Articles and Blogs

Overview In recent years, the Centers for Medicare & Medicaid Services (“CMS”) has been committed to enforcing the requirement that hospitals must be “primarily engaged” in providing inpatient services to be qualified as a hospital under the Social Security Act and thus eligible to participate in Medicare.  This enforcement trend has resulted in the... READ MORE

The Medicare Access and CHIP Reauthorization Act of 2015 (“MACRA”), signed by President Obama in April of 2015, enacted legislation that will significantly impact provider reimbursement. MACRA repealed the Sustainable Growth Rate (“SGR”) formula and implemented: (i) scheduled updates to the Medicare Physician Fee Schedule (“MPFS”) including a 0.5 percent positive annual update beginning... READ MORE

Executive Summary On February 9, 2016, the Substance Abuse and Mental Health Services Administration (“SAMHSA”) issued proposed rules to substantially revise its Confidentiality of Alcohol and Drug Abuse Patient Records regulations (“Proposed Rules”)1.  The last substantive update to these regulations occurred in 1987, nearly 30 years ago, which was before the enactment of the... READ MORE

The Department of Health and Human Services Office of Inspector General (“OIG”) recently issued Advisory Opinions 15-16 and 15-17 approving two financial assistance programs offered by nonprofit, tax-exempt, charitable organizations. Based on the structure of each program, OIG concluded that the arrangements would not constitute grounds for the imposition of civil monetary penalties or... READ MORE

Executive Summary On February 11, 2016, the Centers for Medicare & Medicaid Services (“CMS”) issued its long-awaited Final Rule (“Final Rule”) implementing the overpayment reporting and repayment provisions of the Patient Protection and Affordable Care Act (“PPACA”). The Final Rule clarifies certain provisions set out in the February 14, 2012 Proposed Rule (“Proposed Rule”),... READ MORE

As a result of legislation passed by the Indiana General Assembly in 2014, two important property tax dates are changing for 2016 and going forward. READ MORE

Background The Hart-Scott-Rodino Antitrust Improvements Act of 1976 (“HSR”), as amended, requires all persons contemplating certain mergers or acquisitions that meet or exceed the jurisdictional thresholds (shown below) to file notification with the Federal Trade Commission (“FTC”) and Department of Justice (“DOJ”) Antitrust Division and to wait a period of time before consummating the... READ MORE

As lawmakers return for the second session of the 114th Congress, physician-owned hospitals (“POHs”) across the country are closely watching the status of the Promoting Access, Competition, and Equity Act of 2015 (H.R. 2513) authored by Rep. Sam Johnson (R-TX). Also referred to as the PACE Act of 2015, H.R. 2513 would change existing... READ MORE

This week, the Centers for Medicare & Medicaid Services (“CMS”) posted a much-anticipated FAQ related to off-campus provider-based departments and use of the “PO” modifier. Reporting of the modifier was voluntary in CY 2015 but mandatory beginning in CY 2016. CMS clarified that the “PO” modifier is only required for items and services provided... READ MORE

Executive Summary On December 30, 2015, the Pennsylvania Commonwealth Court struck down a provision of the Older Adults Protective Services Act that barred individuals convicted of certain crimes, such as murder and rape, from working in nursing homes or other health care facilities serving the elderly. In Tyrone Peake et. al. v. Commonwealth of... READ MORE