Comparison of Presidential Candidates’ Health Care Proposals
Health Care
September 22, 2008
Cynthia E. Berry
Leah Mendelsohn Stone
As part of their campaigns for the presidency, both Senator McCain and Senator Obama have outlined health care reform proposals that aim to provide access to affordable health care. The candidates’ plans differ on how they would achieve their stated objectives.
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New Stark Rules Bring Major Changes - 08/08
Health Care
August 27, 2008
Sandra K. Herron
On August 19, 2008, the Centers for Medicare and Medicaid Services published the latest changes to the Stark Law. The Stark Law regulates the types of arrangements into which physicians may enter. Violations of the Stark Law bring hefty civil fines and penalties.
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HHS Proposes New Authority for Secretary to Overturn or Remand Departmental Appeals Board Decisions
Health Care
January 14, 2008
On December 28, 2007, the U.S. Department of Health and Human Services ("HHS") issued a proposed rule that would grant the Secretary of HHS new authority to overturn or remand certain decisions of the Departmental Appeals Board.
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President Signs End-of-Year Healthcare Legislation - 01/08/08
Health Care
January 8, 2008
Steven Stranne
On December 29, 2007, the President signed into law the Medicare, Medicaid and SCHIP Extension Act of 2007. This legislative package made few substantive changes to Medicare, Medicaid or the State Children's Health Insurance Program.
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CMS Issues Interim Final Rule Clarifying Definition of Targeted Case Management - 12/12/07
Health Care
December 12, 2007
On December 4, CMS published an interim final rule clarifying the definition of case management and targeted case management (TCM) services for which states may receive Medicaid payment.
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CMS Issues Proposed Rule Limiting Medicaid Payments for Outpatient Hospital Services
Health Care
October 9, 2007
On September 28, the CMS published a proposed rule entitled "Medicaid Program; Clarification of Outpatient Clinic and Hospital Facility Services Definition and Upper Payment Limit" that could have potentially significant effects on Medicaid reimbursement for outpatient hospital services.
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CMS Proposes Changes to Medicaid Funding for School-Based Administration and Transportation - 10/08/07
Health Care
October 8, 2007
On September 7, the CMS issued a proposed rule titled "Elimination of Reimbursement Under Medicaid for School Administration Expenditures and Costs Related to Transportation of School-Age Children Between Home and School."
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Temporary SCHIP Extension and Health Extenders Package Signed into Law - 10/03/07
Health Care
October 3, 2007
Leah Mendelsohn Stone
On Saturday, September 29th, President Bush signed into law a temporary funding extension of the State Children's Health Insurance Program, as well as a separate bill that will continue several health care programs that were set to expire on September 30th.
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CMS Disapproves New York SCHIP Plan Amendment, Enforcing New Crowd-Out Guidance - 09/11/07
Health Care
September 11, 2007
C. Scott Greene
On September 7, 2007, the Centers for Medicare and Medicaid
Services (CMS) disapproved the State of New York's proposed
amendment to the State's Children's Health Insurance Program (CHIP)
plan, marking the agency's first enforcement action based on
noncompliance with the controversial new crowd-out policy issued on
August 17, 2007.
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CMS Issues Multiple Proposed and Final Rules on Medicare, Medicaid, and SCHIP Compliance and Reimbursement - 09/07/07
Health Care
September 7, 2007
Anne B. Camper
Between August 24 and August 31, 2007, the Centers for Medicare and Medicaid Services (CMS) issued or announced a number of proposed or final rules.
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CMS Unveils New SCHIP Enrollment Policy - 08/28/07
Healthcare
August 28, 2007
On August 17, 2007, the Center for Medicaid and State Operations of the CMS issued a letter to State health officials regarding State initiatives to expand enrollment in the State Children's Health Insurance Program.
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CMS Issues Letter Regarding Cost-Sharing in Emergency Rooms - 08/21/07
Health Care
August 21, 2007
On August 15, 2007, the CMS issued a State Medicaid Directors Letter regarding a change in the law with respect to cost-sharing for non-emergency services furnished to low-income patients in emergency rooms and to announce the implementation of a grant program for non-emergency services.
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Congress Passes New Ethics, Lobbying, and Earmark Requirements - 08/20/07
Health Care & Advocacy & Government Relations
August 20, 2007
Cynthia E. Berry
Before recessing for the month of August, the U.S. House of Representatives and the U.S. Senate passed the "Honest Leadership and Open Government Act" (S. 1), which would tighten ethics guidelines, restrict lawmakers' interactions with lobbyists, increase lobbying disclosure, and impose new requirements on earmarking of federal funds.
