Category Archives: Reform

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California’s End of Life Option Act: Key Requirements and Considerations

On June 9, 2016, California’s End of Life Option Act (the “Act”) will go into effect.  The Act authorizes an adult who is suffering from a terminal disease and meets other qualifications to request an aid-in-dying drug that may be prescribed for the purpose of ending his or her life.  California is the fifth state … 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

House of Representatives v. Burwell: Another Blow to Obamacare

Obama Announces Affordable Care Act Enrollment Crosses the 8 Million Mark
Federal Judge Rosemary Collyer’s May 12, 2016 ruling in House of Representatives v. Burwell, found that the Obama administration (the “Administration”) has been improperly funding an Obamacare subsidy program. House of Representatives v. Burwell involves two sections of The Patient Protection and Affordable Care Act (the “ACA”): Sections 1401 and 1402. Section 1401 provides tax … Continue reading this entry

FCA Penalties Slated to Nearly Double This Year

A little known federal agency, the Railroad Retirement Board (“Board”), which administers retirement-survivor and unemployment-sickness benefit programs for railroad workers, published an interim final rule on May 2, 2016 raising the amounts of penalties “under the Board’s jurisdiction.” Among these are the penalties authorized by the Federal False Claims Act (“FCA”).  The Board proposes increasing the … 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 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

State Efforts to Combat Drug Price Increases

Obama Announces Affordable Care Act Enrollment Crosses the 8 Million Mark
Growth in health care costs has long been a source of political and administrative tension for public health agencies across the country. More and more, health officials, legislators, patient advocacy groups, and third-party payors blame budgetary constraints and patient dissatisfaction and poor outcomes on high prices for once affordable medications. The issue of drug pricing … 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

Recent EHR Meaningful Use Program Updates

American Hospital Association Recommends Revisions to Medicare ACO Models
As we enter the sixth year of the Medicare and Medicaid Electronic Health Records Incentive Programs (commonly referred to as the “Meaningful Use Programs”), the Centers for Medicare & Medicaid Services (CMS) continues to make adjustments to the Meaningful Use Programs to better accommodate providers and suppliers. Two recent updates are described below.… Continue reading this entry

The Who, What, and When for the CMS Final 60-Day Rule

Four years after the issuance of the Proposed Rule and six years after the authorizing statute, CMS has published the much-awaited Final Rule regarding reporting and returning of Medicare Part A and B overpayments (the “Final Rule”). 81 Fed. Reg. 7654-7684 (Feb. 12, 2016).  Since the inception of section 6402(a) of the Affordable Care Act … Continue reading this entry

FDA Unveils Action Plan to Combat Opioid Abuse

Research
The U.S. Food and Drug Administration (“FDA”) recently announced a “far-reaching action plan” to evaluate and improve the agency’s prescription opioid policies. The announcement came amidst public criticism and mounting political pressure on the FDA to address the country’s “opioid abuse epidemic,” including a hold placed by Senate Democrat Edward J. Markey on President Obama’s … Continue reading this entry

SAMHSA Proposes Major Changes to Federal Substance Abuse Privacy Rule

Electronic Health Records
Almost thirty years after the last substantive change to the federal regulations governing the confidentiality of alcohol and drug abuse patient records, the Substance Abuse and Mental Health Services Administration (SAMHSA) today published a proposed rule (Proposed Rule) to modernize the regulations at 42 CFR Part 2 (the Part 2 Rule). Public comment period on … Continue reading this entry

Executive Gun Control Actions Result in HIPAA Modifications

In response to the Obama Administration’s executive actions to reduce gun violence, on January 4, 2016, the U.S. Department of Health and Human Services’ Office of Civil Rights (OCR) issued a final rule, which modifies the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule that previously prevented states from making information available to the … Continue reading this entry

