Health Industry Washington Watch

Updates by Reed Smith on U.S. legislative & regulatory developments affecting the health care industry

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Latest from Health Industry Washington Watch

Health Industry Washington Watch

Medicare Sequestration Extended through FY 2029 under New Budget Law

By Debra A. McCurdy on August 20, 2019

While the latest federal budget agreement signed into law earlier this month provides a reprieve from statutory budget caps for certain defense and domestic programs, it extends Medicare sequestration cuts for an additional two years. Specifically, section 402 of the Bipartisan Budget Act of 2019 (P.L. 116-37) extends the 2% across-the-board reduction to Medicare provider and plan payments through fiscal year 2029. Note that for the last year of sequestration, the Medicare savings are “front…

Health Industry Washington Watch

Medicare Payments to Inpatient Rehabilitation Facilities to Rise 2.5% in FY 2020 under Final CMS Rule

By Debra A. McCurdy on August 19, 2019

The Centers for Medicare & Medicaid Services (CMS) has published its final rule to update the Medicare inpatient rehabilitation facility (IRF) prospective payment system (PPS) for fiscal year (FY) 2020. CMS expects IRF PPS payments to increase by $210 million – or 2.5% – relative to FY 2019 payments under the final rule, due to a 2.9% IRF market basket update reduced by a 0.4 percentage point multifactor productivity adjustment. An IRF that does not…

Health Industry Washington Watch

CMS Issues Final Medicare Inpatient Psychiatric Facility Update for FY 2020

By Debra A. McCurdy on August 19, 2019

The Centers for Medicare & Medicaid Services (CMS) will increase Medicare inpatient psychiatric facility (IPF) prospective payment system (PPS) payments by 1.5%, or $65 million, in fiscal year (FY) 2020 under a recently-published final rule. The final FY 2020 market basket increase is 2.9%, which is reduced by two statutory reductions for an IPF payment rate update of 1.75%. CMS also projects that total payments to IPFs will be further reduced by 0.23 percentage…

Health Industry Washington Watch

CMS Proposes Medicare DMEPOS Policy Updates, Including New Methodology for Pricing New Codes

By Elizabeth B. Carder-Thompson & Debra A. McCurdy on August 19, 2019

The Centers for Medicare & Medicaid Services (CMS) is planning a potentially-significant overhaul of Medicare pricing rules for new items of durable medical equipment (DME), prosthetics, orthotics and supplies (DMEPOS) as part of its proposed annual DMEPOS policy update for calendar year (CY) 2020. The proposed rule also includes DMEPOS competitive bidding program (CBP) updates and proposals to streamline requirements for ordering DMEPOS items. Under a decades-old policy, CMS uses a highly imprecise “gap-fill” process…

Health Industry Washington Watch

CMS Proposes Medicare ESRD PPS Update for CY 2020

By Debra A. McCurdy on August 19, 2019

The Centers for Medicare & Medicaid Services (CMS) has proposed updating Medicare end-stage renal disease (ESRD) prospective payment system (PPS) rates by 1.7% for calendar year 2020. This update reflects a proposed 2.1% market basket increase, partially offset by a -0.4% productivity adjustment. After application of a wage index budget-neutrality adjustment, the proposed CY 2020 ESRD PPS base rate is $240.27, compared with the 2019 rate of $235.27. The same rate would apply to renal…

Health Industry Washington Watch

Medicare Hospice Payments to Rise by $520 Million in FY 2020 under Final CMS Rule

By Debra A. McCurdy on August 16, 2019

The Centers for Medicare & Medicaid Services (CMS) has published its final fiscal year (FY) 2020 Medicare hospice payment rule. CMS forecasts that the final rule will result in an estimated $520 million increase in FY 2020 payments to hospices due to the final hospice payment update percentage of 2.6%. The final FY 2020 hospice cap is $29,964.78, compared with the FY 2019 cap amount of $29,205.44. The rule makes a number of modifications…

Health Industry Washington Watch

CMS Proposes Medicare Physician Fee Schedule Rates and Policies for CY 2020

By Thomas W. Greeson & Debra A. McCurdy on August 15, 2019

The Centers for Medicare & Medicaid Services (CMS) has published its proposed Medicare physician fee schedule (PFS) rule for calendar year (CY) 2020. In addition to updating rates for physician services, CMS proposes changes to numerous other Medicare Part B policies. Highlights of the proposed rule include the following: The proposed 2020 conversion factor (CF) is $36.0896, up slightly from the 2019 CF of $36.0391. CMS also proposes updates to work and practice expense relative value…

Health Industry Washington Watch

CMS Finalizes Medicare SNF PPS Rates and Policies for FY 2020

By Debra A. McCurdy on August 15, 2019

The Centers for Medicare & Medicaid Services (CMS) has published its final rule updating the Medicare skilled nursing facility (SNF) prospective payment system (PPS) for fiscal year (FY) 2020, which begins October 1, 2019. CMS expects SNF PPS payments to increase by 2.4%, or $851 million, in FY 2020, down from the $887 million increase forecasted in the proposed rule. The final update is based on a 2.8% market basket increase offset by a 0.4 percentage…

Health Industry Washington Watch

CMS Proposes 2020 Medicare OPPS and ASC Update, Floats Plan for Hospital Disclosure of Payer-Specific Prices

By Debra A. McCurdy on August 14, 2019

The Centers for Medicare & Medicaid Services (CMS) has published its proposed Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) rates and policies for calendar year 2020. In addition to making annual updates to the OPPS and ASC payment systems, CMS includes a controversial proposal to require all hospitals to disclose payer-specific pricing, including “consumer-friendly” information for hundreds of “shoppable” services. CMS is accepting comments on the proposed rule through September…

Health Industry Washington Watch

HHS OIG Pulls CMP, Safe Harbor Proposed Regs Pending for More Than a Decade

By Elizabeth B. Carder-Thompson & Debra A. McCurdy on August 1, 2019

Seeking to “eliminate any confusion,” the Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) has formally withdrawn proposed civil money penalty (CMP) and anti-kickback (AKS) safe harbor regulations that it no longer intends to finalize. Specifically, the OIG is withdrawing: A 1994 proposed rule that would have codified the OIG’s authority to levy CMPs when a hospital knowingly makes incentive payments to a physician as an inducement for reducing…

Health Industry Washington Watch

Updates by Reed Smith on U.S. legislative & regulatory developments affecting the health care industry

Blog Authors

Medicare Sequestration Extended through FY 2029 under New Budget Law

Medicare Payments to Inpatient Rehabilitation Facilities to Rise 2.5% in FY 2020 under Final CMS Rule

CMS Issues Final Medicare Inpatient Psychiatric Facility Update for FY 2020

CMS Proposes Medicare DMEPOS Policy Updates, Including New Methodology for Pricing New Codes

CMS Proposes Medicare ESRD PPS Update for CY 2020

Medicare Hospice Payments to Rise by $520 Million in FY 2020 under Final CMS Rule

CMS Proposes Medicare Physician Fee Schedule Rates and Policies for CY 2020

CMS Finalizes Medicare SNF PPS Rates and Policies for FY 2020

CMS Proposes 2020 Medicare OPPS and ASC Update, Floats Plan for Hospital Disclosure of Payer-Specific Prices

HHS OIG Pulls CMP, Safe Harbor Proposed Regs Pending for More Than a Decade

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