Leading health authorities have increasingly emphasized how non-medical factors such as socioeconomic status, education, employment, housing, food security, and community support have an outsized impact on health outcomes. By...more
3/28/2024
/ Anti-Kickback Statute ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
Health Care Providers ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Medicaid ,
Medicare ,
OIG ,
Payor Contracts ,
Reimbursements ,
Risk Mitigation ,
Stark Law
Recent federally qualified health center (FQHC) litigation highlights the impact state Medicaid agencies have on FQHC reimbursement. The important decisions summarized below all involve FQHC disputes over state Medicaid...more
On January 30, 2023, the Biden Administration announced its intent to end the COVID-19 public health emergency (PHE) on May 11, 2023. For Federally Qualified Health Centers (FQHCs), flexibilities offered under the PHE...more
Proposed changes to the federal substance use disorder law will increase provider efficiency and alignment with the Health Insurance Portability and Accountability Act (HIPAA). In a move that seeks to decrease administrative...more
The federal government is requesting comments on proposed guidance for federally qualified health centers (FQHCs) that provide services via telehealth. The guidance communicates key criteria for ensuring services delivered...more
Many California health care providers, including hospitals and physician groups, will soon be required to sign on to California’s first-ever statewide data sharing agreement governing the exchange of health and social...more
7/26/2022
/ California ,
Compliance ,
Confidentiality Policies ,
Data-Sharing ,
Exchange of Information ,
Health Care Providers ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Information Blocking Rules ,
Medi-Cal ,
PHI ,
Policies and Procedures ,
Right-To-Access ,
Social Services ,
State Health Departments
On November 4, 2021, the Centers for Medicare & Medicaid Services (CMS) issued an interim final rule that requires most Medicare and Medicaid certified providers and suppliers to vaccinate staff members within 60 days. The...more
11/8/2021
/ Anti-Discrimination Policies ,
Biden Administration ,
Centers for Medicare & Medicaid Services (CMS) ,
Coronavirus/COVID-19 ,
Employer Mandates ,
Executive Orders ,
Healthcare Workers ,
OSHA ,
Reasonable Accommodation ,
Religious Exemption ,
Rulemaking Process ,
Vaccinations ,
Virus Testing ,
Workplace Safety
Medicaid providers cannot sue the state to seek payment from a Medicaid health plan, according to a July 9 Illinois federal district court decision. The court’s holding is likely to be a disappointment to providers...more
As part of the omnibus Federal appropriations bill enacted into law on December 27, 2020, Congress established new reporting requirements for states that make Medicaid supplemental payments. The new requirements follow on the...more
On December 14, 2020, HRSA established a long overdue Administrative Dispute Resolution (ADR) process that allows covered entities and drug manufacturers to bring claims against each other related to the 340B Drug Pricing...more
On July 15, 2020, a final rule revising the federal regulations governing the Confidentiality of Substance Use Disorder Patient Records (also known as 42 C.F.R. Part 2 or Part 2) was published. The revised rule will implement...more
The Coronavirus Aid, Relief, and Economic Security Act (CARES Act) passed by the Senate on March 25, 2020 would make fundamental changes to the federal law, 42 U.S.C. § 290dd-2, implemented at 42 C.F.R. Part 2 that governs...more
This is the fourth article in our series addressing important topics for federally qualified health centers (FQHCs) and the providers who work with them. The first post in the series offered five tips for contracting with...more
1/9/2020
/ Board of Directors ,
CEOs ,
Corporate Governance ,
Corporate Officers ,
Department of Health and Human Services (HHS) ,
FQHC ,
Health Care Providers ,
Healthcare Facilities ,
HRSA ,
Medicaid ,
Regulatory Requirements
This is the third article in our series addressing important topics for federally qualified health centers (FQHCs) and the providers who work with them. The first post in the series offered five tips for contracting with...more
