Jonathan Ishee, of counsel in the Vorys Houston office and a member of the health care group, co-authored an article for the ABA Health Law Section: ESource titled “The Out-of-Network Battle Heats Up.”
Two federal appeals courts ruled yesterday on a key provision of the Affordable Care Act (ACA) – and reached opposite conclusions. At issue is the component of the ACA that allows individuals who earn between 100% – 400% of the federal poverty level (FPL), or $11,670 and $46,680 for an individual, to be eligible to receive a subsidy to purchase insurance in a Health Insurance Marketplace
Each year, Medicare makes additions and deletions to its annual physician fee schedule (PFS). Medicare recently released a proposed rule for calendar year 2015 which includes an expansion of some telemedicine health services. Under the proposed rule, Medicare will expand payment for certain mental health and medical services that are furnished via telemedicine.
On Wednesday, June 11, 2014, the Substance Abuse and Mental Health Services Administration (SAMHSA) will hold a public listening session to solicit information regarding the Confidentiality of Alcohol and Drug Abuse Patient Records Regulations, 42 C.F.R. Part 2. Under these regulations, a federally assisted substance abuse program generally may only release identifiable patient information related to substance abuse treatment services with the individual’s express consent.
Capping one of the most significant periods of antitrust enforcement in the history of the health care industry, today the Sixth Circuit delivered its opinion in ProMedica Health System, Inc. vs. Federal Trade Commission (No. 12-3583), denying ProMedica’s petition for review of the Federal Trade Commission’s (FTC) prior order, directing the divestiture of ProMedica’s acquisition of St. Luke’s Hospital in Toledo, Ohio.
On April 9, 2014, following the release of an injunction against the disclosure of the information, Centers for Medicare and Medicaid Services (CMS) posted all Medicare provider and utilization data (data) on its website.
Lisa Pierce Reisz, a partner in the Vorys Columbus office and a member of the health care group, authored a portion of the first edition of the American Health Lawyers Association’s HIPAA/HITECH Resource Guide.
Sylvia Brown, an associate in the Vorys Columbus office and a member of the health care group, authored a column titled “No Settled Answers On State Medicaid Waivers," which appeared in the March 31, 2014 edition of Health Law360.
On March 20, 2014, the Centers for Medicare and Medicaid Services (CMS) posted a “Transition Plan Toolkit” to assist states in developing their Home and Community-Based Settings (HCBS) 1915(c) waiver and section 1915(i) state plan amendment or renewal application(s) so that they comply with new requirements in the HCBS Final Rule, released earlier this year.
The Department of Justice (DOJ) and the Department of Health and Human Services (HHS) recently announced that 2013 was a record breaking year for health care fraud recovery. In total, $4.3 billion was returned to the federal government, primarily to the Medicare and Medicaid health care programs.
A recent pro-employer decision by the federal Sixth Circuit Court of Appeals has provided some helpful guidance for employers looking to avoid and defend against claims for unpaid time under the federal Fair Labor Standards Act (FLSA). White v. Baptist Memorial Health Care Corp., 699 F. 3d (6th Cir. 2012). The Sixth Circuit is the federal court of appeals for Ohio, Michigan, Tennessee and Kentucky.
The Office of Inspector General posted OIG Advisory Opinion No. 14-01 on January 21, 2014 in response to a nonprofit senior housing and geriatric care provider’s question of whether it may pay an independent placement agency a fee for referring new residents to certain of its facilities. Despite concerns that the arrangement could potentially generate prohibited remuneration under the Anti-Kickback Statute (AKS), the OIG found that the facts and circumstances of the arrangement sufficiently mitigated any fraud and abuse risks.
In a recently published final rule, CMS established the requirements for settings that may be eligible sites for the delivery of reimbursable Medicaid home and community-based services (HCBS) provided under sections 1915(c), 1915(i) and 1915(k) of the Medicaid statute.
The Ohio Supreme Court issued a decision today confirming the constitutionality of the state's decision to expand the Medicaid program through an action of the Controlling Board. The Court rejected a constitutional challenge made by six legislators.
On October 30, 2013, in a letter to Representative Jim McDermott, U.S. Department of Health and Human Services (HHS) Secretary, Kathleen Sebelius clarified that qualified health plans (QHPs) available in the health insurance Marketplaces created under the Affordable Care Act (ACA) are not “federal health care programs.”
Jolie Havens authored a column for the Houston Business Journal outling 7 possible strategies that large Texas employers can consider to comply with the Affordable Care Act’s employer cost-sharing mandate.
In a recently published policy memorandum, the Centers for Medicare & Medicaid Services (CMS) provided guidance regarding the automatic assignment of Medicare Provider Agreements upon a change of ownership.
Lisa Pierce Reisz, a partner in the Vorys Columbus office and a member of the health care group, authored an article for Communications Professional Resources Online (CommPRO.biz). In the article, she provides an overview of the information that public relations professionals need to know about the latest HIPAA breach notification rules, which become law in September 2013.