Medicare’s New Chronic Care Remote Physiologic Monitoring Codes: Everything You Need to Know

remote monitoring

Earlier this year, in a first-of-its-kind move, CMS made remote patient monitoring (RPM) a separately-reimbursable service under Medicare.  Now, CMS has proposed three new codes for RPM services, retitled “Chronic Care Remote Physiologic Monitoring,” which do a far better job reflecting how providers can more effectively and efficiently use RPM technology to monitor and manage patient care needs, including chronic care management.  If finalized, these three codes would go live January 1, 2019.  Until then, CMS is accepting comments on the proposed codes through September 10, 2018.

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The Battle Over Drug Pricing: First Shot Targets Pharmacy Benefit Managers  

pharmacy

On July 18, 2018, the federal Department of Health and Human Services (HHS) sent a proposed rule to the Office of Management and Budget (OMB) for review and clearance. While the substance of the proposed rule is not yet published (or leaked), the title of the rule itself is rather transparent:

Removal of Safe Harbor Protection for Rebates to Plans or PBMs Involving Prescription Pharmaceuticals and Creation of a New Safe Harbor Protection (Proposed Rule).[1]

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Health Care Policy Newsletter

Foley & Lardner LLP’s Bipartisan Public Policy Team is pleased to share this week’s “Public Policy Health Care Newsletter” in which we compile the latest health care policy news and legislation. Please note that the next newsletter will be published on August 27th.

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Loan or Other Financial Obligation Forgiveness– A Continuing Fraud and Abuse Challenge

There are many health care financial arrangements where one entity has a financial obligation to another, with whom it either does business directly, or to which it makes referrals, and that obligation is either past due or for one reason or another cannot be paid. This may come up, for example, in the context of leases to physicians in a hospital owned medical office building (MOB), a loan made to a physician by a supplier or other provider, or a loan by a hospital to a joint venture with physician or suppliers to get it started,  in lieu of capital contributions, or a loan from an MSO to a physician organization. Each of these situations raises an issue with respect to potential violation of the physician self-referral law (Stark) or the Anti-Kickback Statute (AKS), which in turn can give rise to significant liability under the False Claims Act.

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Massachusetts Telehealth Legislation Paves Way for Sweeping Changes

Massachusetts

The Massachusetts House of Representatives has passed sweeping telehealth legislation, accompanying a companion bill passed by the Senate in November 2017.  While Massachusetts is often considered a leader in health care innovation, the Commonwealth has not enacted significant legislation in this area for several years, and is among the minority of states without a meaningful telehealth insurance coverage law.  The new legislation — The Honorable Peter V. Kocot Act to Enhance Access to High Quality, Affordable and Transparent Healthcare in the Commonwealth — could be considered the biggest legislative change to telehealth in Massachusetts to date.

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