Articles and Blogs

Starting on August 1, 2023, Medicare validation edits will be activated to require service location addresses on the UB-04 hospital claim form to match exactly with the service location enrolled in Medicare’s Provider Enrollment, Chain, and Ownership System (“PECOS”). Background In a previous article, we reported on the Center for Medicare & Medicaid Services... READ MORE

NATIONAL 340B pay remedy favors hospitals with the least uncompensated care 10 states struggling most with primary care provider shortage 300+ rural hospitals at immediate risk of closure AHA Responds to Senate Bipartisan RFI on the 340B Drug Pricing Program AHA rejects study suggesting PHE funds overpaid hospitals AHCA warns White House about ‘one-size-fits... READ MORE

The Biden Administration proposed a new rule to strengthen mental health parity under health care plans. The proposed rule, if finalized, would require health plans to provide members with equal access to behavioral health services. The rule also requires health plans to study the impact of plan restrictions on access to mental health and... READ MORE

In 2022, the Biden administration announced an initiative to increase the transparency of corporate and private equity ownership and operation of nursing homes. Recently, the Centers for Medicare & Medicaid Services (“CMS”) announced that it would include ownership and operatorship affiliation information on its Nursing Home Care Compare website and that it would publish... READ MORE

On December 14, 2022, the Office of Inspector General (“OIG”) issued an advisory opinion which approved a hospital program (“Arrangement”) to provide advanced practice provider (“APP”) support for inpatients being cared for by primary care physicians (“Participating Physicians”). Several months later, in May 2023, the Department of Justice (“DOJ”) reached a settlement of $29,744,065... READ MORE

A new mandatory bundled payment model is likely on its way in 2026, and the Center for Medicare & Medicaid Innovation (“CMMI”) is seeking input on how to structure the model to work for existing population-based models, including accountable care organizations (“ACOs”). On July 18, 2023, CMMI released a Request for Information (“RFI”) on... READ MORE

In a unique approach to address the current nursing shortage, Trine University and Cameron Memorial Hospital broke ground on a 32,000-sf nursing education center in Angola, IN. The facility will house training programs for Trine’s Associate of Science in Nursing program as part of a partnership with Cameron to recruit, train and retain nursing talent. A KaufmanHall report on Q2 M&A... READ MORE

NATIONAL 3 major proposals from CMS that could shape the industry 988 suicide hotline made 5 million contacts in first year AMA: Physicians Have Moved from Private to Hospital-Owned Practices Amazon, Google push back against ONC’s predictive healthcare AI rules Changes in US Hospital Financial Performance During the COVID-19 Public Health Emergency CMS announces... READ MORE

On June 29, 2023, the Federal Trade Commission (“FTC”) and the Antitrust Division of the Department of Justice (“DOJ”) (together, the “Agencies”) published a 133-page Notice of Proposed Rulemaking (“Proposed Rule”) in the Federal Register to amend and overhaul the Hart-Scott-Rodino Form and Instructions (“HSR Form”), effectively redesigning the premerger notification process. The Hart-Scott-Rodino... READ MORE

On July 19, 2023, the Federal Trade Commission (“FTC”) and the Antitrust Division of the Department of Justice (“DOJ”) (together, the “Agencies”) released the long-awaited redraft of the Horizontal Merger Guidelines (the “Proposed Merger Guidelines”). The Agencies originally announced their intention to revise their merger guidelines in January 2022. The Proposed Merger Guidelines are... READ MORE