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On February 2, 2026, the Centers for Medicare & Medicaid Services (“CMS”) released a new guidance letter (“February 2 Letter”) regarding state directed payments (“SDPs”) as governed by Section 71116 of Public Law 119-21 (which CMS refers to as the “Working Families Tax Cuts” or “WFTC legislation”). Per CMS, its previous September 9, 2025, guidance letter (“September 9 Letter”) has been rescinded.

The February 2 Letter largely repeats everything in the September 9 Letter. For example, the preprint-related criteria…
Continue Reading CMS Issues New Guidance Letter for State Directed Payments

On February 2, 2026, the Centers for Medicare & Medicaid Services (“CMS”) published a final rule, effective April 3, 2026, that targets a perceived “loophole” in the current regulatory statistical test applied to State proposals for health care-related tax waivers. The test is intended to make certain that non-uniform or non-broad-based health care-related taxes, authorized under a waiver granted by CMS, are “generally redistributive.” CMS claims the loophole impermissibly allowed some health care-related taxes to be imposed at…
Continue Reading CMS Issues Health Care-Related Tax Final Rule

On January 30, 2026, the Centers for Medicare & Medicaid Services (“CMS”) issued a proposed rule that would substantially revise portions of the Conditions for Coverage for Organ Procurement Organizations (“OPOs”) (the “Proposed Rule”). According to CMS, the Proposed Rule is characterized as building on changes in the 2020 OPO Conditions for Coverage rule aimed at increasing accountability, clarifying and strengthening re-certification standards and reinforcing public trust in organ procurement and allocation practices, and in doing so is intended…
Continue Reading Proposed OPO Rule Signals Broad Operational and Compliance Changes Across the Donation and Transplantation System

Congress’s fiscal year 2026 health care appropriations bill introduces a significant new statutory condition of Medicare payment for off-campus hospital outpatient departments. If enacted, effective January 1, 2028, Medicare payment would be prohibited for items and services furnished by an off-campus hospital outpatient department unless two conditions are met: (1) the department has a National Provider Identifier (“NPI”) that is separate from the hospital’s main NPI; and (2) the hospital has submitted the required provider-based status attestation.

Although framed…
Continue Reading Legislative Update: Congress Set to Resurrect Separate NPI and Attestation Requirements for Off-Campus Hospital Outpatient Departments

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On January 21, 2026, the Department of Health and Human Services (“HHS”) Office of Inspector General (“OIG”) released its Semiannual Report to Congress for the six-month period ending September 30, 2025 (“Report”). OIG’s enforcement actions during this period resulted in “the largest health care fraud takedown in the Department of Justice history, involving more than $14.6 billion in intended losses,” and improved the return on investment in OIG to $12.70 in expected recoveries and receivables (money agreed to be…
Continue Reading OIG Recounts Historic Recovery Numbers in Its Latest Semiannual Report to Congress

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Some of the advocacy groups and think tanks that lobbied for the Medicaid provider tax restrictions in last year’s H.R. 1 are now renewing their criticisms of the states’ use of “intergovernmental transfers” (“IGTs”) from governmental health care providers to fund the non-federal share of Medicaid payments to those same providers.[1] The critics’ goal appears to be twofold: first, to shift Medicaid costs away from the federal government despite the federal government’s shared financial responsibility with the states…
Continue Reading In Defense of Intergovernmental Transfers from Governmental Health Care Providers

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The Centers for Medicare & Medicaid Services (“CMS”) continues to scrutinize beneficiary transparency, medical necessity and data‑driven oversight of hospital billing and utilization. This scrutiny means continued compliance risk for hospitals. Two long‑standing compliance tools remain especially relevant for hospital leadership: the Medicare Outpatient Observation Notice (“MOON”) and the Program for Evaluating Payment Patterns Electronic Report (“PEPPER”). Recent CMS communications reaffirm expectations related to proper MOON delivery and highlight PEPPER as an active monitoring mechanism hospitals should be using…
Continue Reading Medicare Outpatient Observation Notice and PEPPER Reports: Key Compliance Considerations

On December 29, 2025, the Centers for Medicare and Medicaid Services (“CMS”) announced the first round of awards under the Rural Health Transformation Program (“RHTP”), a $50 billion, five-year initiative intended to strengthen and modernize health care delivery in rural communities nationwide. All 50 states will receive funding beginning in Federal Fiscal Year (“FFY”) 2026, with first-year awards averaging $200 million per state.

