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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Controversial Medicaid Rule Vacated - 05/08
Health Care
May 27, 2008
William C. Crenshaw
Kristin M. Robinson
Ivan J. Snyder
On May 23, 2008, Judge James Robertson of the U.S. District Court for the District of Columbia entered summary judgment in favor of Powell Goldstein's client hospital plaintiffs, vacating a controversial Medicaid rule that would have severely curtailed payments to Medicaid providers.
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Genetic Non-Discrimination Bill Signed Into Law - 05/08
Health Care/Labor & Employment
May 23, 2008
Cynthia E. Berry
Robyn W. Farmer
Bruce F. Howell
Leah Mendelsohn Stone
Kathryn B. Vargo
After thirteen years of consideration, legislation prohibiting health insurance companies and employers from discriminating against individuals based on genetic information was signed into law on May 21, 2008.
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Expansion of Competitive Bidding Program for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies
Health Care
January 15, 2008
Alan K. Parver
Leah Mendelsohn Stone
The Centers for Medicare & Medicaid Services announced on January 8 the seventy Metropolitan Statistical Areas and eight product categories that will be involved in the second phase of competitive bidding for durable medical equipment, prosthetics, orthotics, and supplies.
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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 Report to Congress on the Medicare Hospital Value-Based Purchasing Program
Health Care
December 5, 2007
Cynthia E. Berry
Leah Mendelsohn Stone
The Centers for Medicare & Medicaid Services (CMS) issued a report to Congress on November 21 which provides a framework for how Medicare hospital payments can be linked to performance measures.
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CMS Proposes Final Medicare E-Prescribing Standards - 11/27/07
Health Care
November 27, 2007
On November 16, the CMS published a proposed rule to implement final e-prescribing standards for the Medicare Part D program (72 Fed. Reg. 64900). Any prescriber or dispenser who electronically transmits prescription data and certain other information related to a Part D beneficiary will be required to comply with these standards.
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House Small Business Committee Holds Hearing on Small Supplier Concerns Over Medicare Competitive Bidding - 11/07/07
Health Care
November 7, 2007
Alan K. Parver
The U.S. House of Representatives Committee on Small Business, Subcommittee on Investigations and Oversight, held a hearing October 31, 2007 about the potential impact of the Medicare competitive bidding program on small providers.
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CMS Issues Medicare Hospital Outpatient Prospective Payment System 2008 Final Rule - 11/07/07
Health Care
November 7, 2007
Alan K. Parver
On November 1, 2007, the Centers for Medicare & Medicaid Services (CMS) issued a final rule with comment period updating the hospital Outpatient Prospective Payment System for calendar year 2008.
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OIG Finds Some Medicare Drug Plan Web Sites Do Not Meet Federal Requirements - 10/31/07
Health Care
October 31, 2007
Leah Mendelsohn Stone
Steven Stranne
A recently released report by the Department of Health and Human Services Office of Inspector General (OIG) revealed that approximately one-third of the Medicare Part D prescription drug plan sponsors' Internet web sites did not contain all of the content required by the Medicare regulations and that eighty-five percent of the web sites did not comply with Federal requirements for accessibility.
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OIG Advisory Opinion Approves Physician On-Call Coverage Payment Arrangement - 10/24/07
Health Care
October 24, 2007
The Office of Inspector General issued an Advisory Opinion on September 27, 2007 announcing its approval of an arrangement in which a nonprofit hospital compensated physicians for emergency department on-call coverage.
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House Fails to Override Presidential Veto of SCHIP Legislation - 10/23/07
Health Care
October 23, 2007
Anne B. Camper
On October 18, 2007, the House failed to override a Presidential veto of legislation that would have reauthorized the State Children's Health Insurance (SCHIP) program.
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FDA Announces Changes in Drug and Device User Fees; Public Workshop on Cell/Scaffold Product Evaluation
Health Care
October 17, 2007
Announcements from FDA on Device and Drug User Fees; Public Workshop on In-Vitro Analysis of Cell/Scaffold Medical Product
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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 Posts Enforcement, Audit and Corrective Action Plan (CAP) Summaries - 10/08/07
Health Care
October 8, 2007
The CMS has posted information regarding agency audit and enforcement initiatives pertaining to Medicare Advantage and Prescription Drug Plan organizations conducted since January of 2006.
