Legal Alerts
HOSPITALS WITH NURSING UNITS PREPARE FOR FEDERAL MINIMUM NURSE STAFFING REQUIREMENTS
CMS is expected to release a much-anticipated final rule soon that may adopt minimum staffing requirements for long-term care facilities. If finalized, this would be the first time that the federal government has regulated individual minimum staffing levels in SNFs and NFs. CMS says that the proposed requirements were developed based on a 2022 study of nursing home staffing, prior public comments on staffing ...
LEGISLATIVE AND REGULATORY DEVELOPMENTS IN THE PROVISION OF SUBSTANCE USE DISORDER SERVICES
In recent years, Congress and CMS have made concerted efforts to address ongoing addiction crises in the United States by expanding access to and coverage of substance use disorder treatment services. Specifically, there have been significant developments in the expansion of health care entities that provide substance use disorder (“SUD”) services and obtain reimbursement from Medicare.
PROPOSED MEDICARE PAYMENT CUTS CONTINUE TO PRESSURE OUTPATIENT THERAPY SERVICES
CMS recently issued the CY 2024 Physician Fee Schedule (“PFS”) Proposed Rule that includes the proposed payment rates and policy changes for the upcoming payment year starting on January 1, 2024. Unfortunately, CMS is once again projecting that its proposed payment rates and policies will result in decreased Medicare payments for the physical therapy and occupational therapy specialty.
NEW REVIEW CHOICE DEMONSTRATION (RCD) PROGRAM FOR INPATIENT REHABILITATION FACILITY (IRF) SERVICES
CMS is instituting a new claim review policy for Inpatient Rehabilitation Facilities (“IRFs”) through a program called Review Choice Demonstration (“RCD”). Complete information regarding this new review policy can be found in the program Operation Guide, FAQ document, and Flow Chart. The claim review policy will require all IRF claims for Medicare Fee-for-Service (“FFS”) reimbursement to be reviewed
FEDERAL COURT RULES THAT AGENCY DECISION AFFIRMING QUALITY REPORTING PROGRAM PENALTY BASED ON TYPO WAS ARBITRARY AND CAPRICIOUS
The court’s opinion is a strongly worded rebuke of the “Kafkaesque regulatory labyrinth for hospitals” the agency created in the LTCH Quality Reporting Program, and the agency’s failure to “navigate it themselves.” The court confirmed that the hospital submitted its quality data timely to CDC which did not send data to CMS. We represented the hospital in this case.
FEDERAL COURT STRIKES DOWN “MUST-BILL” REQUIREMENTS FOR DUAL ELIGIBLE BAD DEBTS OF NON-MEDICAID-PARTICIPATING PROVIDERS
In a long-running challenge to denied Medicare bad debts by 75 LTCHs in 26 states and spanning 6 fiscal years, the United States District Court for the District of Columbia ruled that CMS should not have required them to bill the state Medicaid programs and obtain a remittance advice with a payment determination (i.e., the “must-bill” policy).