Topic: Regulatory

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Texas Attorney General addresses prompt pay requirements for out-of-network emergency services

Yvonne Puig (US)Jeff Wurzburg (US)By Yvonne Puig (US) and Jeff Wurzburg (US) on Posted in Regulatory
An Attorney General Opinion (KP-0250) released on May 22 provides that a court would likely find that the deadline provisions in the Texas Insurance Code applicable to Health Maintenance Organizations (“HMOs”) and Preferred Provider Organizations (“PPOs”) relating to prompt payment apply to out-of-network emergency care providers, while the penalty provisions contained do not apply to … Continue reading

CMS publishes draft “Guidance for Hospital Co-location with Other Hospitals or Healthcare Facilities”

Thomas Dowdell (US)By Thomas Dowdell (US) on Posted in Regulatory
On May 3, the Centers for Medicare & Medicaid Services (CMS) published its long-awaited draft “Guidance for Hospital Co-location with Other Hospitals or Healthcare Facilities.”  The draft guidance is specific to compliance with the general Conditions of Participation for hospitals (CoPs) and does not address the specific location and separateness requirements that apply to other … Continue reading

The Joint Commission releases sentinel events for 2018

Yvonne Puig (US)Jeff Wurzburg (US)By Yvonne Puig (US) and Jeff Wurzburg (US) on Posted in Regulatory
On March 13, 2019, The Joint Commission released Sentinel Event statistics for 2018.  There were 801 sentinel events in 2018, with 87% being voluntarily self-reported.  According to the Joint Commission, it is estimated that less than 2 percent of all sentinel events are reported.  The Joint Commission defines a sentinel event as: Any unexpected occurrence … Continue reading

Centers for Medicare and Medicaid Innovation announces emergency transportation model

Jeff Wurzburg (US)By Jeff Wurzburg (US) on Posted in Regulatory
On February 14, 2019, the Center for Medicare and Medicaid Innovation (CMMI) announced the Emergency Triage, Treat, and Transport (ET3) Model that aims to transform the ambulance system.  Medicare-enrolled ambulance service suppliers and hospital-owned ambulance providers will participate in the model.   CMMI believes this model will improve quality and lower costs by reducing hospitalizations and … Continue reading

OIG proposes to eliminate safe harbor protection for drug manufacturer rebates to PBMs; proposes two new safe harbors

Carol Poindexter (US)Savannah Wiseman (US)By Carol Poindexter (US) and Savannah Wiseman (US) on Posted in Regulatory
On January 31, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) issued a proposed new rule that, if finalized, would eliminate existing protection under the Anti-Kickback Statute (AKS) “discount” safe harbor (42 C.F.R. 1001.952(h)) for drug manufacturers’ rebates to plan sponsors or pharmacy benefit managers (PBMs) acting under contract with plan … Continue reading

Hospital alert: CMS hospital transparency requirements in effect January 1, 2019

Yvonne Puig (US)Jeff Wurzburg (US)By Yvonne Puig (US) and Jeff Wurzburg (US) on Posted in Regulatory
On January 1, 2019, all hospitals are required to make public a list of their standard charges.  As a reminder, Section 2718(e) of the Public Health Service Act, as enacted by the Affordable Care Act, requires: “each hospital operating within the United States” to “make public (in accordance with guidelines developed by the Secretary) a … Continue reading

CMS publishes CY 2019 physician fee schedule final rule

Jeff Wurzburg (US)By Jeff Wurzburg (US) on Posted in Regulatory
On November 2, 2018, CMS published its CY 2019 physician fee schedule final rule.  The final rule implements a number of significant changes to the way practitioners receive reimbursement for items and services provided to Medicare beneficiaries, including: Eliminating the requirement for a practitioner to document the medical necessity of a home visit in lieu … Continue reading

OIG considers new safe harbors and other incentives to promote coordinated care

Elise LeGros (US)By Elise LeGros (US) on Posted in Regulatory
As part of the Health and Human Services Department’s (“HHS”) “Regulatory Sprint to Coordinated Care” efforts aimed at alleviating unnecessary regulatory barriers to coordinated care while protecting against fraud and abuse, the Office of Inspector General (“OIG”) issued a Request for Information (“RFI”) on August 27, 2018, requesting public input on the following items: Care … Continue reading

CMS proposes to expand payment for telehealth services

Health Law PulseBy on Posted in Regulatory
On July 12, 2018, CMS included three proposed changes to telehealth reimbursements within the CY 2019 Physician Fee Schedule (the “Proposed Rule”). Currently, subject to certain exceptions, Medicare reimbursements for certain telehealth services are statutorily limited by the type of health care professional providing the service, and the geographic location of the patient (namely, the … Continue reading

CMS further crystalizes Stark liberalizations

Joseph Keillor (US)Debbi Johnstone (US)By Joseph Keillor (US) and Debbi Johnstone (US) on Posted in Regulatory
On July 12, 2018, CMS included within the CY 2019 Physician Fee Schedule (the “Proposed Rule”) two revisions to Stark Law regulations aimed at further clarifying any actual or perceived differences between current regulations and the recently enacted Bipartisan Budget Act of 2018 (“2018 BBA”). As we previously reported, Section 50404 of the 2018 BBA … Continue reading

CMS issues Pathway to Success ACO proposed rule

Jeff Wurzburg (US)By Jeff Wurzburg (US) on Posted in Regulatory
On August 9, 2018, CMS published the long-awaited Pathways to Success proposed rule.  CMS Administrator Seema Verma published a related  article on the Health Affairs Blog.  The proposed rule would usher in significant changes for Accountable Care Organizations (ACOs).  Groups of providers, such as doctors and hospitals, can join together to form an ACO and … Continue reading

