Category Archives: Reform

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MSSP Final Rule Adopts All Proposed Additional Program Requirements and Beneficiary Protections Provisions

This is the sixth post in Health Care Law Today’s series on the final rule. This post addresses additional program requirements and beneficiary protections. The Medicare Shared Savings Program (“MSSP”) final rule published on June 4, 2015 finalized all proposed additional program requirements and beneficiary protections outlined in the December 2014 proposed rule. The specific … Continue reading this entry

MSSP Final Rule Provides Modification to Shared Savings Financial Arrangement

This is the fifth post in Health Care Law Today’s series on the final rule. The final Medicare Shared Savings Program (“MSSP”) rule released on June 4, 2015, contains a number of modifications to the financial arrangement contained in the existing regulations. The modifications are designed to encourage ACOs to participate or continue participating in the … Continue reading this entry

Beneficiary Assignment Under the MSSP Final Rule

This is the fourth post in Health Care Law Today’s series on the final rule. This post addresses how CMS assigns beneficiaries to an ACO participating in the MSSP. In the MSSP ACO Final Rule, CMS finalized new regulations that govern the assignment of Medicare fee-for-service beneficiaries to an ACO participating in the MSSP.… Continue reading this entry

Final Rule Will Give ACOs Participating in MSSP Access to More Data for More Beneficiaries

American Hospital Association Recommends Revisions to Medicare ACO Models
This is the third post in Health Care Law Today’s series on the final rule. This post addresses changes to sharing of beneficiary identifiable data. In its December 8, 2014 proposed rule revising the Medicare Shared Savings Program (“MSSP”), CMS proposed several changes concerning how it would share beneficiary identifiable data with Accountable Care Organizations (“ACOs”). … Continue reading this entry

How Does the King v. Burwell Decision Affect the Affordable Care Act?

The Supreme Court handed the Obama administration a key victory this morning, upholding the tax credits that allow many low-income Americans to purchase health care insurance in states where the federal government is running the insurance marketplace. These tax credits, available to Americans with household incomes between 100% and 400% of the federal poverty line, operate … Continue reading this entry

HRSA Proposes Civil Monetary Penalties for Drug Manufacturers that Overcharge 340B Covered Entities

The Health Resources and Services Administration (HRSA) within the U.S. Department of Health and Human Services (HHS) published a notice of proposed rulemaking impacting the 340B Drug Pricing Program (340B Program) on June 17, 2015. The proposed rulemaking, required under the Affordable Care Act, address 340B drug ceiling price calculations and penalties that may be imposed … Continue reading this entry

CMS Announces Next Generation ACO Model

CMS announced a new ACO payment initiative on March 10, 2015, the Next Generation ACO Model, designed for entities experienced in coordinating care for populations of patients. The announcement reflects CMS’ commitment to exploring different Medicare payment arrangements that encourage providers to assume higher levels of financial risk and reward while delivering quality care. The Next Generation … Continue reading this entry

CMS Delays Publication of Final Rule Regarding Reporting and Returning of Medicare Overpayments

One of the most challenging compliance changes brought about by the Affordable Care Act (ACA) is the provision mandating the reporting and refunding of Medicare and Medicaid overpayments within 60 days of the date they are identified, or the date that the corresponding cost report is due, if applicable. See ACA Section 6402(a); Section 1128J(d) … Continue reading this entry

Takeaways From the FTC/DOJ Workshop on Health Care Competition

The Federal Trade Commission and Department of Justice Antitrust Division held their second public workshop on health care competition on February 24-25, 2015. The workshop is part of the FTC and DOJ’s commitment to periodically “step back” from the work of day-to-day antitrust enforcement to take in a broader perspective of trends in the health care … Continue reading this entry

Happy Holidays!

Thank you for reading, subscribing and being a part of our blog community in 2014. We hope you have a happy holiday season and a wonderful new year! – The Health Care Law Today Team We will be back with new posts the week of January 5.… Continue reading this entry

Happy Thanksgiving!