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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 Issues Final Rule on Revisit User Fees - 09/26/07
Health Care
September 26, 2007
On September 19, 2007, the Centers for Medicare & Medicaid Services published a final rule establishing "revisit user fees." These fees will be assessed against health care facilities participating in the Medicare program.
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Significant Changes to Federal False Claims Act Introduced by Senator Grassley - 09/19/07
Health Care
September 19, 2007
R. Joseph Burby, IV
Ralph J. Caccia
On September 12, Senator Charles Grassley (R-Iowa), ranking member of the Senate Finance Committee, proposed Senate Bill 2041 to amend the federal False Claims Act ("FCA") in ways which would directly impact qui tam suits initiated against health care providers.
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Stark II, Phase III: And Still More to Come! - 09/14/07
Health Care
September 14, 2007
Sandra K. Herron
On August 27, 2007, The Centers for Medicare and Medicaid Services
(CMS) released the third phase of rulemaking to amend the regulations
implementing the Ethics in Patient Referrals Act, commonly known as
"Stark." This Phase III Final Rule (Phase III) was published on
September 5, 2007 and will become effective 90 days later, on December 5, 2007. In publishing Phase III, CMS both responds to public comments on Phase II and addresses the entire regulatory scheme.
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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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Proposed Stark Amendment Targets Physician-Owned Hospitals - 08/08/07
Health Care
August 8, 2007
On July 23, 2007, Representative Pete Stark co-sponsored legislation that included a proposed amendment to the Ethics in Patient Self-Referral Statute (the "Stark law"). The proposed amendment is part of the Children's Health and Medicare Protection Act of 2007 and significantly limits an important existing exception to the Stark law prohibition on certain physician referrals to hospitals.
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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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OPPS for 2008 May Change from CMS' Proposed Rule - 07/31/07
Health Care
July 31, 2007
Alan K. Parver
On July 16, 2007, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule regarding changes to the Medicare Outpatient Prospective Payment System (OPPS) for calendar year 2008. This rule will be published in the Federal Register on August 2, 2007, and comments will be accepted until September 14, 2007.
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CMS Solicits Comments for 2008 PQRI and PAQI Fund - 07/25/07
Health Care
July 24, 2007
On July 12, 2007, the CMS issued a proposed rule with respect to the Physician Quality Reporting Initiative for calendar year 2008.
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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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CMS Publishes Medicaid Drug Payment Final Rule - 07/12/07
Health Care
July 12, 2007
Alan K. Parver
Leah Mendelsohn Stone
On July 6, the Centers for Medicare and Medicaid Services (CMS) released a final rule pertaining to the reimbursement of prescription drugs under the Medicaid program. The rule will be published in the Federal Register on July 17, 2007.
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Summary Judgment for PoGo Client in Multidistrict Litigation Affirmed on Appeal - June/July
Health Care and Litigation
July 2, 2007
On Wednesday, June 13, just one week after oral argument, the Eleventh Circuit Court of Appeals affirmed the grant of summary judgment to our client, Coventry Health Care, Inc., in the lead case in the Managed Care Multidistrict Litigation.
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MedCAC to Review CPAP Diagnostic Criteria - 06/26/07
Health Care
June 26, 2007
MedCAC announces upcoming meeting to discuss testing methods that may be used to support Medicare coverage for CPAP devices.
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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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Study Finds Pay-for-Performance Is Not Associated with Significant Quality Improvement - 06/12/07
Health Care
June 12, 2007
Leah Mendelsohn Stone
A recent study conducted by researchers at the Duke Clinical Research Institute concluded that the pay-for-performance pilot program, which was launched by the Center for Medicare & Medicaid Services in 2003, has not demonstrated a significant improvement in quality of care or outcomes in hospital patients with acute myocardial infarction.
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AHRQ's Online Health Care Report Card - 06/05/07
Health Care
June 5, 2007
On May 30, the AHRQ unveiled a compendium which is a searchable directory of over 200 samples of report cards produced by a variety of organizations.
