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

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

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

The recently passed Wisconsin Act 265 (the “Act”) establishes a new statutory requirement that all “pain clinics” obtain and maintain a special certification to be issued by the Wisconsin Department of Health Services (“DHS”), Division of Quality Assurance (“DQA”). Any organizations engaged in providing pain clinic services should carefully assess whether this requirement applies... READ MORE

On August 22, 2016, the Department of Health and Human Services Office of the Inspector General (“OIG”) released additional guidance (“IRO Guidance”) on relevant principles that should be used to assess the independence of Independent Review Organizations (“IROs”) performing reviews required as a condition of Corporate Integrity Agreements (“CIAs”). This most recent update reflects... READ MORE

Update: The IRS has modified the effective date of Rev. Proc. 2016-44 to extend the transition period by 6 months. The revision allows an issuer to apply the safe harbors in Rev. Proc. 97-13, as modified and amplified, to a management contract entered into before August 18, 2017 and that is not materially modified... READ MORE

Enrollment will soon be closing for the Centers for Medicare and Medicaid Services’ (“CMS”) new Comprehensive Primary Care Plus (“CPC+”) payment model. Building on the success of the Comprehensive Primary Care model, CPC+ aims to strengthen primary care by creating new incentives for providers to invest in resources to improve the quality and efficiency... READ MORE