Definition, Governance, Medicaid and Medicare - Health Care Compliance Brief

CMS Issues a Final Rule Requiring Nursing Facilities and Other Providers and Suppliers to Disclose Additional Ownership Information

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]

Nurses

Nurses Medicaid Medicaid Medicare

CMS Issues Contract Year 2023 Final Rule for Medicare Advantage Organizations and Prescription Drug Sponsors

Healthcare Law Blog

MAY 16, 2022

On April 29, 2022 , the Centers for Medicare and Medicaid Services (“CMS”), issued the final rule on Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs (the “Final Rule”). Refining Definition for Fully Integrated and Highly Integrated D-SNPs (§§ 422.2

Medicare

Medicare Medicare Medicaid Medicaid

CMS Issues CY2024 Proposed Rule for Medicare Advantage Organizations and Part D Sponsors

Healthcare Law Blog

JANUARY 5, 2023

Just in time for the holidays, the Centers for Medicare and Medicaid Services (“CMS”) issued the Contract Year 2024 Proposed Rule for Medicare Advantage organizations (“MAOs”) and Part D sponsors (the “Proposed Rule”). Health Equity in Medicare Advantage. These changes include: Amending 42 C.F.R.

Medicare

Medicare Medicare Medicaid Medicaid

2020 Medicaid Managed Care Rule Summary

C&M Health Law

FEBRUARY 16, 2021

On November 13, 2020, the Centers for Medicare & Medicaid Services (“CMS”) published a final rule , demonstrating long-awaited efforts to streamline the regulatory framework governing the Medicaid and Children’s Health Insurance Program (“CHIP”) managed care programs. Actuarial Soundness.

Medicaid

Medicaid Medicaid Medicare Medicare

HHS Issues Proposed Rule to Provide Clarity on Rights of Conscience in Healthcare

Healthcare Law Blog

JANUARY 26, 2023

In this article we provide a brief summary of the Proposed Rule, while also examining the statutory amendments and previous rulemakings that create its foundation. BACKGROUND The Proposed Rule is the latest in a long line of federal legislation and rulemakings governing the conscience rights of healthcare providers and entities.

ACA

ACA Medicaid Medicaid Compliance

HIPAA Continuity of Care

HIPAA Journal

MAY 12, 2023

The term “continuity of care” has various definitions. Some definitions imply care is continuous within the same healthcare organization (or Organized Health Care Arrangement), while others extend the definition to multiple healthcare settings.

HIPAA

HIPAA Compliance Health Services Administration Medicare

Skilled Nursing Transactions Update: CMS Enhances Scrutiny of Changes of Ownership for Skilled Nursing Facilities

Hall Render

NOVEMBER 18, 2022

On November 2, 2022, CMS announced revisions to the Calendar Year 2023 Payment Policies that impact Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; and Medicare and Medicaid Provider Enrollment Policies (“CY 2023 PFS Final Rule”).

Nurses

Nurses Nursing Homes Medicare Medicare

TAKE TWO: CMS’s Second Attempt to Streamline Breakthrough Device Coverage Limited to 5 Devices Per Year

Health Law Advisor

JULY 21, 2023

On June 22, 2023, the Centers for Medicare & Medicaid Services (CMS) announced its proposed “Transitional Coverage for Technologies” (TCET) pathway—the Biden administration’s highly anticipated take on a mechanism to expedite coverage for certain devices designated by the U.S.

FDA

FDA Medicare Medicare Patient Advocacy

OIG Issues Information Blocking Penalties Final Rule: Health IT Developers and Health Information Exchanges/Networks Have a Million Reasons to Care

Health Law RX

JULY 18, 2023

2] The information blocking provisions of the Cures Act apply to three categories of actors: healthcare providers, Developers, and HIN/HIEs. The CMP Final Rule does not apply to healthcare providers unless they also fit the definition of Developers or HIN/HIEs.

Fraud

Fraud Compliance Medicaid Medicaid

Prescription Drugs in the Pandemic, Year 2: Pricing Rx and Going Direct-to-Consumer

Health Populi

AUGUST 16, 2021

adults favor increased government funding allocated to lowering the out-of-pocket costs for patients. For prescription drug manufacturers, several cost line items: providing or maintaining administrative support services, direct financial assistance (like copay cards), and donating drugs to insured patients via patient assistance programs.