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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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GAO Report on Medicaid Financing Fuels Congressional Debate over Proposed CMS Medicaid Regulation - 05/09/07
Health Care
May 9, 2007
On April 30, the U.S. Government Accountability Office released a report on CMS oversight of Medicaid program financing entitled "Federal Oversight Initiative is Consistent with Medicaid Payment Principles but Needs Greater Transparency."
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IPPS Proposed Rule - 05/02/07
Health Care
May 2, 2007
Alan K. Parver
On April 16, 2007, CMS issued a proposed rule regarding changes to the Medicare Inpatient Prospective Payment System (IPPS) for fiscal year 2008. Comments on the rule will be accepted until June 12, 2007.
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CMS Clarifies Emergency Services Requirements for Hospitals - 05/01/07
Health Care
May 1, 2007
On April 26, 2007, the Centers for Medicare and Medicaid Services (CMS) issued a memorandum to state survey agency directors clarifying the regulatory requirements for hospitals' emergency capabilities.
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CMS Issues Final Rule for Medicare Competitive Acquisition Program - 04/24/07
Health Care
April 24, 2007
Alan K. Parver
On April 2, 2007, CMS released the final rule implementing the new competitive bidding program for medical equipment, prosthetics, orthotics, and supplies (DMEPOS) as mandated by Congress in the MMA.
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Bill Permitting Medicare Drug Price Negotiation Blocked - 04/24/07
Health Care
April 24, 2007
Leah Mendelsohn Stone
On April 18, "The Medicare Fair Prescription Drug Price Act of 2007," a Senate bill that would have allowed the government to negotiate lower prices for prescription drugs under Medicare Part D, failed on a procedural vote.
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OIG Advisory Opinion Concludes Credit Card Rewards Doesn't Violate Anti-Kickback Statute - 04/17/07
Health Care
April 17, 2007
On April 3, the Office of Inspector General ("OIG") posted Advisory Opinion 07-03 in which it determined that a nursing home's utilization of rewards from credit card purchases does not violate the federal Anti-Kickback Statute. 42 U.S.C. § 1320a-7b(b).
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National Provider Identifier Deadline Eased - Slightly 04/16/07
Health Care
April 16, 2007
Sandra K. Herron
Implementation of a single, standardized provider identifier is a mammoth undertaking, and one that requires close attention to testing and planning. CMS estimates that once a Covered Entity obtains its NPI, the testing and implementation process will take 120 days - a time period longer than the time remaining before the May 23, 2007 deadline.
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CMS Posts List of Quality Measures for Physician Quality Reporting - 04/16/07
Health Care
April 16, 2007
Interested providers should review the list of quality measures to determine those measures that apply to their practices and begin preparing for submission of the quality data.
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Senator Grassley Asks GAO to Examine Nonprofit Hospitals' Community Benefits - 04/11/07
Health Care
April 11, 2007
On April 5, 2007, Senator Chuck Grassley (R-IA), the ranking minority member of the Finance Committee, requested that Congress' investigative arm, the Government Accountability Office study nonprofit hospitals' uncompensated care and other community benefits.
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Third Circuit Ruling: When Does the Fiduciary Exception to the Attorney-Client Privilege Not Apply? 04/09/07
Health Care
April 10, 2007
Paige Arden Stanley
Under the common-law evidentiary rule known as the "fiduciary exception" to the attorney-client privilege, certain fiduciaries who obtain legal advice during the execution of their fiduciary obligations may not thereafter assert the attorney-client privilege against their beneficiaries.
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Genetic Information Bill May See House Floor Action This Month - 04/04/07
Health Care
April 4, 2007
Cynthia E. Berry
A bill to address concerns about the potential for discrimination in employment and insurance based on genetic information is almost ready for House floor action after attempts to pass the bill in several previous Congresses have stalled in committee.
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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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Healthcare Businesses and the Appointment of a Patient Care Ombudsman in Bankruptcy - 03/14/07
Bankruptcy & Financial Restructuring
March 14, 2007
Wendy L. Hagenau
Under the Bankruptcy Abuse Prevention and Consumer Protection Act of 2005 ("BAPCPA"), a number of special provisions were enacted for "healthcare businesses". One provision in particular requires the appointment of a patient care ombudsman in a case under chapter 7 (liquidation) or chapter 11 (reorganization) if the debtor is a healthcare business.
