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CMS to Repay Hospitals Millions After Court Finds Reduction in Rates Improper

By Robinson+Cole's Health Law Group on Posted in Hospitals and Health Systems, Legislation, Medicare and Medicaid, Reimbursement

On December 12, 2019, the Centers for Medicare and Medicaid Services (CMS) announced that it will automatically reprocess claims which had been reimbursed at a reduced rate in 2019 under the site-neutral payment policy and pay hospitals monies that were withheld due to the policy.

In November 2018, CMS promulgated a Final Outpatient Prospective Payment System (OPPS) Rule and implemented its site-neutral payment policy, which cut Medicare reimbursement rates for outpatient hospital services provided at certain off-campus, provider-based departments (PBDs) to the lower Physician Fee Schedule (PFS) rate for the …

DOJ Announces Physician Self-Referral (Stark) Law Settlement in Excess of $46 Million with California Health System and Surgical Group

By Robinson+Cole's Health Law Group on Posted in Ambulatory Surgical Centers (ASC), Department of Justice, False Claims Act, Fraud and Abuse, Government Enforcement, Hospitals and Health Systems, Medicare and Medicaid, Physicians and Allied Health Professionals, Reimbursement, Stark Law

On November 15, 2019, the Department of Justice (DOJ) announced it had reached a settlement with Sutter Health (Sutter) and Sacramento Cardiovascular Surgeons Medical Group Inc. (Sac Cardio) to resolve alleged violations of the Physician Self-Referral Law (PSR Law), commonly known as the Stark Law. Sutter is a California-based health services provider; Sac Cardio is a Sacramento-based practice group of three cardiovascular surgeons. The total settlement in excess of $46 million includes $30.5 million from Sutter to resolve allegations of an improper financial relationship specific to compensation arrangements with Sac …

CMS Proposes Rule Clarifying Physician Self-Referral Law Rules for Group Practice Profit Sharing

By Robinson+Cole's Health Law Group on Posted in Fraud and Abuse, Medicare and Medicaid, Physicians and Allied Health Professionals, Stark Law

On October 9, 2019 the Department of Health and Human Services Centers for Medicare and Medicaid Services (CMS) published a proposed rule making changes to the Physician Self-Referral Law (PSR Rule), also called the Stark Law. Among other revisions to the PSR Rule, the proposed rule would modify the group practice special rule that allows physician profit sharing in certain circumstances. Under the proposed rule, the “overall profits” group practice physicians can share must be a combination of all designated health services (DHS) profits, not just the DHS profits from …

Massachusetts Board of Registration in Medicine Adds New Physician Credentials Verification Requirement for First Time Licensure

By Robinson+Cole's Health Law Group on Posted in Academic Medical Centers, Hospitals and Health Systems, Physicians and Allied Health Professionals

On October 11, 2019, the Massachusetts Board of Registration in Medicine (BORIM) announced a new requirement for initial physician licensure in the state. Effective January 1, 2020, all first-time applicants in Massachusetts will be required to also complete an application through the Federation Credentials Verification Service (FCVS). FRVS’s website indicates it is “a Lifetime Repository of Verified Core Credentials … that can be used for multiple state medical boards.” The new BORIM requirement will require first-time applicants to apply for a verified profile with FCVS that designates BORIM as …

CMS Passes Final Rule Reducing Regulations Burdensome on Health Care Providers

By Robinson+Cole's Health Law Group on Posted in Academic Medical Centers, Ambulatory Surgical Centers (ASC), Employment Law, Government Enforcement, Home Health Agencies, Hospice, Hospitals and Health Systems, Legislation, Long Term Care Facilities, Medicare and Medicaid

The Centers for Medicare and Medicaid Services (CMS) is moving forward with its Patients over Paperwork initiative, which was created in accordance with President Trump’s Executive Order directing federal agencies to reduce burdensome regulations in order to improve the patient and provider experience, and the health care system as a whole. On September 26, 2019, CMS passed the Omnibus Burden Reduction (Conditions of Participation) Final Rule (Final Rule), with the goal of removing CMS regulations that have become extraneous or burdensome on health care providers, allowing providers to increase and …

New Connecticut Legislation Affecting Healthcare Providers and Entities Effective October 1, 2019

By Robinson+Cole's Health Law Group on Posted in 2019 Connecticut Legislative Update, Hospitals and Health Systems, Legislation, Long Term Care and Nursing Homes, Physicians and Allied Health Professionals

Multiple public acts from Connecticut’s 2019 legislative session go into effect on October 1, 2019. Below is a list of public health legislation effective October 1, with links to our previous posts summarizing the acts:

