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Texas 85th Legislature (2017) Legislation Update: Out-of-network billing limitations

In addition to H.B. 307 (discussed in a prior post), H.B. 1566 and its companion bill, S.B. 507, propose to expand the requirement for mediation of balance bills. Currently, Chapter 1467 of the Texas Insurance Code requires a facility-based physician to mediate balance bills upon the request of the patient if the patient is responsible … Continue Reading

Slow repeal of the ACA and its impact on rural healthcare and communities

This is the fifth article in our series on the effect of the “slow repeal” of the Affordable Care Act (ACA). This week’s article focuses on the potential impact of the slow repeal of the ACA on rural communities and healthcare. Continued Fragile System Leads to Uncertainty or Closure Causing Economic Ripple Effect Throughout Rural … Continue Reading

Managing MACRA – Part VII: What happens to MACRA if the Affordable Care Act is repealed?

Even without potential changes to the Medicare program, MACRA poses a significant challenge for any clinician trying to determine the best strategy to maximize Medicare reimbursement – there are hundreds of pages of guidance in the proposed and final regulations to review and understand. But, at this point, clinicians attempting to assess MACRA must also … Continue Reading

Gorsuch, marijuana and taxes

With the nomination of Judge Neil Gorsuch of the United States Court of Appeals for the Tenth Circuit to the United States Supreme Court, much of the conversation in coming days and weeks will be about his views on abortion, free speech, and his stated skepticism regarding the Chevron doctrine. But his opinion in a recent … Continue Reading

2017 NDAA brings privatization and cost-savings incentives to TRICARE

The 2017 National Defense Authorization Act, Pub. L. No. 114-328 (Dec. 23, 2016), introduces major changes to the Defense Department healthcare program known as TRICARE. By this time next year, we’ll see a new program to contain the cost of prescription drugs at retail pharmacies, contractual incentives for improving the quality of healthcare and reducing … Continue Reading

Slow repeal of the ACA and its effect on the pharmaceutical industry

This is the third article in our series on the effect of a “slow repeal” of the ACA. This week’s discussion focuses on the potential impact of a slow repeal of the ACA on the pharmaceutical industry (Pharma). Unlike many of the players detailed in our prior articles on the slow repeal of the ACA, … Continue Reading

Slow repeal of the ACA and its effect on physicians

This is the second article in our series on the effect of a “slow repeal” of the ACA, which began January 3, 2017, when Senate Budget Committee Chairman Mike Enzi introduced a budget resolution with instructions to the relevant Senate and House committees to develop a plan to repeal the ACA. The four committees that … Continue Reading

St. Clair v. CVS Pharmacy, Inc. and healthcare calls under the TCPA’s emergency purpose exception

A California federal court handed down a decision last Friday that may further influence how healthcare entities should approach the Telephone Consumer Protection Act’s (TCPA) “emergency purpose” exception as applied to calls or texts related to patient health and safety. In St. Clair v. CVS Pharmacy, Inc., No. 16-CV-04911-VC, 2016 WL 7489047, at *1 (N.D. Cal. … Continue Reading

Slow repeal of the ACA and its effect on health systems

President-elect Donald Trump has said repealing the ACA will be a priority for his administration. On Dec. 6, 2016, Senate Majority Leader Mitch McConnell (R-Ky.) announced that a measure to repeal parts of the ACA will be the first item the Senate considers when it convenes on Jan. 3, 2017.… Continue Reading

Texas 85th Legislature (2017) Legislation Update: Out-of-network billing limitations

Rep. Dustin Burrows (Dist. 83, Lubbock) introduced H.B. 307, which could significantly impact facilities and practitioners that provide services on an out-of-network basis. Specifically, for services other than emergency services, H.B. 307 requires that a facility or practitioner provide a patient with the amount, including facility fees, that: (1)  the patient’s health benefit plan will … Continue Reading

What’s next for Trump’s HHS Secretary nominee?

