Articles and Blogs

HHS Sued Over Appeals Backlog On May 22, the American Hospital Association sued HHS over a backlog at the third level of the Medicare appeals process.  The suit would compel HHS to meet the deadlines for reviewing an appeal, which at the Administrative Law Judge level is 90 days. 

Executive Summary On May 23, 2014, the United States District Court for the District of Columbia issued an opinion invalidating a final agency rule issued on July 23, 2013 (“Final Rule”) by the Health Resources and Services Administration (“HRSA”).  The Final Rule had served to clarify the scope of the 340B Program’s “Orphan Drug” exclusion. …Read More

Executive Summary On Friday, May 23, 2014, the Provider Reimbursement Review Board (“PRRB”) released an alert directed at hospitals with pending appeals on the issue of allowable “Medicaid Eligible” days in the calculation of hospitals’ disproportionate share (“DSH”) payments.  Hospitals with Medicaid eligible day appeals have 60 days to provide additional information to the PRRB.  Further,…Read More

A growing number of lawsuits, including collective action cases, are aimed at requiring employers to pay employees such as nurses and other surgical staff starting from the time they commence getting changed into their required work clothes. Until recently, hospitals and health systems may not have thought twice about requiring nurses to change into their…Read More

CMS Formalizes Plan to Extend Meaningful Use Deadlines On May 20, CMS and the Office of the National Coordinator for Health Information Technology formalized its decision to extend Stage 2 of the Electronic Health Records (“EHR”) Incentive Programs for an additional year (through 2016), meaning the earliest hospitals could move to Stage 3 would be…Read More

On May 16, 2014, CMS issued a Survey and Certification Transmittal (“Transmittal”) to the state survey agency directors providing infomation on how Medicare and Medicaid certifed long-term care facilities may obtain an extension of time for the installation of automatic sprinkler sytems.  The Transmittal sets forth the procedures on how a nursing home may seek an extension…Read More

Executive Summary On May 12, 2014, the Office of Inspector General (“OIG”) issued proposed rules to substantially revise its Civil Monetary Penalty Rules (“Proposed Rules”).  The Patient Protection and Affordable Care Act (“ACA”) and the Medicare Prescription Drug, Improvement and Modernization Act enhanced OIG’s statutory authority to exclude persons from participating in federal health care…Read More

On June 1, 2014, Indiana will change the way Indiana residents obtain Medicaid coverage in the age, blind or disabled categories. Currently, when Indiana residents apply for Medicaid coverage, they are subject to state-specific restrictive criteria. After June 1, 2014, Indiana residents will automatically be enrolled in Medicaid if the Federal Social Security Administration determines…Read More

On May 1, 2014, the House Energy and Commerce Subcommittee on Health announced it is seeking input and feedback on federal legislation that would encourage the deployment and adoption of telehealth technology.  The announcement was made in conjunction with a hearing, “Telehealth to Digital Medicine: How 21st Century Technology Can Benefit Patients,” led by Subcommittee…Read More

What Is the “Compendium of Priority Recommendations”? In March 2014, the Department of Health and Human Services Office of the Inspector General (“OIG”) published the 2014 “Compendium of Priority Recommendations” (“Compendium”), a compilation of 25 of its most significant open recommendations that, in OIG’s view, would best protect the integrity of HHS programs, if implemented….Read More