Healthcare Law Blog

Shaping the World of Healthcare Law

On May 30, 2021, Illinois lawmakers passed House Bill 3308 (“HB3308” or the “Bill”) aimed at expanding the use of telehealth services in the state. The Bill would increase access and coverage to telehealth by establishing payment parity for behavioral health and substance abuse services and by establishing a panel to study payment parity for all telehealth services.…
On May 13, 2021, MITRE Corporation, a non-profit that provides engineering and technical guidance for the federal government, published a long-awaited report proposing a National Strategy for Digital Health (the “Report”).  The proposed strategy provides a framework and prescribes tangible action items in order to revolutionize the American healthcare system through digital tools and technology.  The underlying premise is that harnessing the power of research, data, and innovation can further shared goals and accomplish priority outcomes to transform not only the digital plane of the healthcare system, but every facet of modern American healthcare.…
On May 21, 2021, the Centers for Medicare and Medicaid Services (“CMS”) announced that the Next Generation Accountable Care Organization (“ACO”) Model (“NGACO Model” or “Model”), set to end December 31, 2021, will not be extended after receiving a one-year extension due to COVID-19.  The decision comes as a surprise to NGACO participants and other industry groups who have been calling on CMS to revisit its decision and closely consider the Model’s merits and potential as a permanent program option.  Industry stakeholders, such as the National Association of ACOs (“NAACOS”), expressed initial disappointment with CMS’ decision to end the program,…
In our January 26, 2021 blog post “Permanency for Out of State Telehealth Services? Arizona Seeks to Make Permanent Changes to Licensure Requirements”, we discussed Arizona’s push to make permanent resolutions to the temporary telehealth exceptions issued in connection with the public health emergency (the “Pandemic”). In that article, we also noted that Arizona Governor, Doug Ducey, as part of his “State of the State” address, proposed permanent changes to healthcare access which would allow Arizona residents to access healthcare providers through the use of telemedicine.  As of May 5th, we have begun to see the…
On May 6, 2021, the comment period for the proposed modification to regulations implementing the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) Privacy Rule and Health Information Technology for Economic and Clinical Health Act of 2009 (“HITECH”) closed.  The Office for Civil Rights (“OCR”) at the Department of Health and Human Services (“HHS”) issued its initial request for information in December 2018, subsequently released the Notice of Proposed Rulemaking (“NPRM”) to the public on December 10, 2020, and published the Proposed Rule in the Federal Register on January 21, 2021 (the “Proposed Rule”).  After a significant degree of…
On April 27, 2021, the Centers for Medicare and Medicaid Services (“CMS”) released the Hospital Inpatient Prospective Payment System (“IPPS”) and Long-Term Care Hospital (“LTCH”) unpublished Proposed Rule for 2022 (“Proposed Rule”). The Proposed Rule, if enacted, would eliminate the requirement from the Hospital IPPS and LTCH Final Rule for 2021 (“IPPS Final Rule for 2021”), as discussed in our September 11, 2020 blog post, that hospitals report the median payer-specific negotiated charge with Medicare Advantage (“MA”) payers, by MS-DRG, on its Medicare cost reports for cost reporting periods ending on or after January 1, 2021. CMS estimates that…
The Biden Administration’s American Rescue Plan Act of 2021 (H.R. 1319) (the “Act”) could present an opportunity for the growth of utilization of ambulatory surgery centers (“ASCs”), continuing the trend of migration of inpatient procedures to the outpatient setting.  This shift toward the outpatient setting initially began prior to the COVID-19 public health emergency, but was accelerated by the pandemic’s effect on hospitals, likely continuing the substantial increase in investment in the ASC marketplace.…
The Biden Administration used the annual rulemaking that governs health plans sold on the Affordable Care Act’s exchanges to lower health care costs for consumers and improve access to health care. Part 2 of the Notice of Benefit and Payment Parameters for 2022 Final Rule (the Payment Notice), issued April 30, 2021, is the second in a series of rulemakings addressing exchange plans.[1]  The Department of Health and Human Services (HHS) anticipates additional rulemakings on the 2022 Payment Notice later this year.[2] The rulemaking announced changes to out-of-pocket costs, special enrollment periods, risk adjustment, and HHS’s audit and…