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Eight Circuit Denies Minnesota Appeal of CMS Rejection of Medicaid State Plan Amendment - 08/15/07
Health Care
August 14, 2007
In an opinion filed July 31, 2007, the U.S. Court of Appeals for the Eight Circuit rejected Minnesota's appeal of a Centers for Medicare and Medicaid Services (CMS) decision to deny a state plan amendment as a result of inadequate responses to the agency's increased scrutiny of Medicaid reimbursement and state funding mechanisms.
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House and Senate Passed SCHIP Bills - 08/07/07
Health Care
August 7, 2007
Leah Mendelsohn Stone
Prior to adjourning for the August recess, the Senate and the House of Representatives passed different bills reauthorizing the State Children's Health Insurance Program (SCHIP). Reconciling these bills in September may be complicated due to the variation in the bills and the issues that they raise.
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CMS Document Sheds Light on the New Medicaid World - 07/31/07
Health Care
July 31, 2007
Sandra K. Herron
On July 20, 2007, the Centers for Medicare and Medicaid Services (CMS) Office of Acquisition & Grants Management issued a document that provides vital information to health care providers about what to expect during the coming years of intensified Medicaid review and enforcement.
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CMS Says Providers Can Charge for Missed Appointments - 07/18/07
Health Care
July 18, 2007
On June 29, 2007, the Center for Medicaid & Medicare Services ("CMS") implemented a new policy that will allow physicians, providers, and suppliers to charge Medicare beneficiaries for missed appointments.
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CMS Issues Final Medicaid Citizenship Documentation Rule - 07/17/07
Health Care
July 17, 2007
On July 13, 2007, the Centers for Medicare and Medicaid Services (CMS) published a final rule on citizenship documentation requirements for Medicaid eligibility.
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OIG Withdraws Proposed Rule on Exclusion for Excessive Charges - 06/19/07
Health Care
June 19, 2007
On Monday, June 18, 2007, the OIG of the HHS withdrew a proposed rule that would have clarified its authority to exclude providers from the Medicare and Medicaid programs for submitting claims containing excessive charges, responding to significant concerns raised by the provider community.
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Final Rule on Cost Limit for Public Providers and Defining "Public" Status - 05/31/07
Health Care
May 31, 2007
On Friday, May 25, the CMS issued a final version of the Medicaid cost limit regulations proposed in January.
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Legislation Introduced to Extend the 340B Drug Discount Program to Inpatient Drugs - 05/24/07
Health Care
May 24, 2007
On May 14, 2007, Senators Jeff Bingaman (D-NM) and John Thune (R-SD) introduced the "340B Program Improvement and Integrity Act of 2007." This bill would extend mandatory drug pricing discounts under the federal 340B program.
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CMS Proposes Rule to Eliminate Federal Reimbursement for Medicaid Direct GME Payments - 05/07
Health Care
May 23, 2007
The Centers for Medicaid and Medicare Services issued a proposed regulation to clarify that costs and payments associated with graduate medical education (GME) programs are not eligible for federal financial participation under state Medicaid programs.
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IRS Releases Guidance to Assist Tax-Exempt Organization in Completing Form 990 - 05/09/07
Health Care
May 9, 2007
On April 26, 2007, the Tax Exempt and Government Entities Division of the Internal Revenue Service ("IRS") released informal guidance to supplement revised instructions for IRS Form 990 for 2006.
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Fiscal Year 2008 Senate Budget Resolution - 03/21/07
Health Care
March 21, 2007
Alan K. Parver
Leah Mendelsohn Stone
On March 15 the Senate Budget Committee reported its fiscal 2008 budget resolution. The budget resolution contains notable provisions relating to Medicare and the State Children's Health Insurance Program (SCHIP). It also includes funding for Federally Qualified Health Centers.
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Opposition Growing To Proposed Regulation - 02/28/07
Health Care
February 28, 2007
On January 18, 2007, the Centers for Medicare and Medicaid Services published a proposed regulation that would dramatically affect payments to public providers and state-Medicaid financing arrangements.
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SCHIP Reauthorization Remains a Top Congressional Priority - 02/13/07
Health Care
February 13, 2007
As lawmakers establish priorities for the 110th Congress, reauthorization of the State Children's Health Insurance Program (SCHIP) is being given top billing.
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President Releases FY 2008 Budget - 02/06/07
Health Care
February 6, 2007
On Monday, President Bush sent his $2.8 trillion fiscal year (FY) budget to Capitol Hill, which preliminary analyses show includes $66 billion in savings from Medicare and $6.8 billion from Medicaid and the State Children's Health Insurance Program (SCHIP).