On November 18, 2019, the Centers for Medicare & Medicaid Services (CMS) proposed changes to federal Medicaid rules that, if implemented, would affect billions of dollars of Medicaid payments nationwide, creating new...more
11/20/2019
/ Centers for Medicare & Medicaid Services (CMS) ,
Disproportionate Share Adjustments ,
Federal Funding ,
Fees ,
Funding ,
Health Care Providers ,
Hold Harmless ,
Medicaid ,
Proposed Amendments ,
Public Agencies ,
Public Entities ,
Reporting Requirements ,
Risk Retention ,
Rulemaking Process ,
State and Local Government ,
State Funding ,
State Taxes
This is the second article in our series addressing important topics for federally qualified health centers (FQHC) and the providers who work with them. Our first post in the series offered five tips for contracting with...more
Partnerships with federally qualified health centers (FQHCs) are essential to serve patients in high-need areas and strengthen the social safety net. For health care providers, collaborating with FQHCs can also open the door...more
Recently proposed changes to the federal regulations governing the confidentiality of substance-use disorder patient records (Part 2) would all but eliminate the most significant and intractable barrier to sharing protected...more
An ambitious California proposal to regulate health care rates and curb long-term health care spending was unveiled last week in Assembly Bill 3087 (Proposed Legislation). The key concept in the Proposed Legislation is the...more
4/19/2018
/ Advisory Board ,
Affordable Care Act ,
CalPERS ,
Employee Retirement Income Security Act (ERISA) ,
Health Care Providers ,
Healthcare ,
Medicaid ,
Medicare ,
Medicare Advantage ,
Payment Rates ,
Proposed Legislation ,
Provider Payments ,
State Legislatures
California’s Medicaid agency has posted draft language of a new state plan amendment (SPA) that would make major changes to federally qualified health center (FQHC) and Rural Health Clinic (RHC) reimbursement. Public comments...more
New federal regulations published on January 3, 2018, clarify when lawful holders of substance-use disorder records may use and disclose patient identifying information for payment, health care operations, and audits and...more
1/15/2018
/ Confidential Information ,
Consent ,
Electronic Protected Health Information (ePHI) ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Medical Records ,
Mental Health ,
New Regulations ,
Patient Privacy Rights ,
SAMHSA ,
Subcontractors ,
Substance Abuse
Congress is now back in session and, once again, focus has turned to health care. With all eyes on returning health care reform to the forefront, a flurry of activity has sparked new legislative efforts including the...more
9/19/2017
/ Affordable Care Act ,
Federal Grants ,
Health Insurance ,
Health Savings Accounts ,
Healthcare Reform ,
Legislative Agendas ,
Medicaid Expansion ,
Medicare ,
Political Parties ,
Repeal ,
Trump Administration
The Ninth Circuit held August 7 that the Department of Health and Human Services Secretary erred in approving a Medicaid State Plan Amendment (SPA) that cut reimbursement for outpatient hospital services in California by 10%...more
The Centers for Medicare and Medicaid Services (CMS) has proposed reducing the Medicare payment rate to hospitals for most separately payable drugs purchased under the 340B program from average sales price (ASP) plus six...more
After weeks of secrecy, the Senate has released a discussion draft of legislation that is the counterpart of the American Health Care Act (AHCA) previously passed by the House. The Senate legislation, entitled the Better Care...more
6/28/2017
/ Affordable Care Act ,
Block Grants ,
Cadillac Tax ,
Congressional Budget Office ,
Cost-Sharing ,
Dependents ,
Essential Health Benefits ,
Flexible Spending Accounts ,
Health Insurance ,
Health Savings Accounts ,
Healthcare Reform ,
High Risk Pools ,
Legislative Agendas ,
Medicaid ,
Medicaid Expansion ,
Medicare ,
Penalties ,
Planned Parenthood ,
Political Parties ,
Preexisting Conditions ,
Prescription Drugs ,
Proposed Legislation ,
Repeal ,
Tax Benefits ,
Trump Administration ,
Waivers