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CMS Proposes to Expand the Scope of Medicare Coverage Determinations

USA - September 4 2020 On September 1, 2020, the Centers for Medicare & Medicaid Services (“CMS”) published a proposed rule that would, for the first time, establish formal…

OMHA’s second Medicare Appellant Forum reveals some forward momentum but no simple or quick solutions for Medicare administrative appeals backlog

USA - November 6 2014 On October 29, 2014, the Office of Medicare Hearings and Appeals ("OMHA") hosted its second Medicare Appellant Forum ("Forum") to address the status…

Amy F. Lerman

CMS’s New Process for Issuing Local Coverage Determinations

USA - October 24 2018 In October 2018, the Centers for Medicare & Medicaid Services (“CMS”) announced that it made significant changes to the process by which local…

Arthur J. Fried, Elena M. Quattrone

CMS Proposes to Reverse Course and Repeal Its Final Rule Expediting Medicare Coverage of Breakthrough Devices and Defining the Medicare “Reasonable and Necessary” Coverage Standard

USA - September 21 2021 On September 15, 2021, CMS published a proposed rule that would repeal a final rule that created an expedited pathway for Medicare coverage of…

HHS Limits the Use of Guidance Documents in the Good Guidance Practices Rule and Advisory Opinion 20-05

USA - December 10 2020 On December 7, 2020, the Department of Health and Human Services (“HHS”) published the Good Guidance Practices final rule (“Rule”), which limits…

Jonah D. Retzinger