News & Analysis as of

Prior Authorization

CMS Announces New Medicare Prior Authorization Requirements for Two Types of Power Wheelchairs

by Reed Smith on

Beginning in March 2017, CMS is phasing in new Medicare prior authorization (PA) requirements for two types of power wheelchairs under a policy adopted in a final rule issued late in 2015. As previously reported, CMS...more

California Legislative Update: Heading Into The 2016 Session's Final Month

by Littler on

The California Legislature will return from its July recess on August 1, and will devote that month to final consideration of legislation for 2016. The session has entered a somewhat anticlimactic stage for employment...more

Two Additional HIPAA Settlements Demonstrate Breadth of HIPAA Enforcement Activity

by Saul Ewing LLP on

During the week of April 18, 2016, the U.S. Department of Health and Human Services, Office for Civil Rights (OCR) announced two significant settlements with a large New York City hospital and a North Carolina orthopaedic...more

Lights, Camera, Settlement: OCR says a picture is worth $2.2 million

A New York hospital has settled with the U.S. Department of Health and Human Services Office for Civil Rights (“OCR”) for $2.2 million after allowing a TV crew for the ABC documentary series “NY Med” to film patients...more

DMEPOS Prior Authorization Rules Expand

by Baker Ober Health Law on

On December 30, 2015, CMS published a final rule entitled: "Medicare Program; Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies," implementing Section 1834(a)(15) of the...more

Washington Healthcare Update

by McGuireWoods LLP on

This Week: The Senate and House pass legislation to repeal the Affordable Care Act but without enough votes to override a potential veto... However, this is the first time repeal legislation makes it to the President’s...more

CMS Finalizes New Medicare Prior Authorization Rules for DMEPOS Subject to “Unnecessary Utilization,” But Policy Questions Remain

by Reed Smith on

The Centers for Medicare & Medicaid Services (CMS) has issued a final rule to require Medicare prior authorization (PA) for certain durable medical equipment (DME), prosthetics, orthotics, and supplies (DMEPOS) items that the...more

CFPB Reminds Companies of Automatic Debit Authorization Requirements

by Morrison & Foerster LLP on

The Consumer Financial Protection Bureau (“CFPB”) issued a compliance bulletin (“Bulletin”) reminding entities of their obligation to obtain consumer authorization prior to automatically debiting a consumer’s account for...more

CMS Finalizes Prior Authorization Program for Certain DMEPOS Items

by McDermott Will & Emery on

On December 30, 2015, the Centers for Medicare & Medicaid Services (CMS) published its final rule establishing a prior authorization program for certain durable medical equipment, prosthetics, orthotics and supplies (DMEPOS)...more

CFPB Releases Compliance Bulletin about Obtaining Authorizations for Preauthorized Electronic Fund Transfers

by Reed Smith on

The Consumer Financial Protection Bureau (the “CFPB”) warned financial companies in a compliance Bulletin Monday that they must have proper authorization before automatically debiting funds from customers’ accounts. (CFPB...more

CFPB Releases Bulletin Outlining Automatic Debit Requirements for Financial Entities

by BakerHostetler on

On Monday, November 23, the CFPB released a new Compliance Bulletin to remind financial entities of their requirements when obtaining consumer authorizations for preauthorized electronic fund transfers (EFT). Mortgage...more

CMS Expands Medicare Prior Authorization Model for Repetitive Scheduled Non-Emergent Ambulance Transport

by Reed Smith on

As previously reported, CMS announced in November 2014 that it would test a Medicare prior authorization process for repetitive scheduled nonemergent ambulance transport services in New Jersey, Pennsylvania, and South...more

When Is a Hospital Not a Hospital?

by Faegre Baker Daniels on

Rebecca was a nurse at North Cypress Medical Center, in Texas. Back in 2011 she was treated for an eating disorder at Timberline Knolls Residential Treatment Center, in Illinois. When she sought reimbursement under the...more

CMS Extends Medicare Prior Authorization for Power Mobility Devices Demonstration through August 2018

by Reed Smith on

CMS has announced that it is extending its Medicare Prior Authorization for Power Mobility Devices (PMDs) demonstration for three years, through August 31, 2018. This demonstration was launched on September 1, 2012 in seven...more

Business Processing Debit Card Payment Held Liable for Failure to Obtain Written Authorization

by Varnum LLP on

With the increasing use of debit cards to pay for goods and services comes risk for businesses who do not routinely process debit card payments. A recent example of this risk is highlighted in Kelsey v Pitsch Companies. ...more

Texas Adopts Standard Prior Authorization Form

by King & Spalding on

In an effort to reduce the number of different prior authorization forms with which providers must contend, the Texas Department of Insurance (TDI) has adopted a single, standard form for requesting prior authorization of...more

CMS Proposes Rule to Expand Authorization Program, Solicits Comments on Implementation

by McDermott Will & Emery on

On May 28, the Department of Health and Human Services (HHS), Centers for Medicare & Medicaid Services (CMS) published a proposed rule to establish a prior authorization process for certain durable medical equipment,...more

Medicare Proposes Prior Authorization Process for Certain DMEPOS Items

by Baker Ober Health Law on

On May 28, 2014, CMS issued a proposed rule to establish a permanent prior authorization process for certain durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) items that are “frequently subject to...more

French Decree Extends List of Foreign Investments That Must Obtain Prior Authorisation

by McDermott Will & Emery on

The French Government issued a decree on 14 May 2014 amending key provisions of the French Monetary and Financial Code dealing with foreign investments. The decree extends the list of investments for which foreign investors...more

Attention: All Medicaid Providers Whose Services Require Prior Authorization

by Williams Mullen on

A Way to Increase Revenue and Help Medicaid Recipients - Have you heard the cliché: “Killing two birds with one stone….?” The phrase is thought to have originated in the early 1600s when slingshots were primarily...more

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