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Senate Passes New Ethics, Lobbying, and Earmark Regulations - 01/29/07
Health Care
January 29, 2007
Cynthia E. Berry
After considerable debate, Senate leaders from both parties forged an agreement to pass legislation on January 18 that would tighten ethics guidelines, change lawmakers' relationships with lobbyists, and require stronger regulations regarding earmarks.
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CMS Proposes Restrictions on Medicaid Payments to Public Providers and on Financing Arrangements with State Medicaid Programs - 01/23/07
Health Care
January 23, 2007
Anne B. Camper
On January 18, the Centers for Medicare and Medicaid Services published a proposed regulation that would dramatically limit payments to public providers and State Medicaid financing arrangements.
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HRSA Proposes Changes to Definition of Patient and Contract Pharmacy Arrangements in the 340B Drug Pricing Program - 01/23/07
Health Care
January 23, 2007
On January 12, 2007, the federal Health Resources and Services Administration (HRSA) published two notices in the Federal Register proposing amended guidelines for the 340B Drug Pricing Program, which allows certain qualified providers (known under the program as "covered entities") access to substantially discounted prices on outpatient drugs.
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End of Year Legislation Increases HSA Flexibility - 01/04/07
Health Care
January 4, 2007
In the final days of the 109th Congress, lawmakers approved several health care measures, including The Tax Relief and Health Care Act of 2006, Pub. L. No. 109-432 (otherwise known as the "tax extender bill").
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OIG Finds Medicare Beneficiaries Not Receiving Drug Subsidies - 11/27/06
Health Care
November 27, 2006
Cynthia E. Berry
On Friday, November 17, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) released a report highlighting that low-income Medicare beneficiaries are not receiving the drug subsidies to which they are entitled under the new Medicare drug benefit.
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Fall Elections May Bring Increased Oversight of the Medicare Program - 10/30/06
Health Care
October 30, 2006
Alan K. Parver
Representative Fortney "Pete" Stark, Ranking Minority Member for the House Ways and Means Health Subcommittee recently identified areas in health law and policy that could draw the attention of a Democratically-led Congress.
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Recent AHA Report Shows Uncompensated Care Costs Climbing - 10/30/06
Health Care
October 30, 2006
Recent statistics released by the American Hospital Association show that uncompensated care costs for U.S. hospitals continued to rise in 2005.
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Congress Fails to Reach Health IT Agreement - 10/10/06
Health Care
October 10, 2006
Lawmakers involved in negotiating the differences between two health information technology (Health IT) bills (H.R. 4157, S. 1418) failed to reach an agreement prior to Congress' recess. The bills may still go to a conference committee if lawmakers can reconcile the differences.
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CMS Announces DSH Allotments - 10/10/06
Health Care
October 9, 2006
Last week, CMS announced Medicaid disproportionate share hospital (DSH) allotment levels for states for FY 2005, as well as preliminary allotment levels for FYs 2006 and 2007.
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Medicaid Commission Hears Testimony on Medicaid Financing Issues - 09/08/06
Health Care
September 8, 2006
On September 6 and 7, the Medicaid Commission met in Arlington, Virginia. One of the presentations focused on Medicaid reimbursement, financing issues, and the Bush Administration's budget proposals. The 28-member body, appointed by Department of Health and Human Services ("HHS") Secretary Michael Leavitt, was tasked in 2005 with advising HHS and Congress on ways to reform and modernize the Medicaid program. The Commission is comprised of current and former governors, state Medicaid officials, health policy academics, business leaders, patient advocates, and representatives from the provider community.
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OIG Announces Guidelines for State Medicaid False Claims Laws - 08/29/06
Health Care
August 29, 2006
On August 21st, the OIG issued guidelines for States' Medicaid false claims laws. The Deficit Reduction Act created financial incentives for States to enact laws that establish liability for people or entities that submit false or fraudulent claims to Medicaid programs. In order to qualify for the incentive, the laws must meet specified criteria.
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CMS Issues Guidance On Citizenship Verification Requirements For Medicaid Applicants & Recipients - 06/28/06
Health Care
June 28, 2006
Section 6036 of the Deficit Reduction Act of 2005 ("DRA) requires State Medicaid agencies to verify through documentation the citizenship status of all U.S. citizens receiving Medicaid. The verification provisions take effect July 1, 2006 and states are expected to comply as of that date.
