On April 11, 2020 the U.S. Departments of Labor (DOL), Health and Human Services (HHS), and the Treasury (collectively, the Departments) issued guidance in the form of frequently asked questions (the “FAQs”) regarding the Families First Coronavirus Response Act (the FFCRA), the Coronavirus Aid, Relief, and Economic Security Act (the CARES Act), and other health coverage issues related to COVID-19. The guidance states that the FAQs “answer questions from stakeholders to help individuals understand the law and benefit from it, as intended.” Certain guidance offered by the FAQs is summarized below; however, these are non-inclusive and stakeholders would be well advised to review the updated FAQs document in full.
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Commercial Health Insurance
Connecticut Governor Limits COVID-19 Liability for Providers and Facilities, Restricts Surprise Billing for COVID-19 Treatment, and Expands the Health Care Workforce in Recent Executive Orders.
Governor Lamont issued two new executive orders designed to expand the health care workforce, immunize providers from COVID-19-related liability, and protect patients from out-of-network bills for COVID-19 treatment. On April 5, 2020 Governor Lamont issued Executive Order 7U creating financial protections for uninsured patients and insured patients receiving out-of-network care. On April 7, 2020 Governor Lamont issued Executive Order 7V expanding temporary practice permits, allowing practice before licensure for certain health care profession graduates and applicants, and limiting civil liability for health care professionals and facilities for acts and omissions related to the State’s COVID-19 response.
Continue Reading Connecticut Governor Limits COVID-19 Liability for Providers and Facilities, Restricts Surprise Billing for COVID-19 Treatment, and Expands the Health Care Workforce in Recent Executive Orders.
Massachusetts Issues New COVID-19 Guidance and Updates
By Robinson+Cole's Health Law Group on
Massachusetts government agencies have issued recent guidance and updates concerning the COVID-19 emergency. A summary is provided below.
Allowing Health Care Personnel with Potential Exposure to COVID-19 to Continue to Work
On March 19, the Massachusetts Department of Public Health issued the following Guidance for Health Care Personnel with Potential Exposure to Patients with COVID-19…
Massachusetts COVID-19 Guidance for Health Care Providers, Payors and Laboratories on Issues Including Telehealth, Elective Procedures, COVID-19 Testing, and Provider Licensure
By Robinson+Cole's Health Law Group on
Massachusetts executive agencies have been issuing an array of further guidance to the healthcare provider community regarding COVID-19. All orders and guidance are available at https://www.mass.gov/2019coronavirus. Review of this website and CDC websites for periodic updates is strongly encouraged, as the situation is fluid and continually evolving.
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CMS Issues Final Regulations for Hospital Price Transparency
By Robinson+Cole's Health Law Group on
On November 15, 2019, the U.S. Department of Health and Human Services (HHS) Centers for Medicare and Medicaid Services (CMS) announced final regulations implementing greater price transparency requirements for hospitals. Issued on the heels of a Trump Administration Executive Order directing HHS to propose regulations on increased price transparency, the new regulations modify and finalize CMS’ earlier guidance implementing section 2718(e) of the Public Health Service Act, to further expand price transparency requirements for hospitals. (See our previous analysis of the Executive Order here.) Effective January 1, 2021, the new regulations will be located at 45 C.F.R. 180.00 et. seq. and will require hospitals to make accessible specific “standard charge” pricing data for all “items and services” provided. Furthermore, the regulations include special requirements for posting pricing information about “shoppable services.” Key details are summarized below:
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Government Releases Proposed Rules on Physician Self-Referral Law (Stark Law), Anti-Kickback Statute and CMP Law; Significant Regulatory Changes Intended to Encourage Care Coordination and Value-Based Care
By Conor Duffy & Melissa (Lisa) Thompson on
Posted in Academic Medical Centers, Accountable Care Organizations, Commercial Health Insurance, False Claims Act, Fraud and Abuse, Government Enforcement, Health Information Exchanges and Electronic Medical Records (EMRs), Health Information Technology, Hospitals and Health Systems, Legislation, Medicare and Medicaid, Office of Inspector General, Physicians and Allied Health Professionals, Reimbursement, Stark Law
On October 9, 2019, the Department of Health and Human Services (HHS) released its long-awaited proposals (the Proposed Rules) to update regulatory exceptions and safe harbors, for the federal Physician Self-Referral Law (also known as the Stark Law), the Anti-Kickback Statute (AKS), and the beneficiary inducement Civil Monetary Penalties Law (CMP). The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to update exceptions to the Physician Self-Referral Law (the PSR Rule), and the HHS Office of Inspector General (OIG) issued a proposed rule to update the AKS safe harbors and expand exceptions to the CMP’s beneficiary inducements prohibition (the AKS Rule). The Proposed Rules are intended to reduce perceived regulatory barriers to beneficial health care arrangements, and to facilitate the implementation of new approaches to health care service delivery and coordination, including value-based care models.
Continue Reading Government Releases Proposed Rules on Physician Self-Referral Law (Stark Law), Anti-Kickback Statute and CMP Law; Significant Regulatory Changes Intended to Encourage Care Coordination and Value-Based Care
Connecticut Expands Scope of Practice for Advanced Practice Registered Nurses
By Robinson+Cole's Health Law Group on
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.
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White House Issues Executive Order to Increase Transparency in American Healthcare
On June 24, 2019, President Donald Trump issued an “Executive Order on Improving Price and Quality Transparency in American Healthcare to Put Patients First” (the Order). The Order requires multiple federal agencies to issue regulations and take other actions as part of an ongoing focus of the Trump Administration to “enhance the ability of patients to choose the healthcare that is best for them” through transparency and competition. The Order addresses the following five initiatives.
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New York Court of Appeals Holds that PCs that Cede Excessive Control to MSOs Violate the Corporate Practice of Medicine Doctrine
On June 11, 2019, the New York Court of Appeals issued an opinion in Andrew Carothers, M.D., P.C. v. Progressive Insurance Company, 2019 NY Slip Op 04643, holding that an insurer could withhold payments for medical services provided by professional corporations “when there is willful and material failure to abide by licensing and incorporation statutes” without a direct finding of fraud. The court found that medical professional corporations (PCs) ceding too much control of management activities, including finances and operations, to a non-physician violates the Business Corporation law and the corporate practice of medicine doctrine, making the entity improperly incorporated, thus allowing an insurance company to withhold payment. While the scope of the Carothers case was limited to “no-fault” insurance reimbursement, this opinion is instructive on how New York courts may in the future examine the arrangements between PCs and management service organizations (MSOs).
Continue Reading New York Court of Appeals Holds that PCs that Cede Excessive Control to MSOs Violate the Corporate Practice of Medicine Doctrine
Eighth Circuit Affirms Preliminary Injunction Blocking Physician Practice Acquisition in North Dakota
On June 13, 2019, the U.S. Court of Appeals for the Eighth Circuit affirmed a preliminary injunction granted to the Federal Trade Commission (FTC) and North Dakota Attorney General (NDAG) blocking the proposed acquisition of Mid-Dakota Clinic, P.C. (MDC) – a multispecialty physician group in North Dakota – by Sanford Health, a large South Dakota-based health system (Sanford). This decision may foreclose continued pursuit of MDC by Sanford, and represents another success for the FTC in challenging health care consolidation (see our previous analysis of the granting of the injunction here, and of the FTC’s intervention here).
Continue Reading Eighth Circuit Affirms Preliminary Injunction Blocking Physician Practice Acquisition in North Dakota