Articles and Blogs

On May 17, Sen. James Lankford (R-OK) introduced companion legislation (S. 1133) to the House bill that would repeal the Affordable Care Act’s (“ACA”) moratorium on physician-owned hospitals. Named the Patient Access to Higher Quality Health Care Act of 2017, the bill is the Senate’s version of legislation (H.R. 1156) previously introduced in the... READ MORE

Physician groups composed of MIPS eligible clinicians (“MECs”[1]) may elect to have their members’ MIPS performance scored individually or as a group. This article notes a few key aspects of MIPS group scoring for 2017. MIPS Group Scoring Includes Performance Data from New Medicare-Enrolled MECs For the 2017 MIPS performance period, a new Medicare-enrolled... READ MORE

While many providers recognize there are benefits to integrating behavioral health and primary care, reimbursement for services continue to be one of the most challenging barriers to achieving integration. The Mental Health Parity and Addiction Equity Act of 2008 and the 21st Century Cures Act signed into law in December 2016 are efforts made... READ MORE

On May 25, 2017, the Michigan Supreme Court dealt another blow to medical providers seeking payment for services provided to individuals injured in car accidents in Michigan. In the opinion, the court held that a medical provider does not have standing to bring a claim against a no-fault insurer for the payment of personal... READ MORE

The Supreme Court of the United States (“SCOTUS”) ruled on Monday, June 5, 2017 that retirement plans maintained by religiously affiliated hospitals meet the definition of a church plan under the Employee Retirement Income Security Act of 1974, as amended (“ERISA”). As church plans, they are not subject to ERISA’s rules and regulations unless... READ MORE

On May 31, 2017, 184 legislators wrote a bipartisan letter to Secretary Tom Price of the Department of Health and Human Services (“HHS”) to request that HHS revisit and roll back a 2013 policy memo that discourages insurance companies selling Qualified Health Plans on the exchanges from accepting payments from hospitals and other third... READ MORE

On May 26, 2017, the U.S. Court of Appeals for the Sixth Circuit issued a decision (NLRB v AEI) holding that an employment agreement provision requiring arbitration of employment disputes, but prohibiting class action or other multiple-employee arbitrations, is unlawful. The court upheld a National Labor Relations Board order striking down the provision. Employees were... READ MORE

Providers and payers alike are increasingly exploring ways to treat the “whole person” by integrating behavioral health care with physical medicine. This integration is critical to helping achieve better outcomes and increasing quality of care. Achieving full integration has proven to be quite challenging, including navigating the legal and compliance requirements when designing and... READ MORE

On May 18, 2017, the Centers for Medicare & Medicaid Services (“CMS”) published a final rule (the “Final Rule”) effectively postponing the start date of CMS’s new episode payment models (“EPMs”) and the Cardiac Rehabilitation Incentive Payment Model (“CR Incentive Model”) from July 1, 2017 until January 1, 2018. The Final Rule also delayed... READ MORE

In a May 15, 2017 7-1[1] decision authored by Hon. Justice Kagan, the U.S. Supreme Court held that the Kentucky Supreme Court’s “clear statement rule” – that an agent can deprive her principal of the rights of access to the courts and trial by jury through an arbitration agreement only if expressly provided in... READ MORE