This is an uncomfortable summer for health care providers in Florida! The legal landscape changed dramatically over the 4th of July holiday. Buried in Florida’s HB 369 regarding substance abuse services was a dramatic...more
On November 2, 2018, CMS released an on-line display copy of its Outpatient Prospective Payment System (OPPS) Final Rule implementing payment changes effective January 1, 2019. The official Federal Issuance is expected on...more
On November 6, 2018, when Massachusetts voters go to the polls to select a new Governor and other key elected officers, they will also consider Ballot Question 1, which will mandate rigid registered nurse staffing ratios for...more
Hospitals with off-campus provider-based departments (PBDs) may want to rethink their end of summer vacation plans in order to focus on a recent slate of proposed regulations from the Center for Medicare and Medicaid Services...more
On June 19 and 20, 2018, more than 60 innovators and thought leaders came together for the 13th annual, invitation-only CEO/Innovators Roundtable (Roundtable), hosted by Foley & Lardner LLP and BDC Advisors, LLC. The overall...more
6/28/2018
/ Artificial Intelligence ,
Big Data ,
CEOs ,
Digital Health ,
Health Care Providers ,
Health Information Technologies ,
Healthcare ,
Innovative Technology ,
Investors ,
Patient Referrals ,
Patients ,
Pharmacies ,
Roundtable ,
Telemedicine
On March 30, 2018, Massachusetts Governor Charlie Baker signed into law a bill intended to provide individuals with more privacy protection from their health insurance companies.
The “Protecting Access to Confidential...more
In some states, including the Commonwealth of Massachusetts, “site neutrality” for outpatient hospital reimbursement is factoring into state-specific health reform and cost containment initiatives. This potentially goes...more
11/1/2017
/ Affordable Care Act ,
Bipartisan Budget Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Comment Period ,
Employee Retirement Income Security Act (ERISA) ,
EMTALA ,
Healthcare Costs ,
Healthcare Facilities ,
Medicare ,
Off-Campus Departments ,
Out of Network Provider ,
Outpatient Services ,
Physicians ,
Proposed Legislation ,
Public Health ,
Stark Law
On Monday, two House committees with oversight over health care and taxation, Energy and Commerce and Ways and Means, released draft reconciliation bills designed to repeal and alter significant portions of the Patient...more
3/9/2017
/ Affordable Care Act ,
Employer Mandates ,
Health Insurance ,
Health Savings Accounts ,
Individual Mandate ,
Legislative Agendas ,
Medicaid ,
Planned Parenthood ,
Proposed Legislation ,
Repeal ,
State Health Insurance Exchanges ,
Tax Penalties
Center for Medicare and Medicaid Services (CMS) issued the long-awaited implementation of the “site-neutrality” provisions of the H.R. 1314 Bipartisan Budget Act of 2015 (BiBA Section 603) on November 1, 2016. The Final Rule...more
CMS issued its Outpatient Prospective Payment System (“OPPS”) Proposed Rule for 2017 (the “Proposed Rule”) on July 6, 2016. The Proposed Rule will be published in the Federal Register on July 14, 2016. One highly-anticipated...more
7/13/2016
/ Bipartisan Budget Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Comment Period ,
Grandfathered Status ,
Health Care Providers ,
Hospitals ,
Medicare ,
MPFS ,
Off-Campus Departments ,
OPPS ,
Proposed Legislation ,
Proposed Regulation ,
Section 340B
A bill amending the “site neutrality” limitations brought by Section 603 of the Bipartisan Budget Act of 2015 was introduced in the House of Representatives last week and passed out of committee yesterday. H.R. 5273, the...more
Four years after the issuance of the Proposed Rule and six years after the authorizing statute, CMS has published the much-awaited Final Rule regarding reporting and returning of Medicare Part A and B overpayments (the “Final...more
Section 603 of the Bipartisan Budget Act of 2015 was initially passed to cut payments to hospital departments in order to provide funding to lift the Federal debt ceiling, increase domestic spending in Fiscal Year 2016, and...more
The recently enacted Bipartisan Budget Act (P. L. 114-74) included a provision that will significantly alter the future of hospital-based outpatient care.
The provision, Section 603, will exclude from Medicare’s...more
Legislation being drafted as part of a budget deal between members of Congress and the White House includes language that will significantly alter the future of hospital-based outpatient care. The “discussion draft” of the...more
10/30/2015
/ Ambulatory Surgery Centers ,
Federal Budget ,
Health Care Providers ,
Healthcare ,
Hospitals ,
Medicare ,
MedPAC ,
OIG ,
OPPS ,
Pending Legislation ,
Physician Fee Schedule ,
Reimbursements
This past June, leaders from health systems, outpatient services companies, health insurers, IT and equipment suppliers, health retailers, home care providers, pharmaceutical companies, and investors gathered in Chicago for...more
10/1/2015
/ CEOs ,
Complete Genomics ,
Cost-Sharing ,
Ethics ,
Health Care Providers ,
Health Information Technologies ,
Health Insurance ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Healthcare ,
Healthcare Reform ,
Personal Data ,
Personalized Medicine ,
PricewaterhouseCoopers ,
Public Health Insurance Marketplace ,
Purchase Price ,
Retail Market ,
Social Media ,
Telehealth ,
Thought Leadership ,
Value-Based Purchasing ,
Venture Capital ,
Walgreens ,
Wellness Programs
A New York Federal District Court issued an Opinion and Order, on August 3, 2015, in a closely-watched False Claims Act (FCA) case, Kane v. Healthfirst, Inc. The Court refused to dismiss the whistleblower complaint in which...more
At the core of King v. Burwell is the concern of whether patients will have access to affordable medical care across the country, regardless of how a state chose to implement health care exchanges. In this video, Foley...more
In this video, Foley Partner Lawrence Vernaglia discusses the biggest obstacle to realizing a value-based system of health care, and what realistically can be done in the industry by taking "measured steps."...more
One of the most challenging compliance changes brought about by the Affordable Care Act (ACA) is the provision mandating the reporting and refunding of Medicare and Medicaid overpayments within 60 days of the date they are...more
We get this question every year: will Medicare, Medicaid or other payors continue to recognize hospital-level facility fee reimbursement for hospital outpatient departments meeting the provider-based designation criteria at...more
Technology has influenced nearly every sector of the economy, and the health care industry is following suit. Among telemedicine’s many benefits are the potential to exponentially expand a provider’s geographic footprint, use...more
As part of the Affordable Care Act, Congress outlined the process for providers to return Medicare and Medicaid overpayments. In 2012, CMS proposed the 60-day Refund Rule, as it is commonly known, requiring Medicare providers...more
Potential for Increase in Whistleblower Litigation -
On April 8, 2014, The Centers for Medicare & Medicaid Services (CMS) released, with tremendous fanfare, hundreds of thousands of points of billing data regarding...more
On January 30, 2014, CMS released results on the Medicare Shared Savings Program (“MSSP”) and the Pioneer Accountable Care Organization Program (“Pioneer ACO Program”) for 2012, the initial performance year of each program....more