As the health care industry shifts from fee-for-service to value-based arrangements, providers are facing a lot of challenges. A provider’s relationship with payers is often strained by the new business model, and a provider’s ability to collaborate with payers has never been more important.

On this episode of Value-Based Care Insights, host Daniel J. Marino

On June 19, 2020, the Texas Department of Insurance adopted final rules specifying patient notice and election requirements in order for out-of-network providers to balance bill. The final rules replace similar emergency rules that were adopted on December 18, 2019.

Under the new rules, which are meant to implement legislation passed in 2019 by the Texas Legislature, out-of-network providers are prohibited from Balance Billing for nonemergency services unless a patient elects, in writing, to obtain the service from the out-of-network provider. The patient’s election is only effective if the provider satisfies the following notice and disclosure requirements: (1) the patient is provided with a “meaningful choice between an in-network provider and an out-of-network provider,” (2) the patient is not “coerced” into choosing the out-of-network provider, and (3) the patient is provided with a written notice and disclosure. The notice and disclosure statement must be signed by the patient at least 10 business days before receiving any care.[1]

The U.S. Department of Health and Human Services (HHS) will soon make targeted distributions of the next tranche of the Provider Relief Fund to hospitals and other facilities that have been particularly affected by caring for those with the coronavirus. By 11:59 p.m. ET, hospitals will need to complete the HHS information request on ICU beds, COVID-19 positive patients, etc. Specifically, to be eligible to receive a portion of the $10 billion of the next $70 billion in funding from the CARES Act, providers need to submit the information via a CMS portal. This is not a guarantee of payment—rather, CMS is using this information to decide how to allocate the remaining funds.

Governor Laura Kelly signed Executive Order 20-26 which provides liability protections and regulatory flexibility for health care providers in the state of Kansas. The order went into effect on April 22nd and remains in effect until May 31st or until the COVID-19 state of emergency is declared over. The six page document eases regulatory requirements related to health care delegation and supervision as well as increases the pool of health care workers. Further, health care providers will be protected against liability for death or personal injury in response to COVID-19 care.

Updated April 3, 2020

In response to the growing Coronavirus pandemic, the Small Business Administration (“SBA”) will make loans available to businesses that employ fewer than 500 people (and in certain instances a larger number of employees) through the new Paycheck Protection Program (“PPP”). In this post we address some of the most frequently-asked questions about the PPP, and how eligible healthcare entities can apply.

On June 12, 2017, the Department of Health and Human Services Office of Inspector General (OIG) published a report with the objective of determining whether the Centers for Medicare & Medicaid Services (CMS) made proper incentive payments to providers for “meaningful use” of a certified electronic health record (EHR).  The report, entitled “Medicare Paid Hundreds of Millions in Electronic Health Record Incentive Payments That Did not Comply with Federal Requirements,” estimates that CMS improperly paid $729 million in EHR incentive payments to providers who did not actually comply with the requirements of meaningful use.