Montana Makes Telehealth Expansion Permanent On April 19, 2021, Montana Governor, Greg Gianforte, signed House Bill 43 (“HB43” or the “Bill”) into law. The Bill, which is effective on January 1, 2022, expands access to telehealth services in Montana that was originally extended because of the public health emergency (the “Pandemic”).  HB43 continues in a long line of legislation across the country that have made permanent changes to telehealth exceptions implemented at the height of the Pandemic. The Bill permanently lifts telehealth limitations that were paused during the Pandemic, like requiring an established patient-provider relationship in order to enable a…
Texas Makes Significant Strides to Expand Telehealth On April 14, 2021, the Texas House passed House Bill 4 (the “Bill” or “HB4”), a telehealth bill seeking to make permanent the temporary waivers issued during the public health emergency (the “Pandemic”) to expand telemedicine. The Bill, sponsored by State Rep. Walter Thomas Price, IV, is intended to provide expansive coverage to Texas citizens and address the technology gaps that exist in more rural communities by incorporating audio-only services into the scope of the telehealth exceptions in the state. The Bill follows the trend of recent legislation across the country by expanding…
In 2019, the Chair of the U.S. House Committee on Ways and Means (the “Committee”) asked the Medicare Payment Advisory Commission (“MedPAC”), an independent congressional agency established in 1997 to advise Congress on issues affecting the Medicare program, to examine the role that private equity (“PE”) plays in the Medicare program.  More specifically, MedPAC was asked to examine the following four issues related to PE investment: Gaps in Medicare data that make it difficult to track PE investments in Medicare-participating providers; Business models that PE firms use when they invest in the health care sector; The effects of PE ownership…
Late last month, the Biden Administration announced the second installment of its recovery plan, dubbed the “American Jobs Plan” (the “Plan”).  The Plan’s $2.3 trillion price tag includes $400 billion to revamp and reinvest in Medicaid’s home and community-based services (“HCBS”) over the next eight (8) years – representing over 17% of the Plan’s budget. Biden’s HCBS strategy aims to provide more solutions to help the overburdened healthcare system serve America’s aging and other special-needs populations through increased funding for Medicaid HCBS. The Plan Aims to Support Independent Living and Foster the “Care Infrastructure.” Medicaid is the federal-state…
On April 15, 2021, the FCC announced that on Thursday, April 29, 2021 at 12:00 PM ET it will begin accepting applications for the second round of its COVID-19 Telehealth Program (the “Program”).  The filing window will last for seven days and will close on Thursday, May 6, 2021 at 12:00 PM ET.  All applications filed during this period will be reviewed after the application filing window has closed. Under this application processing round, the FCC will distribute nearly $250 million to eligible health care providers to provide telehealth and connected care services to patients in response to the COVID-19…
State and federal regulators, Congress, and the plaintiffs’ bar are increasingly focused on compliance with the Mental Health Parity and Addiction Equity Act (MHPEA), particularly given the opioid epidemic and COVID-19’s impact on mental health. MHPAEA compliance and enforcement is a top priority for the United States Department of Labor (DOL) and the National Association of Insurance Commissioners (NAIC) with market conduct exams, state attorneys general investigations, and DOL investigations and subpoenas focused specifically on MHPAEA. A recent amendment to MHPAEA requires DOL, the Department of Health and Human Services, and the Treasury (collectively, the Departments) to audit MHPAEA compliance…
As many of us are starting to see the small light at the end of the tunnel, many hospitals are still reeling from the stress of the last year. Following the recent release of “Hospital Experiences Responding to the COVID-19 Pandemic: Results of a National Pulse Survey March 23–27, 2020” (the “Report”), a report issued by the Department of Health and Human Services Office of Inspector General (“OIG”) that examines the impact of the public health emergency on United States hospitals, we review federal and state efforts to keep hospitals afloat during this time, and expectations as we…
On Thursday, April 8, 2021, the Center for Medicare and Medicaid Innovation (the “Innovation Center”) announced its final list of 53 organizations set to participate in the Global and Professional Direct Contracting (“GPDC”) Model (previously named the Direct Contracting Model for Global and Professional Options).  The 53 Direct Contracting Entities (“DCEs”) are participating in the first Performance Year (“PY2021”) of the GPDC Model, which runs from April 1, 2021 through December 31, 2021. The DCEs will serve Medicare fee-for-service (“FFS”) beneficiaries in 38 states as well as in the District of Columbia and Puerto Rico.…