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CMS Releases Draft Guidance on Shared Space Arrangements

The Centers for Medicare & Medicaid Services (“CMS”) recently released draft guidance for state survey agencies regarding shared space and co-location arrangements between hospitals and other hospitals or health care...more

Two Recent Developments Are Easing Restrictions on Licensure and Transactions in the Home Health Industry

Two recent legal developments (one at the federal level and one at the state level) will inevitably reduce barriers to new licensing and transactions in the home care industry and, in particular, for home health agencies...more

CMS’s New Process for Issuing Local Coverage Determinations

In October 2018, the Centers for Medicare & Medicaid Services (“CMS”) announced that it made significant changes to the process by which local coverage determinations (“LCDs”) are developed and issued. These changes were...more

Healthcare Fraud Prevention Partnership Issues a Review of Clinical Laboratory Services

The Healthcare Fraud Prevention Partnership (“HFPP”) recently published its second white paper, entitled “Examining Clinical Laboratory Services,” which provides a comprehensive overview of practices that raise fraud and...more

D.C. District Court Clarifies Standard for Laboratory Determination of Medical Necessity

This past June, a federal district court in the District of Columbia made headlines when it declined to dismiss an action brought by a qui tam plaintiff (“Relator”) against defendant Boston Heart Diagnostics (“Boston Heart”),...more

New York State Office of the Medicaid Inspector General Releases Guidance on Compliance Program Reviews

In the 1990s, as part of the Federal Sentencing Guidelines, the U.S. Sentencing Commission developed for the first time the criteria upon which it will view an organization’s compliance program to be “effective.” In October...more

$750,000 HIPAA Settlement Reinforces Need to Be Proactive

As the Department of Health and Human Services’ (“HHS”) Office of Civil Rights (“OCR”) proceeds with its second round of HIPAA audits, this time covering business associates as well as covered entities, a recent settlement...more

Legislation to Curb Medicare and Medicaid Fraud Would Increase Cost and Compliance Burdens on Health Care Providers

On March 25, 2015, a bipartisan group of U.S. Senators reintroduced the Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (“PRIME Act” or “Act”) following the lead of the U.S. House of Representatives,...more

“Next-Generation ACO” Model Is CMS’s Newest Effort to Encourage More ACO Risk

On March 10, 2015, the Centers for Medicare & Medicaid Services’ (“CMS’s”) Center for Medicare and Medicaid Innovation (“Innovation Center”) announced a demonstration project incorporating new risk models for reimbursement of...more

Time to Freshen Up Your Charity Care Policies: Treasury and IRS Issue Final 501(r) Regulations

Among the many new requirements of the Patient Protection and Affordable Care Act of 2010 (“Affordable Care Act” or “ACA”) are amendments to the Internal Revenue Code (“IRC”) that formalize and impose some uniformity in the...more

New York Announces Revisions to the Certificate-of-Need Process

The New York State Department of Health (“NYSDOH”) recently released proposed revisions to its certificate-of-need (“CON”) process. The regulations aim to streamline the administrative process for hospitals, nursing homes,...more

The New York State Department of Health Releases Long-Awaited Proposed Regulations Authorizing the Formation of ACOs

The long-awaited proposed regulations authorizing the formation of accountable care organizations (“ACOs”) in New York are finally here. Interested parties may comment on the proposal until December 1, 2014. The regulations...more

New York Certificate of Public Advantage (COPA) Program Alert: Revised Regulations Are Particularly Relevant to DSRIP Participants

On August 27, 2014, the New York State Department of Health ("DOH") issued revisions to its proposed regulations implementing the Certificate of Public Advantage ("COPA") process, which will facilitate immunity for New York...more

8/29/2014  /  Affordable Care Act , DSRIP , Healthcare
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