AHCA Sues to Enjoin Prohibition on Binding Arbitration


On October 4, 2016 CMS issued its Final Rule entitled “Reform of Requirements for Long Term Care Facilities” which updates the requirements for all SNFs and NFs participating in Medicare and Medicaid. Many of the changes impact quality of care, discharge, behavioral health issues and related issues associated with the general direction of CMS to more value based payment methods evidenced by ACO’s, bundled payments and other initiatives. Continue reading this entry

Three Dozen States Sue Makers of Opioid Addiction Treatment Medications for Antitrust


With opioid abuse continuing to dominate national headlines, manufacturers of opioid overdose medications are facing intense scrutiny over pricing practices that threaten (or those perceived as threatening) public availability of these medications.  In March 2015, for instance, Congress investigated “price hikes” by Amphastar Pharmaceuticals, Inc. (“Amphastar”) for naloxone (sold under the brand name Narcan®), a generic prescription medicine that blocks the effects of opioids and reverses an overdose.  Ranking Members of the House Committee on Oversight and Government Reform and the Senate Committee on Health, Education, Labor and Pensions claimed “[t]he rapid increase in the cost of this life-saving medication in such a short time frame is a significant public health concern” and requested drug profit and cost information from Amphastar “to evaluate the underlying causes of recent increases in the price.” Continue reading this entry

Hospital Short-Stay Review Ban Lifted by CMS


Effective September 12, 2016, the Centers for Medicare & Medicaid Services (CMS) lifted the temporary ban on patient status reviews of hospital short stays for Medicare beneficiaries. Those reviews are currently conducted by the Beneficiary and Family Centered Care (BFCC) Quality Improvement Organizations (QIOs).1 As of October 1, 2015, the responsibilities of the BFCC-QIOs include conducting the first-line medical reviews of short-stay inpatient hospital claims by acute care inpatient hospitals, long term care hospitals, and inpatient psychiatric facilities to determine the appropriateness of Medicare Part A (Part A) payments under the so-called “two-midnight rule.”

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Update: Arkansas (Again!) Medical Board Approves Telemedicine Rules


Author’s note: Yesterday’s post included a reference to an “originating site” definition under Regulation 38.  This post below corrects that reference, noting how the proposed regulation does not change the statutory definition of originating site.

The Arkansas State Medical Board on Thursday voted unanimously to pass Regulation 38 establishing key definitions for telemedicine practice in the State. The new regulation imposes specific Board of Medicine requirements for practicing telemedicine, and is to be read in connection with Regulation No. 2(8) (valid doctor-patient relationships). However, neither regulation addresses the definition of “originating site” under Arkansas Code 17-80-118 or how the Board would apply it to telemedicine consults where the patient is located at his or her home. Continue reading this entry

California Targets Surprise Medical Bills, Follows on the Heels of New York and Florida


Governor Brown approved a new law last Friday that limits patient exposure to so-called surprise medical bills.  AB 72 caps the cost-sharing obligations of patients who unexpectedly receive care from non-contracted providers during or because of a stay at an in-network facility.  The law limits cost sharing for covered services to in-network amounts unless the patient consents in writing to receive care from a noncontracting provider.  The law passed the California legislature with broad bipartisan support.

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