The regulation of pharmacies at the state level might not be what Justice Louis Brandeis had in mind as an example of a “laboratory of democracy,” but for pharmacists and consumers, state-level policy-making can have important real-world effects and encourage efforts on the federal stage. Over the past twelve months a number of regulatory trends have played out that define the current operating environment for pharmacies, many of which are anticipated to continue in 2019. Continue Reading Recent Developments in State Pharmacy Law & Regulation: Looking Back at 2018 and What to Expect in 2019

This is the third article in our series on the new “Pathways” rules for Accountable Care Organizations.  Our first two articles in the series can be found here.

The Centers for Medicare and Medicaid Services (CMS) issued its anticipated final rule revising the Medicare Shared Savings Program to improve cost savings and quality.

With the changes in the final rule, the revamped program, called “Pathways to Success,” is projected to save Medicare $2.9 billion over 10 years—that’s $0.7 billion more than projected in the proposed rule issued August 9, 2018. Continue Reading The “Pathways to Success” Final Rule is Here: ACO’s Face Big Decisions

outside a hospitalLast August, the Healthcare Worker Violence Protection Act was signed into law by Illinois Governor Rauner. This law creates a new set of employee rights and obligations for healthcare providers in Illinois. Generally, this law is designed to provide personal safety to frontline healthcare providers, such as doctors and nurses, and protect the rights of those who would raise or report safety concerns and assaults by expanding the Illinois Whistleblower Act. Continue Reading Workplace Violence Protection Act: Illinois Hospitals and Healthcare Providers Face New Challenge

One conclusion drawn from the 2018 midterm elections is health care is a big deal for Americans. In fact, according to pre- and post-election polling, health care may be the biggest deal, as a plurality of voters identified health care as their top issue in casting their vote.   Continue Reading Health Care Drives Voters at the Polls, but Will Health Care Drive Policymaking?

A new rule proposed by the Centers for Medicare and Medicaid Services (CMS) on October 26, 2018, would revise the way the agency validates the risk adjustment data and collects repayments from Medicare Advantage (MA) organizations. With the new methodology, CMS is expecting to return $4.5 billion in savings to the Medicare Trust Fund over 10 years, according to an October 26 CMS news release. Continue Reading CMS Issues Proposed Rule Addressing Payment Error in Medicare Advantage, Expects to Recover $4.5 Billion Over 10 Years

The Rape, Abuse and Incest National Network (“RAINN”) reports that sexual assault and abuse of people with disabilities often goes unnoticed, and, according to the National Crime Victimization Survey, people with disabilities are victimized by crime at higher rates than the rest of the population. Too often, it is the caregivers who are the perpetrators. While one with a disability may give consent to sexual activity, there can never be consent between one who is disabled and receiving care and a member of the caregiving staff. Continue Reading Sexual Abuse of People with Disabilities

In the wake of the #MeToo Movement, New York, California and a number of other jurisdictions, both local and state, have passed new laws aimed at combatting sexual harassment in the workplace.  The New York laws require written sexual harassment prevention policy, assurance that all current and new employees, and even applicants for employment, receive a copy of the policy, and mandate annual sexual harassment training for all employees.  In addition, New York law now provides that employers can be liable for sexual harassment of nonemployees in the workplace, such as contractors, vendors and subcontractors.  Recent legislation prohibits employers from using mandatory arbitration provisions in employment contracts or nondisclosure agreements except when this is the victim preference.  Let me suggest that there are some important lessons to be learned from these laws. Continue Reading Lessons From Changes to New York State’s Sexual Harassment Laws

On Wednesday, the Department of Health and Human Services (“HHS”) reversed course in its delay of implementing fines against drug manufacturers that intentionally overcharge 340B providers. In a notice of proposed rulemaking, HHS intends to advance the effective date of its final rule on the 340B drug price ceiling and civil monetary penalties to January 1, 2019, rather than July 1, 2019, as previously proposed. Continue Reading HHS proposes moving up the enforcement of 340B penalties to January 1, 2019

Anticipating open enrollment season for coverage in 2019, the Centers for Medicare and Medicaid Services (CMS) released coverage and premium information that will factor into consumer decisions about Medicare and individual commercial plans offered through exchanges. Enrollment and premium trends also inform regulatory and broader policy decisions at both federal and state levels. Continue Reading Open Enrollment Update: CMS Releases Benefit and Market Data