Category Archives: Compliance

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Ransomware Reporting Requirements & New HHS Guidance

New York Office of the Medicaid Inspector General Releases 2014-2015 Work Plan
Ransomware is malicious software that denies access to data, usually by encrypting the data with a private encryption key that is only provided once a ransom is paid. Sometimes the ransomware will actually destroy, steal, or export data from information systems. Ransomware has become a significant threat to all U.S. businesses and individuals, and a … Continue reading this entry

Additional Opioid Policy Changes Announced: What You Need to Know

Despite the July 4 holiday, the past week featured significant regulatory and legislative action addressing the use of opioids and pain management. The changes are in keeping with the Government-wide push to better understand and reduce opioid drug abuse. We discuss here the week’s two most notable developments. Updating the HCAHPS Hospital Survey and Value-Based Purchasing … Continue reading this entry

“Site Neutrality” for Off-Campus Outpatient Departments: Proposed Rule is Worse than You Expected!

Please note, Cheryl Storey, CPA with Moss Adams LLP is also a co-author of this post. CMS issued its Outpatient Prospective Payment System (“OPPS”) Proposed Rule for 2017 (the “Proposed Rule”) on July 6, 2016. The Proposed Rule will  be published in the Federal Register on July 14, 2016. One highly-anticipated section of the Proposed Rule … Continue reading this entry

CMS Issues Final Rule on ACOs Participating in the Medicare Shared Savings Program

The Centers for Medicare & Medicaid Services (“CMS”) issued a final rule (the “Final Rule”) for accountable care organizations (“ACOs”) participating in the Medicare Shared Savings Program (“MSSP”) on June 6, 2016. In the Final Rule, CMS reflects its continuing efforts to modify alternative payment programs to make them more workable while also moving toward … Continue reading this entry

HIPAA Compliance: Navigating a Health Care Minefield

Compliance
In the two decades since its original passage, complying with the federal Health Insurance Portability and Accountability Act (HIPAA) hasn’t gotten any easier. Enacted with the primary goal of protecting the confidentiality, integrity and availability of healthcare information, HIPAA presents daunting administrative, technological and financial burdens for health care organizations. The burdens are only becoming … Continue reading this entry

Health Care IT Program Discusses Alternative Payment Model Opportunities

A distinguished panel of providers, consultants and IT firms convened on Tuesday, June 21st  in New York at the Foley and Lardner LLP offices to share a discussion focused on the convergence of IT spend and new value based purchasing models (“VBP”) coming out of CMS in increasing frequency—ACOs, BPCI, CJR and CCM.  Key Takeaways … Continue reading this entry

DOJ and North Carolina Challenge Anti-Steering and Tiering Provisions in Managed Care Contracts

CMS Releases Medicare Part B Supplier Billing and Payment Data
The Department of Justice’s antitrust division (the “DOJ”)and the State of North Carolina (“NC”) jointly sued, on June 9, 2016, Carolinas HealthCare System (“CHS”), the largest healthcare system in North Carolina, over anti-steering restrictions in its managed care contracts that the DOJ believes limits competition. In its complaint, the DOJ and NC claim that CHS used its … Continue reading this entry

Summary: Final Rule on Nondiscrimination in Health Programs and Activities

Section 1557 of the Affordable Care Act (“ACA”) establishes a broad prohibition on discrimination on the basis of race, color, national origin, sex, age or disability in health programs and activities. After almost 3 years of rulemaking activity, the Department of Health and Human Services(“HHS”) Office for Civil Rights (“OCR”) issued its final rule implementing … Continue reading this entry

Shining a Brighter Light on Massachusetts Public Records - HB 4333

If, as Justice Louis Brandeis famously said, “sunlight is said to be the best of disinfectants,” Massachusetts public records have just received a substantial splash of bleach. On June 3, 2016, Governor Charlie Baker signed into law the first update to Massachusetts’s public records law since 1973.  The law, as amended, will change how Massachusetts … Continue reading this entry

Legislation to Expand Definition of Grandfathered Off-Campus Hospital Departments to Address “Mid-Build” and Cancer Hospital Projects Moves Forward

A bill amending the “site neutrality” limitations brought by Section 603 of the Bipartisan Budget Act of 2015 was introduced in the House of Representatives last week and passed out of committee yesterday. H.R. 5273, the “Helping Hospitals Improve Patient Care Act of 2016,” was introduced by two powerful Members of the House Ways and … Continue reading this entry

Recent New York Medicaid Settlement with Pharmacy Shows Importance of Checking Excluded Provider List Prior to Filling Prescriptions

A New York pharmacy has agreed to pay approximately $500,000 to the State of New York for improperly billing New York Medicaid for prescriptions written by a physician who had been excluded from the Medicaid program. This settlement serves as an important reminder to all pharmacies operating in New York: Before filling a prescription, pharmacies … Continue reading this entry

DOL’s Increased Salary Test: What Health Care Employers Need to Know

As detailed here in our Labor & Employment blog, the Department of Labor recently announced significant increases to its minimum salary threshold to be considered exempt from the overtime requirements under the Fair Labor Standards Act (FLSA).  Health care employers — both in the non-profit and for-profit sector — will be impacted profoundly because many managers … Continue reading this entry