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CMS Issues Guidance on Citizenship Verification Requirements for Medicaid Applicants and Recipients - 06/13/06
Health Care
June 13, 2006
Under section 6036 of the Deficit Reduction Act of 2005 (DRA), states must now verify that all Medicaid applicants and recipients are U.S. citizens or nationals. Prior to enactment of the DRA, Medicaid applicants were required to declare under penalty of perjury that they were U.S. citizens or nationals but were not required to submit any supporting evidence.
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Problems with Physician Recruitment Agreements: Hospital Avoids Medicare Exclusion - 06/01/06
Health Care
June 1, 2006
On May 17, 2006, Tenet Healthcare Corporation has agreed to divest itself of Alvarado Medical Center ("Alvarado") in San Diego, protecting Alvarado from a possible exclusion from participation in Medicare, Medicaid and all other Federal health care programs.
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Georgia's Medicaid Managed Care Program Delayed Again - 03/21/06
Health Care
March 21, 2006
The implementation of the Georgia's Medicaid managed care program Georgia Healthy Families has been delayed again for another two months. In September 2005, the Department of Community Health ("DCH") delayed the program start from December 2005 to April 1, 2006 due to Hurricane Katrina's devastating impact on the call centers in the Gulf region designed to guide Medicaid recipients in enrollment procedures. The implementation schedule for the Atlanta and Central region will now begin on June 1, 2006 not April 1, 2006. The remaining regions (North, East, Southwest and Southeast) are scheduled to begin on September 1, 2006.
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Congress Targets Medicaid Fraud - 01/10/06
Health Care
January 10, 2006
This alert outlines important operational changes that Medicaid providers will be required to make possibly as early as calendar year 2006 under new federal legislation expected to become law later this month.
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Electronic Medical Records on the Fast Track - 10/10/05
October 10, 2005
This Health Care Update discusses a new series of Health and Human Services regulations that will accelerate the use and the implementation of electronic medical records ("EMR") and electronic prescribing.
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Expansive Interpretation of Medicare DSH Formula Adopted by Appeals Board - 10/07/05
Health Care
October 7, 2005
A recent Provider Reimbursement Review Board ("PRRB") decision, Ashtabula County Medical Center v. BCBS (2005-D49), expands the category of patients that are counted for Medicare Disproportionate Share Hospital ("DSH") payment purposes. Contrary to established CMS policy, the PRRB ruled in favor of Ohio providers permitting Medicaid DSH patients to be counted for Medicare DSH purposes. Such a policy change could significantly expand Medicare DSH payments for hospitals that treat a large percentage of uninsured patients.
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Hurricane Response: Government Suspends Certain Healthcare Laws - 9/12/05
Health Care Client Alert
September 12, 2005
Sandra K. Herron
In the wake of what many are calling the greatest disaster in United States history, both the Federal and the Louisiana State governments have suspended the application of certain healthcare laws to the extent necessary, in the words of the Secretary of Health and Human Services, "to ensure that sufficient health care items and services are available to meet the needs of individuals enrolled in Medicare, Medicaid and SCHIP programs, and to ensure that health care providers that furnish such items and services in good faith, but are unable to comply with one or more of these requirements as a result of the effects of Hurricane Katrina, may be reimbursed for such items and services and exempted from sanctions for such noncompliance, absent any determination."
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Nuclear Medicine Proposed To Be Included In Stark Designated Health Services - 08/08/05
Health Care
August 8, 2005
The Center for Medicare and Medicaid Services has reconsidered whether nuclear medicine services should be considered as designated health services under the federal Self-Referral Statute otherwise known as Stark.
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Sale of Non-Profit Hospitals in Bankruptcy - 06/30/05
Health Care
June 30, 2005
Wendy L. Hagenau
It is not uncommon in a bankruptcy case for the debtor to sell its assets, either as part of a plan of reorganization or liquidation or pursuant to section 363 of the Bankruptcy Code. The Bankruptcy Code provides that such a sale occurs after notice to all creditors and an opportunity for a hearing.
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Patient Care Ombudsman - 06/13/05
Health Care
June 13, 2005
Wendy L. Hagenau
Over the last five to ten years, the number of healthcare businesses filing bankruptcy petitions has greatly increased. The bankruptcy courts found themselves grappling not simply with business issues, but also with issues of patient care. Judges founds themselves sometimes ill-equipped to evaluate whether a business proposal or business strategy would in fact have adverse effects on patient care. As a result, the bankruptcy amendments have added a new section to address the needs of patients when the healthcare business is in bankruptcy.
