Perspectives on Federal & State Health Policy

The Centers for Medicare & Medicaid Services (CMS) issued its annual proposed rule related to the Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems for 2023 (the HOPPS Proposed Rule) on July 26, 2022.

In Khoiny v. Dignity Health, the California Court of Appeal held that hospital residency programs are primarily employment programs and medical residents are primarily employees. Therefore, courts should not give special deference to residency programs’ termination decisions.

The US Department of Health and Human Services’ (HHS) declaration that COVID-19 remains a public health emergency (PHE) will continue through July 15, 2022, and is expected to be renewed again through October 13, 2022.

Health Care Partner Stephanie Trunk will give a presentation and participate in a Fireside Chat about policy updates surrounding transparency and reporting requirements at the 2022 Informa Connect Medicaid & Government Pricing Congress.

Health Care Partner Stephanie Trunk will co-chair the American Conference Institute’s 20th Annual Rx Drug Pricing Boot Camp, providing intensive training in the essentials and complexities of pricing calculations, rebates, and reporting under Medicaid, Medicare, and PHS 340B Programs.

Some commentators have misinterpreted the Bichai decision to mean that a medical staff and its affiliated hospital are entirely independent of each other. In reality, the two entities are practically and legally interdependent. 

On February 22, 2022, the California Department of Public Health (CDPH) announced that vaccinated health care workers with documented recent infection will be allowed to defer booster shot by up to 90 days from infection.

Health Care Partner Stephanie Trunk is presenting at the Healthcare Distribution Alliance’s 2022 Distribution Management Conference on March 8.

On February 23, 2022, in what is being heralded as a significant victory for health care providers, a federal court in Texas vacated portions of the Biden Administration’s rules governing the arbitration procedures to resolve surprise billing disputes under the federal No Surprises Act (the Act).

Health Care Practice Leader Douglas Grimm and Senior Government Relations Director Oliver Spurgeon will present at CTeL’s Digital Health Summit on June 9, 2021.

On September 25, 2020, the Centers for Medicare & Medicaid Services (CMS) announced that it streamlined the federal Clinical Laboratory Improvement Amendments (CLIA) certification process for laboratories applying to perform COVID-19 testing.

In a new final rule released on April 9, 2018, CMS is allowing states substantially more flexibility in selecting Essential Health Benefits (EHB)-benchmark plans for the 2020 plan year.

Recently, the Health Resources and Services Administration released a new addendum to amend the existing Pharmaceutical Pricing Agreements that drug manufacturers participating in the 340B Drug Pricing Program must have in place with the Secretary of Health and Human Services.

On August 12, 2016, the Health Resources and Services Administration published a proposed rule setting forth the requirements and procedures of the administrative dispute resolution process applicable to all covered entities and drug manufacturers participating in the 340B Drug Pricing Program.

Everyone working in the health care industry today knows how often overpayments can occur; nevertheless, it is clear under the Affordable Care Act that any provider who receives an identified overpayment is under a direct legal mandate to return it.

On Friday, February 12, 2016, the Centers for Medicare and Medicaid Services (CMS) released the long-awaited Final Rule and regulations, providing much needed guidance to providers and suppliers on how to meet the Affordable Care Act’s (ACA’s) 60-day overpayment mandate.

On January 21, 2016, the Centers for Medicare & Medicaid Services (CMS) released the long-awaited Final Rule implementing changes to the Medicaid Drug Rebate Program (MDRP) under the Affordable Care Act (ACA).

On September 21, 2015, the US DOJ and whistleblowers’ counsel announced that Florida-headquartered Adventist Health System (Adventist) had agreed to pay $118.7 million to resolve allegations that it violated the FCA by submitting claims in violation of the Stark law and by miscoding claims.

After surviving two challenges that resulted in U.S. Supreme Court decisions that essentially preserved the law, the Affordable Care Act will face additional judicial scrutiny as a federal district court has denied the administration’s motion to dismiss the case brought by the House last year.

On Monday, a federal district court judge in New York issued a ruling that, if adopted broadly, will have a significant – and potentially nightmarish – impact on any provider who receives an overpayment from Medicare or Medicaid.  Kane v. Healthfirst, Inc. and U.S. v. Continuum Health Partners Inc. 

King v. Burwell understandably took the attention of the health care industry a couple of weeks ago when it upheld a key component of the ACA. A day later, the Supreme Court released another decision that may have a more significant going-forward impact on the health care industry: Obergefell.

In the long awaited decision in King v. Burwell, the Supreme Court ruled this morning in a 6-to-3 decision that the Affordable Care Act (ACA) permits tax credits for individuals who purchase their health insurance through a Federal health insurance marketplace (Federal Exchange), not just for indivi