Healthcare Law Blog

JANUARY 20, 2023

ILOS permits Medicaid managed care plans to provide food, transportation, housing transition services and many more categories to meet enrollees’ needs. Please refer to our prior blog for more information on CalAIM. Further, agencies with existing ILOS offerings must comply with the new policy framework by January 2024.

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MedTrainer

NOVEMBER 29, 2023

The Indiana Family and Social Services Administration (FSSA) is a state’s Medicaid agency that provides essential support and services, such as healthcare, mental health, and social services, to improve the welfare and quality of life for families and individuals in Indiana. Learn more about MedTrainer today!

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Health Law Advisor

JUNE 1, 2023

As already noted, they tend to be different for each algorithm, but here are the general categories of data that are fed into some of these algorithms: The most popular data are vital signs, which include such things as blood pressure, heart rate, respiration rate, temperature, oxygen saturation and so forth. Medical images.

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Health Law RX

JULY 18, 2023

On June 27, 2023, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) issued its long-anticipated final rule amending the OIG’s civil monetary penalty (CMP) regulations as they relate to information blocking (CMP Final Rule or Rule). The CMP Final Rule was published in the Federal Register on July 3, 2023.

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Fraud Compliance Medicaid Medicaid 52

Hall Render

NOVEMBER 28, 2023

Agencies that fail to submit their quality data will have an additional 2% deducted from their reimbursement as indicated below. CMS also dismissed concerns about agencies operating with negative profit margins. More importantly, the number of agencies operating with a negative margin has also declined. 7,872 2018 5,851 77.1%

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Health Law Advisor

MARCH 1, 2023

Federal agencies in health care publish large amounts of data, and my posts typically analyze that data. Information is important, and thus so is access to it. One of the reasons FDA was able to respond so quickly is that all the data I needed were in spreadsheets in the FDA’s Division of Freedom of Information.

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Healthcare Law Blog

NOVEMBER 16, 2023

Department of Health and Human Services’ Centers for Medicare and Medicaid Services (“CMS”) will publish a final rule requiring Medicare skilled nursing facilities (“SNFs”) and Medicaid nursing facilities (“Facilities”) to provide more detailed ownership, managerial and other information on Form CMS-855A (the “Final Rule”). [1] Definitions.

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Healthcare Law Blog

JANUARY 26, 2024

This sweeping new rule is designed to cast a wide net over entities that, except in the case of taxes, do not regularly report to federal agencies (i.e., For additional information on a particular topic, links to helpful resources have been provided in the footnotes. There is time to think through those questions.

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Provider Trust

APRIL 26, 2023

An increasing trend of nurse strikes and hospital staffing shortages across the country in early 2023 has led many healthcare organizations to turn to travel nurses and staffing agencies to fulfill their workforce needs. But working with staffing agencies and travel nurses comes with its own unique set of compliance risks.

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Licensing Nurses Compliance COVID-19 52

Health Law Advisor

JULY 21, 2023

Notably, CMS stated that the agency only anticipates accepting five candidates to participate in the TCET pathway each year. [2] Most notably, in the Procedural Notice, CMS stated that it expected that the agency would only accept up to five TCET candidates annually.

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Healthcare Law Blog

JULY 21, 2023

According to the agencies, the Proposed Merger Guidelines “build upon, expand, and clarify” the prior guidance, [1] to keep up with “modern” market realities. [2] Guideline 9 : When a merger is part of a series of multiple acquisitions, the agencies may examine the whole series. They also cite case law for the first time. [3]

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Healthcare Law Blog

JANUARY 26, 2024

On December 13, 2022, the Centers for Medicare and Medicaid Services (“CMS”) issued a proposed rule, titled Advancing Interoperability and Improving Prior Authorization Processes (“Proposed Rule”), to improve patient and provider access to health information and streamline processes related to prior authorizations for medical items and services.

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MedTrainer

DECEMBER 5, 2023

Connecticut has made strides in developing health information exchange (HIE) systems, facilitating secure data sharing among healthcare providers. The act defines personal data broadly and includes a category for “sensitive data.” This centralized repository ensures all employees have easy access to essential information.

