News & Analysis as of

Healthcare Medical Reimbursement

Marshall Dennehey

Florida Tort Reform: The Impact of House Bill 837 on Health Care Litigation

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On March 24, 2023, Florida Governor Ron DeSantis signed House Bill 837 into law. Also known as the “Civil Remedies” or “Tort Reform” law, HB 837 has changed civil litigation in Florida, including providing a uniform standard...more

Saul Ewing LLP

Pennsylvania Expands Use and Reimbursement of Telemedicine and Bans Noncompete Agreements for Certain Health Care Practitioners

Saul Ewing LLP on

In July 2024, Pennsylvania enacted two significant pieces of legislation relating to telemedicine and physician noncompetition agreements that will have a meaningful impact within the healthcare delivery system with the...more

Schwabe, Williamson & Wyatt PC

Recent Decision Allows Tribes to Recover Healthcare Expenses ‎

In its recent decision, Becerra v. San Carlos Apache, No. 23-250, the U.S. Supreme Court ruled the Indian Self Determination and Education Assistance Act (ISDEAA), 25 U.S.C. § 5301 et seq., requires the Indian Health Service...more

McDermott Will & Emery

Trending in Telehealth: July 2 – 8, 2024

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Trending in Telehealth highlights state legislative and regulatory developments that impact the healthcare providers, telehealth and digital health companies, pharmacists and technology companies that deliver and facilitate...more

Manatt, Phelps & Phillips, LLP

Do Health Care Providers That Serve Historically Marginalized Populations Get Paid Less? An Analytic Investigation

Executive Summary - Health inequities are pervasive across the country, with the health and well-being of Americans too often diverging along racial and ethnic lines. While recent studies have identified many factors...more

Snell & Wilmer

Supreme Court Ruling Supports Tribal Healthcare Funding and Self-Determination

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By Heidi McNeil Staudenmaier and Kelsey Haake  In a momentous decision on June 6, 2024, the U.S. Supreme Court delivered a resounding victory for Native American tribes. The Court ruled that the Indian Health Service (IHS)...more

Epstein Becker & Green

A Day for Specialists - SCOTUS Today

Another Three-for Thursday at the Supreme Court, with none of the decisions a landmark but each of utmost relevance to legal specialists and technicians in the fields of bankruptcy, estate taxation, and Indian affairs....more

Jones Day

California Health Care Providers to Face Greater Headwinds as State Implements Health Care Cost Targets

Jones Day on

Pursuant to California's Health Care Quality and Affordability Act (the "HCQA"), the newly created Office of Health Care Affordability ("OHCA") recently proposed statewide health care cost targets and standards and goals for...more

Manatt, Phelps & Phillips, LLP

Fact Sheet: Policy Opportunities to Expand Equitable Access to Telehealth across New York State

Background - Telehealth utilization spiked during the COVID-19 pandemic, facilitated by state and federal policy change through the COVID-19 public health emergency (PHE) declaration. Use has tapered off from the height...more

Arnall Golden Gregory LLP

Ninth Circuit Publishes New Opinion Regarding Healthcare Provider Assignments and Reinforcing Broad Standing to Bring Suit Against...

On January 10, 2024, the United States Court of Appeals for the Ninth Circuit published an opinion in the matter of South Coast Specialty Surgery Center, Inc., v. Blue Cross of California, which resolidified the Ninth...more

Manatt, Phelps & Phillips, LLP

Palliative Care Reimbursement, Innovation and Reform

Palliative Care Defined The term “palliative care” is often used by doctors and other health care professionals during a serious illness or toward the end of life. Federal regulations define palliative care as...more

Bass, Berry & Sims PLC

Behavioral Health: Momentum Continues in the CY 2024 Medicare Physician Fee Schedule

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On November 16, the Centers for Medicare & Medicaid Services (CMS) published its Medicare Physician Fee Schedule (PFS) final rule for calendar year 2024 (PFS Final Rule). According to the CMS press release, the PFS Final Rule...more