One of President-elect Trump’s many campaign promises included “repealing and replacing” the Affordable Care Act (ACA), known as Obamacare. Trump nominated Rep. Tom Price, M.D. (R-Ga.) to serve as the Secretary for the Department of Health & Human Services. Trump’s selection of Price signals that Trump is pushing forward with his promise to aggressively repeal … Continue Reading

OIG updates policy regarding gifts of nominal value

On Dec. 7, 2016, the U.S. Department of Health & Human Services Office of Inspector General (OIG) released an update to its 2000 policy regarding gifts of nominal value given to a Medicare or Medicaid beneficiary. The update increases the nominal value of gifts given to a Medicare or Medicaid beneficiary to $15 per occurrence … Continue Reading

Managing MACRA – Part V: What do I have to do if I’m in an ACO?

As of January 2016, there were 433 Medicare Shared Savings Program (MMSP) Accountable Care Organizations (ACOs) with almost 7.7 million assigned beneficiaries and more than 14,000 participants (a participant may be a group or an individual). Most of these ACOs are one-sided model ACOs that may generate shared savings and do not involve shared losses (Track … Continue Reading

EEOC’s targeting of wellness programs and what that means for your company

Husch Blackwell was recently named a finalist for the St. Louis Business Journal’s Healthiest Employers 2016 competition. The Business Journal’s profile of Husch Blackwell highlights the firm’s effective use of wellness challenges in the workplace and praises Chris Smith, a partner in our St. Louis office, for his dedicated participation in the wellness initiatives. Given … Continue Reading

Managing MACRA – Part IV: When does it begin?

Under MACRA, the merit-based incentive payment system (MIPS) automatically applies to eligible clinicians (generally a physician or mid-level – see our previous blog post for details) and most clinicians who treat Medicare patients are expected to be included in MIPS. As a result, one of the most common questions about MACRA is when it starts. CMS’s … Continue Reading

OSHA issues recommendations for employer safety and health programs

Last week, OSHA published its new “Recommended Practices for Safety and Health Programs,” which advises employers in the healthcare industry and other private sector industries to establish comprehensive internal safety and health programs. The OSHA bulletin also provides extensive guidelines and resources for creating such programs. In releasing the updated recommendations, OSHA argues that employers … Continue Reading

Revised Cuba rules allow medical collaboration, ease some pharmaceutical trade

The U.S. Department of Treasury’s Office of Foreign Assets Control (OFAC) and the U.S. Department of Commerce’s Bureau of Industry and Security (BIS) recently announced additional rule amendments intended to continue improving relations between the U.S. and Cuba by allowing even greater commerce and humanitarian efforts between the two countries. These new OFAC  and BIS  … Continue Reading

Managing MACRA – Part III: What is an APM?

Under MACRA, the merit-based incentive payment system (MIPS) automatically applies to an eligible clinician (generally a physician or mid-level – see our previous blog post for details) except in certain circumstances. One of the circumstances in which an eligible clinician is excluded from MIPS is when the clinician participates in an advanced alternative payment model … Continue Reading

Managing MACRA – Part II: Does MACRA apply to me?

MACRA is making big changes to Medicare clinician reimbursement, so which clinicians are affected? Under MACRA, the merit-based incentive payment system (MIPS) automatically applies to an eligible clinician except in certain circumstances. A MIPS Eligible Clinician (defined at 42 C.F.R. §414.1305) is a: physician, including: (1) a doctor of medicine or osteopathy; (2) a doctor … Continue Reading

How much does it cost to identify and repay federal health plan overpayments late?

Roughly $2.95 for each $1 overpaid (plus legal costs and the overpayment) based on an August 24, 2016, U.S. Attorney’s Office press release regarding settlement of State of New York, ex rel. Robert P. Kane v. Healthfirst, Inc. et al case in the U.S. District Court for the Southern District of New York. Defendants previously … Continue Reading

Fifth Circuit decision finds new exception to at-will employment: employee gun rights

Recently, Husch Blackwell partners Stephen Cockerham and Kevin Koronka presented a webinar to Texas employers concerning the impact legislation concerning gun rights may have on employers. The Fifth Circuit Court of Appeals, the federal appellate court with jurisdiction over Texas federal district courts, recently released a decision concerning employee gun rights of which employers, particularly … Continue Reading

CMS targets inappropriate social media use in nursing homes

The U.S. Dept. of Health & Human Services Centers for Medicare and Medicaid Services (CMS) published a memo (Ref:  S&C: 16-33-NH) Aug. 5, 2016, to state nursing home survey agency directors related to protecting resident privacy and prohibiting mental abuse related to photographs and audio/video recordings by nursing home staff. The memo is a response to … Continue Reading
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