Articles and Blogs

An increasing number of employer-sponsored health plans are electing not to enter into contractual agreements with hospitals through an established provider network. These plans seek to limit payment for hospital services provided to plan beneficiaries by repricing the services at a plan-determined amount, typically based upon a percentage of Medicare reimbursement, an amount far below... READ MORE

On May 17, 2016, the U.S. Department of Labor (“DOL”) announced the details of its final rule under the Fair Labor Standards Act, establishing new salary thresholds for millions of traditionally exempt white collar employees effective December 1, 2016. These changes would significantly impact many employers’ budgets in the coming months.  The main points of the new... READ MORE

House, Senate Chairman Highlight GAO Report on Medicaid Reform Late last week, House Energy and Commerce Committee Chairman Fred Upton (R-MI) and Senate Finance Committee Chairman Orrin Hatch (R-UT) highlighted a new GAO report on Medicaid reform. The report was released by the non-partisan Government Accountability Office (“GAO”) detailing policy considerations regarding per capita caps... READ MORE

As has been widely reported, CMS’s Acting Administrator, Andy Slavitt, recently announced four participation options under the Quality Payment Program (i.e., participation in the MIPS and Advanced APM programs) for 2017. In part because the September 8 announcement provides only summary descriptions, many questions surround the four participation options and their implementation for 2017.... READ MORE

Background Hospitals and other facilities that are accredited by The Joint Commission work to ensure compliance with The Joint Commission’s “Life Safety” chapter, which requires compliance with the National Fire Protection Association’s NFPA 101: Life Safety Code (“LSC”).  As part of those efforts, many accredited facilities have used The Joint Commission’s Statement of Conditions (“SOC”) as... READ MORE

Congress Returns for Final Work Period Before the Election The House and Senate returned on Tuesday for their final work period prior to the November elections. The most pressing issue is funding the federal government, which is set to end on September 30, 2016. That gives lawmakers few legislative days to complete a Continuing Resolution... READ MORE

On September 8, 2016, the Michigan Senate passed a bill on a 22-15 vote, which expands the scope of practice for certified nurse anesthetists (“NAs”). Senate Bill 1019 amends Sections 17210 and 17708 of the Michigan Public Health Code (the “Code”). Specifically, the bill adds certain anesthesia and analgesia services to an NA’s scope of... READ MORE

Hospitals are increasingly becoming targets for investment by real estate investment trusts (“REITs”), with the past year seeing a number of high profile joint ventures between REITs and health care providers structured as RIDEA investments. While hospital/REIT joint ventures can help hospitals fund expansions or monetize valuable real estate assets, hospitals should enter into... READ MORE

On September 8, CMS’s Acting Administrator Andy Slavitt announced new options in how MIPS eligible clinicians may participate in MIPS for 2017. In doing so, Mr. Slavitt also stated that CMS will publish the final rule for MIPS, APM incentive payments, etc. no later than November 1, 2016. Mr. Slavitt’s announcement provided only a... READ MORE

Last week, the Seventh Circuit Court of Appeals handed down its decision in  US ex rel. Presser v. Acacia Mental Health Clinic, LLC.¹  The FCA case was brought by a nurse practitioner whistleblower who alleged that services being provided were not medically necessary. The court affirmed dismissal under Rule 9(b) for failure to plead fraud... READ MORE