MedicareIf you track national health care policy developments, you’ve been busy lately.

Following weeks of growing declarations from Democrats in support of Medicare for All, US House Speaker Nancy Pelosi tamped down exuberance over any plans to replace the Affordable Care Act (ACA).  Then the US Justice Department spoke up.

In a March 25 statement to the Court of Appeals for the Fifth Circuit, Justice Department lawyers said US District Court Judge Reed O’Connor’s ruling should be affirmed—that the entire ACA coverage mandate is unconstitutional, and since the provision is inseverable from the ACA, the entire Act is invalid.  The ACA remains in place as the District Court ruling is under appeal. Continue Reading Medicare for All, Part 2: Cost, Financing and Impact on Provider Payment

As provided in the Texas Register on March 22, 2019, the Texas Health and Human Services Commission (“HHSC”) has proposed several amendments to Title 1 of the Texas Administrative Code, which include amendments to the rules and procedures for preventing and investigating Medicaid fraud and abuse. Continue Reading Texas Health & Human Services Proposes Amendments to Fraud and Abuse Rules

After years of insisting that nursing colleges separately incorporate from related hospitals and hospital systems, causing some schools to relinquish Medicare “pass-through” funding,  the Higher Learning Commission (HLC) has changed course. Today, HLC issued a Separate Incorporation Policy Change.

Removing language interpreted by prior HLC leadership as requiring separate incorporation, the revised policy substitutes a requirement that HLC-accredited institutions have a “primary purpose” of providing higher education. More specifically, the revised policy (HLC’s “Jurisdiction” policy, INST.B.10.010): Continue Reading HLC Announces Separate Incorporation Policy Change

Recently enacted federal law expanding criminal liability for kickbacks related to all payors, and increased government enforcement activity in behavioral health (see press release), has heightened the importance of clinical due diligence for private equity investors targeting deals and acquisitions in the emerging behavioral health space.  PE firms continue to target behavioral health opportunities as federal and commercial insurance coverage expands for mental health, including substance abuse treatment and telehealth services.  Such commercial coverage will only become more commonplace after a federal court this month found United Behavioral Health improperly denied benefits for treatment of mental health and substance use disorders to plan participants because United’s guidelines did not comply with the terms of its own insurance plans and state law.[1]  PE firms entering the behavioral health market, though, particularly opportunities related to substance abuse treatment and laboratory services, should carefully review a company’s compliance with the Eliminating Kickbacks in Recovery Act of 2018 (“EKRA”). Continue Reading Private Equity in Behavioral Health: Clinical Due Diligence Requires Consideration of EKRA, the New Anti-Kickback Law Applicable to All Payors

First in a series.

Like it or not, the 2020 presidential election campaign is well underway. With it comes the latest in public policy ideas, including more attempts to overhaul health care in the U.S.

The phrase “Medicare for All” has captured the minds, if not the hearts, of several candidates and an impressive portion of the voting public. It has shifted the conversation about health care in politics, at least temporarily, away from both “repeal and replace” and “protect the Affordable Care Act.” Continue Reading Medicare for All…or Is It?

Husch Blackwell's Wakaba Tessier and Renee Zerbonia and ARJ Infusion Services Edie GigotThis year’s National Home Infusion Association (NHIA) conference kicked off with the 2nd Annual Sterile Compounding Forum. The well-attended track provided an overview of the state of sterile compounding, insight into the most common citations confronting sterile compounders, considerations for compliance and risks relating to compounding, background on how states and the FDA are implementing rules and regulations, including those involved in the delivery of home infusion products.

We are pleased to sponsor the NHIA conference and participate in the following activities: Continue Reading NHIA 2019 Annual Conference

For decades, pundits, policymakers and consumer groups have called for better tools to make health care purchasing decisions easier.  Greater cost transparency and clear indicators of quality, they say, would help consumers make the right choices, which would lead to lower costs and better quality care.

If only it were as easy as using Angie’s List:  describe the need and up pops the names of local providers, along with comparative information on their performance.

Increasingly, such information and tools are available.  But their impact is unclear.

Since 2010, Medicare consumers have had an “Angie’s List” type of resource in Physician Compare, an online service produced by the Centers for Medicare and Medicaid Services (CMS).  The website was mandated by the Patient Protection and Affordable Care Act (ACA).  It serves a two-fold purpose, according to CMS: Continue Reading Physician Quality Measures—Growing Numbers of them, but are they being used?

It’s an exciting time to be in Austin for those in the healthcare and technology space. Members of our local healthcare team will be attending and participating in the various sessions and events that are occurring Friday, March 8 – Monday, March 11 in conjunction with the SXSW Interactive Festival.

Continue Reading Innovators, Entrepreneurs and Investors Gear Up for the 2019 SXSW Interactive Festival

Healthcare professionals, entrepreneurs and investors once again descended on San Francisco this past January for the J.P. Morgan Healthcare Conference (JPM). While the invitation-only JPM conference is the headline event, most people who come to San Francisco for the week are focused on what’s happening outside of the JPM, with learning and network opportunities literally around every corner.

With JPM in the backdrop, nearly two dozen healthcare and life science conferences and events occur simultaneously, nearly all of them within a four-block radius of JPM itself. These events cover a wide range of perspectives and topics, with innovation being the permeating theme. In a 24-hour period, an investor can take in presentations from a dozen private companies developing new therapies, seminars on disruptive technologies like artificial intelligence, and global perspectives on industry trends across multiple continents. Continue Reading JP Morgan Healthcare Conference, And So Much More

If you happen to miss our NHIA Talk Infusion Webinar on Compliance and Risk Considerations for Compounding Pharmacies, please click on the link to enjoy a free on-demand recording.

Our program guides you through the current landscape and common compliance concerns in compounding. We will help you understand the focus of FDA and state boards of pharmacy, including the areas of greatest risk and how to protect your business. You will also learn how to respond to an FDA inspection regarding a variety of areas, from onsite triage to handling requests for records and remediation.

Presenters include:

Bruce Ball, CEO, Britton Gallagher

Greg Rockers, Managing Director, Williamson Rockers Group

Wakaba Y. Tessier, Partner, Husch Blackwell

Brian Williamson, Managing Director, Williamson Rockers Group

Renee Zerbonia, Attorney, Husch Blackwell

For more information on compliance and risks associated with compounding pharmacies, please contact a member of the Husch Blackwell Pharmacy Team.