Senate Workgroup’s Proposals Address Chronic Illness Through Medicare

The Senate Finance Committee chronic care working group recently released a Policy Options Document continuing an effort that started with a hearing titled, “Chronic Illness: Addressing Patients’ Unmet Needs” in the summer of 2014. The workgroup, which is led by Chairman Orrin Hatch, Ranking Member Ron Wyden, and Senators Johnny Isakson and Mark Warner, compiled … Continue reading this entry

Medicare Proposes to Increase RAC Use

By now, providers are very familiar with Medicare recovery audit contractors, or RACs – the private companies who have authority to review medical records at a moment’s notice. For every dollar they opine has been improperly billed, the RACs recover a share of the bounty, creating a perverse incentive and an appeal process years behind … Continue reading this entry

CMS Approves California’s Section 1115 Medicaid Demonstration

The Centers for Medicare and Medicaid Services (CMS) has approved a new section 1115 Medicaid demonstration for the state of California. Under the demonstration, the California Department of Health Care Services (DHCS) will develop and redesign components of its Medicaid delivery system consistent with the approved terms and conditions, creating significant changes to California’s Medicaid … Continue reading this entry

New Guidance Outlines Requirements for State Innovation Waivers

New guidance from Centers for Medicare & Medicaid Services (CMS) places the spotlight on the ability of states to seek approval of “State Innovation Waivers” to test new approaches for delivering health insurance reform. Authorized under Section 1332 of the Affordable Care Act (ACA), State Innovation Waivers can grant statewide modifications to many of the … Continue reading this entry

Budget Law Moves Towards Site-Neutral Medicare Payments; Join Foley for a Discussion on November 13

The recently enacted Bipartisan Budget Act (P. L. 114-74) included a provision that will significantly alter the future of hospital-based outpatient care. The provision, Section 603, will exclude from Medicare’s outpatient hospital prospective payment system (“OPPS”) any new off-campus departments of a hospital, as determined by Medicare’s provider-based standards, unless it is a “dedicated emergency … Continue reading this entry

Medicare Advantage Value-Based Insurance Design Model

CMS, through the Center for Medicare and Medicaid Innovation, announced on September 1, 2015, the introduction of the Medicare Advantage Value-Based Insurance Design (VBID) Model as part of the Health Plan Innovations Initiatives, which are intended to test innovations in health plan design. The VBID Model will test whether the offering of supplemental benefits or … Continue reading this entry

Will the TELE-MED Act of 2015 Really Change Licensure Rules?

Congress is reviewing legislation designed to permit telemedicine providers to treat Medicare patients across state lines without the need for separate state licensure. The Telemedicine for Medicare Act of 2015 (S. 1778 and H.R. 3081), known as the TELE-MED Act of 2015, is sponsored by Representative Devin Nunes (R-CA), 15 Republicans and 9 Democrats in … Continue reading this entry

Providers + Retailers - The New Front Door to Health

During last week’s webinar on providers and retail health, the second in a series sponsored by Foley and Oliver Wyman, top executives representing different industry sectors shared their points of view on the challenges and opportunities presented by rapidly emerging alternatives to traditional primary care settings. Highlights include:… Continue reading this entry

New Report Highlights Period of Transformation for the Medicaid Program, Urges Greater Federal Oversight

Obama Announces Affordable Care Act Enrollment Crosses the 8 Million Mark
The U.S. Governmental Accountability Office (GAO) has issued a new report to Congress identifying key issues facing the Medicaid program and urging greater federal oversight. The report comes at a time of significant transformation for the Medicaid program, which is currently celebrating its 50th year. Following its historic expansion as a result of the Affordable … Continue reading this entry

4 Ways Medicare and Medicaid Have Changed the Health Care Industry

It’s a bizarre program that is absolutely essential to American healthcare. That is the opinion of Theodore Marmor, professor of public policy at Yale and author of the book, The Politics of Medicare. Whether you agree with him or not, it is difficult to deny the influence of Medicare and Medicaid on the health care … Continue reading this entry