The Health Care Law Today team is thankful for you, our readers and subscribers. Thank you all for reading, contributing to, and sharing our blog. We hope you have a safe and happy holiday. Have a great weekend!… Continue reading this entry

To Pay (Directors) or Not to Pay – That is the Question

The question of whether to pay the directors of a tax-exempt organization is hotly contested. Although this practice is legal, there can be drawbacks with providing compensation. Despite the perceived hesitancy to compensate directors, a 2010 study found that out of the ten largest nonprofit healthcare organizations, seven compensated their directors. Mark S. Blodgett et al., … Continue reading this entry

New York Office of the Medicaid Inspector General Releases 2014-2015 Work Plan

The New York State Office of the Medicaid Inspector General (OMIG) is the New York State (NYS) Medicaid program’s “watchdog” agency. (Last year they recovered in excess of $851 million from providers and others.) It is one of the most prominent state OMIG’s in the country, so providers in other states keep an eye on what the … Continue reading this entry

American Hospital Association Recommends Revisions to Medicare ACO Models

The American Hospital Association (AHA) submitted a letter to the Centers for Medicare and Medicaid Services (CMS) on April 17, 2014, recommending modifications to the Medicare Shared Savings Program (MSSP) and the Pioneer ACO program to make both of these programs more attractive to hospitals and health systems. The AHA letter begins by noting that … Continue reading this entry

Obama Announces Affordable Care Act Enrollment Crosses the 8 Million Mark

Late last week, President Obama announced that more than 8 million had people signed up for health insurance under the Affordable Care Act. According to the White House, 35 percent of those that obtained insurance are under 35 years old and some 28 percent are between the ages of 18 and 34. The new figures indicate … Continue reading this entry

Medicare’s 60-Day Proposed Refund Rule Imposes Significant Liability on Providers

Medicare’s 60-Day Proposed Refund Rule Imposes Significant Liability on Providers
As part of the Affordable Care Act “ACA”, Congress outlined the process for providers to return Medicare and Medicaid overpayments. In 2012, CMS proposed the 60-day Refund Rule, as it is commonly known, requiring Medicare providers and suppliers to report and return reimbursements made in error within 60 days of their identification.  While the proposed rule … Continue reading this entry

Preparing for the Conversion to ICD-10

With the ICD-10 implementation date delayed once again until October 1, 2015, providers who were previously unprepared for the transition or had only begun their transition planning have an extra year to address the upcoming changes in an attempt to minimize any potential disruption to their organization.  As part of the implementation planning, it is imperative … Continue reading this entry

ICD-10 Delayed Again

While I didn’t intend for the theme of my Health Care Law Today posts to be delays, there is no shortage of postponements to write about lately. The House and Senate passed H.R. 4302, Protecting Access to Medicare Act of 2014, which delays ICD-10 implementation until October 1, 2015. The main purpose of the bill … Continue reading this entry

Post-Acute Care: The Hottest Area in Health Care

Much has been written about hospital consolidation premised upon the search for efficiencies driven by scale and integration as reflected in the white hot hospital merger market over the last several years. While no doubt that will continue, stakeholders including hospitals, payers, providers and investors are now seeing the enormous role that Post-Acute Care (PAC) … Continue reading this entry

Remaining Independent: A Viable Option for Community Hospitals

The environment for independent community hospitals is challenging. Government reimbursement reductions, technology enhancements and other capital demands, preparation for a changing health care system based on population health management, the cost to attract and retain physicians, increased leverage of managed care companies, and challenging capital markets are among the factors that have contributed to this … Continue reading this entry

IRS Releases Helpful Guidance for Tax-Exempt Hospitals

The IRS released guidance at the end of 2013 that is helpful for tax-exempt hospitals in complying with the detailed additional federal tax requirements set forth in section 501(r) of the Internal Revenue Code. The guidance (1) sets forth specific proposed procedures for correcting and disclosing instances of failure to comply with the requirements and … Continue reading this entry