Hospitals and Health Systems

The Department of Health and Human Services Office of Inspector General (OIG) recently released a Data Brief summarizing the findings of a review of program integrity risks related to telehealth services reimbursed by Medicare during the first year of the COVID-19 pandemic (the Pandemic).[1] The OIG analyzed Medicare and Medicare Advantage claims data from March 1, 2020, to February 28, 2021, focusing on providers that billed for telehealth services, with an emphasis on identifying providers that posed a high risk to the Medicare program.

Continue Reading OIG Releases Data Brief on Medicare Telehealth Program Integrity Risks During the First Year of the Pandemic

On August 18, 2022, New Jersey Governor Phil Murphy signed S-315, “An Act concerning changes in control of health care entities” (the Act). The Act implements employment protection for healthcare workers when certain licensed health care facilities, staffing registries, and home care services in New Jersey undergo a change in ownership. The Act first requires that former health care entity employers provide the successor health care entity with information pertaining to employees (i.e., employee names, addresses, dates of hire, phone numbers, wage rates, employment classifications) not less than thirty days before a change in control. The Act also requires former health care entity owners to inform eligible employees of the rights provided by the Act and to post a notice of their rights under the Act in a conspicuous location.

Continue Reading New Jersey Governor Signs Act Concerning Changes in Control of Health Care Entities

Health care providers subject to the Information Blocking rules issued under the 21st Century Cures Act, Pub.L. 114–255, are reminded that such Information Blocking rules will apply to an expanded set of information beginning on October 6, 2022. The Information Blocking rules currently apply only to a limited portion of electronic health information (EHI) represented by the specific data elements identified in the United States Core Data for Interoperability version 1 standard (commonly referred to as USCDIv1). Effective October 6, 2022, the Information Blocking rules will apply to all EHI, which is defined as all electronic protected health information (as defined by HIPAA) to the extent that such electronic protected health information is included in a designated record set (also as defined by HIPAA), and excluding psychotherapy notes and information compiled in reasonable anticipation of, or for use in, a civil, criminal, or administrative proceeding.

Continue Reading REMINDER: October 6 Deadline for Information Blocking Rules Approaches

On August 19, 2022, the Department of Health and Human Services (HHS), Department of Labor (DOL), and Department of the Treasury (DOT), released “Requirements Related to Surprise Billing: Final Rules” (the Rules). The Rules change and finalize the prior interim final rules concerning the information health insurers must share regarding the qualifying payment amount (QPA) and the independent dispute resolution (IDR) process under the No Surprises Act.  The Rules address comments received pertaining to the interim final rules as well as the recent judicial decisions in Texas Medical Association[1]and LifeNet. [2]

Continue Reading New Final Rule Under the No Surprises Act Released

The Department of Health and Human Services (HHS) Office for Civil Rights (OCR) recently issued new guidance (Guidance) on the use of remote communication technologies to deliver audio-only telehealth in accordance with HIPAA. Per OCR, the Guidance is intended to ensure continued access for patients to audio-only telehealth in a secure and compliant manner, particularly once OCR’s notification of enforcement discretion (previously discussed here) tied to the COVID-19 pandemic is rescinded (i.e., once the HHS-declared COVID-19 public health emergency is ended).

Continue Reading HHS Issues HIPAA Guidance to Support Audio-Only Telehealth Services

On June 15, 2022, the U.S. Supreme Court unanimously ruled in favor of “340B” hospitals in a notable statutory interpretation case concerning how the federal Medicare program reimburses hospitals for prescription drugs. The case, which was brought by the American Hospital Association, arises from reimbursement reductions imposed by the Department of Health and Human Services (HHS) in 2018 and 2019 on hospitals participating in the 340B program (which the Court noted are hospitals that “generally serve low-income or rural communities”). In those years, HHS sought to impose reductions in reimbursement due to favorable pricing available to 340B hospitals under that program. The hospitals challenged those reductions based on the process HHS followed when setting the reimbursement rates, claiming that HHS’s failure to conduct a survey of hospitals’ average acquisition costs for the drugs prevented HHS from varying reimbursement rates for this distinct group. Therefore, according to the hospitals, HHS was required to pay them based on the average sales price charged by manufacturers for the drugs.

Continue Reading Supreme Court Decides in Favor of 340B Hospitals Regarding Medicare Reimbursement Methodology

On June 2, 2022, the Federal Trade Commission announced a pair of antitrust enforcement actions to block pending health system transactions that, according to it, would harm competition in the provision of inpatient general acute care hospital services.

Continue Reading FTC Takes Action to Block Hospital Transactions in Utah and New Jersey

As we have previously written on, Connecticut Governor Ned Lamont recently signed into law the state’s budget as Public Act 22-118 (Act), which makes various changes to the Connecticut statutes. Among the changes, the Act expands the authority of Connecticut’s Office of Health Strategy (OHS).

Continue Reading Connecticut Expands OHS Authority

Connecticut Governor Ned Lamont recently signed into law Public Act No. 22-58, “An Act Concerning the Department of Public Health’s Recommendations Regarding Various Revisions to the Public Health Statutes” (the Act). The Act is an omnibus bill that includes a number of notable updates to state laws concerning health care and hospitals, certain of which are summarized below.

Continue Reading Connecticut Enacts Legislation Making Various Changes to Public Health Laws

As part of Connecticut’s budget implementer bill (Act) signed into law earlier this month, the state made significant revisions to its laws concerning collaborative drug therapy management agreements between pharmacists and certain prescribing practitioners to expand the (1) types of permitted arrangements; (2) prescribers eligible to participate in the collaborative arrangements with pharmacists; and (3) scope of pharmacists’ authority under these arrangements. These revisions are effective as of July 1, 2022.

Continue Reading Connecticut Makes Significant Changes to its Collaborative Drug Therapy Laws