Articles and Blogs

 NATIONAL States inch forward on nurse staffing laws Bill backed by generic drug companies gets PhRMA endorsement at Senate hearing As MACRA Implementation Turns 2, Industry Leaders Call for Change Best & worst states for physicians to practice, ranked by Medscape Some hospitals turn away ambulances when the patients are more likely to be... READ MORE

On April 30, 2019, the U.S. Department of Justice (“DOJ”) released an updated version of is guidance known as “The Evaluation of Corporate Compliance Programs” (“2019 Guidance Document”). This document provides actionable guidance for health care providers seeking to assess and enhance their compliance programs. The DOJ’s updates emphasize the government’s view that not... READ MORE

The Centers for Medicare & Medicaid Services (“CMS”) recently published a final rule (“Final Rule”) revising the procedures that CMS uses to administer its Preclusion List. As outlined below, CMS now requires Medicare Advantage, Medicare Part D and other designated plans to deny payment for items or services provided by or prescribed by a... READ MORE

NATIONAL Costs for the same medical procedures show wide variation between hospitals CBO: HHS’ rebate rule would boost federal spending by $177B, lead to higher Part D premiums Trump administration announces ‘conscience rule’ for health care providers CMS lays out strategy to foster medical innovation in Medicare CVS exec: ‘We don’t discount Amazon’ Hospitals... READ MORE

On April 22, 2019, the Centers for Medicare & Medicaid Services (“CMS”) announced a new set of value-based payment models for reimbursement of primary care services. CMS has coined the new models its “Primary Cares Initiative.” Although participation in the models is currently voluntary, CMS hopes the initiative will accelerate the nationwide transition of... READ MORE

In keeping with the trends of the commercial market, on April 22, 2019, the Centers for Medicare & Medicaid Services (“CMS”) announced opportunities to participate in new direct contracting models under Medicare’s Part A and Part B fee-for-service program. CMS intends to focus these models particularly on primary care coordination for medically complex and... READ MORE

On May 6, 2019, the United States District Court in Washington, D.C. issued its opinion on the appropriate remedy to address the invalidated payment cuts set forth in the 2018 and 2019 Outpatient Prospective Payment System final rules (“2018 and 2019 OPPS Rules”) for drugs purchased under the 340B drug discount program (“340B Program”).... READ MORE

On May 3, 2019, CMS released its long-awaited guidance on hospital co-location and shared service arrangements in the form of a draft survey memo (“Memo”), which is available here. The Memo clarifies how a hospital can co-locate with other health care entities without violating the Medicare Conditions of Participation (“CoPs”). CMS has been promising... READ MORE

NATIONAL How hospitals are making investments that create new revenue streams Civica Rx CEO predicts ‘stampede’ if Amazon’s Haven succeeds HHS cuts maximum civil monetary penalties for HIPAA violations Healthcare sweeps ranking of top-paying jobs — Salaries for surgeons, orthodontists & more PBM executive: Industry has been discussing end of rebates for a ‘long,... READ MORE

On April 23, 2019, the Centers for Medicare & Medicaid Services (“CMS”) released the Federal Fiscal Year (“FFY”) 2020 Medicare Inpatient Prospective Payment System (“IPPS”) proposed rule (“IPPS Proposed Rule”). Among many other changes, CMS proposed several changes to address disparities between high and low wage index areas and fixing the so-called “rural floor.”... READ MORE