News & Analysis as of

OIG Report: MCOs Cause Limited Access to Primary Care for Medicaid Enrollees!

With flu season well under way, access to care to primary care physicians for Medicaid recipients is (as it is always) extremely important. During flu season, in particular, emergency rooms (ERs) are full of people suffering...more

The Future of MassHealth: Five Priority Issues for the New Administration

Executive Summary - The past decade marked an era of seismic change in the Massachusetts health care market and one in which the Commonwealth led the nation in coverage and delivery system reform. In 2006,...more

New Rule Permits CMS to Revoke Medicare Billing Privileges for Providers/Suppliers with “Pattern or Practice” of Denied Claims

On December 5, 2014, the Centers for Medicare & Medicaid Services (CMS) issued a final rule titled “Requirements for Medicare Incentive Reward Program and Provider Enrollment” (“the Rule”). The Rule implemented several...more

Health Alert (Australia) - December 8, 2014

In This Issue: Judgments and Reports. Excerpt from Reports: Australia. Department of Social Services - 4 December 2014 - 2014 Aged Care Approvals Round (ACAR) results. Senator Mitch Fifield,...more

Reminder: Amendments needed to reflect $2,500 limit on Health FSA contributions by year end

As mentioned in a prior Alert, beginning in 2013 employees’ salary reduction contributions to a health flexible spending account (health FSA) may not exceed $2,500 per plan year. This limit is to be indexed for inflation in...more

Florida, No Grants For You!

In November 2014, the federal government’s Distance Learning and Telemedicine (DLT) program awarded over $10 million in grants to support telemedicine and rural health research. The list of 65 DLT grant recipients included...more

"New Preventive Services Under the Affordable Care Act"

The Affordable Care Act (ACA) requires non-grandfathered group health plans to provide benefits for items or services recommended by the U.S. Preventive Services Task Force (USPSTF). These benefits must be provided without...more

Ninth Circuit Rules Assignee Health Care Providers May Sue Health Plans Under ERISA for Payment of Benefits

In an opinion with mixed implications for both insurers and health care providers, the U.S. Court of Appeals for the Ninth Circuit recently ruled that when plan beneficiaries assign their claims for payment of benefits to...more

Impact of Health Care Reform on Provider Liability

In this presentation: - The Changing Healthcare Landscape - Key Features of an ACO/CIN - ACO Standards and Quality Metrics - Examples of Quality Standards - Impact on Board and Corporate...more

CMS Publishes Additional (but Limited) Guidance on the Coverage with Evidence Development Process

On November 20, 2014, the Centers for Medicare and Medicaid Services (“CMS”) published its latest round of guidance on its Coverage with Evidence Development (“CED”) policy for selected items and services under the Medicare...more

Seventh Circuit Limits the Use of the Federal Assignment Law under the False Claims Act

It’s common in the healthcare industry for large insurers to negotiate discounts from pharmacies for prescription drugs. The federal government, the granddaddy of all insurers, does this too, when it negotiates discounts on...more

Reimbursement Changes, Shift to Consumerism Discussed at Akerman Healthcare Briefing

Changing reimbursement models and a shift to consumerism were two of the hot topics discussed at Akerman LLP's recent Healthcare Briefing event titled "Financial and Corporate Implications of the Affordable Care Act: A Look...more

Health Care Update - November 2014 #3

In This Issue: - 21st Century Cures Remains Top Bi-Partisan Priority for 2015 - Senate Passes Critical Access Hospital Direct Supervision Bill - Implementation of the Affordable Care Act - Other...more

Health Law Pulse - November 2014

In This Issue: - Connecticut Supreme Court: HIPAA Does Not Preempt Negligence Claims - CMS Removes Continuing Education Exemption to Physician Payments Sunshine Act - Federal Government and New York...more

Parents' Medical History May Make Long-Term Care Insurance More Expensive

Your parents' health could be one of the many factors that long-term care insurance providers take into account when deciding how much to charge you. One large insurer has started rating applicants based, in part, on the...more

CMS Issues Proposals Related to Payments Under Basic Health Programs

Last week, CMS proposed the payment methodology and data sources for Basic Health Programs (BHPs), which include state-level insurance coverage created by the Affordable Care Act (ACA) for low-income residents. The proposal...more

Airline Industry Alert: RLA System Board Rules That Cessation of Operations as an Air Carrier Resulted in Termination of the CBA

In a recent decision, an RLA System Board of Adjustment has ruled that unilateral termination of a pilot retiree health insurance plan was permissible because the underlying CBA had terminated....more

Do You Offer or Accept Copayment Coupons? OIG says YOU are Responsible for Compliance with Federal Law

In recent years, copayment coupon programs have become standard promotional practices for both large and small pharmaceutical manufacturers. Copayment coupons are typically offered to commercially insured patients in order...more

Ninth Circuit Holds That Provider Cannot Sue Nonsignatory Insurer for Breach of Contract

On October 10, 2014, the Ninth Circuit affirmed a grant of summary judgment in favor of Manatt client The MEGA Life and Health Insurance Company. In an unpublished memorandum opinion, the Ninth Circuit held that a health care...more

From Competitors to Co-Adventurers, Seven Hospital Systems Join with Anthem Blue Cross to Shake Things Up in Southern California

Anthem Blue Cross and seven competing hospital systems in Southern California are joining forces to establish a new health plan offering, Vivity.[1] Operating with a combined 14 hospitals and approximately 6,000 physicians,...more

Health Care Update - October 2014

In This Issue: - CMS Publishes Long-Awaited “Health Plan Innovation Initiative” RFI - Implementation of the Affordable Care Act - Other Federal Regulatory Initiatives - Other Congressional...more

OIG Proposes Rules on Free Transportation, Hospital Gainsharing, and Other Access to Care Arrangements

The proposed rule to give providers more protections to promote beneficiary access to care solicits significant industry input. On October 2, the Department of Health and Human Services (HHS) Office of Inspector...more

Health Law Alert: American Telemedicine Association Releases Report Showing Minnesota, Upper Midwest Fare Well Among State...

The American Telemedicine Association (ATA) recently released two reports that compare and contrast telemedicine polices of every state in the U.S. The reports offer a state-by-state comparison, allowing providers to easily...more

Health Alert (Australia) - September 29, 2014

In This Alert: Judgments; Legislation; and Reports. Excerpt from Judgments: Western Australia - 25 September 2014 - Goh v Murdoch Eye Pty Ltd [2014] WASC 344: The plaintiff, Dr Goh, carried...more

Health Care Update - September 2014 #3

In This Issue: - Post-Acute Care Bill Passes, Sets Up Policymakers for Comprehensive Reform Effort - Lawmakers still Focusing on SGR During “Lame Duck:” - Implementation of the Affordable Care Act - Other...more

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