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Compliance Licensing Public Health Governance 52

Hall Render

OCTOBER 7, 2022

On Wednesday, September 28, 2022, Hurricane Ian made landfall along western Florida as a Category 4 storm, causing significant property damage, including to many health care facilities. Hall Render blog posts and articles are intended for informational purposes only. Overview of the Stafford Act. Resources. [i] i] 42 U.S.C.

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Nursing Homes Hospitals Public Health Nurses 73

Health Law Advisor

APRIL 4, 2023

This post uses topic modeling, a natural language processing algorithm I’ve used in previous blog posts, including here [1] and here [2] , to discern the major topics of these requests. There is no reason to believe that the categories would be obvious and completely distinct from one another. They don’t fall into cookie-cutter topics.

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Healthcare Compliance Blog

APRIL 21, 2022

The EEO-1 Component 1 report is a mandatory annual data collection that requires all private sector employers with 100 or more employees and federal contractors with 50 or more employees meeting certain criteria, to submit workforce demographics including data by race/ethnicity, sex, and job categories. 2000e-8(c), and 29 CFR 1602.7-.14

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Hall Render

NOVEMBER 30, 2023

This final stage solidifies the FDA’s regulatory oversight across all risk categories of IVDs, establishing a uniform standard for the safety and efficacy of IVDs. It is crucial to assess whether any of their LDTs fit these categories, especially in light of the FDA’s decision not to “grandfather” existing LDTs.

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Health Law Advisor

MARCH 1, 2022

But they are not nearly as accurate as they should be, or as they could be, if FDA just released a key bit of information they have been promising to share for years. The key piece of missing information is the clinical trial identifier number that clinicaltrials.gov assigns to every clinical trial posted there. They just haven’t.

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Provider Trust

JANUARY 26, 2022

According to the OIG site on Fraud Risk: OIG applies published criteria to assess future risk and places each party to an FCA settlement into one of five categories on a risk spectrum. OIG uses its exclusion authority differently for parties in each category (as described in the criteria…). So what are the risk categories?

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Fraud US Department of Health and Human Services Medicaid Medicaid 52

Provider Trust

AUGUST 16, 2023

While medical providers comprise a large percentage of healthcare vendors, other facility staff members also fall under this category. ProviderTrust data has also shown that 20% of vendor information changes annually. Gather vendor information: Obtain as much information as possible from vendors to conduct exclusion checks accurately.

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Hall Render

JANUARY 31, 2022

Information Needed within Four Hours of Entrance. laundry room, kitchen, unit, ward, wing) and if the staff is PRN/floater/agency, indicate their assigned work area on the first day of the survey. The sample size will not change if staff in a category do not exist. One whose primary vaccine series has been temporarily delayed.

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Hall Render

JULY 14, 2023

However, agencies will not see a 3.0% Agencies that fail to submit their quality data will have an additional 2% deducted from their reimbursement. Every year the rates in the final rule change slightly as CMS utilizes more current data, but agencies need to begin planning for yet another rate reduction in 2024. in June 2022.

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Medicare Medicare Payment Systems Governance 52

AIHC

AUGUST 30, 2023

Is your engagement with the telemarketing firm include providing that firm with patient names and contact information? Patient consent is essential before any personal health information is shared over the phone. The most common is your own “Web site” with information reflecting your business model and services.

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Compliance Fraud Medicare Medicare 52

Healthcare IT Today

NOVEMBER 20, 2022

Because there’s so much happening out there in healthcare IT we aren’t able to cover in our full articles, we still want to make sure you’re informed of all the latest news, announcements, and stories happening to help you better do your job. News and Studies. Specifically, certified health IT developers have a Dec.

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COVID-19 Telemedicine Hospitals Nurses 52

Healthcare Law Blog

DECEMBER 11, 2023

Imposing minimum standards on online display of information and conduct on web-brokers across all Marketplaces to protect consumer access to accurate and reliable information. CMS proposes that states should have the option to seek federal financial assistance for access to alleviate financial burden on state agencies.

