Health Updates

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CMS Increases Oversight of Medicaid Managed Care Contracts

As noted in a post published yesterday, CMS issued the final rule regarding Medicaid managed care earlier this week. With this rule, CMS is taking a much more active role in overseeing states’ Medicaid managed care...more

OIG Issues Revised Policy Statement Regarding Permissive Exclusion

On April 18, 2016, the Office of Inspector General of the United States Department of Health and Human Services (“OIG”) issued a revised policy statement containing the new criteria that OIG intends to use in implementing its...more

After New York, Florida Curbs Surprise Bills for Emergency and Out-of-Network Services

It is generally understood that if a managed care member utilizes the services of a non-participating provider, the member could incur significant out of pocket expenses. However, there are instances where a member may...more

Your daily dose of financial news The Brief – 4.29.16

Dealbook looks back at a crazy Thursday of healthcare company deals [with Abbott/St. Jude taking the prize for biggest] and concludes that the industry appears to be “convinced, regardless of tax benefits [or common financial...more

FTC Settles Monopolization Charges Stemming from Contract Exclusivity Terms Used by First-to-Market Medical Polymer Maker

The mere possession of monopoly power does not violate federal antitrust laws. The laws only address the anticompetitive acquisition, maintenance, or abuse of that power. The Federal Trade Commission (“FTC”) entered into a...more

CMS's Proposed IPPS and LTCH FY 2017 Rule: Key Takeaways

On April 18, 2016, CMS released its proposed rule addressing new payment rates and policies under both the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS),...more

OIG Issues New Exclusion and CIA Guidance

On April 18, 2016, Inspector General Daniel R. Levinson announced the publication of updated guidance on how the Office of Inspector General (OIG) makes decisions about using its permissive exclusion authority and requiring...more

IREG Update - Insurers and big data

Insurers and big data - Insurance companies are increasingly using “big data” to optimize all aspects of their businesses—from claims processing and marketing to underwriting and pricing. Recognizing this trend among...more

L.A. hospital under fire for ‘dumping’ poor patient after emergency treatment

Is this any way to treat the most needy? Los Angeles prosecutors have announced a $450,000 settlement with yet another of the city’s hospitals accused of “patient dumping,” the practice of hustling individuals, particularly...more

Cadillac Tax: A Levy in Limbo

The future of the Cadillac tax, a key cost-control mechanism and federal revenue source enacted as part of the Patient Protection and Affordable Care Act (ACA), is unclear. Though initially set to take effect in 2018,...more

FDA Proposes Ban on Electrical Stimulation Devices for Aggressive or Self-Injurious Behavior

On April 25, the U.S. Food and Drug Administration published a proposed rule banning electrical stimulation devices (ESDs) used to treat aggressive or self-injurious behavior....more

CMS Releases Hospital Inpatient PPS and Long-Term Care Hospital PPS Proposed Rule

CMS released updates to the Hospital Inpatient Prospective Payment System (Hospital IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) in a proposed rule on April 18, 2016 (Proposed Rule). The Proposed...more

CMS publishes final Medicaid managed care rule

On April 25, 2016, the Centers for Medicare & Medicaid Services (CMS) released its long-awaited Medicaid managed care Final Rule, the first update to Medicaid managed care regulations since 2002, and implements dozens of...more

Your daily dose of financial news The Brief – 4.28.16

As expected, the Fed held steady on rates as it waits for the American economy and labor market to keep improving. June remains on the table for the next incremental increase, though some analysts are shifting expectations...more

Changing Time for Clinical Laboratories

As Bob Dylan wrote, ‘‘The times, they are a-changin’ ’’ While Dylan certainly had larger issues in mind than the state of the clinical laboratory industry, it still is a fair description of what is happening for laboratories...more

A&B Healthcare Week in Review

I. REGULATIONS, NOTICES, & GUIDANCE - On April 21, 2016, CMS issued a proposed rule entitled, “Medicare Program: FY 2017 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements.” This...more

New HIPAA Phase 2 Audits: Targets Notified by Email Only

The U.S. Department of Health and Human Services Office for Civil Rights (OCR) recently announced the long-awaited launch of Phase 2 of its HIPAA Audit Program (Phase 2 Audits). The Phase 2 Audits will review the policies...more

New York Presbyterian Hospital Settles OCR HIPAA Investigation

On April 21, 2016, the U.S. Department of Health and Human Services, Office for Civil Rights (“OCR”) announced a $2.2 million settlement with The New York and Presbyterian Hospital (“NYP”) regarding NYP’s impermissible...more

Section 1557 of the ACA: The Legal Side of Health Equity

This week marks the end of National Minority Health Month and its 2016 theme of “Accelerating Health Equity for the Nation.” This month, the HHS Office of Minority Health’s goal was to “raise awareness of the health...more

New ACA, et. al. FAQs Cover Items From “Top” to “Bottom”

On April 20, the “Big Three” agencies (DOL, Treasury/IRS, and HHS) released another set of FAQs (the 31st, for those of you counting at home). Consistent with earlier FAQs, the new FAQs cover a broad range of items under the...more

New Law Aims to Ensure Updated and Accurate Physician Directories

An effort is underway to offer patients more accurate and complete provider information so that they may identify which providers are within their health plan and make educated decisions regarding treatment. On July 1, 2016,...more

Wyoming Medical Center victim of phishing scheme affecting 3,184 patients

Phishing incidents in February that may have compromised the data of 3,184 patients, including their names, dates of birth, medical record and account numbers, dates of service and medical information is causing Wyoming...more

The IMD Exclusion: Changes Now and Changes to Come

On Monday, CMS finalized their long-awaited Medicaid managed care regulation. Deep in the regulation was a change to allow Medicaid reimbursement for facilities that had previously been excluded from receiving payments. ...more

Manatt on Health Reform: Weekly Highlights - April 2016 #4

CMS's sweeping final rule aligns Medicaid and CHIP managed care with QHP and Medicare Advantage regulations; New York's DSRIP is enabling change in the State's Medicaid delivery system; and Medicaid expansion reduces...more

Illinois Governor Initiates Fight Against Health Care Fraud Amid Growing Deficit

As Illinois' finances continue to deteriorate and the budget crisis remains unsolved, the Rauner administration recently announced an initiative to focus on identifying and recouping health care fraud in Illinois. On April 5,...more

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