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CMS Withdraws Heightened Restrictions for Independent Diagnostic Testing Facilities - 03/06/07
Health Care
March 6, 2007
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NGA Urges Part D Implementation Changes - 02/28/07
Health Care
February 28, 2007
On January 18, 2007, the Centers for Medicare and Medicaid Services (CMS) published a proposed regulation that would dramatically affect payments to public providers and state-Medicaid financing arrangements. Since the regulation was released, opposition to the regulation has been mobilizing.
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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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American Health Lawyers Association Issues Guidance for Nonprofit Boards - 02/19/07
Health Care
February 19, 2007
On February 7, 2007, the American Health Lawyers Association distributed guidance regarding the Internal Revenue Service's expectations for nonprofit boards. The guidance, entitled Good Governance Practices for 501(c)(3) Organizations addresses such issues as the composition, size, and education of nonprofit boards.
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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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CMS Manual IDTF Changes - 02/13/07
Health Care
February 13, 2007
On January 26, 2007, the Centers for Medicare and Medicaid Services ("CMS") released modifications to the CMS Medicare Program Integrity Manual, Pub. 100-08 (the "Manual"), which detail CMS' position on carrier and contractor enforcement of new requirements for independent diagnostic testing facilities ("IDTF"s).
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Commonwealth Fund Report Suggests Improvements to the Use of Demonstration Project - 02/13/07
Health Care
February 13, 2007
Alan K. Parver
Leah Mendelsohn Stone
A recent report released by the Commonwealth Fund suggests that the processes used to evaluate and implement findings from Medicare demonstration projects and initiatives can be improved. Enhancing these processes may help Medicare address the challenges of improving the quality and effectiveness of care while controlling costs.
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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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MRI Lease Agreements: Problems at a State Level - 01/31/07
Health Care
January 31, 2007
Illinois Attorney General Joins Whistleblower Suit Challenging Sham Physician Lease Arrangement
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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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Fourth Circuit Affirms that ERISA Preempts "Fair Share" Legislation - 01/29/07
Health Care
January 29, 2007
In its January 17, 2007, opinion, the Fourth Circuit Court of Appeals affirmed the Maryland District Court's ruling that Section 514(a) of the Employee Retirement Income Security Act of 1974 preempted Maryland's "Fair Share Health Fund Act."
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Congress Strengthens IRS Whistleblower Statute - 01/26/07
Tax & White Collar Crime
January 26, 2007
Ralph J. Caccia
The Tax Relief and Health Care Act of 2006, signed into law on December 20, 2006, amended the Internal Revenue Code to provide more incentives for private citizens to blow the whistle on tax evaders.
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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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Elimination of 2007 Late Enrollment Penalty for Low-Income Medicare Beneficiaries - 01/17/07
Health Care
January 17, 2007
Leah Mendelsohn Stone
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CMS Issues Guidance on DRA Employee Education Requirements - 1/17/07
Health Care
January 17, 2007
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Illinois Uninsured Litigation - 01/17/07
Health Care
January 17, 2007
Eric P. Schroeder
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Medicaid Commission Issues Final Report - 01/09/07
Health Care
January 9, 2007
Cynthia E. Berry
Leah Mendelsohn Stone
The Medicaid Commission issued its final report and recommendations on December 29, 2006, recognizing that "fundamental reform" is vital to ensuring the lasting fiscal sustainability of the Medicaid program.
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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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Charity Care and Bad Debt Proposal Released by HFMA - 12/12/06
Health Care
December 12, 2006
The Healthcare Financial Management Association (HFMA) recently joined a growing list of healthcare organizations in calling for clarity and reform in how this country's hospitals and other healthcare providers characterize charity care, bad debt, and community benefit in their financial statements.
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Fifth Circuit Holds Patient Cannot Bring Suit to Enforce HIPAA - 12/11/06
Healthcare
December 11, 2006
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GA Supreme Court Upholds Narrow Construction of Anti-SLAPP Statute - 12/05/06
Health Care
December 5, 2006
Eric P. Schroeder
On November 28, the Georgia Supreme Court ruled that Georgia's anti-SLAPP statute only applies to the statements regarding governmental proceedings specifically set forth in O.C.G.A. §9-11-11.1(c). The Court rejected the argument that the statute should be construed broadly so as to cover all statements made which touch upon matters of public concern.