Employee Assistance Programs and State Insurance Regulation Structuring EAPs to Ensure Compliance

Employee Assistance Programs (or EAPs) have served employers and their employees for decades, providing a variety of benefits to address issues that might otherwise adversely affect the overall health and work of employees. A National Study of Employers conducted in 2008 found that 65 percent of employers in the United States provided EAP benefits, an … Continue reading this entry

Finance Committee Report Place Medical Device Arrangements under Increasing Scrutiny

Hospitals and providers participating in physician-owned distributorships, or “PODs” may be at increased risk for government investigation or enforcement. A Senate Finance Committee (SFC) Report issued this month highlights the SFC’s concerns that certain POD structures may violate fraud and abuse statutes, including the Anti-Kickback Statute, Stark Law, as well as the Sunshine Act. According … Continue reading this entry

OCR Releases Updated HIPAA Audit Protocol and Business Associate Listing Template

The Office of Civil Rights (OCR) recently updated the audit protocol that it will be using to assess Covered Entities’ and Business Associate’s compliance with the Health Insurance Portability and Accountability Act (HIPAA) privacy, security, and breach notification rules. OCR also released a template that Covered Entities and Business Associates may use to keep track of … Continue reading this entry

CMS Abandons Payment Cut Imposed By Two-Midnight Rule

In the Fiscal Year (FY) 2014 Inpatient Prospective Payment System (IPPS) final rule, the Centers for Medicare & Medicaid Services (CMS) revised its Medicare policy for determining whether hospital encounters will be considered appropriately inpatient or outpatient. The status distinction has important consequences for both the provider and the beneficiary, including differences in co-insurance and … Continue reading this entry

CMS Announces Latest Alternative Payment Model - Comprehensive Primary Care Plus

Continuing in its efforts to promote alternative payment models, on April 11, 2016, CMS announced the Comprehensive Primary Care Plus (CPC+) model. CMS hopes to implement CPC+ in up to 20 regions, accommodating up to 5,000 practices, which would potentially encompass more than 20,000 doctors and clinicians and the 25 million people they serve. The … Continue reading this entry

Four Distinct Federal and State Policies Addressing Prescription Opioid Abuse

The first quarter of 2016 has witnessed a great deal of attention in government to the problem of opioid-related overdose and death in the United States. In just the past few weeks, the Senate passed prescription drug treatment and abuse prevention legislation—the Federal Comprehensive Addiction and Recovery Act (CARA), Senate Bill 524—while two states—Massachusetts and … Continue reading this entry

At The Intersection of New Bundled Payment Programs and New Discharge Rules: Private Equity Opportunities

Recently, CMS has promulgated new bundled payment rules for Comprehensive Joint Replacement (CJR) that require the mandatory participation of approximately 800 hospitals across the US. This bundle includes not only the inpatient DRG care, but also 90 days of post-discharge care. Contemporaneously, CMS has initiated rulemaking which totally revamps the discharge planning process for hospitals by requiring … Continue reading this entry

Phase 2 of HIPAA Compliance Audits Now Underway

The Office of Civil Rights (OCR) within the U.S. Department of Health and Human Services (DHHS) recently announced that it has initiated Phase 2 of its audit program to assess Covered Entities’ and Business Associate’s compliance with the Health Insurance Portability and Accountability Act (HIPAA) privacy, security, and breach notification rules (the HIPAA Audit Program). … Continue reading this entry

CMS Proposed Rule Reduces Drug Payments & Requires Implementation of Value-Based Purchasing Tools

Proposed Rule Recently, CMS published a Proposed Rule seeking to test a new model for how Medicare pays for drugs and biologicals paid under the Medicare Part B program. With the goals of determining whether alternative drug payment models will result in “better care” and “smarter spending” by reducing Medicare expenditures while enhancing the quality … Continue reading this entry

Part 2: Shelf Registration Extended Offering Period

This is the second post of a two-part series, you can view the first post here. Our first post in this series examined the regulatory and contractual considerations for municipal securities issuers and conduit borrowers using shelf registration. Now we examine the equally important considerations for implementation.… Continue reading this entry

Shelf Registration Extended Offering Period: Ready for the Municipal Marketplace?

This is the first post of a two-part series. Recently, a significant municipal issuer entered the market with its first sale under a $1 billion borrowing program that will use an offering statement style novel to the municipal market. For years, issuers of traditional corporate securities have used shelf registration for their securities. Shelf registration … Continue reading this entry

Comprehensive Joint Replacement Bundled Payment Program Begins April 1st

Approximately 800 hospitals in 67 Metropolitan Statistical Areas will begin mandatory participation in the Comprehensive Care for Joint Replacement (CJR) Model on April 1, 2016. The CJR bundled payment program applies to MS-DRG 469 (major joint replacement or reattachment of lower extremity with major complications or comorbidities) and MS-DRG 470 (major joint replacement or reattachment … Continue reading this entry