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The Centers for Medicare & Medicaid Services (“CMS”) recently issued its calendar year (“CY”) 2026 Outpatient Prospective Payment System (“OPPS”) proposed rule (“Proposed Rule”). The following summarizes several major proposals of the Proposed Rule, and the corresponding fact sheet can be found here. For interested parties and stakeholders, comments should be submitted by September 15, 2025.
Site-Neutral Payment for Drug Administration Services
A major component of the Proposed Rule targets excepted off-campus hospital provider-based departments (“HOPDs”), intending to…
Continue Reading Medicare: Key Highlights of the 2026 OPPS Proposed Rule

On July 14, 2025, the Centers for Medicare & Medicaid Services (“CMS”) announced its CY 2026 Physician Fee Schedule (“PFS”) Notice of Proposed Rulemaking (“Proposed Rule”). The Proposed Rule includes information on a new Center for Medicare & Medicaid Innovation (“CMMI”) mandatory payment model called the Ambulatory Specialty Model (“ASM”). If finalized, the new mandatory model would begin on January 1, 2027, and run through December 31, 2031.

The ASM falls within CMMI’s larger framework of activities focusing on…
Continue Reading What Is ASM? New Ambulatory Specialty Model Proposed by CMMI in CY 2026 Physician Fee Schedule Proposed Rule

The SSDI eligibility ban in Wisconsin is no more. On July 14th, a federal court issued a preliminary injunction to the Department to stop enforcing the SSDI eligibility ban effective July 20th.
Note: The Wisconsin Examiner and Fox6 have stories on this court order.
This order should mean that, as of July 20th, any kind of unemployment claim (initial claim or weekly certification) or any initial determination or appeal tribunal hearing or decision (and any Commission decision over…
Continue Reading SSDI eligibility ban in Wisconsin no longer enforced

On July 15, 2025, the Centers for Medicare & Medicaid Services (“CMS”) issued the CY 2026 Hospital Outpatient Prospective Payment System (“OPPS”) and Ambulatory Surgical Center (“ASC”) Payment System proposed rule. The rule, as drafted, proposes updating the payment rates of both OPPS hospital rates and ASC rates by 2.4%, calculated via the respective market basket percentage increases of 3.2% and reduced productivity adjustment of 0.8 percentage points. Regarding the ASC Covered Procedures List (“ASC-CPL”), the CY 2026…
Continue Reading Medicare’s ASC Proposals for CY 2026

On July 17, 2025, the Centers for Medicare & Medicaid Services (“CMS”) extended the due date to complete and submit the new Form CMS-855A SNF Disclosures Attachment for every Skilled Nursing Facility (“SNF”). 

In its Medicare Learning Network, 2025-07-17-MLNC, CMS formally announced that enrolled SNFs should collect data on ownership, managerial and related party information and submit their revalidation, and that the new due date is January 1, 2026. 

Hall Render’s overview of the Medicare disclosure requirements for SNFs…
Continue Reading CMS Extends (Yet Again!) Deadline for Disclosure Requirements for Skilled Nursing Facilities – Provider Enrollment Off-Cycle Revalidations 

On July 14, 2025, the Centers for Medicare & Medicaid Services (“CMS”) released the CY 2026 Medicare Physician Fee Schedule (“PFS”) proposed rule. Several of the PFS proposals are related to telehealth, signaling a continued investment and interest in telehealth policies and use post the COVID-19 pandemic. The proposed rule does not address or discuss the continued coverage of telehealth services via the pandemic waiver flexibilities, as this coverage was established through legislation unrelated to CMS’s PFS rulemaking.
Continue Reading Medicare’s Telehealth Proposals for CY 2026

On April 30, 2025, the Centers for Medicare & Medicaid Services (“CMS”) released the FFY 2026 Inpatient Prospective Payment System (“IPPS”) Proposed Rule (“Proposed Rule”) to update IPPS payment rates, change DSH payments, increase uncompensated care payments and request input on ways to streamline Medicare regulations and reduce provider burden.
Increase to Payment Rates Under the IPPS
CMS proposes to increase annual operating payment rates for IPPS hospitals by 3.2%, reduced by a productivity adjustment of 0.8 % for…
Continue Reading CMS Publishes FY 2026 IPPS Proposed Rule

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The Center for Medicare & Medicaid Innovation (“CMMI”) has announced a new strategy for establishing payment systems that incentivize healthier lives through a focus on three key pillars: (1) promoting evidence-based prevention; (2) empowering patients to achieve their health goals; and (3) driving choice and competition. This strategy includes several positives for providers participating (or considering participation) in CMMI’s alternative payment models, including efforts to reduce administrative burden for participants, increase predictability through reducing significant mid-model changes and increased…
Continue Reading CMMI’s New Strategy: What’s Changing for Providers?

Safety first.
Ümit Yıldırım, Unsplash

If you’re getting Long-Term Disability (LTD) benefits, you might wonder: can I work part-time when I’m on Long-Term Disability?  

The answer is usually yes! Long-Term Disability policies are all different and so it’s important to consult the terms of your specific policy (also called the “plan documents.”) If you don’t have a copy of the policy terms, you should be able to obtain them from either the Long-Term Disability insurance company or your employer. The plan documents are usually…
Continue Reading The Hidden Dangers of Working Part-Time While on Long-Term Disability

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Unemployment benefits application

On July 17, 2024, the United States District Court for the Western District of Wisconsin ruled on a case challenging whether it was legal to prevent recipients of Social Security Disability Insurance (SSDI) from also receiving Wisconsin unemployment compensation benefits. The court held that the state law that automatically prevented SSDI recipients from receiving unemployment compensation benefits violated federal law that protects disabled people. As a result, the SSDI eligibility ban has been found to discriminate against disabled…
Continue Reading SSDI eligibility ban in Wisconsin is illegal

Healthcare fraud is a serious offense that can result in significant penalties for medical providers. In addition to criminal charges that may lead to fines or imprisonment if a person is convicted, accusations of fraud can lead to the loss of a professional license, loss of provider status with Medicare and Medicaid, and damage to a provider’s personal reputation. If you are facing healthcare fraud charges, it is crucial to understand your rights and options for defense.
Continue Reading How Can Medical Providers Defend Against Healthcare Fraud Charges?

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UPDATE: Our July 28, 2020, post informed you that the Wisconsin Medicaid divisor would remain unchanged in 2020. As we enter 2021, the Medicaid divisor will now be changed as follows. These changes are effective as of January 1, 2021.

  • New daily average divisor = $303.38
  • New monthly average divisor = $9,227.81

If you have any questions or would like assistance with Wisconsin Medicaid, we are here for you. Please contact one of Ruder Ware’s elder law attorneys to…
Continue Reading Wisconsin Medicaid Divisor Update