April 2015 Archives

What Does the Medicare Access and CHIP Reauthorization Act of 2015 Mean for Health Care Providers?

On Friday, April 17, President Barack Obama signed into law the Medicare Access and CHIP Reauthorization Act of 2015, repealing the "sustainable growth rate" formula or "SGR" which was set by Congress in 1997 to control Medicare spending by limiting annual increases in physicians' reimbursements. Although the removal of the SGR formula is the most notable effect of the bill, the new law also includes potentially more important revisions to rates for Medicare health care services in 2015 and beyond, as well as the implementation of payments based on performance and a number of other changes.

Revocation of Home Health Agency's Medicare Enrollment and Billing Privileges Upheld

The revocation of a home health agency's (HHA) Medicare enrollment and billing privileges was recently upheld by an Administrative Law Judge in the Civil Remedies Division of the Health & Human Services Departmental Appeals Board (ALJ). The ALJ determined that the HHA was not in compliance with Medicare program requirements for home health care certification and therefore, the Centers for Medicare & Medicaid Services (CMS) had a legitimate basis to revoke the HHAs enrollment and billing privileges and impose a three-year re-enrollment bar. The case is CJN Enterprises, Inc. v. Centers for Medicare & Medicaid Services.

Health Care Providers Cannot Sue States Over Low Medicaid Reimbursement Rates

On Tuesday, March 31, 2015, in a 5-4 vote, the Supreme Court of the United States ("SCOTUS") ruled in the case Armstrong v. Exceptional Child Center, Inc., that health care providers cannot sue a state to challenge low Medicaid reimbursement rates.

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