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Healthcare Law Blog

MAY 25, 2023

1] Specifically, the Texas Data Privacy and Security Act (the “Act”) adds protections for consumers [2] and their personal data, which includes any information that is linked or reasonably linkable to an identified or identifiable individual. [3] 15] In addition, the Act also imposes a number of duties on processors. [16] Section 541.001(19).

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HIPAA Governance 52

SQA

FEBRUARY 26, 2024

The products had been improperly regularized in ANVISA as cosmetics since they are indicated for injectable use, a form that is not authorized for this category of product. After receiving complaints, ANVSA performed joint inspections with local health surveillance agencies. is a medical device or an accessory to a medical device.

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FDA Compliance COVID-19 Public Health 52

Healthcare Law Blog

MARCH 20, 2023

The Kaiser Family Foundation surveyed forty-four state Medicaid officials about strategies to address behavioral health workforce shortages and found the following four categories to be most critical. [6] Please refer to our blog for more information on the proposed rule. 6] Increase provider reimbursement strategies.

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Medicaid Medicaid Licensing ACA 52

Health Law Advisor

AUGUST 10, 2023

In the last couple of years, each Fall, FDA has been updating a list of machine learning applications in health care that the agency has cleared or otherwise approved. [1] In this blog post, we take on the question of when machine learning software developed by those involved in delivering health care is FDA regulated.

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FDA Licensing Hospitals Medicaid 98

Healthcare Law Blog

FEBRUARY 1, 2023

Several Current Procedural Terminology (CPT) codes are launching this year, including a category for remote therapeutic monitoring treatment-management services, codes for digital ophthalmology services and codes for remote examination by pathologists or in conjunction with the use of artificial intelligence (AI) algorithms.

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Electronic Medical Records Medicare Medicare Health Outcomes 52

SQA

FEBRUARY 22, 2021

Noteworthy changes consist of the down-classification of 15 device types (including optical endoscopes and medical microscopes) and revisions to the entries for 13 product categories (including additional classification adjustments). 26 of 2020 (link in Chinese), relating to the submission of Unique Device Identifier (UDI) information.

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COVID-19 Compliance Licensing Governance 52

Healthcare Law Blog

NOVEMBER 13, 2023

In addition, the notification would include the scope of the benefit, cost-sharing, instructions on how to access the benefit, any network application information for each available benefit, and a customer service number to call if additional help is needed.

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Medicare Medicare Medicaid Medicaid 59

Hall Render

NOVEMBER 10, 2023

New Terms OIG has identified “senior leadership” as an additional category of individuals to which the compliance officer shall advise on compliance risks and the operation of a compliance program. Hall Render blog posts and articles are intended for informational purposes only.

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Healthcare Law Blog

MAY 16, 2022

It envisions enhanced coordination, integration, and information exchange among managed care plans (MCPs); physical, behavioral, community-based, and social service providers; and county agencies. In 2015, DHCS launched the WPC Pilots as part of its Medi-Cal 2020 Section 1115 Demonstration.

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Medicaid Medicaid Nurses Health Care Access 59

Provider Trust

MAY 18, 2022

If the answer is yes, then the best mechanism for limiting CMP liability is to screen all persons that perform under that contract or that are in that job category. In addition, the suit involved alleged submission of false claims for reimbursement to the Massachusetts Medicaid Agency. The defendants settled and paid $19.95

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Compliance Due Diligence Medicaid Medicaid 52

Healthcare Law Blog

JANUARY 26, 2023

251 (1997), included conscience provisions for Medicaid and Medicare programs, prohibiting Medicaid managed care-managed organizations and Medicare Advantage plans from prohibiting or restricting a physician from informing a patient about their health and full range of treatment options. The proposed regulation 45 C.F.R.

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Healthcare Law Blog

SEPTEMBER 28, 2023

Prior to the Final Rule, CMS recouped payments for the specific hierarchical condition categories (“HCCs”) that were determined upon audit to be unsupported, but did not extrapolate those findings. The Final Rule therefore violates the APA’s requirement for the Defendants to put forth reasoned agency decision-making.

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