flag_160540827This is the seventh article in our series on the effect of a “slow repeal” of the ACA. This week’s discussion focuses on the potential impact on healthcare technology.

Industry experts are predicting that a slow repeal of the ACA will have very little, if any, negative impact on healthcare technology. Healthcare technology grew at an unprecedented pace under the ACA, in part because the ACA contains provisions which provide healthcare technology with incentives to develop and implement new systems aimed at increasing efficiency. Despite the significant amount of uncertainty with a slow repeal of the ACA for many players in the healthcare industry, healthcare technology appears to be poised for continued growth through value-based care, telemedicine, and the increased need for interoperability.

Continue Reading Slow Repeal of the ACA and Its Effect on Healthcare Technology

Earlier we wrote that two Fifth Circuit cases seemed to reach inconsistent determinations about the availability of punitive and pain and suffering damages under the FLSA and ADEA. The Fifth Circuit previously expressed its intent to interpret the remedies provision under the FLSA and ADEA consistently with each other. Please see our discussion at via our January 13 blog post.

One of those opinions has been withdrawn and a new opinion substituted, but the inconsistency remains, The Vaughan v. Anderson Regional Medical Center decision was first issued on December 16, 2016 (we discussed the first issued version in our prior post). But because the opinion contained some manifest inconsistencies with the Pineda v. JTCH Apartments, LLC opinion issued just three days later, the plaintiff in Vaughan requested a rehearing en banc. Although the court denied the petition for a rehearing en banc, the court withdrew the prior opinion and substituted a new opinion. The new Vaughan opinion reaches the same ultimate conclusion and holding as the prior opinion, but it contains a few revisions that make clear its holding on ADEA remedies does not extend to FLSA remedies. But still, the two panels did not interpret remedies available under the ADEA and the FLSA consistently.
Continue Reading In the 5th Circuit, Pain and Suffering and Punitive Damages Recoverable under FLSA, not ADEA

flag_160540827This is the sixth article in our series on the effect of a “slow repeal” of the ACA. This week’s discussion focuses on the potential impact on post-acute care providers.

The term “post-acute care provider” encompasses a large and diverse group of healthcare providers that includes nursing facilities, home health agencies, hospice agencies and assisted living communities. While each group has its own very unique industry characteristics, they all have at least one thing in common: none of them rely, to any great extent, on private insurance as a form of payment. This is because the vast majority of the patients served by post-acute care providers are older than 65 and, accordingly, are covered by Medicare. So, any repeal efforts relating to the private insurance exchanges that expanded healthcare coverage for more than 30 million Americans will have minimal impact on post-acute care providers. Instead, the key issue facing post-acute care providers relating to the slow repeal of the ACA is the threatened conversion of Medicaid into a block grant program. Continue Reading Slow Repeal of the ACA and Its Impact on Post-Acute Care Providers

Texas_157051216In 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 to a facility-based physician, after copayments, deductibles, and coinsurance, including the amount unpaid by the administrator or insurer, for an amount greater than $500 and either (i) the facility-based physician fails to disclose projected amounts for which the patient may be responsible and the circumstances under which the enrollee would be responsible for those amounts; or (ii) the facility-based physician makes the disclosures but the amount billed is greater than the maximum amount projected in the disclosure. Continue Reading Texas 85th Legislature (2017) Legislation Update: Out-of-network billing limitations

flag_160540827This 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 America

There are nearly 5,000 short-term, acute care hospitals in the United States, half of which are in rural areas. About four in 10 rural hospitals are located in the South. More than half of rural hospitals are Critical Access Hospitals (CAHs) (53.5%); a smaller share of rural hospitals are designated as Sole Community Hospitals (SCHs) (13%), Medicare Dependent Hospitals (MDHs) (8%), and Rural Referral Centers (RRCs) (11%). All of these designations provide enhanced or supplemental reimbursement under Medicare, using different formulas. Rural hospitals that do not qualify for these Medicare programs are reimbursed as standard Medicare Prospective Payment System (PPS) hospitals. Continue Reading Slow Repeal of the ACA and Its Impact on Rural Healthcare and Communities

dollar-signiStock_000013001848_LargeOn February 15, 2017, the IRS announced on its website that, based upon its review of the White House’s January 20, 2017, executive order, it would continue to accept returns filed by taxpayers that do not report whether the taxpayer has complied with the individual mandate of the Affordable Care Act. Individual taxpayers are required to report on their returns whether they have health insurance coverage, qualify for an exemption to the coverage requirement, or are making a shared responsibility payment. Previously, the IRS had made changes to its software that processes tax returns so that returns filed without these sections completed would be automatically rejected and treated as not filed. Now, those returns will be treated as filed, and the missing information will be addressed by the IRS. Continue Reading IRS announces changes to individual mandate enforcement

Childrens_Hopsital_Shuttle_1xThe Department of Health and Human Services Office of Inspector General (OIG) recently implemented a new safe harbor to the federal Anti-Kickback Statute and beneficiary inducement statute, which went into effect on January 6, 2017.1 The new safe harbor, which was published by the OIG in a final rule dated December 7, 2016,2 protects the provision of free or discounted local transportation by eligible entities to Medicare or Medicaid beneficiaries, provided that certain conditions are met. While non-compliance with the safe harbor does not necessarily mean that a transportation arrangement will violate the Anti-Kickback Statute, children’s hospitals should take note of the safe harbor requirements and assess whether any of their existing transportation arrangements should be restructured. Continue Reading New Local Transportation Safe Harbor to the Anti-Kickback Statute and Beneficiary Inducement Statute

A stethoscope and American money on a white background - HealthcEven 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 deal with uncertainty about changes to the Medicare program. A significant source of uncertainty is the Trump administration’s stated intent to repeal the Affordable Care Act (“ACA” and also known as Obamacare), which is being implemented by current legislative efforts. Uncertainty about the ACA should be considered in developing a strategy to comply with MACRA. Continue Reading Managing MACRA – Part VII: What happens to MACRA if the Affordable Care Act is repealed?

Group of Children in a CircleOn January 6, 2017, several new regulatory exceptions to the beneficiary inducement statute went into effect. These regulations, published by the Department of Health and Human Services Office of Inspector General (OIG) in a final rule dated December 7, 2016,1 bring long awaited closure to many of the outstanding issues raised in the statutory versions of the exceptions implemented by the Affordable Care Act (ACA) and in the proposed regulations issued by the OIG on October 3, 2014.2 Several exceptions that may be of particular interest to children’s hospitals are highlighted below. Continue Reading New Regulatory Exceptions to the Beneficiary Inducement Statute

flag_160540827This is the fourth article in our series on the effect of the “slow repeal” of the ACA. This week’s article starts a three-part discussion on the potential impact of the slow repeal of the ACA on the health insurance industry, with this week’s focus on the individual health insurance market.

On February 2, 2017, an important House Subcommittee – the Energy and Commerce Health Subcommittee – began addressing four bills that address portions of the ACA. Although three of the four bills were introduced in previous years, all four measures come at a time when lawmakers are grappling with the impact of “repeal and replace” – or just “repeal” – on the increasingly fragile individual health insurance markets. Continue Reading Slow Repeal of the ACA and Its Impact on the Individual Health Insurance Industry