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Legislation Proposed to Restrict DOJ Practices on Waiver of Attorney-Client Privilege - 11/28/06
Health Care
November 28, 2006
R. Joseph Burby, IV
On November 21, 2006, Senator Arlen Specter (R-Pa.) introduced a bill that would prohibit the U.S. Department of Justice ("DOJ") from compelling companies to waive their attorney-client and work product privileges to avoid indictment or otherwise receive credit for cooperating with a federal investigation. Because health care fraud enforcement remains a top priority for the DOJ, the issue of waiver of attorney-client privilege is critical for health care providers because it affects providers' expectations that they can retain the confidentiality of internal investigations conducted by counsel and legal advice on compliance matters.
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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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Medicare Finalizes Changes to Outpatient Hospital Payments - 11/07/06
Health Care
November 7, 2006
Cynthia E. Berry
On November 1, CMS released the Medicare Outpatient Prospective Payment System final rule, which describes many of the most significant changes to Medicare hospital outpatient payments in the coming year and is effective for services delivered on or after Jan. 1, 2007. The rule includes a 3.4 percent market basket update for hospital outpatient services as well as a host of other significant updates
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SCHIP Funding Redistribution Could be on U.S. Senate Agenda - 11/09/06
Health Care
November 7, 2006
Cynthia E. Berry
The State Children's Health Insurance Program is projecting a $930 million shortfall in fiscal year (FY) 2007 across 17 states and three territories unless Congress steps in with new funding. The Senate may consider legislation to respond to this funding deficit. Read details in this alert.
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Virginia Mason Settles Provider-Based Facility Fee Class Action Suit - 11/07/06
Health Care
November 7, 2006
In January 2005, two patients of Virginia Mason Medical Center filed suit against the healthcare provider seeking recovery of "facility charges" for treatment received at the hospital's downtown outpatient clinic, which is connected to the main hospital.
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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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GAO Report on Medicaid Third-Party Liability Indicates States Need Federal Guidance - 10/24/06
Health Care
October 24, 2006
Leah Mendelsohn Stone
The Deficit Reduction Act of 2005 (DRA), in response to perceived problems in enforcing Medicaid third-party liability, required that states have legislation requiring health insurers and other entities legally responsible for paying health claims.
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Catholic Health Association Releases Template for Tax-Exempt Hospitals Annual Returns - 10/24/06
Health Care
October 24, 2006
Leah Mendelsohn Stone
Responding to the repeated requests of Congress that nonprofit hospital differentiate themselves from for-profit health care institutions, the Catholic Health Association (the "CHA"), a nonprofit association that serves Catholic health care organizations, has released a template for tax-exempt hospitals, which would be submitted with IRS Form 990, Return of Organization Exempt from Income Tax. The CHA's goal is to urge nonprofit hospitals to voluntarily report community benefit information.
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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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JCAHO Revises Credentialing Process Requirements - 10/04/06
Health Care
October 4, 2006
The Joint Commission on Accreditation of Healthcare Organizations ("JCAHO") recently released the 2007 Pre-Publication Medical Staff Standards for Hospitals. Considerable changes have been made to the medical staff chapter. Some of the more significant differences are in the area of medical staff credentialing.
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Senate Introduces Sweeping Bipartisan HealthCare Disparities Legislation - 10/04/06
Health Care
October 4, 2006
Cynthia E. Berry
In the last hours before Congress recessed for the fall elections, a bipartisan group of Senators including Majority Leader Frist (R-TN) and Senator Kennedy (D-MA) introduced sweeping new legislation targeted at addressing healthcare disparities.
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OIG 2007 Work Plan: Risk Areas for Physicians and Physician Practices - 10/04/06
Health Care
October 4, 2006
On September 25, 2006, the United States Department of Health and Human Services' (HHS) Office of the Inspector General (OIG) published its Fiscal Year 2007 Work Plan. In general, the Work Plan identifies areas perceived by OIG as having a high risk for abuse in the programs and activities administered by HHS, and provides a list of areas in which providers can expect the OIG to pursue enforcement activities, and therefore, a road map for providers' compliance programs, monitoring, and follow-up.
