Articles and Blogs

The U.S. District Court for the District of Columbia recently found in favor of a hospital that challenged CMS’s outlier reconciliation process. The District Court in Clarian Health West v. Burwell1 stated the outlier reconciliation process violated the Administrative Procedure Act (“APA”) because CMS should have allowed for notice and comment prior to starting... READ MORE

The Department of Health and Human Services Office of Inspector General (“OIG”) recently issued Advisory Opinion 16-09, which provided a favorable opinion of a company’s (“Requestor’s”) proposal to provide physician offices with a computerized point-of-care vaccine storage and dispensing system free of charge, subject to certain other requirements (“Arrangement”). OIG stated it would not... READ MORE

To transfer personal data from the European Union (“EU”) to the United States (“US”), a legal basis for the transfer must exist. The EU and the US have agreed to new principles, referred to as Privacy Shield Principles (“Privacy Shield” or “Principles”), that will permit the transfer of personal data between the US and... READ MORE

On September 28, 2016, the Centers for Medicare & Medicaid Services (“CMS”) released a complete overhaul of Part 483 to Title 42 of the Code of Federal Regulations, the Requirements for States and Long-Term Care Facilities. CMS’s Final Regulations (the “Final Regulations”) cover many regulatory requirements for long-term care facilities (“Facilities”) and create new... READ MORE

On September 14, 2016, the Office for Civil Rights (“OCR”) of the Department of Health and Human Services (“HHS”) issued a list of Frequently Asked Questions (“FAQs”) addressing the language tagline requirements imposed by Section 1557 of the Affordable Care Act (“ACA”). Along with the FAQs, OCR also released a list of the top... READ MORE

As part of their mission and outreach, health care providers (“Provider(s)”) often establish patient assistance programs offering free or discounted services or items in an effort to promote preventive health and wellness in their communities (e.g., free health screenings, treatment or testing, pharmaceuticals, accommodations and transportation services) (“Programs”). The goals of such Programs are... READ MORE

An increasing number of employer-sponsored health plans are electing not to enter into contractual agreements with hospitals through an established provider network. These plans seek to limit payment for hospital services provided to plan beneficiaries by repricing the services at a plan-determined amount, typically based upon a percentage of Medicare reimbursement, an amount far below... READ MORE

As has been widely reported, CMS’s Acting Administrator, Andy Slavitt, recently announced four participation options under the Quality Payment Program (i.e., participation in the MIPS and Advanced APM programs) for 2017. In part because the September 8 announcement provides only summary descriptions, many questions surround the four participation options and their implementation for 2017.... READ MORE

Background Hospitals and other facilities that are accredited by The Joint Commission work to ensure compliance with The Joint Commission’s “Life Safety” chapter, which requires compliance with the National Fire Protection Association’s NFPA 101: Life Safety Code (“LSC”).  As part of those efforts, many accredited facilities have used The Joint Commission’s Statement of Conditions (“SOC”) as... READ MORE

On September 8, 2016, the Michigan Senate passed a bill on a 22-15 vote, which expands the scope of practice for certified nurse anesthetists (“NAs”). Senate Bill 1019 amends Sections 17210 and 17708 of the Michigan Public Health Code (the “Code”). Specifically, the bill adds certain anesthesia and analgesia services to an NA’s scope of... READ MORE