Tag Archives: Hospitals

CMS to Repay Hospitals Millions After Court Finds Reduction in Rates Improper

By David Gilboa on Posted in Hospitals and Health Systems, Legislation, Medicare and Medicaid, Reimbursement

On December 12, 2019, the Centers for Medicare and Medicaid Services (CMS) announced that it will automatically reprocess claims which had been reimbursed at a reduced rate in 2019 under the site-neutral payment policy and pay hospitals monies that were withheld due to the policy.

In November 2018, CMS promulgated a Final Outpatient Prospective Payment System (OPPS) Rule and implemented its site-neutral payment policy, which cut Medicare reimbursement rates for outpatient hospital services provided at certain off-campus, provider-based departments (PBDs) to the lower Physician Fee Schedule (PFS) rate for the …

Starting in 2020, Connecticut Hospitals Will Be Required to Test for Spinal Muscular Atrophy in Newborns

By Robinson+Cole's Health Law Group on Posted in 2019 Connecticut Legislative Update, Legislation

On July 9, 2019, Connecticut Governor Ned Lamont signed into law Public Act No. 19-176 (PA 19-176), “An Act Concerning Newborn Screening for Spinal Muscular Atrophy.” Starting on January 1, 2020, this law requires hospitals and other institutions that care for newborn infants to screen such infants for spinal muscular atrophy. As with other statutory requirements for newborn infant screening under Connecticut law – including testing for HIV, phenylketonuria, sickle cell disease, cystic fibrosis, and critical congenital heart disease – the requirement to test for spinal muscular atrophy …

Connecticut Enacts Legislation to Address Hospital-Insurer Network Conflicts

By Robinson+Cole's Health Law Group on Posted in 2018 Connecticut Legislative Update, Commercial Health Insurance, Hospitals and Health Systems, Legislation, Reimbursement

On June 6, 2018, Connecticut Governor Dannel P. Malloy signed into law Public Act No. 18-115 “An Act Concerning Disputes Between Health Carriers and Participating Providers That Are Hospitals” (PA 18-115). This legislation updates state laws concerning the departure or removal of a hospital from an insurance carrier’s provider network. PA 18-115 takes effect July 1, 2018.…

CMS Updates Hospital Compare Website

By Nathaniel Arden on Posted in Hospitals and Health Systems

CMS recently announced updates to its Hospital Compare website. CMS provides the Hospital Compare website to give patients, their families and other health care stakeholders information on the performance of hospitals participating in Medicare. CMS also provides a star rating for each hospital to assist patients in choosing a hospital for their care. CMS updated the star rating methodology in response to feedback from hospitals and other industry stakeholders. In addition to changes to the statistical modeling used, CMS has decreased the emphasis on patient experience and increased the importance …

REMINDER: Annual Reporting Deadline Approaches for Connecticut Hospitals and Hospital Systems

By Conor Duffy on Posted in Government Enforcement, Hospitals and Health Systems, Physicians and Allied Health Professionals

Hospitals and hospital systems in Connecticut must file annual reports by January 15, 2018 describing (1) the activities of their group practices (e.g., medical foundations or faculty practice plans), and (2) their respective affiliations with other hospitals or hospital systems.

Under Section 19a-486i of the Connecticut General Statutes, hospitals and hospital systems in Connecticut are obligated to file the separate reports in writing on an annual basis with the Connecticut Attorney General (AG) and Department of Public Health (DPH).  Previously, the reports had been due by December 31 each year, …

OIG Publishes Prioritized Recommendations for HHS

By Robinson+Cole's Health Law Group on Posted in Hospice, Hospitals and Health Systems, Medicare and Medicaid, Nursing Facilities, Office of Inspector General

The OIG has released the 2017 Compendium of Unimplemented Recommendations, summarizing prioritized recommendations relating to HHS programs and operations.   Topping the list are recommendations relating to hospitals, including:

  • Reimbursement rates for critical access hospital swing beds should be adjusted to the lower rates for similar services provided in skilled nursing facilities.
  • Reimbursement rates for hospital outpatient department procedures should be adjusted to the lower rates for similar procedures conducted in ambulatory surgical centers.
  • Medicare should adopt a hospital transfer payment policy to lower hospital reimbursement for beneficiaries who are
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Massachusetts’ Health Policy Commission Further Limits Health Care Cost Growth

By Nathaniel Arden on Posted in Hospitals and Health Systems, Medicare and Medicaid, Physicians and Allied Health Professionals

On March 29, 2017, the Massachusetts Health Policy Commission voted to decrease its annual health care cost growth benchmark from 3.6 percent to a 3.1 percent, effective in 2018. The benchmark applies to hospitals, certain physician groups and individual health insurers. The Commission also voted to finalize regulations to require those entities that fail to comply with the benchmark to file and follow performance improvement plans. Non-compliant entities will be subject to oversight by the Commission, during which they will be required to file monthly progress reports and demonstrate that …

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