McDermott Will & Emery

Trending in Telehealth: November 8 – 14, 2023

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Trending in Telehealth highlights state legislative and regulatory developments that impact the healthcare providers, telehealth and digital health companies, pharmacists and technology companies that deliver and facilitate...more

Ankura

Four Lessons for Health Systems From the Private Equity Playbook

Ankura on

The value of private equity (PE) deals in the healthcare sector has grown from <$2B in 2001 to $151 billion in deals in 2021. Barring government intervention, PE in healthcare is here to stay....more

McDermott+

Policy Update - CMS Finalizes Remedy for 340B-Acquired Drugs Purchased in CYs 2018–2022

McDermott+ on

On November 2, 2023, the Centers for Medicare and Medicaid Services (CMS) finalized the rule Medicare Program; Hospital Outpatient Prospective Payment System: Remedy for the Calendar Years 2018–2022 to addresses how the...more

Robinson+Cole Health Law Diagnosis

CMS Announces 0.8 Percent Aggregate Home Health Payment Increase in 2024

On Wednesday, November 1, the Center for Medicare & Medicaid Services (CMS) released its Home Health Prospective Payment System Rate Update final rule for CY 2024 (the Final Rule). The Rule estimates that the aggregate...more

Manatt, Phelps & Phillips, LLP

Increasing Community Health Workers’ Role in Supporting Medicaid Members

Community health workers (CHWs) are frontline public health workers who come from and/or have deep roots in the communities they serve. Many states are leveraging CHWs to build trusting relationships with patients, including...more

Manatt, Phelps & Phillips, LLP

Court Rules Provider’s Prior Authorization Calls with Payor Not a Binding Contract

In a decision important to health care payors and providers alike, a California Court of Appeal, in AToN Center, Inc. v. United Healthcare Insurance Company, et al., 93 Cal.App.5th 1214 (2023), agreed with a lower court...more

Verrill

How to Comply with the Health FSA Debit Card Claims Substantiation Rules

Verrill on

The IRS’s recent Chief Counsel Advice Memorandum 202317020 (the “Memo”) brings into focus the importance of compliance with the debit card claims substantiation requirements for medical care expenses reimbursed or paid for...more

Robinson+Cole Health Law Diagnosis

Connecticut Governor Signs Legislation Implementing New Requirements for Hospitals and Nursing Home Facilities

Connecticut Governor Ned Lamont recently signed two important pieces of legislation that affect hospitals and certain Medicaid providers and programs. First, Public Act No. 23-39, “An Act Requiring Discharge Standards...more

Manatt, Phelps & Phillips, LLP

Accessing Cell and Gene Therapies : Insights on Coverage, Reimbursement and Emerging Models

Over the past five years, cell and gene therapies have increasingly moved from the R&D pipeline to the health care setting, putting lifesaving treatments for certain cancers and genetic diseases within patients’ reach. Over...more

Robinson+Cole Health Law Diagnosis

Connecticut Places Checks on PBM Contracts in Support of 340B Covered Entities

On June 27, 2023, Connecticut Governor Ned Lamont signed into law Public Act 23-171“An Act Protecting Patients and Prohibiting Unnecessary Health Care Costs” (Act), which includes changes to the state’s implementation of the...more

Manatt, Phelps & Phillips, LLP

Prenatal Vaccines in Medicaid and CHIP: Coverage, Reimbursement and State Policy Solutions

Editor’s Note: In a new white paper funded by Pfizer, Inc., Manatt Health discusses the current landscape of Medicaid and Children’s Health Insurance Program (CHIP) coverage and reimbursement for prenatal vaccines, informed...more

Nelson Mullins Riley & Scarborough LLP

Understanding the Medicare Overpayment Appeals Process

Every Medicare provider should understand the Medicare administrative appeals process. Providers are entitled to be reimbursed for their services and want to keep those reimbursements safe from audits. However, if Medicare...more

Burr & Forman

The DOJ Continues to Scrutinize Telemedicine

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Telemedicine saw a dramatic increase during the COVID-19 pandemic. A recent study from the U.S. Department of Health and Human Services (HHS), released in December 2021, showed an increase in Medicare telemedicine visits...more

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