On July 10, the Centers for Medicare & Medicaid Services (CMS) released the Medicare Physician Fee Schedule Proposed Rule (Proposed Rule) for the calendar year 2025. The Proposed Rule would implement certain provisions of the...more
7/30/2024
/ Centers for Medicare & Medicaid Services (CMS) ,
Drug Treatment ,
FDA Approval ,
Food and Drug Administration (FDA) ,
Medicaid ,
Medicare ,
Opioid ,
Physician Fee Schedule ,
Popular ,
Proposed Rules ,
SAMHSA ,
Substance Abuse ,
Telemedicine
On January 18, 2024, the Centers for Medicare & Medicaid Services (CMS) announced a new innovation model designed to improve quality of care and behavioral and physical health outcomes for Medicaid and Medicare patients with...more
This year’s Going Digital Health’s Behavioral Health Tech Conference (GDBH) was well-attended and rife with insightful panel presentations and discussions featuring key players from across the behavioral health and substance...more
On November 2, 2023, the Centers for Medicare and Medicaid Services (CMS) issued its 2024 Physician Fee Schedule final rule (Final Rule) for calendar year 2024 that will, in part, implement some of the most important changes...more
Starting January 1, 2023, Medicare will cover telehealth-based treatment services delivered by federally-accredited opioid treatment programs (OTPs), commonly referred to as “methadone clinics.” This new reimbursement is...more
11/10/2022
/ Consolidated Appropriations Act (CAA) ,
DEA ,
Drug Treatment ,
Final Rules ,
Medicare ,
Opioid ,
Physician Fee Schedule ,
Public Health Emergency ,
Ryan Haight Act ,
SAMHSA ,
Social Security Act ,
Substance Abuse ,
Telehealth
Starting January 1, 2023, Medicare will expand and increase coverage of certain services and providers to advance access to prevention and treatment services for substance use disorders (SUD) and mental health services. These...more
A multi-part series highlighting the unique health regulatory aspects of Telemedicine mergers and acquisitions, and financing transactions -
Investors in the telehealth space and buyers and sellers of telehealth companies...more
Over the last two years, behavioral health (BH) has been one of the biggest growth areas in the health care ecosystem, fueled by the Public Health Emergency (PHE) but in many ways an ignored, overlooked, understaffed, and...more
4/1/2022
/ CMMI ,
Consolidated Appropriations Act (CAA) ,
DEA ,
Department of Health and Human Services (HHS) ,
Department of Labor (DOL) ,
Health Care Providers ,
Investors ,
Medicaid ,
Mental Health ,
Mental Health Parity Rule ,
MHPAEA ,
NQTLs ,
Out of Network Provider ,
Public Health Emergency ,
Reimbursements ,
Substance Abuse ,
Surprise Medical Bills
In the 12-month period starting in April 2021, over 100,000 people have died from drug overdoses, a 28.5% increase from the same period the year before. While the opioid crisis has been a declared public health emergency...more
In a Press Release issued on October 14 2021 by the Office of Massachusetts Attorney General Maura Healy, a potentially groundbreaking settlement was announced. Below is an excerpt from the release, followed by our takeaways....more
Medical groups that have division-based or service-level approaches to physician compensation should spend their summer evaluating their models in light of Stark Law revisions that go into effect on January 1, 2022. The...more
Payment misalignment in Medicare FFS for Substance Use Disorder (SUD) treatment as the subject of potential legislative and/or regulatory reforms -
New opportunities for investor-backed behavioral health platforms in...more
3/3/2021
/ Biden Administration ,
Coronavirus/COVID-19 ,
Drug Treatment ,
Medicaid ,
Medicare ,
Medicare Advantage ,
Medicare Part A ,
Medicare Part B ,
Medicare Part D ,
Mental Health Parity Rule ,
Opioid ,
Substance Abuse
As discussed in detail in a prior post, U.S. Health and Human Services Secretary Alex M. Azar II (the Secretary) issued blanket waivers of sanctions under the federal Physician Self-Referral Law (Section 1877 of the Act),...more
On March 30, 2020, United States Health and Human Services Secretary Alex M. Azar II (the Secretary) exercised emergency authority under Section 1135 of the Social Security Act (Act) and issued blanket waivers of sanctions...more
... Massachusetts House Bill 4134 includes several provisions aimed at expanding access to treatment for mental health and substance use conditions in the Massachusetts Commonwealth. Most notably, the Bill would require...more
1/23/2020
/ APRNs ,
Denial of Insurance Coverage ,
Governor Baker ,
Health Care Providers ,
Health Insurance ,
Healthcare Facilities ,
HMOs ,
Hospitals ,
Insurance Industry ,
Mental Health ,
Mental Health Parity Rule ,
Proposed Legislation ,
Public Health ,
Substance Abuse
On May 6, 2019, a federal district court held that the Department of Health and Human Services’ (HHS) 2018 and 2019 rate reductions for 340B Program participants, including safety net On May 6, 2019, a federal district court...more
5/22/2019
/ Appeals ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
Drug Pricing ,
Hospitals ,
Medicare ,
Outpatient Prospective Payment System (OPPS) ,
Pharmaceutical Industry ,
Prescription Drugs ,
Remand ,
Section 340B
Providers and suppliers who have been assessed overpayments for Medicare services are entitled, by statute, to a stay of recoupment while the provider or supplier’s appeal is pending – but only at the first two levels of...more
7/19/2018
/ Administrative Appeals ,
Administrative Law Judge (ALJ) ,
Centers for Medicare & Medicaid Services (CMS) ,
Due Process ,
Health Care Providers ,
Medicare ,
Medicare Provider Agreements ,
Overpayment ,
Physician Medicare Reimbursements ,
Recoupment ,
ZPIC
New Hampshire is starting 2017 with stepped-up efforts to manage its oft-described opioid epidemic. Though the most recent regulations are directed at individual prescribers, and do not apply to the administration of opioids...more