Health Care is one of the most regulated industries in the country, and for many years, one of the key administrative agencies overseeing health care in the United States, the Department of Health and Human Services’ (“HHS”)...more
The President and his administration continue to tout their efforts to strengthen coverage for behavioral health care, including significantly increasing behavioral health spending and strengthening parity between physical...more
4/4/2022
/ Biden Administration ,
Denial of Insurance Coverage ,
Employee Retirement Income Security Act (ERISA) ,
Health Insurance ,
Health Plan Sponsors ,
Healthcare ,
Healthcare Reform ,
Insurance Claims ,
Insurance Litigation ,
Mental Health ,
Plan Administrators ,
Scope of Coverage ,
Standard of Care
The end of 2021 brings positive indications of the continued acceptance of telehealth as an important clinical care approach post public health emergency (“PHE”). The Centers for Medicare and Medicaid Services (“CMS”), like...more
2/22/2022
/ Ambulatory Surgery Centers ,
Centers for Medicare & Medicaid Services (CMS) ,
Drug Pricing ,
Health Care Providers ,
Health Insurance ,
Healthcare ,
Healthcare Reform ,
Inpatient Prospective Payment System (IPPS) ,
Medicaid ,
Medical Reimbursement ,
Medicare ,
Medicare Advantage ,
Outpatient Prospective Payment System (OPPS) ,
Payor Contracts ,
Physician Fee Schedule ,
Section 340B ,
Surprise Medical Bills ,
Telehealth
Less than one week after hearing oral arguments, the U.S. Supreme Court has stayed injunctions against the Centers for Medicare & Medicaid Services (“CMS”) Omnibus COVID-19 Health Care Staff Vaccination Rule (“Vaccine...more
1/14/2022
/ Biden Administration ,
Biden v Missouri ,
Centers for Medicare & Medicaid Services (CMS) ,
Constitutional Challenges ,
Coronavirus/COVID-19 ,
Employer Liability Issues ,
Employer Mandates ,
Essential Workers ,
Healthcare Workers ,
Infectious Diseases ,
Lack of Authority ,
Preliminary Injunctions ,
Stays ,
Vaccinations ,
Virus Testing ,
Workplace Safety
While the Centers for Medicare & Medicaid Services (“CMS”) Omnibus COVID-19 Health Care Staff Vaccination Rule (“CMS Vaccine Requirement”) heads to the Supreme Court, CMS will resume enforcement in the half of U.S. states not...more
12/31/2021
/ Biden Administration ,
Centers for Medicare & Medicaid Services (CMS) ,
Coronavirus/COVID-19 ,
Employer Liability Issues ,
Employer Mandates ,
Essential Workers ,
Health Care Providers ,
Healthcare Facilities ,
Healthcare Workers ,
Infectious Diseases ,
Preliminary Injunctions ,
Vaccinations ,
Workplace Safety
Two U.S. District Courts issued preliminary injunction orders this week barring CMS’ implementation of the Ominibus COVID-19 Health Care Staff Vaccination Rule (“CMS Vaccine Mandate”) on a nationwide basis. The CMS Vaccine...more
12/6/2021
/ Centers for Medicare & Medicaid Services (CMS) ,
Coronavirus/COVID-19 ,
Employer Liability Issues ,
Employer Mandates ,
Essential Workers ,
Healthcare Facilities ,
Healthcare Workers ,
Infectious Diseases ,
Preliminary Injunctions ,
Vaccinations ,
Workplace Safety
In the latest update to the fight surrounding vaccination of health care workers, the Centers for Medicare & Medicaid Services (“CMS”) announced that it suspended activities related to the implementation and enforcement of...more
12/6/2021
/ Centers for Medicare & Medicaid Services (CMS) ,
Coronavirus/COVID-19 ,
Employer Liability Issues ,
Employer Mandates ,
Essential Workers ,
Healthcare Facilities ,
Healthcare Workers ,
Infectious Diseases ,
Preliminary Injunctions ,
Vaccinations ,
Workplace Safety
The Centers For Medicare & Medicaid Services Issues New Inpatient Prospective Payment System Final Rule -
On September 3, 2020, the Centers for Medicare & Medicaid Services (CMS) issued the fiscal year (FY) 2021 Medicare...more
12/31/2020
/ Centers for Medicare & Medicaid Services (CMS) ,
Cramdown ,
Drug Pricing ,
Health Care Providers ,
Healthcare Reform ,
Inpatient Prospective Payment System (IPPS) ,
