Health Law Observer

Timely insights and legal commentary on various health care issues and developments surrounding regulations, employment, transactions and a range of key industry matters. This blog is maintained by the Health Care Department of Stevens & Lee.

Health care law

Delaware Executive Order 25 to Address State’s High Per Capita Health Care Spending

Delaware hospitals’ revenue will likely be adversely affected by the initiative as it is designed to address over reliance on the most costly forms of care, such as that rendered by emergency departments.

Skeptical, At Best: Will the New CMS Physician Payment Models Make a Difference?

CMS continues to attempt to shift from a fee-for-service model to a value-based model offering significant upside (and now downside) risk through CMS’ newly-announced payment models called Primary Care First.
Doctors Walking Through Shared Space

Shared Space and Shared Services – Some Much Needed Flexibility from CMS

In connection with this Guidance, CMS indicated that it wants providers to have flexibility in providing care, as long as the shared space and services will not adversely affect the health and safety of patients.
Physician Prescribing Medication

Mandatory E-Prescribing for Controlled Substances Coming Soon to Pennsylvania

Practitioners who violate the law are subject to administrative penalties up to a maximum of $5,000 per calendar year.
piggy bank and money in front of a computer

CMS Innovation Center Announces Two New Payment Models

On April 22, 2019, the CMS Innovation Center announced two new Medicare payment models that will launch in 2020: the Primary Care First model; and the Direct Contracting model.
doctor opening a small red box

Reminder: There is No Stark Law De Minimis Exception

We are frequently asked about the Stark Law implications of gifts, items or services that a hospital wants to give (or, in some cases, already gave) to referring physicians.

CMS Continues to Expand Medicare Coverage and Reimbursement of Telehealth Services

The adoption of this final rule follows CMS’s recent trend of expanding coverage and reimbursement of telehealth services under traditional Medicare.

Responding to Requests for Service and Emotional Support Animals in Health Care Facilities

Health care providers must grapple with some unique challenges that arise when a patient presents at a hospital or clinic appointment with an animal.
Practical Guidance for Health Care

Federal Judge Blocks Medicaid Work Requirement Waivers in Arkansas and Kentucky

With Judge Boasberg’s narrow rulings on procedural grounds as well as the federal and certain state governments’ continued support for work requirement waivers, it is important to recognize the potential impact such waivers may have on providers.
Changes to HSR Reportability

Changes to HSR Reportability of Nonprofit Affiliation Transactions

The net effect of such guidance is that certain affiliation structures among nonprofit organizations will now be reportable for HSR Act purposes.
Home Health Agency PPS Rules

CMS Issues Display Copy of Updates to Home Health Agency PPS Rules

CMS believes the provisions of the Final Rule will strengthen and modernize the home health prospective payment system by “focus on patient needs and not on the volume of care.”
gavel

Implications of Federal Court’s Ruling Allowing AT&T/Time Warner Merger Are Less Clear in Health Care Than in Other Industries

The landmark case was the DOJ’s first suit in 40 years seeking to block a so-called “vertical merger,” i.e., a merger between a buyer and a supplier.
reports with magnifying glass

Outline of Certain Tax Reform Changes Impacting Tax-Exempt Health Care Organizations

This post includes a preliminary outline of certain key provisions that specifically affect tax-exempt health care organizations as well as some practical takeaways and outstanding questions.
Outline of Certain Tax Reform

Hospital’s 501(c)(3) Status Revoked for 501(r) Non-Compliance

The IRS recently issued a private letter ruling revoking a hospital’s Section 501(c)(3) tax-exemption on account of failing to meet Section 501(r) requirements.
FTC Policy Change May Signal Increased Scrutiny for “Anticompetitive” Healthcare Transactions

CMS Issues Final Rule Implementing Section 603 of the Bipartisan Budget Act of 2015

CMS issued the long-awaited Final Rule implementing Section 603 of the Bipartisan Budget Act of 2015 relating to payment for certain items and services furnished by off-campus provider-based departments of hospitals.
Tax Exempt Status

IRS Denies ACO Tax-Exempt Status

In denying Section 501(c)(3) tax-exempt status to an accountable care organization (ACO) formed by a Section 501(c)(3) health system, the IRS focused on four facts.
Payment Rates

Final Rule on Reporting and Returning Overpayments – the “60 Day Rule”

CMS stated that the Final Rule provides needed clarity and consistency for providers and suppliers on the actions they need to take to comply with requirements for reporting and returning of self-identified overpayments.
stethoscope laying on a book

CMS Updates Place of Service Codes for Professional Claims

Each of the new POS codes will be effective January 1, 2016, and neither of the new codes will have any effect on reimbursement.
Piggy Bank wiht Money and Computer

Change in CMP Law Affecting Gainsharing Arrangements

The change could clear the way for hospitals and physicians to share payments for reducing or limiting medically unnecessary services provided to Medicare and Medicaid beneficiaries.

Practical Guidance for Health Care Governing Boards on Compliance Oversight

An educational resource designed to assist governing boards of health care organizations to carry out their compliance oversight obligations was published on April 20, 2015.
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