Articles and Blogs

Executive Summary On October 24, 2011, the Centers for Medicare and Medicaid Services (“CMS”) released a final rule (“Final Rule”) revising the Patient Rights Conditions for Coverage (“CfCs”) for ambulatory surgical centers (“ASCs”).  Effective on December 23, 2011, ASCs will be permitted to provide the patient, the patient’s representative or the patient’s surrogate, patient... READ MORE

The July 2011 version of the CMS-855A, Medicare Enrollment Application (the “855A”) contains new disclosure requirements arising from risk screening criteria found in the Affordable Care Act (the “Act”). These reporting requirements apply not only to applications for new providers enrolling in the Medicare program, but to existing providers that will be required, under... READ MORE

The Department of Health and Human Services by the end of the year is expected to publish its final regulations implementing changes to the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) arising from the Health Information Technology for Economic and Clinical Health Act (“HITECH”).  With these regulations pending and a trend toward increasing... READ MORE

Executive Summary In a flurry of regulatory activity aimed at improving efficiencies in health care delivery, on October 24, 2011, the Centers for Medicare and Medicaid Services (“CMS”) issued, among other rules1, a proposed rule to eliminate anachronistic and burdensome regulations (“Proposed Rule”).   The Proposed Rule applies to a variety of health care providers. ... READ MORE

The Indiana Office of Medicaid Policy and Planning (“OMPP”) has released a revised prior authorization policy for early refills of prescriptions.  The change will be effective December 1, 2011 and requires that at least 85% of a prescription claim’s days transpire before subsequent claims or prior authorizations can be approved.  This is a change... READ MORE

On November 3, 2011, GlaxoSmithKline (“GSK”) announced an agreement in principle with the U.S. government for the largest settlement to date to conclude ongoing government investigations against a pharmaceutical company marketing products in the U.S.  The $3 billion settlement against GSK, the world’s fourth largest pharmaceutical company, should be finalized in 2012 and is... READ MORE

On November 1, 2011, the Centers for Medicare and Medicaid Services (CMS) issued its Calendar Year (CY) 2012 Medicare Physician Fee Schedule Final Rule (Final Rule) finalizing proposed changes that impact physician billing for services subject to a billing policy commonly known as the 3-Day Payment Window Rule (or 1-Day Payment Window Rule for... READ MORE

On October 28, 2011, the Centers for Medicare and Medicaid Services (“CMS”) published a Federal Register notice to inform the public that an application for Rural Health Clinic (“RHC”) deeming authority was submitted by the American Association for Accreditation of Ambulatory Surgery Facilities (“AAAASF”).  If approved, AAAASF, in addition to CMS, will be able... READ MORE

On November 1, 2011, the Indiana Court of Appeals issued a decision that will have an impact on all Indiana employers that have No-Fault attendance policies.  In particular, in the unemployment compensation setting, an employee will not be found to have been discharged for “just cause” (and therefore disqualified from receiving benefits) if the discharge was... READ MORE

One of the most interesting recent developments is the NLRB’s focus on private employer polices that restrict employees on what they can say about their company and the people who work for it. Last month, an Administrative Law Judge for the NLRB ruled that an employer’s policies on “Courtesy,” “Unauthorized Interviews” and “Outside Inquiries... READ MORE