At the same time, CMS formally established the Office of Rural Health Transformation within the Center…
Continue Reading CMS Announces $50 Billion Rural Health Transformation Program Awards to All 50 States

On December 11, 2025, the Centers for Medicare & Medicaid Services (“CMS”) extended the due date indefinitely to complete and submit the new Form CMS-855A Skilled Nursing Facility  (“SNF”) Disclosures Attachment for every SNF.

In its Medicare Learning Network, 2025-12-11-MLNC, CMS formally announced that enrolled SNFs should continue collecting data on ownership, managerial, and related party information and submit their revalidation. However, there is no submission deadline until further notice. Guidance for SNF Attachment on Form CMS-855A, updated …
Continue Reading CMS Extends Deadline Indefinitely for Disclosure Requirements for Skilled Nursing Facilities – Provider Enrollment Off-Cycle Revalidations

On November 14, 2025, the Centers for Medicare & Medicaid Services (“CMS”) issued a letter, which it describes as “preliminary guidance,” concerning two significant restrictions on Medicaid provider taxes set forth in H.R. 1, including: (i) a change in the indirect hold harmless threshold for provider taxes—which, in effect, prohibits states from increasing the rates of their current provider taxes beyond the rates in effect as of July 4, 2025, and prevents states from adopting any new provider taxes…
Continue Reading CMS Provides Guidance Regarding Provider Taxes Under Sections 71115 and 71117 of H.R. 1

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On October 31, 2025, the Centers for Medicare & Medicaid Services (“CMS”) issued its calendar year (“CY”) 2026 Medicare Physician Fee Schedule (“MPFS”) final rule (“Final Rule”), announcing finalized policy changes for Medicare payments under the MPFS and other Medicare Part B (“Part B”) issues, effective on or after January 1, 2026. The Final Rule is largely consistent with what was previously shared in CY 2026 proposed rules, with a few modifications as a result of public comment. Several…
Continue Reading Key Highlights from the 2026 Medicare Physician Fee Schedule Final Rule

For many years, alcohol use disorder (AUD) was often viewed as a matter of poor choices or a lack of willpower. Today, medical research makes it clear that this isn’t the case—AUD is a medical condition, not a moral flaw. Like other medical conditions, it can cause difficulty in daily functioning, leading to cravings, compulsive behaviors, and impaired control over drinking. These symptoms can interfere with daily life, relationships, and the ability to work.
What is Alcohol Use Disorder?
Continue Reading Disabled by Alcohol Use Disorder? You Might be Eligible for Short- or Long- Term Disability Benefits

Recent weeks and months have witnessed several Medicaid developments that may significantly impact Medicaid funding across the country. Not all of these developments are related to the Medicaid-related provisions of H.R. 1 (Public Law 119-21 (July 4, 2025), otherwise known as the “One Big Beautiful Bill”). This article summarizes three developments that are unrelated to H.R. 1:

  • U.S. Fourth Circuit Court of Appeals (“Fourth Circuit”) remands intergovernmental transfer (“IGT”) funding case back to the Centers for Medicare & Medicaid

    • …
    Continue Reading Medicaid Developments Unrelated to Recent Congressional Actions

    In United States ex rel. O’Laughlin v. Radiation Therapy Services, P.S.C., the Sixth Circuit (also referred to as the “Court”) recently affirmed dismissal of a relator’s False Claims Act (“FCA”) action, concluding that he failed to plead or prove with particularity that radiation service providers submitted false claims for radiation or chemotherapy services, relying instead on misguided faulty regulatory interpretations, unreliable evidence and abandoned arguments.
    Background
    The FCA, codified at 31 U.S.C. §§ 3729-3733, empowers private individuals, known…
    Continue Reading Sixth Circuit Rejects FCA Claims Involving ‘Incident to’ Services and Implied Certification Theories

    Do I Get Medicare on SSDI? 
    If you are approved for Social Security Disability (SSD) benefits, then you have already proven to the federal government that you suffer from disabling health conditions that likely require extensive medical treatment. Health insurance plays an integral role in ensuring that disabled individuals are able to pay for the care they need. Many individuals on SSD benefits are wondering if they get Medicare as part of their benefits. The answer is often yes,…
    Continue Reading Do I Get Medicare on SSDI?

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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