Articles and Blogs

On Tuesday, March 31, the Supreme Court of the United States issued an opinion denying individual Medicaid providers the ability to sue state officials in court for failing to reimburse them appropriately under §1396a(30)(A) of the Medicaid Act. In a 5-4 decision, the Court rejected the providers’ argument that the Act or the Constitution provided…Read More

Executive Summary On Tuesday, March 24, 2015, representatives from the Government Accountability Office (“GAO”), the Department of Health and Human Services Office of the Inspector General (“OIG”) and the Health Resources Services Administration (“HRSA”) testified regarding the drug discount program authorized by Section 340B of the Public Health Services Act (“340B Program”).  The testimony took…Read More

Inpatient-Only Procedures. Earlier this month, CMS quietly revised its billing policy related to inpatient-only procedures.  In a Transmittal issued on March 13, CMS included inpatient-only procedures provided in the outpatient setting as preadmission services subject to the Three-Day (One-Day) Payment Window Rule.  Effective April 1, hospitals can bill Medicare for inpatient-only procedures provided to an…Read More

Subject to various exceptions, a covered skilled nursing facility (“SNF”) stay must initiate within 30 days of a qualifying hospital stay.  In some cases where it is medically predictable that an individual will require a covered level of SNF care within a determinable time frame, that same individual may also have a need for a covered level…Read More

House Approves SGR Repeal On Thursday, March 26, the House overwhelmingly approved the bipartisan Medicare Access and CHIP Reauthorization Act of 2015 (H.R. 2) to repeal the Medicare physician payment formula.  The bill passed with a vote of 392-37, with the support of 212 Republicans and 180 Democrats.  The legislation now shifts to the Senate,…Read More

Summary of the Bill The United States House of Representatives overwhelmingly approved a measure this week to repeal the Sustainable Grow Rate (“SGR”), which has been used to determine Medicare physician payment rates for more than a decade.  The SGR was established as part of the Balanced Budget Act of 1997 as a method for…Read More

Yesterday, March 25, 2015, the U.S. Supreme Court published its long-awaited opinion in the case of Peggy Young v. United Parcel Service. The issue in this case was whether an employer must reasonably accommodate a pregnant worker as it does other workers who are not pregnant. The Court vacated the Fourth Circuit’s decision affirming summary judgment…Read More

In January, HHS Secretary Sylvia Burwell announced that HHS is accelerating Medicare’s transition to “alternative payment models.”  HHS’s goal is to shift 30 percent of all Medicare provider payments to alternative payment models by 2016 and for 50 percent of all Medicare payments to be in alternative payment models by 2018.  These goals, according to HHS, will be…Read More

Lawmakers Moving Closer to Permanent SGR Repeal and Replacement On Thursday, March 19, House leaders, led by Rep. Michael Burgess, M.D. (R-TX), introduced part of a legislative package to permanently repeal and replace the Medicare physician payment formula known as the Sustainable Growth Rate (“SGR”), which is set to expire on March 31. However, the most…Read More

A Helpful Memo? Almost every employer has an employee handbook of some sort or at least a set of rules and policies that are established to let employees know what is expected of them. In the private sector, the NLRB has been focusing for several years on rules and policies that are too broad and…Read More