  • Public Act No. 19-89 “An Act Concerning Nursing Home Staffing Levels” (previous post available here).
  • Public Act No. 19-98 “An Act Concerning The Scope Of Practice Of Advanced Practice Registered Nurses” (previous post available here).
  • Public Act No. 19-113 “An Act Concerning the Use of Automatic External Defibrillators” (previous post available here).
…

D.C. Circuit Court of Appeals Allows HHS Rule that Includes Payments Received from Third Parties in DSH Payment Cap Calculation

By Robinson+Cole's Health Law Group on Posted in Academic Medical Centers, Hospitals and Health Systems, Medicare and Medicaid

On August 13, 2019, the D.C. Circuit Court of Appeals (the D.C. Circuit) issued an opinion in Children’s Hospital Association of Texas v. Azar (No. 18-5135), allowing the Department of Health and Human Services (HHS) to include payments from third parties, including Medicare and private insurers, in calculations of Disproportionate Share Hospital (DSH) payment caps. The D.C. Circuit had previously ruled against HHS’ implementation of its 2017 rule, which included third-party payments in the calculation of the hospital-specific caps on allowable DSH payments. …

Allscripts Announces $145 Million Preliminary Settlement with DOJ Related to an Investigation of Practice Fusion, a Recently Acquired EHR Company

By Robinson+Cole's Health Law Group on Posted in Academic Medical Centers, Department of Justice, False Claims Act, Fraud and Abuse, Government Enforcement, Health Information Exchanges and Electronic Medical Records (EMRs), Health Information Technology, Healthcare Technology, HIPAA, Hospitals and Health Systems, Medicare and Medicaid, Privacy and Security, Reimbursement, Stark Law

In its second quarter Securities Exchange Commission (SEC) filing, Allscripts addressed its announced agreement in principle with the Department of Justice (DOJ) to resolve investigations into certain alleged practices of Practice Fusion, an electronic health records (EHR) vendor acquired by Allscripts in February 2018 for $100 million. Allscripts indicated the agreement is still subject to further negotiation and government approval, and would likely include additional non-monetary terms, including a deferred prosecution agreement, if a finalized settlement is reached.…

Connecticut Expands Minors’ Confidential Access to Treatment for HIV and AIDS, Adds Reporting Requirement

By Robinson+Cole's Health Law Group on Posted in 2019 Connecticut Legislative Update, Academic Medical Centers, HIPAA, Hospitals and Health Systems, Legislation, Pharmaceuticals and Biologics, Physicians and Allied Health Professionals

On July 1, 2019, Connecticut Governor Ned Lamont signed into law Public Act No. 19-109 “An Act Concerning The Prevention Of The Human Immunodeficiency Virus” (PA 19-109) which increases access to preventative and prophylactic human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) interventions for minor patients, and adds two exceptions to the confidentiality requirements for HIV/AIDS treatment of a minor patient. The Act is effective July 1, 2019.…

Connecticut Empowers DSS to Expand Medicaid Coverage of Telehealth Services

By Robinson+Cole's Health Law Group on Posted in 2019 Connecticut Legislative Update, Accountable Care Organizations, Healthcare Technology, Hospitals and Health Systems, Legislation, Medicare and Medicaid, Physicians and Allied Health Professionals, Reimbursement, Telehealth, Telemedicine

On June 28, 2019, Connecticut Governor Ned Lamont signed into law Public Act No. 19-76 “An Act Expanding Medicaid Coverage of Telehealth Services” (PA 19-76).  PA 19-76 revises the criteria and process by which the Connecticut Department of Social Services (DSS) determines the telehealth services covered by the Medicaid program. PA 19-76 is effective July 1, 2019.…

Connecticut Revises Physician Assistant Statute to Clarify Collaborative Nature of Practice Relationship Between Physician Assistants and Physicians

By Robinson+Cole's Health Law Group on Posted in 2019 Connecticut Legislative Update, Legislation, Physicians and Allied Health Professionals

On July 9, 2019, Connecticut Governor Ned Lamont signed into law Public Act 19-144, “An Act Concerning A Collaborative Relationship Between Physician Assistants And Physicians” (19-144). This legislation revises the statutory definition of a “physician assistant” (PA) under Connecticut law to provide that a PA functions in a “collaborative” relationship with a physician – not a “dependent” relationship – effective July 1, 2019.  The legislation retains the current requirement that a PA is also an individual licensed under Connecticut law “to provide patient services under the supervision, control, …

Connecticut Expands Scope of Practice for Advanced Practice Registered Nurses

By Robinson+Cole's Health Law Group on Posted in 2019 Connecticut Legislative Update, Commercial Health Insurance, Hospitals and Health Systems, Managed Care, Pharmacy Law, Physicians and Allied Health Professionals

