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Showing 54 posts tagged Health Care Law.

CMS Executes About-Face on Pre-Dispute Arbitration Ban

The Centers for Medicare & Medicaid Services (“CMS”) published a proposed rule on June 5, 2017, that serves as an effective course reversal on pre-dispute arbitration agreements in a long-term care (“LTC”) setting. This caps off an effort by many in the healthcare and nursing home industry to stop the prior rule, which banned such agreements, from taking effect. More >

Compliance Programs for Nursing Facility Providers

Nursing facilities are now required to develop and implement effective compliance and ethics programs under newly-created Section 483.85 of the Affordable Care Act (“ACA”) §6102. These programs must be in effect by November 28, 2017. These regulatory requirements are highly complex, especially the requirement of annual review and revision of the programs.   More >

Medicaid Expansion in Kentucky

The Supreme Court upheld much of President Obama’s Patient Protection and Affordable Care Act (“PPACA”) in National Federation of Independent Business et al v. Sebelius, but overturned a key element of PPACA’s Medicaid expansion provisions. Originally, PPACA required states to expand Medicaid coverage to individuals at or below 133 percent of the federal poverty level or risk forfeiting existing federal funding for the state’s Medicaid program.  In National Federation, the Supreme Court held that PPACA could not withdraw existing Medicaid funding from states choosing not to expand their programs. This change presents each state with a meaningful choice to opt in or out of PPACA’s Medicaid expansion. More >

Senate Finance Committee Takes an In-Depth Look at Fraud & Abuse

Earlier this week, I discussed the HHS and DOJ Annual Report for the Health Care Fraud and Abuse Program.  HHS and DOJ are not the only ones who are determined to purge the health care industry of its woes.   On January 31, 2013 a group of six current and former members of the Senate Finance Committee released a comprehensive report detailing recommendations on combating waste, fraud and abuse in the Medicare and Medicaid Programs. More >

Annual Report Details Record Breaking Success in Health Care Fraud Prevention

The Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), required the establishment of a national Health Care Fraud and Abuse Control Program (“HCFAC”). The HCFAC Program is a joint Department of Justice (“DOJ”) and Health and Human Services (“HHS”) coordination of federal, state and local law enforcement activities to combat fraud committed against all health plans, both public and private. More >

CMS 2014 Call Letter: A Bright Future for CMS Star Rating System

On February 15, the Centers for Medicare & Medicaid Services (CMS) issued the draft calendar year (CY) 2014 Call Letter for the Medicare Advantage (MA) and Part D programs (Call Letter). It contains information that MA organizations and Part D plan sponsors (collectively, Plan Sponsors) need to prepare their 2014 bids and operations. More >

CMS Proposes to Change Physician Requirements for RHC's and FQHC's

Since the passage of the Patient Protection and Affordable Care Act of 2010 (“PPACA”), many providers, suppliers and physicians that were enrolled in Medicare and Medicaid were mandated to create compliance programs for their healthcare facilities. Since that time, small and rural providers have been scrambling to adopt and implement programs that can adequately withstand regulatory and law enforcement scrutiny. Larger providers, such as multi-state hospitals, were already equipped with a compliance program. It is the small and rural providers, limited by staff and financial resources, which have had their hands full complying with the new regulatory requirements. More >

State Legislation, the ACA, and Autism: New Laws Bring in Waves of Change

In recent years, state legislators across the country have closely focused on a specific health problem that can affect mental capacity: autism. Autism and autism spectrum disorders (ASD’s) cause developmental disabilities and numerous social, behavioral, and physical challenges. The tragedy at Sandy Hook Elementary School renewed intense public debate about this particular diagnosis and treatment of other mental health issues. More >

HHS Issues Final HIPAA/HITECH Rule

The United States Department of Health and Human Services (“HHS”) issued its Final Rule modifying the requirements of the Health Insurance Portability and Accountability Act (“HIPAA”) privacy and security regulations pursuant to the Health Information Technology for Economic and Clinical Health Act (“HITECH”) on January 17, 2013.  The Final Rule strengthens the privacy and security requirement of HIPAA governing protected health information (“PHI”) and gives HHS greater enforcement authority to police violations of the privacy and security requirements.  The Final Rule will require health care providers and their business associates to re-evaluate their HIPAA compliance policies and procedures to avoid potential liability for violations of HIPAA requirements. More >

The Wrap-Around Slap-Around for Primary Care Centers

For Kentucky Primary Care Centers (“PCCs”), Rural Health Centers (“RHCs”), and Federally Qualified Health Centers (“FQHCs”), getting the run-around from Medicaid on wrap-around payments is not so unusual.  Frequently, these providers complain that supplemental payments distributed by the Kentucky Department for Medicaid Services’ (“Medicaid”) are too low, too late or both. More >

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