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Manatt, Phelps & Phillips, LLP

Community Reinvestment: Forging New Partnerships in Medicaid

At least 10 states have implemented, or are in the process of implementing, a community reinvestment requirement in which Medicaid managed care organizations (MCOs) are required to reinvest in the communities they serve to...more

Alston & Bird

Health Care Week in Review: Agencies issued Requirements Related to the Mental Health Parity and Addiction Equity Act final rules;...

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Below is Alston & Bird’s Health Care Week in Review, which provides a synopsis of the latest news in health care regulations, notices, and guidance; federal legislation and congressional committee action; reports, studies,...more

Ballard Spahr LLP

Health Plan Compliance Deadlines Draw Near

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Regulations under Section 1557 of the Affordable Care Act and HIPAA will require health plans and health care providers to take action in the coming months to meet new requirements. Health plan sponsors and providers that...more

Manatt, Phelps & Phillips, LLP

CMS Releases Guidance to Promote Continuity of Coverage for Individuals Receiving HCBS

On August 19, the Centers for Medicare & Medicaid Services (CMS) released a Center for Medicaid and CHIP Services (CMCS) Informational Bulletin (CIB) and an accompanying slide deck reminding states of their obligation to...more

Sheppard Mullin Richter & Hampton LLP

Attention Maryland Providers: Are You Availing Yourselves of Regulatory Flexibilities under the TCOC Model?

An April 2024 independent report (“Report”) analyzed the results of the first four years following implementation of the Maryland Total Cost of Care Model (the “TCOC Model”), finding that between 2019 and 2022 (the “TCOC...more

Arnall Golden Gregory LLP

Healthcare Authority Newsletter - August 2024 #2

News Briefs - State Governments Taking Steps to Make Rules on Healthcare AI - In the absence of federal guardrails on artificial intelligence in healthcare, state governments are figuring out their own rules of the road....more

Hall Benefits Law

9th Circuit Explains ERISA Preemption of State Law Claims Arising from Preservice Coverage Communications

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The U.S. Court of Appeals for the Ninth Circuit recently issued an opinion with critical implications for the healthcare industry. This court decision clarifies the expansive reach of the Employee Retirement Income Security...more

Harris Beach PLLC

Court Rejects IDR Rules in No Surprises Act Case

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Out-of-network health providers recently won a huge legal victory when the Fifth Circuit Court ruled that federal guidelines regarding Independent Dispute Resolution (“IDR”) proceedings were unlawfully slanted in favor of...more

Epstein Becker & Green

Affordable Care Act Overpayments in the CY 2025 Medicare Physician Fee Schedule Proposed Rule: Implications for False Claims

Epstein Becker & Green on

Stakeholders are continuing to analyze the implications of the mammoth proposed rule on “Medicare and Medicaid Programs: [Calendar Year (CY)] 2025 Payment Policies under the Physician Fee Schedule and Other Changes to Part B...more

Nelson Mullins Riley & Scarborough LLP

FY 2025 Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS)...

On August 1, the Centers for Medicare & Medicaid Services (CMS) issued a final rule to increase Medicare inpatient prospective payment system rates for certain acute care hospitals by a net 2.9% in fiscal year 2025, compared...more

Manatt, Phelps & Phillips, LLP

New CMS Guidance on the Provision of Medicaid and CHIP Services to Incarcerated Children and Youth

This is an excerpt from a recent Manatt article published on State Health & Value Strategies. Click here to download insight. On July 23, 2024, the Centers for Medicare & Medicaid Services (CMS) released a State Health...more

Manatt, Phelps & Phillips, LLP

CMS Approves Seven Reentry Section 1115 Demonstrations in July

In July, the Centers for Medicare and Medicaid Services (CMS) approved seven new Reentry Section 1115 Demonstrations in Illinois, Kentucky, New Hampshire, New Mexico, Oregon, Utah, and Vermont. These states join California,...more

Burr & Forman

“Incident To” Billing Promotes Productivity, But Presents Many Potential Pitfalls