Connecticut Governor Ned Lamont recently signed into law Public Act No. 19-98 “An Act Concerning The Scope Of Practice Of Advanced Practice Registered Nurses” (PA 19-98), which generally expands the scope of practice for Connecticut-licensed advanced practice registered nurses (APRNs). Among other things, PA 19-98 addresses matters related to medical records, emergency treatment, insurance coverage, and workers’ compensation, as further described below. PA 19-98 becomes effective October 1, 2019.…

Connecticut Legislature Modifies Public Health Statutes

By Robinson+Cole's Health Law Group on Posted in 2019 Connecticut Legislative Update, Ambulatory Surgical Centers (ASC), Home Health Agencies, Hospice, Hospitals and Health Systems, Legislation, Long Term Care and Nursing Homes, Physicians and Allied Health Professionals

On July 9, 2019, Connecticut Governor Ned Lamont signed into law Public Act No. 19-118 “An Act Concerning the Department of Public Health’s Recommendations for Various Revisions to the Public Health Statutes” (PA 19-118). Certain relevant provisions of PA 19-118 are described below.…

Connecticut Codifies Nursing Home Daily Posting Requirements, Adds Requirement for Reinstatement after Retaliation

By Robinson+Cole's Health Law Group on Posted in 2019 Connecticut Legislative Update, Hospitals and Health Systems, Long Term Care and Nursing Homes

On July 1, 2019, Connecticut Governor Ned Lamont signed into law Public Act No. 19-89 “An Act Concerning Nursing Home Staffing Levels” (PA 19-89). PA 19-89 sets forth new state-level daily nurse staffing level disclosure requirements for nursing home facilities (including nursing homes and rest homes with nursing supervision as set forth in Conn. Gen. Stat. § 19a-521), authorizes the Department of Public Health (DPH) to take disciplinary action against or issue citations to nursing home facilities for non-compliance with nurse staffing requirements, and newly requires nursing home …

Connecticut Enacts Budget that Includes Provisions Affecting Health Care Providers

By Robinson+Cole's Health Law Group on Posted in 2019 Connecticut Legislative Update, Home Health Agencies, Hospitals and Health Systems, Legislation

Connecticut Governor Ned Lamont recently signed into law Public Act No. 19-117 (PA 19-117), which contains provisions affecting health care providers, including revisions to the hospital provider tax, a prohibition on non-compete agreements for home care workers and an expansion to Connecticut’s current surprise bill law. Highlights of PA 19-117, including the effective dates for each provision, are described below.…

Connecticut Legislature Modifies Statutes Relevant to Preventing and Treating Opioid Use Disorder

By Robinson+Cole's Health Law Group on Posted in 2019 Connecticut Legislative Update, Home Health Agencies, Hospitals and Health Systems, Legislation, Long Term Care and Nursing Homes, Pharmaceuticals and Biologics, Pharmacy Law, Physicians and Allied Health Professionals

On July 9, 2019, Connecticut Governor Ned Lamont signed into law Public Act No. 19-191 “An Act Addressing Opioid Use” (PA 19-191). PA 19-191 makes various revisions to Connecticut’s opioid use prevention and treatment statutes, and also creates new legislation pertaining to opioid use prevention and treatment. …

Connecticut Legislature Extends Immunity for Emergency Assistance by Health Care Professionals to Cover Malfunctioning Automatic External Defibrillators

By Robinson+Cole's Health Law Group on Posted in 2019 Connecticut Legislative Update, Healthcare Technology, Legislation, Physicians and Allied Health Professionals

On July 1, 2019, Connecticut Governor Ned Lamont signed into law Public Act No. 19-113 “An Act Concerning the Use of Automatic External Defibrillators” (PA 19-113). This law takes effect October 1, 2019.…

Connecticut Legislature Places Restrictions on the Use of the Title “Social Worker”

By Robinson+Cole's Health Law Group on Posted in 2019 Connecticut Legislative Update, Physicians and Allied Health Professionals

On July 9, 2019, Connecticut Governor Ned Lamont signed into law Public Act No. 19-164 “An Act Concerning Social Workers,” (PA 19-164) which sets forth new restrictions on individuals seeking to hold themselves out as social workers in the State. This law takes effect October 1, 2019.…

Starting in 2020, Connecticut Hospitals Will Be Required to Test for Spinal Muscular Atrophy in Newborns

By Robinson+Cole's Health Law Group on Posted in 2019 Connecticut Legislative Update, Legislation