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Bill Introduced to Open Medicare Claims Data to Researchers - 09/22/06
Health Care
September 22, 2006
On September 14, Senate Finance Committee Chairman Charles Grassley (R-Iowa) and Senator Max Baucus (D-Mont.) introduced a bill (S. 3897) to the Senate designed to give researchers access to Medicare beneficiary data for use in the study and improvement of medical treatments. The proposed Medicare Data Access and Research Act would link data from the new Medicare drug benefit to claims, utilization and diagnostic data collected from hospital and physician providers under Medicare.
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Senate Finance Committee Heightens Pressure on Non-Profit Hospitals Over Charity Care - 09/20/06
Health Care
September 19, 2006
Senate Finance Committee Chairman Charles Grassley (R-Iowa) urged non-profit hospitals to increase the level of charity care they provide to the poor and uninsured, noting in a statement released September 12, 2006, the day before a Senate Finance Committee hearing was to begin, that in exchange for tax breaks, "[t]he public has a right to expect significant, measurable benefits in return." Although Senator Grassley said he was not anticipating legislation relating to the level of charity care provided by non-profit hospitals, he did not rule out such legislation.
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MedPAC Discusses the Future of Medicare DSH and IME - 09/18/06
Health Care
September 18, 2006
On September 7 and 8, the Medicare Payment Advisory Commission (MedPAC) met in Washington to discuss the future of Medicare Disproportionate Share Hospital (DSH), Indirect Medical Education payments, and improvements to Medicare physician payments
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CMS Announces Plans to Move-forward with Profit Sharing Demonstration for Hospitals and Physicians - 09/18/06
Health Care
September 18, 2006
Cynthia E. Berry
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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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Executive Order Requires Health Care Price and Quality Information for Consumers -08/29/06
Health Care
August 29, 2006
On August 22nd, President Bush signed an executive order that requires departments that administer federal health care programs to provide cost and quality information to beneficiaries so that they can compare providers and services.
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E-Regulation At Last - 08/29/06
Health Care
August 29, 2006
Sandra K. Herron
On August 8, 2006, the Office of Inspector General of HHS and Centers for Medicare and Medicaid Services published final rules creating a safe harbor to the Anti-kickback Statute and an exception to the Stark law for health information technology. Under the new rules, a hospital, or certain other entity "donors," may donate technology to physicians, or certain other "recipients," that facilitates the implementation of electronic health records and electronic prescribing.
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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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Final CMS Report on Specialty Hospitals Sent to Congress - 08/22/06
Health Care
August 22, 2006
The Centers for Medicare and Medicaid Services (CMS) recently issued a report to Congress on physician investment in specialty hospitals. The report, mandated under the Deficit Reduction Act of 2005, addresses a range of issues relating to specialty hospitals, including investment transparency, Medicare reimbursement, and fraud and abuse.
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CMS' Proposed Changes To Medicare Physician Fee Schedule: Implications For Stark II, Reassignment Rules, & IDTFS - 08/22/06
Health Care
August 22, 2006
On June 29, 2006, the Centers for Medicare and Medicaid Services ("CMS") issued a notice in the Federal Register that included proposed revisions to the work relative value units (RVUs) and proposed changes in the methodology for calculating practice expense RVUs. Less than two months later, on August 8, 2006, CMS announced that its release of a proposed rule to "revise payment rates and policies under the Medicare Physician Fee Schedule" (the "Proposed Rule").
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CMS Releases Quality Standards for DMEPOS Suppliers - 08/22/06
Health Care
August 22, 2006
Alan K. Parver
On August 14, 2006, the Centers for Medicare and Medicaid Services (CMS) issued quality standards for suppliers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS). Read details in our alert.
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CMS Announces Revisions to the Emergency Medical Treatment and Active Labor Act - 08/21/06
Health Care
August 21, 2006
Raquel M. Gayle
On August 1, 2006, the Centers for Medicare and Medicaid Services ("CMS") issued the hospital Inpatient Prospective Payment System ("IPPS") final rule for Federal fiscal year 2007 (the "2007 IPPS Final Rule"). The 2007 IPPS Final Rule, which commences CMS's three year transition of hospital inpatient payment reform, finalizes two revisions to existing regulations under the Emergency Medical Treatment and Active Labor Act.