The US Departments of HHS, Labor, and Treasury finalize expanded access to short-term, limited duration insurance

Jeff Wurzburg (US)By Jeff Wurzburg (US) on Posted in Regulatory
On August 1 the Departments of Treasury, Labor, and Health and Human Services (the Departments) published a final rule that will expand the availability of short-term limited duration insurance (STLDI).  A Health Law Pulse summary of the proposed rule may be read here.  STLDI is not required to comply with the Affordable Care Act (ACA) … Continue reading

CMS proposes significant Medicare OPPS and ASC payment system changes for 2019

Thomas Dowdell (US)Jeff Wurzburg (US)By Thomas Dowdell (US) and Jeff Wurzburg (US) on Posted in Regulatory
On July 25, 2018, the Centers for Medicare & Medicaid Services published its 2019 Medicare hospital outpatient prospective payment system (OPPS) and ambulatory surgical center (ASC) payment system proposed rule.  A fact sheet describing the proposed rule is available here. The proposed rule can be accessed here. CMS proposes to update hospital OPPS payment rates … Continue reading

CMS issues CY 2019 home health proposed rule

Thomas Dowdell (US)By Thomas Dowdell (US) on Posted in Regulatory
On July 12, 2018, the Centers for Medicare & Medicaid Services (CMS) published its calendar year (CY) 2019 proposed rule for Medicare payment updates and proposed quality reporting changes for home health agencies (HHA) under the home health prospective payment system (HH PPS). CMS proposes certain changes to Medicare payment and quality reporting standards for … Continue reading

CMS solicits comments for easing Stark Law burdens

Benjamin Wallfisch (US)By Benjamin Wallfisch (US) on Posted in Regulatory
Last week, the U.S. Centers for Medicare & Medicaid Services (“CMS”) released a Request for Information (“RFI”) that seeks feedback from stakeholders in the healthcare industry on possible regulatory changes to the Stark Law. CMS has expressed concern that the Stark Law may have a negative effect on alternative payment models, integrated delivery models, and … Continue reading

Department of Labor publishes final rule to expand access to Association Health Plans

Jeff Wurzburg (US)By Jeff Wurzburg (US) on Posted in Regulatory
The United States Department of Labor (DOL) published a final rule on June 19 that relaxes the regulation of, and expands access to, association health plans (AHPs).  President Donald J. Trump’s October 12, 2017 Executive Order instructed the DOL to consider expanding access to association health plans and the Department released a proposed rule on … Continue reading

HHS requests comments on healthcare innovation and investment workgroup

Jeff Wurzburg (US)By Jeff Wurzburg (US) on Posted in Regulatory
A Request for Information (RFI) published in the June 7 Federal Register seeks comments on the structure of a workgroup to increase innovation and investment in the healthcare industry.  The Immediate Office of the Secretary of HHS seeks comments on how to structure the workgroup  in order to “spur investment, increase competition, accelerate innovation and … Continue reading

Joint Commission issues advisory on continuity of operations planning

Jeff Wurzburg (US)Yvonne Puig (US)By Jeff Wurzburg (US) and Yvonne Puig (US) on Posted in Regulatory
On May 22, 2018, the Joint Commission released an advisory addressing the importance of continuity of operations planning (COOP).  When an emergency strikes, an ill-prepared health care organization can put patients at risk.  The goal of an COOP is “to protect the organization’s physical plant, information technology systems, business and financial operations, and other infrastructure … Continue reading

OCR proposes to share HIPAA data breach settlements with victims

Health Law PulseBy on Posted in Regulatory
The U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) plans to issue an advance notice of proposed rulemaking this November on potentially sharing HIPAA breach settlements with victims. The notice would solicit public opinion on creating a process for sharing a percentage of any penalty or settlement with those harmed … Continue reading

CMS FY 2019 IPPS and LTCH PPS proposed rule targets interoperability, transparency and burden reductions

Jeff Wurzburg (US)By Jeff Wurzburg (US) on Posted in Regulatory
On April 24, the Centers for Medicare & Medicaid Services (CMS) released its fiscal year (FY) 2019 inpatient prospective payment system (IPPS) and long-term care hospital prospective payment system (LTCH PPS) proposed rule. CMS proposes to reduce regulatory burdens for inpatient hospitals and increase price transparency and better data sharing between hospitals and other providers … Continue reading

NIST releases latest version of its Cybersecurity Framework

Health Law PulseBy on Posted in Regulatory
On April 16, 2018, the National Institute of Standards and Technology (NIST) unveiled Version 1.1 of its widely known Cybersecurity Framework, which incorporates changes based on feedback collected through comments, questions, and workshops held in 2016 and 2017. The Cybersecurity Framework aims to focus on industries vital to national and economic security, including energy, banking, … Continue reading

Recent effort to regulate pharmaceutical pricing deemed unconstitutional by Fourth Circuit

Robin Adelstein (US)By Robin Adelstein (US) on Posted in Enforcement, FDA & Food Safety, News from DC, Regulatory
In the absence of federal action, states have attempted to rein in high pharmaceutical pricing by enacting laws aimed at regulating drug pricing. Following what now has become a trend, on March 13, 2018, Oregon became the newest state to enact such legislation, The Prescription Drug Price Transparency Act, H.B. 4005. But many of these … Continue reading

CMS publishes annual exchange final rule for 2019

Jeff Wurzburg (US)By Jeff Wurzburg (US) on Posted in Regulatory
On April 9, 2018, the Centers for Medicare and Medicaid Services (CMS) published the Notice of Benefit and Payment Parameters for 2019 final rule (Payment Notice) and related guidance affecting the health insurance markets, including: key dates for calendar year 2018; the final 2019 Letter to Issuers in the Federally-facilitated Exchanges; guidance extending the transitional … Continue reading
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