On July 9, 2019, Connecticut Governor Ned Lamont signed into law Public Act No. 19-176 (PA 19-176), “An Act Concerning Newborn Screening for Spinal Muscular Atrophy.” Starting on January 1, 2020, this law requires hospitals and other institutions that care for newborn infants to screen such infants for spinal muscular atrophy. As with other statutory requirements for newborn infant screening under Connecticut law – including testing for HIV, phenylketonuria, sickle cell disease, cystic fibrosis, and critical congenital heart disease – the requirement to test for spinal muscular atrophy …

Connecticut Legislature Permits Facilities to Administer Emergency Medication to Defendants Without Consent in Limited Circumstances

By Robinson+Cole's Health Law Group on Posted in 2019 Connecticut Legislative Update, Academic Medical Centers, Ambulance, Ambulatory Surgical Centers (ASC), Americans With Disabilities, Home Health Agencies, Hospice, Hospitals and Health Systems, Legislation, Long Term Care and Nursing Homes, Pharmaceuticals and Biologics, Physicians and Allied Health Professionals

On July 1, 2019, Connecticut Governor Ned Lamont signed into law Public Act No. 19-99 “An Act Concerning the Recommendations of the Department of Mental Health and Addiction Services Regarding Emergency Medication” (PA 19-99). PA 19-99 went into effect on the same date.

Existing law provides for certain court procedures a facility must follow in order to provide treatment without informed consent for psychiatric disabilities to defendant patients in the custody of the Department of Mental Health and Addiction Services. A facility includes any inpatient or outpatient hospital, clinic or …

Connecticut Enacts Law Modifying CME Requirements to Include Alzheimer’s Disease and Dementia Training

By Robinson+Cole's Health Law Group on Posted in 2019 Connecticut Legislative Update, Legislation, Physicians and Allied Health Professionals

On July 1, 2019, Connecticut Governor Ned Lamont signed into law Public Act No. 19-115, “An Act Concerning Alzheimer’s Disease and Dementia Training and Best Practices” (PA 19-115). This legislation modifies the continuing medical education (CME) requirements for Connecticut-licensed physicians and the continuing education (CE) requirements for advanced practice registered nurses (APRNs).…

Connecticut Enacts Law to Increase Access to Epinephrine Auto Injectors

By Robinson+Cole's Health Law Group on Posted in 2019 Connecticut Legislative Update, Academic Medical Centers, Ambulance, Ambulatory Surgical Centers (ASC), Employment Law, Home Health Agencies, Hospice, Hospitals and Health Systems, Legislation, Long Term Care and Nursing Homes, Long Term Care Facilities, Medical Devices, Pharmaceuticals and Biologics, Pharmacies, Pharmacy Law, Physicians and Allied Health Professionals

On June 13, 2019, Connecticut Governor Ned Lamont signed into law Public Act No. 19-19 “An Act Concerning Epinephrine Auto Injectors” (PA 19-19), which went into effect on the same date.

This legislation expands access to epinephrine, which can be lifesaving when treating anaphylactic allergic reactions. PA 19-19 permits “authorized entities” to acquire and maintain a supply of epinephrine cartridge injectors, subject to certain conditions. With a few exceptions, authorized entities are for-profit or nonprofit entities or organizations that employ at least one “person with training.” …

CMS Finalizes Overhaul of the Medicare Shared Savings Program in “Pathways to Success” Final Rule

By Robinson+Cole's Health Law Group on Posted in Accountable Care Organizations, Hospitals and Health Systems, Legislation, Medicare and Medicaid, Physicians and Allied Health Professionals, Reimbursement, Telemedicine

On December 31, 2018, the Centers for Medicare and Medicaid Services (CMS) published a final rule (Final Rule) establishing the “Pathways to Success” program that overhauls the Medicare Shared Savings Program (MSSP). The Final Rule largely mirrors CMS’ proposed rule (see our summary here), but with several modifications in response to public comments. Accountable care organizations (ACOs) may participate in the Pathways to Success program beginning July 1, 2019, and those ACOs interested in beginning participation in July must submit to CMS a notice of intent to apply by …

2019 Physician Fee Schedule Rule Review: Off-Campus Provider-Based Hospital Departments

By Robinson+Cole's Health Law Group on Posted in Legislation, Medicare and Medicaid, Physicians and Allied Health Professionals

On November 1, 2018, the Centers for Medicare & Medicaid Services (CMS) released a final rule (Rule), which includes modifications to Medicare payment policies and rates.

One area that is discussed in the rule is with regards to the payment of certain items and services when provided by certain off campus provider based hospital departments. As per Section 603 of the Bipartisan Budget Act of 2015, certain items and services, when provided by certain off-campus provider-based hospital departments, are not to be paid under the Hospital Outpatient Prospective …

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