On June 21, 2024, a three-judge panel of the United States Court of Appeals for the Fifth Circuit issued an opinion in Braidwood Management Inc. et al. v. Xavier Becerra et al. reversing an injunction entered by the lower...more
On March 18, 2024, the Office for Civil Rights (OCR) of the Department of Health and Human Services (HHS) updated the guidance first issued in December 2022 regarding the use of online tracking technologies in the...more
On Friday, October 6, 2023, OIG announced the results of an audit performed on the Medicare Part A hospital transfer policy for discharges to post-acute care (PAC). The hospital transfer policy, which was established in...more
On July 28, 2023, CMS issued a final rule (CMS-1787-F) updating Medicare hospice payment rates and the aggregate cap amount applicable to fiscal year 2024 (the Final Rule). According to CMS, the Final Rule is part of CMS’s...more
On February 28, 2023, a jury in the United States District Court in Minnesota issued a $43 million verdict in favor of the plaintiffs in United States ex rel. Fesenmaier v. Cameron-Ehlen Grp, a False Claims Act (FCA) suit...more
On December 21, 2022, HHS issued a new proposed rule to implement the requirements of the Administrative Simplification subtitle of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Patient...more
On December 28, 2021, HHS released a proposed rule governing plans issued in the Patient Protection and Affordable Care Act (ACA) marketplaces beginning with the 2023 plan year (the Proposed Rule). Among other changes to the...more
Lawsuits challenging the CMS Interim Final Rule (IFR) on COVID-19 vaccine requirements for healthcare workers and Occupational Safety and Health Administration’s (OSHA) COVID-19 Emergency Temporary Standards on Health Care...more
11/24/2021
/ Administrative Procedure Act ,
Appeals ,
Centers for Medicare & Medicaid Services (CMS) ,
Congressional Review Act ,
Coronavirus/COVID-19 ,
Employer Mandates ,
Healthcare Workers ,
Interim Final Rules (IFR) ,
Medicaid ,
Medicare ,
OSHA ,
Social Security Act ,
Vaccinations
Over the past 16 months, three of the nation’s largest commercial payers – UnitedHealthcare, Anthem and CIGNA – have instituted new policies affecting how and whether they will pay for high-cost drugs administered in hospital...more
On May 3, 2021, HHS announced a new program to cover the costs of COVID-19 vaccination for patients enrolled in health plans that either do not cover vaccinations generally, or cover them but with patient cost-sharing...more
On January 21, 2021, the HHS Office for Civil Rights (OCR) published a notice of proposed rulemaking (the Proposed Rule) proposing modifications to the HIPAA Privacy Rule to address standards that might impede the transition...more
On July 27, 2020, Senate Republicans released their plan for the next phase of coronavirus relief. Instead of a single bill, the Senate plan (dubbed the Health, Economic Assistance, Liability Protection, and Schools Act, or...more
8/10/2020
/ CARES Act ,
Centers for Disease Control and Prevention (CDC) ,
Coronavirus/COVID-19 ,
Department of Health and Human Services (HHS) ,
Medicare ,
Nursing Homes ,
Personal Protective Equipment ,
Popular ,
Public Schools ,
Relief Measures ,
Skilled Nursing Facility ,
Telehealth ,
Virus Testing
On June 9, 2020, CMS released recommendations for re-opening healthcare facilities to provide non-emergent, non-COVID-19 related health care. The guide is intended for use by states or regions in Phase II of re-opening under...more
President Trump signed the Families First Coronavirus Response Act, H.R. 6201, on March 18th, 2020 after it passed in the Senate without amendment. The Act, Public Law 116-127, has become known as “Phase II” of the...more
On February 14, 2020, the United States Court of Appeals for the District of Columbia Circuit issued its decision in Gresham et al. v. Azar et al., Case No. 19-5094, a case challenging HHS’s Medicaid waiver that allowed...more
CMS recently announced updates and milestones for several programs run by the Center for Medicare and Medicaid Innovation (CMMI). CMMI is the internal CMS agency responsible for developing and testing new health care payment...more
1/20/2020
/ Alternative Payment Models (APM) ,
Centers for Medicare & Medicaid Services (CMS) ,
CMMI ,
Fee-for-Service ,
Health Care Providers ,
Hospitals ,
Medicare ,
Medicare Access and CHIP Reauthorization (MACRA) ,
Next Generation ACO (NGACO) ,
Physicians ,
Quality Payment Program (QPP)
On July 10, 2019, CMS announced a new proposal for episode-based payment for radiation oncology services. The aim of this new proposal is to determine whether episode-based payment to hospitals, physician groups, and...more
On Monday, June 24, 2019, President Trump issued an executive order requiring HHS and other agencies to propose regulations designed to promote transparency and upfront disclosure by hospitals to patients of the charge prices...more
On April 5, 2019, CMS issued final rules (the Final Rule) implementing various provisions of the 2018 Bipartisan Budget Act (the 2018 Budget). The 2018 Budget includes provisions allowing Medicare Advantage plans to provide...more
King & Spalding partner Daron Tooch represented NorthBay HealthCare Group, a two-campus hospital in Solano County, California at trial in the Northern District of California against Blue Shield for underpayment of...more