibility to certain aspects regarding the addendum. When should hospices provide the addendum to patients? What should hospices do if a patient refuses a signer’s discharge prior to signing the addendum? In this episode we answer these questions and discuss other key changes related to the addendum announced in the final rule: https://bit.ly/3zx5SGJ
Continue Reading Parsing Out Changes in the Election Addendum Made by the Final Hospice Wage Index Rule

On October 1, 2020 the Department of Health and Human Services (“HHS”) announced that it will distribute a total of $20 billion as part of Phase 3 of the Provider Relief Funds. The application for Phase 3 funding is now open and will be available from October 5 – November 6, 2020. However, HHS has urged providers to apply early, which may be an indication that the funds will be available on a first-come first-serve basis.

Below are some key details regarding Phase 3:
Continue Reading HHS Opens Application for $20 Billion of Phase 3 General Distribution Provider Relief Funds

Updated Thursday, April 2, 2020

CMS 1135 waivers allow the U.S. Dep’t of Health and Human Services Secretary to temporarily waive or modify certain Medicare, Medicaid, Children’s Health Insurance Policy (CHIP), and Health Insurance Portability and Accountability Act (HIPAA) requirements to ensure that sufficient health care items and services are available to meet needs during a declared public health emergency.  Individual health care providers and associations may trigger additional waivers through feedback and requests to the Assistant Secretary for Preparedness and Response or CMS Regional Offices.
Continue Reading COVID-19 Update: Kansas 1135 Waivers and State Flexibilities

Updated Thursday, April 2, 2020

CMS 1135 waivers allow the U.S. Dep’t of Health and Human Services Secretary to temporarily waive or modify certain Medicare, Medicaid, Children’s Health Insurance Policy (CHIP), and Health Insurance Portability and Accountability Act (HIPAA) requirements to ensure that sufficient health care items and services are available to meet needs during a declared public health emergency.  Individual health care providers and associations may trigger additional waivers through feedback and requests to the Assistant Secretary for Preparedness and Response or CMS Regional Offices.
Continue Reading COVID-19 Update: Missouri 1135 Waivers and State Flexibilities

On March 24, 2020, the Wisconsin Department of Health Services (DHS) prepared correspondence to the Center for Medicare and Medicaid Services (CMS) seeking waivers of certain Medicaid requirements pursuant to Section 1135 of the Social Security Act (42 U.S.C. § 1320b-5) due to the COVID-19 pandemic. The correspondence to CMS was shared on March 24, 2020 with the Wisconsin Legislature Joint Committee on Finance seeking their approval to submit the Section 1135 Waiver to CMS. The letter to CMS prepared by DHS states that Wisconsin is implementing all the blanket waivers issued by CMS on March 13, 2020 in Medicare, Medicaid and the Children’s Health Insurance Program (CHIP), to the extent applicable.
Continue Reading Wisconsin DHS requests authority to seek additional Medicaid Waivers from CMS

physicians

COVID-19 Update: CMS Waiver Information for Private Practice Physicians and Non-Physician Practitioners

By Hal Katz and Tamar E. Hodges

President Donald Trump declared the coronavirus pandemic a National Emergency on March 13, 2020. This declaration granted the Department of Health and Human Services (HHS) Secretary Alex Azar authority to relax certain Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) requirements set forth in Section 1135 of the Social Security Act. The primary purpose of this waiver is to give providers greater flexibility to meet the needs of Medicare, Medicaid, and CHIP beneficiaries during an emergency.  CMS may issue “blanket waivers” after a declaration of a public health emergency when it determines many “similarly situated providers” would require certain waivers. CMS requires providers to put the state licensing agency and CMS Regional Office on notice if it intends to modify their operations in light of such waivers, although the blanket waivers are essentially automatic and, therefore, do not require the provider to submit a request. The waiver is in effect through the duration of the emergency or until CMS terminates the waiver.
Continue Reading COVID-19 Update: CMS Waiver Information for Private Practice Physicians and Non-Physician Practitioners

As provided in the Texas Register on March 22, 2019, the Texas Health and Human Services Commission (“HHSC”) has proposed several amendments to Title 1 of the Texas Administrative Code, which include amendments to the rules and procedures for preventing and investigating Medicaid fraud and abuse.
Continue Reading Texas Health & Human Services Proposes Amendments to Fraud and Abuse Rules

First in a series.

Like it or not, the 2020 presidential election campaign is well underway. With it comes the latest in public policy ideas, including more attempts to overhaul health care in the U.S.

The phrase “Medicare for All” has captured the minds, if not the hearts, of several candidates and an impressive portion of the voting public. It has shifted the conversation about health care in politics, at least temporarily, away from both “repeal and replace” and “protect the Affordable Care Act.”
Continue Reading Medicare for All…or Is It?

This is the third article in our series on the new “Pathways” rules for Accountable Care Organizations.  Our first two articles in the series can be found here.

The Centers for Medicare and Medicaid Services (CMS) issued its anticipated final rule revising the Medicare Shared Savings Program to improve cost savings and quality.

With the changes in the final rule, the revamped program, called “Pathways to Success,” is projected to save Medicare $2.9 billion over 10 years—that’s $0.7 billion more than projected in the proposed rule issued August 9, 2018.
Continue Reading The “Pathways to Success” Final Rule is Here: ACO’s Face Big Decisions