Medicaid ,
Medicare ,
Physician Fee Schedule ,
Physician Medicare Reimbursements ,
Section 340B ,
Telehealth ,
Value-Based Care
Introduction -
CMS has taken extensive measures to assist providers and promote access to care in light of the Public Health Emergency (PHE) related to the COVID-19 pandemic. The efforts taken have and continue to benefit...more
8/4/2020
/ Audits ,
CARES Act ,
Centers for Medicare & Medicaid Services (CMS) ,
COBRA ,
Coronavirus/COVID-19 ,
Health Care Providers ,
Health Insurance ,
Medicaid ,
Medical Reimbursement ,
Medicare ,
Skilled Nursing Facility ,
Telehealth ,
Telemedicine
March 4, 2019 was the mid-point of the 120 day regular session of Colorado’s General Assembly. Before adjournment on May 3, 2019, significant legislative actions and resulting changes in the regulatory framework seem likely...more
Medicaid is a shared federal and state program. Federal and state dollars are combined so states can furnish Medicaid health coverage to poor and disabled Coloradans including many who need nursing facility care. ...more
Within just weeks of each other, the U.S. Department of Justice (DOJ) and the U.S. Department of Health and Human Services’ Office of Inspector General (OIG) issued separate documents that health care organizations may use to...more
4/21/2017
/ Compliance Management Systems ,
Corporate Governance ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
Health Care Providers ,
Healthcare Fraud ,
Investigations ,
OIG ,
Policies and Procedures ,
Resource Guide ,
Third-Party Relationships
In November, Colorado voters will cast ballots on Amendment 69, also known as ColoradoCare. ColoradoCare is an ambitious, far-reaching plan to amend the Colorado constitution which would establish a statewide universal...more
The Supreme Court of the United States in Universal Health Services, Inc. v. Escobar et al., weighed in on and embraced the implied certification theory of liability within the False Claims Act (FCA)....more
6/22/2016
/ False Claims Act (FCA) ,
False Implied Certification Theory ,
Federal Contractors ,
Health Care Providers ,
Implied Certification ,
Material Misrepresentation ,
Medicaid ,
Medicare ,
Mental Health ,
SCOTUS ,
Universal Health Services Inc v United States ex rel Escobar ,
Unlicensed Medical Providers
Olympus Corporation of the Americas, the United States’ largest distributor of endoscopes and related medical equipment, recently agreed to pay $623.2 million to resolve criminal charges and civil claims, according to a...more
On February 12, 2016, CMS published the Reporting and Returning of Overpayments Final Rule (Final Rule). The Final Rule takes effect on March 14, 2016. Overall, CMS appears to have listened to stakeholders and acknowledged...more
On Jan. 22, 2016, CMS issued a new application and sweeping changes to the Medicare Electronic Health Records (EHR) Incentive Program hardship exception application process. The changes are intended to temporarily ease the...more
The Department of Health and Human Services Office of Inspector General (HHS-OIG) recently released its FY 2016 Work Plan, in which it identified key areas of focus for the upcoming year. Consistent with its mandate to detect...more
On Friday, the Centers for Medicare & Medicaid Services (“CMS”) issued a long-awaited proposed rule that would drastically change the payment rates for clinical laboratory services beginning January 1, 2017 (the “Proposed...more
9/29/2015
/ Centers for Medicare & Medicaid Services (CMS) ,
Civil Monetary Penalty ,
Clinical Laboratories ,
Health Care Providers ,
Healthcare ,
Medicaid ,
Medicare ,
Medicare Advantage ,
Medicare Part D ,
PAMA ,
Physician Fee Schedule ,
Physicians ,
Protecting Access to Medicare Act ,
Reporting Requirements
On June 1, 2015, the Centers for Medicare and Medicaid Services (CMS) will publish in the Federal Register a long-awaited proposed rule addressing Medicaid Managed Care Organizations (MMCOs). Comments on the proposed rule...more