December 8, 2022

Volume XII, Number 342

Advertisement

December 07, 2022

Subscribe to Latest Legal News and Analysis

December 06, 2022

Subscribe to Latest Legal News and Analysis

December 05, 2022

Subscribe to Latest Legal News and Analysis

Healthcare Regulatory Check-Up April 2022: CMS Regulatory Developments

CMS RADIATION ONCOLOGY MODEL DELAYED

CMS decided to delay indefinitely the start date of the Radiation Oncology (RO) Model. The start date will be determined through future rulemaking. CMS also decided to modify the definition of the model performance period to provide that its start and end dates will be established in future rulemaking.

The RO Model would allow CMS to test whether making site-neutral, prospective, episode-based payments to hospital outpatient departments, group practices and freestanding radiation therapy centers would preserve or enhance quality of care while reducing or maintaining spending. Critics are concerned that the model in its current form is punitive, and that while value-based payments are generally supported, discount factors folded into the payment model could have a significant impact on realized revenue and would be a non-starter for the radiation oncology community.

The Protecting Medicare and American Farmers from Sequester Cuts Act, passed on December 10, 2021, included a provision prohibiting implementation of the RO Model prior to January 1, 2023. The start date had previously been delayed to January 1, 2022, as a result of the COVID-19 pandemic.

CMS intends to use the delay to modify the definition of the model performance period and to establish a start date. However, CMS is cognizant of the cost and funding necessary to prepare for participant onboarding, claims system changes, and updates to the data used in the RO Model design and participant-specific payment amounts. The indefinite pause allows the agency and RO Model participants and practices to cease preparatory activities.

Evie Atwater, Carole M. Becker, Kristina Dipano, Dexter Golinghorst, Adetoro Olugbemi also contributed to this article.

© 2022 McDermott Will & EmeryNational Law Review, Volume XII, Number 146
Advertisement
Advertisement
Advertisement

About this Author

James A. Cannatti III* practices at the intersection of today's most pertinent health care issues, including digital health, health IT policy, and fraud and abuse, including Anti-Kickback Statute/Stark Law matters. With more than 10 years of experience in the US Department of Health & Human Services’ (HHS) Office of Inspector General (OIG), most recently as Senior Counselor for Health Information Technology, James is well-attuned to the regulatory issues impacting the rapidly evolving digital health landscape, including:

  • Information...

202-756-8866
Emily J. Cook, McDermott Will Emery Law Firm, Health Care Attorney
Partner

Emily J. Cook is an associate in the law firm of McDermott Will & Emery LLP and is based in the Firm’s Los Angeles office.  She focuses her practice on Medicare provider certification, reimbursement and regulatory compliance.

310-284-6113
Gregory E. Fosheim Associate Chicago Healthcare  Healthcare Mergers & Acquisitions  Healthcare Regulatory & Compliance  Cannabis Industry
Associate

Gregory E. Fosheim advises healthcare and life sciences clients across a variety of corporate, transactional and regulatory compliance matters. Working with hospitals, physician practice groups, clinical research programs, pharmaceutical companies, device manufacturers and others, Greg provides counsel on healthcare fraud and abuse risks, Medicare, Medicaid, and private payor billing, and clinical research and laboratory compliance in connection with federal grants, among other issues. Greg also provides regulatory due diligence support on healthcare transactions and collaborations,...

312-984-7511
Tony Maida Health Care Attorney McDermott WIll Law Firm
Partner

Tony Maida is a partner in the law firm of McDermott Will & Emery LLP and is based in the Firm’s New York office.  Tony has extensive experience in health care fraud and abuse and compliance issues, including the federal Anti-Kickback and Physician Self-Referral/Stark laws, false claims and overpayments, and government investigations.    He works closely with our health and white collar teams on criminal, civil, and administrative investigations and counseling clients on corporate transactions and compliance programs.

Tony previously served...

1 212 547 5492
Caroline Reignley Healthcare Attorney McDermott Will & Emery Washington, DC
Associate

Caroline Reignley provides valuable counsel on healthcare regulatory and reimbursement law to her clients, including for-profit and nonprofit hospitals, health systems and physician groups.

She is particularly focused on advising clients on Medicare and Medicaid fee-for-service reimbursement, billing and coding, licensure, accreditation and healthcare compliance matters.

Caroline also advises on internal and government investigations related to the False Claims Act, Stark Law and Anti-Kickback Statue. Her experience...

202-756-8548
Advertisement
Advertisement
Advertisement