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CMS Issues Final MMA Section 1011 Guidance - 06/10/05
Health Care
June 10, 2005
On May 9, almost 10 months after publishing a proposed implementation notice, the Centers for Medicare and Medicaid Services (CMS) released the final implementation notice for Section 1011 of the Medicare Prescription Drug Improvement and Modernization Act of 2003, which authorizes $250 million each year in federal reimbursement from FYs 2005 through 2008 directly to hospitals, physicians, and ambulance services for the costs associated with providing emergency services to undocumented and other specified immigrants.
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HHS Releases Guidance for Medicaid Commission as Congress, Governors Consider Other Medicaid Savings Proposals - 06/03/05
Health Care
June 3, 2005
In April, Congress reached agreement on a FY 2006 budget resolution that directs the committees with jurisdiction over Medicaid to identify $10 billion in savings over five years. As part of the budget deal, the White House agreed to create a commission to study Medicaid and recommend reform proposals that could result in Medicaid savings.
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HIPAA Portability Final Regulations - 05/16/05
Employee Benefits & Executive Compensation
May 16, 2005
Richard L. Arenburg
Armin G. Brecher
Paul F. Concannon
Edmund Emerson III
Castles R. Hollis
Steven G. Schaffer
The federal agencies enforcing HIPAA's "portability" requirements have issues final regulations that will become effective for plan years beginning on or after July 1, 2005.
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GAO Recommends Changes to Inpatient Rehabilitation Facility 75 Percent Rule - 05/09/05
Health Care
May 9, 2005
In April, The Government Accountability Office released a study recommending that CMS make significant refinements to the so-called "75 percent rule," which governs the eligibility of Inpatient Rehabilitation Facilities to receive enhanced Medicare payments.
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CMS releases Medicare IPPS Proposed Rule for FY 2006 - 05/09/05
Health Care
May 9, 2005
On April 25, CMS released the Medicare Inpatient Prospective Payment System proposed rule for FY 2006.
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What You Need To Know About The New Medicare Claims Appeal Process - 05/09/05
Health Care
May 9, 2005
On March 8, 2005, the Centers for Medicare and Medicaid Services released an interim final rule outlining changes to the Medicare claims appeal procedures. The rule sets forth the administrative appeals requirements for Medicare carriers, fiscal intermediaries, Qualified Independent Contractors, administrative law judges and the Medicare Appeals Council.
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Positive Changes Proposed To Medicare and Medicaid Conditions of Participation - 04/05
Health Care
On March 24, 2005, the Centers for Medicare & Medicaid Services issued a proposed rule to revise four requirements in the current conditions of participation hospitals must meet to participate in the Medicare and Medicaid programs.
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OIG Demonstrates Increased Willingness to Allow Physician Malpractice Insurance Subsidies - 01/12/05
Health Care
January 12, 2005
The Office of Inspector General of the U.S. Department of Health and Human Services (OIG) is the Federal agency that is charged with enforcing the Federal Medicare/Medicaid Anti-Kickback Statute, which makes it a criminal offense to knowingly and willingly offer, pay, solicit or receive any remuneration for referrals of items or services paid by Federal health care programs.
In the past, OIG has expressed a deep distrust of arrangements in which hospitals or other entities subsidize malpractice insurance premiums for physicians. In the agency's view, physicians are potential referral sources and subsidies could be considered payments to influence referrals to hospitals.
The OIG's first departure from this position was the creation of a safe harbor for obstetrical malpractice insurance subsidies on November 19, 1999. The safe harbor provision permits hospitals and other entities in rural or urban underserved areas to pay for some or all of the obstetrical malpractice insurance premiums for obstetrical practitioners, including physicians and certified nurse midwives. However, at the time, it was not clear that the agency would allow such subsidies in other areas.
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Department of Health and Human Services Task Force Releases Report on Prescription Drug Importation - 12/23/04
December 23, 2004
Cynthia E. Berry
In this edition of the Advocacy & Government Relations Client Alert we discuss the final report (released on December 21) of the Department of Health and Human Services Task Force on Drug Importation. Reiterating that access to safe and affordable prescription drugs is an important policy goal, the Task Force concluded that drug importation would be costly to implement, provide little overall savings and, if not restricted to commercial importation from Canada, could be dangerous to consumers. The Task Force advised that all aspects of achieving safety, quality and cost-effectiveness must be comprehensively examined before imported drugs can be considered safe.
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New Stark Rules Bring Major Changes - 08/26/08
Health Care
Sandra K. Herron
Sandra K. Herron
On August 19, 2008, the Centers for Medicare and Medicaid Services published the latest changes to the Stark Law. The Stark Law regulates the types of arrangements into which physicians may enter. Violations of the Stark Law bring hefty civil fines and penalties.
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