Category:

Health Insurance

Rural Hospitals in Crisis Receive a Boost to Value-Based Care Model from New CMS CHART Model

The Centers for Medicare & Medicaid Services (“CMS”) Innovation Center (“CMMI”) recently announced a new model for health care providers in rural areas to receive payment from the federal government. The Community Health Access and Rural Transformation (“CHART”) initiative aims to improve rural health care while promoting the Trump Administration’s push to shift health care providers into a more expansive value-based payment model.

The Constitutionality of the ACA: California v. Texas

Signed by President Obama on March 23, 2010, The Affordable Care Act (“ACA”) provided a monumental change to healthcare. The ACA created access, added provisions to improve quality, and created cost containment measures. However, the ACA created a quintessential question of Federalism. As it exists today, the Supreme Court will listen to oral arguments in November on the constitutionality of the ACA, in California v. Texas. If the Court decides that the ACA is unconstitutional, millions of Americans who are insured under the Act will lose coverage. Additionally, aside from access, the ACA includes regulatory laws such as Section 1557’s nondiscriminatory provisions, and amendments to the False Claims Act & HIPAA.

CMS Issues New Rigid COVID-19 Requirements for Skilled Nursing Facilities

The Centers for Medicare & Medicaid Services (“CMS”) released new guidance for skilled nursing facilities (“SNFs”) as  part of a larger rulemaking agenda for healthcare institutions in the throes of the current public health emergency with COVID-19. CMS has also detailed the fines for non-compliance with the new COVID-19 requirements for SNFs and other healthcare institutions such as hospitals and laboratories.

COVID-19 Break in Regulation of Waivers for State Medicaid Agencies

COVID-19 was an unexpected pandemic that hit the United States, causing Centers for Medicare and Medicaid Services (“CMS”) to rush to make accommodations for the states. States administer their Medicaid programs following a state plan and under the regulation of federal rules. With approval, states are allowed to amend their state plan and apply for waivers to improve the effectiveness of their Medicaid program. During COVID-19, the Trump Administration made available for states to apply for 1115 waivers, creating a new section labeling 1115(a), the 1135 waiver, and Appendix K to amend 1915(c) waivers for national emergencies. As of May 2020, CMS reported over 200 approved waivers across multiple states.

CMS Launched Pilot Project to Offer Individual Market Wellness Programs

Workplace wellness programs — efforts to get workers to lose weight, eat better, stress less and sleep more — are an $8 billion industry in the U.S. Recently, Centers for Medicare and Medicaid Services (CMS) launched a pilot project for states to implement health-contingent wellness programs in the individual market. The project is part of a mandate under the Affordable Care Act that added a provision to the Public Health Service Act calling for health-contingent wellness programs to be tested in the individual market through a pilot project operated by HHS, the Department of Labor and the Treasury Department.

CMS Issues New Rule to Tighten Provider Enrollment

On September 5, 2019, the Centers for Medicare and Medicaid Services (“CMS”) released its final rule with comments on Program Integrity Enhancements to the Provider Enrollment Process (“ The Program Integrity Enhancements”).  The final rule gives CMS the power to revoke Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) enrollments of providers or suppliers who have an “affiliation” with previously sanctioned entities, even if those providers and suppliers aren’t directly violating any existing rules themselves. CMS says that this new authority will help to “stop fraud before it happens.”

Removing “Incident to” Billing: Recommendations from Policy Experts

Earlier this year, the Medicare Payment Advisory Commission (MedPAC) uninamously voted to recommend removing “incident to” Medicare billing for advanced practice registered nurses (APRNs) and physician assistants (PAs). MedPAC serves as an independent congressional agency that advises Congress on Medicare-related issues by analyzing access and quality of care. If this recommendation is adopted, APRNs and PAs would only be able to bill Medicare directly, thus reducing the amount paid by Medicare from 100% under services billed “incident to” to 85% directly. This recommendation could potentially save the Medicare program up to $250 million annually and would allow for better data collection into the amount of services performed by APRNs and PAs, whose services are often masked under “incident to” billing reports. Though there is still some debate on whether the financial loss of losing this option is too high for primary physicians who may hire APRNs and PAs for their practice, the benefits of billing directly likely outweigh the losses.

Protecting PHI as the Health Care Industry Promotes Shift to TeleMedicine

In a time where much of the healthcare industry has shifted to incorporate telehealth and telemedicine, health care organizations and providers are faced with the upkeep of the growing influx of patient data and the challenges associated with their obligation to maintain patient privacy. These challenges increasingly more burdensome as providers strive to keep up to date with the advancement of technology. Healthcare organizations must maintain patient privacythrough close monitoring of clouds, employee use of mobile devices, patient access to medical information and scheduling, and access to the provider networks through non-organizational devices. Maintaining the multiple platforms is costly and the industry remains at risk due to the rising volumes of cybersecurity attacks and breaches. UConn Health recently experienced a data breachthat necessitated notifying 326,000 people of potential impact to their protected health information (PHI) including names, dates of birth, address, billing information, and even social security numbers due to potential access by an unauthorized person.

Injunctions Halt Trump Administration’s Attempt to Expand Religious Exemption for Obamacare Contraceptive Mandate

A pair of injunctions in the Northern District of California on January 13, and the Eastern District of Pennsylvania on January 14, halted the implementation of amendments to a religious exemption to the so-called contraception “mandate” of the Affordable Care Act, also known as Obamacare. The “mandate” requires most employers to include contraception coverage in the insurance plans they offer to employees. While Obama administrative agencies contemplated religious exemptions early on, contentious litigation and political transition expanded the scope of the exemption until these latest developments.

Illinois Law Makers Seeking to Curb E-Cigarette Use Among Teens and Children

In the wake of rising e-cigarette use among teens and children, Illinois lawmakers seek a legal solution to protect Illinois youths from smoking-related illnesses and pre-mature death. Illinois’s Congress introduced Tobacco 21, a bill designed to raise the legal age to purchase tobacco products like e-cigarettes to 21 years of age. Despite a lack of support from Governor Bruce Rauner, Illinois politicians continue to fight to save the bill, and with good reason. The United States Food and Drug Administration (FDA) recently announced its Youth Tobacco Prevention Plan, which addresses the rising e-cigarette use among adolescents. The FDA’s plan is two-fold: (1) crack down on the sale and marketing of e-cigarettes and (2) educate teens and children about the dangers of using e-cigarettes. Tobacco 21 provides support for the FDA’s Plan.