CMS Finally Agrees To Follow High Court Opinion From 1988

By Kenneth Marcus (May 3, 2018, 12:18 PM EDT) -- In Centers for Medicare & Medicaid Services Ruling 1727-R on April 23, 2018, CMS announced that it would follow the 2016 decision in Banner Heart Hospital v. Burwell[1] that the 2008 "self-disallowance regulation"[2] for establishing jurisdiction for purposes of contractor or Provider Reimbursement Review Board (PRRB) appeals does not apply to appeals challenging a payment regulation or other policy that the Medicare contractor cannot address. The ruling applies to provider cost report appeals for periods ending on or after Dec. 31, 2008, and beginning before Jan. 1, 2016,[3] that were pending or filed on or after April 23, 2018. CMS explained that Banner Heart Hospital held "that given the Supreme Court's interpretation of Section 1878(a)(1)(A) of the act (42 U.S.C. 1395oo(a)(1)(A)) in Bethesda Hospital, the 2008 self-disallowance regulation may not be applied to appeals raising a legal challenge to a payment regulation or other policy that the Medicare contractor cannot address."...

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