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Congress Examines Emergency Department Use Across the U.S. - 08/16/06
Health Care
August 16, 2006
Leah Mendelsohn Stone
The House Ways and Means Health Subcommittee recently held a hearing on emergency care in response to a report issued by the Institute of Medicine, which found that emergency care faces a growing crisis.
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CMS Issues Outpatient Prospective Payment Proposed Rule - 08/15/06
Health Care
August 15, 2006
Leah Mendelsohn Stone
On August 8, CMS issued the proposed rule for the outpatient prospective payment system for calendar year 2007. In the same rule, CMS proposed a revision of payments for ambulatory surgical centers.
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Court of Appeals Holds Medical Malpractice Release Authorization Preempted by HIPAA - 08/14/06
Health Care
August 14, 2006
The Georgia Court of Appeals has ruled that a Georgia statute requiring medical malpractice plaintiffs to attach to their complaint a medical record release is preempted by the Health Insurance Portability and Accountability Act of 1996.
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House Passes Health IT Bill; Legislation Now Awaits Reconciliation - 08/08/06
Health Care
August 8, 2006
On July 27th, the House passed legislation to foster the adoption of health IT systems by providers. The bill now needs to be reconciled with Senate-passed health IT legislation passed earlier this year.
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CMS Issues Inpatient Prospective Payment Rule - 08/08/06
Health Care
August 8, 2006
On August 1st, CMS released the Medicare inpatient prospective payment system (IPPS) final rule. The rule provides a full market basket update to IPPS rates. It also includes significant revisions to the Medicare diagnosis related group (DRG) methodology.
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OIG Calls For Better Oversight of 340B Program - 7/25/06
Health Care
July 25, 2006
Congress established the 340B Drug Discount Program in 1992 to allow certain providers to receive substantial discounts on outpatient drugs because they serve the nation's poor and uninsured.
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Tenet Agrees To Pay $900 Million in Settlement - 07/24/06
Health Care
July 24, 2006
Nearly two months after Tenet Healthcare Corporation ("Tenet") agreed to pay $21 million for illegal kickbacks to physicians and sell Alvarado Medical Center in San Diego, Tenet, the nation's second largest hospital chain, has reached a $900 million dollar settlement with the federal government ending a four-year investigation by the U.S. Justice Department into allegations of unlawful billing practices. Tenet has not admitted any wrongdoing.
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OIG Study Results in Decrease in Physician Reimbursement for Five Oncology Procedure Codes - 07/18/06
Health Care
July 18, 2006
The Office of the Inspector General of the Department of Health and Human Services ("OIG") has released its report, "A Comparison of Average Sales Prices to Widely Available Market Prices: Fourth Quarter 2005," detailing the OIG's findings on the prices paid by hematologists and medical oncologists for thirty-nine Medicare Part B prescription drugs.
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CMS Proposes Payment Increases for Physician E&M Services - 07/07/06
Health Care
July 7, 2006
On June 21, 2006, the Center for Medicare & Medicaid Services (CMS) notified providers of its proposed revisions to the Medicare Physician Fee Schedule. CMS' proposed revisions provide for significant payment increases for "evaluation and management" services, which cover physician time and effort spent with patients evaluating their conditions and counseling them in health management.
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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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Supreme Court Allows ERISA Plan to Bring Suit to Recoup Payments Under § 502(a)(3) - 06/13/06
Health Care
June 13, 2006
In a recent unanimous opinion, the Supreme Court has held that an ERISA fiduciary may bring suit under ERISA § 502(a)(3) seeking reimbursement of medical payments it had made on behalf of its beneficiary where the beneficiary has received a tort settlement from a third-party on the same incident.
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New IRS Independent Contractor Test - 06/08/06
Health Care
June 8, 2006
In January of this year the Internal Revenue Service modified and simplified its test to determine whether an individual is working as an employee or independent contractor for employment tax purposes. This test has also been adopted by the Office of Inspector General and the Centers for Medicare/Medicaid Services for purposes of their bona fide employment safe harbor and exception under the Anti-Kickback Statute and the Physician Self-Referral Law known as the Stark Law.