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Under certain circumstances, Medicare allows physician practices to bill eligible non-physician practitioners (NPPs) under a supervising physician’s provider number and at 100 percent of the supervising physician’s allowable...more

Manatt, Phelps & Phillips, LLP

CMS Releases Technical Guidance to States on Complying with Medicaid Access Final Rule

On July 12, CMS released a companion guide to the Ensuring Access to Medicaid Services final rule (the “Access Final Rule”). This technical guidance—which focuses on the provisions regarding fee-for-service (FFS) payment...more

Saul Ewing LLP

Pennsylvania Expands Use and Reimbursement of Telemedicine and Bans Noncompete Agreements for Certain Health Care Practitioners

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In July 2024, Pennsylvania enacted two significant pieces of legislation relating to telemedicine and physician noncompetition agreements that will have a meaningful impact within the healthcare delivery system with the...more

Nelson Mullins Riley & Scarborough LLP

Medicaid Overpayment Audits: What Medical Providers Need to Know

The Audit Process - While Medicaid audits are meant to ensure integrity and efficiency of the Medicaid Program, they can often be incredibly cumbersome and challenging for medical providers to navigate. During an audit,...more

Alston & Bird

Health Care Week in Review: CMS Releases Final Medicare Prescription Payment Plan Part 2 Guidance

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Below is Alston & Bird’s Health Care Week in Review, which provides a synopsis of the latest news in health care regulations, notices, and guidance; federal legislation and congressional committee action; reports, studies,...more

McDermott Will & Emery

Trending in Telehealth: July 9 – 15, 2024

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Trending in Telehealth highlights state legislative and regulatory developments that impact the healthcare providers, telehealth and digital health companies, pharmacists and technology companies that deliver and facilitate...more

McDermott Will & Emery

Trending in Telehealth: July 2 – 8, 2024

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Trending in Telehealth highlights state legislative and regulatory developments that impact the healthcare providers, telehealth and digital health companies, pharmacists and technology companies that deliver and facilitate...more

McDermott+

Regs, Regs and More Regs: The Biden Administration Releases Spring 2024 Unified Agenda

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We are in the midst of a storm of regulations that are being released by the Centers for Medicare & Medicaid Services (CMS) and the US Department of Health and Human Services (HHS), including the Calendar Year (CY) 2025...more

Manatt, Phelps & Phillips, LLP

Do Health Care Providers That Serve Historically Marginalized Populations Get Paid Less? An Analytic Investigation

Executive Summary - Health inequities are pervasive across the country, with the health and well-being of Americans too often diverging along racial and ethnic lines. While recent studies have identified many factors...more

Napoli Shkolnik

Pricing Algorithms Help Insurers and Harm Patients

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The healthcare industry grapples with a pervasive issue of providers overcharging insurers for medical procedures performed on their patients. To combat this, insurers have turned to MultiPlan—a data analytics firm that...more

Robinson+Cole Health Law Diagnosis

DOJ Charges 36 Defendants in Connection with Telemedicine and Clinical Laboratory Fraud and Abuse Schemes

On June 27, 2024, the Department of Justice (DOJ) announced its 2024 National Health Care Fraud Enforcement Action, which resulted in criminal charges against 193 defendants for alleged participation in various health care...more

Alston & Bird

Health Care Week in Review: Senate Democrats Released Draft Legislation to Prevent Labor and Delivery Unit Closures; CMS Announced...

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Below is Alston & Bird’s Health Care Week in Review, which provides a synopsis of the latest news in health care regulations, notices, and guidance; federal legislation and congressional committee action; reports, studies,...more

Hall Benefits Law

Biden’s Proposed FFY 2025 Budget Seeks Mental Health Access Expansion

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The Biden administration unveiled its FFY 2025 budget, which calls for $7.3 trillion in spending. In the proposed budget, Biden maintains his pledge to focus on expanding and transforming the nation’s mental health system. He...more

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