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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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House Advances Health IT Legislation - 05/30/06
Health Care
May 30, 2006
On May 24, 2006, health information technology (health IT) legislation advanced from the House Ways and Means Health Subcommittee to the full committee. The House Energy and Commerce Health Subcommittee will mark up its own health IT legislation shortly. The Senate already passed a comprehensive health IT bill last December.
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Congress Responds to the Enrollment Deadline for Part D - 05/23/06
Health Care
May 23, 2006
Cynthia E. Berry
Alan K. Parver
On May 15th, the enrollment deadline for the Medicare Part D prescription drug benefit went into effect; as a result, individuals with Medicare will not be able to join a plan until the next enrollment period (beginning November 15th) and will be subject to a lifetime financial late-enrollment penalty. Members in both the House and Senate have already introduced bills aimed at mitigating the effect of the deadline on seniors and other vulnerable groups.
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IRS Launches New Compliance Audit Initiative Targeting Hospital Bond Issues - 05/16/06
Public Law & Finance
May 16, 2006
Robert C. Lewinson
Do you have outstanding tax-exempt bonds? The IRS recently announced that it was launching a new audit initiative, targeting qualified 501(c)(3) bond issues in general, and hospital bond issues in particular. Audits will focus primarily on post-closing compliance by bond issuers and conduit borrowers - especially focusing on private use, federal research agreements, management contracts and lease arrangements.
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Update on Federal Funding for Emergency Care to Undocumented Immigrants - 05/16/06
Health Care
May 16, 2006
Through the Section 1011 program, the Centers for Medicare and Medicaid Services (CMS) is directly reimbursing hospitals, physicians, and ambulance services for the cost of providing emergency care to undocumented immigrants. Nationally, providers are eligible to receive $250 million annually.
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Medicare Prescription Drug Benefit Update - 05/16/06
Health Care
May 16, 2006
Now in its fifth month of operation, the Medicare Part D prescription drug benefit continues to enroll new beneficiaries. On April 20, officials announced that approximately 36 million Medicare beneficiaries are receiving coverage vis-à-vis Part D. Of these, approximately 8.1 million beneficiaries are enrolled in a standalone prescription drug plan
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Court Allows Litigation for Failure to Disclose Business Impact of Proposed Regulations - 05/10/06
Health Care
May 10, 2006
In a case involving a class action, a federal court recently refused to dismiss claims that an operator of long-term acute care hospitals listed on the NYSE and some of its officers violated the anti-fraud rules of the Securities Exchange Act of 1934, as amended by failing to disclose information regarding: (i) anticipated regulatory changes that would have an adverse impact on its business; and (ii) alleged illegal kickback payments for patient referrals, testing and admissions.
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PBMs Win Another Battle but the War is Not Over - 05/03/06
Health Care
May 3, 2006
In a positive decision for the pharmacy benefit management industry, the United States District Court for the District of New Jersey recently held that a pharmacy benefits manager ("PBM") is not a fiduciary under the Employee Retirement Income and Security Act of 1974. Recent litigation and legislative trends reveal an increasing tendency to seek to hold PBMs to higher fiduciary duty standards.
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Inspector General Issues First Open Letter - 05/03/06
Health Care
May 3, 2006
On April 24, 2006, the Inspector General of the Department of Health and Human Services issued guidance encouraging providers to voluntarily disclose violations of the physician self-referral law and the Anti-Kickback Statute. This guidance is Daniel Levinson's, the Inspector General, first Open Letter to Health Care Providers. This guidance relates his perspectives on compliance, the resolution of health care fraud cases, corporate integrity agreements, and the OIG's Provider Self Disclosure Protocol. This letter also introduces a new voluntary disclosure initiative that supplements prior guidance issued in 1998.
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Once Again, Hospital's Unilateral Amendment of Medical Staff Bylaws Prohibited - 05/02/06
Health Care
May 2, 2006
In the wake litigation filed by the Medical staff of the Community Memorial Hospital of San Buenaventura and its ensuing settlement, see http://www.ama-assn.org/ama/pub/category/8102.html, a Florida court has struck down Lawnwood Medical Center's ability to unilaterally amend its Medical Staff bylaws. The Lawnwood case differs from San Buenaventura in that involves a St. Lucie County, Florida hospital governance law.
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CMS Releases Proposed DMEPOS Competitive Bidding Rule - 05/02/06
Health Care
May 2, 2006
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