COVID-19

COVID-19 Nurses Doctors Medicaid

HIPAA Updates and HIPAA Changes in 2023

HIPAA Journal

JANUARY 9, 2023

Changing the Privacy Rule to make sharing PHI with other providers mandatory rather than permissible. Changing the maximum time to provide access to PHI from 30 days to 15 days. Stating when individuals should be provided with ePHI without charge. A definition has been added for electronic health records.

HIPAA

HIPAA COVID-19 COVID-19 Vaccine Compliance

The 2022 Health Populi TrendCast for Consumers and Health Citizens

Jane Sarashon

DECEMBER 13, 2021

This big number is comprised by personal care and beauty (which had various shifts within the category in the pandemic – less color cosmetics and more skin health and hygiene), health eating and nutrition and weight loss, physical activity, and wellness tourism, among other categories.

COVID-19

COVID-19 Public Health Governance Medicaid

FDA Oversight of AI Software Developed by Health Care Providers

Health Law Advisor

AUGUST 10, 2023

Introduction Hardly a day goes by when we don’t see some media report of health care providers experimenting with machine learning, and more recently with generative AI, in the context of patient care. But the question is, to what extent do health care providers need to worry about FDA requirements as they use AI? Very brief.

FDA

FDA Licensing Hospitals Medicaid

Home Health PPS Proposed Rule for CY 2024: Broad Rule Has Something for Everyone

Hall Render

JULY 14, 2023

On Friday, June 20, 2023, the Centers for Medicare & Medicaid Services (“CMS”) posted a pre-publication copy of the Calendar Year (“CY”) 2024 Home Health Prospective Payment System Rate Update (“PPS Rule”), which has since been published in the Federal Register and is currently open for comment. in June 2022.

Medicare

Medicare Medicare Payment Systems Governance

The Cobra Effect & Enforcing Compliance Standards

AIHC

FEBRUARY 16, 2024

The GCPG is a reference guide for the health care compliance community and other health care stakeholders and provides information about relevant Federal laws, compliance program infrastructure, OIG resources, and other information useful to understanding health care compliance. Indian citizens started breeding cobras for the cash reward.

Compliance

Compliance US Department of Health and Human Services COVID-19 Hospitals

The Cobra Effect & Enforcing Compliance Standards

AIHC

FEBRUARY 16, 2024

The GCPG is a reference guide for the health care compliance community and other health care stakeholders and provides information about relevant Federal laws, compliance program infrastructure, OIG resources, and other information useful to understanding health care compliance. Indian citizens started breeding cobras for the cash reward.

Compliance

Compliance US Department of Health and Human Services COVID-19 Hospitals

A Health-Heavy State of the Union

Kaiser Health News

FEBRUARY 9, 2023

He took a victory lap on recent accomplishments like capping prescription drug costs for seniors on Medicare. And he sparred with Republicans in the audience — who jeered and called him a liar — over GOP proposals that would cut Medicare and Social Security. Here is the tape.

US Department of Health and Human Services

US Department of Health and Human Services Medicare Medicare FDA

Costs, Consumerism, Cyber and Care, Everywhere – The 2019 Health Populi TrendCast

Health Populi

DECEMBER 25, 2018

This bill would create a government-run drug company to produce and distribute generic medicines. Employers will endeavor to artfully design consumer-directed benefit plans (CDHPs) that nudge insured workers toward healthier habits, while integrating a broader definition of wellness.

Health Insurance

Health Insurance Hospitals Doctors Medicaid

GOP House Opens With Abortion Agenda

Kaiser Health News

JANUARY 12, 2023

But Medicare is likely to be on the agenda, which will require the input of the chairs of both committees. Still to be determined is whether Medicare — which provides insurance to most people with Alzheimer’s — will cover the drug. One thing is certain: The new GOP-controlled House will do a lot of investigations.

US Department of Health and Human Services

US Department of Health and Human Services FDA Medicare Medicare

Gearing up for Immunizations

Redox

DECEMBER 4, 2020

As an aside, I definitely enjoyed Pfizer’s bump from 90% to 95% efficacy after Moderna’s announcement …yay for capitalism? Those challenges can be broken down into two general categories: How do we get it to everyone? Providers would submit records of the vaccinations that they had performed, which were then recorded manually.

Public Health

Public Health Governance Doctors Medicare

Universal Health Care and Financial Inclusion – Not Mutually Exclusive

Health Populi

MAY 6, 2018

government (which offers several flavors of plans through the VA, Tricare for active military, Medicare for aging people and Medicaid for people with low-incomes) or private sector employers, unions, and other insurance-conveners. .” At the time, this was one of the world’s biggest public-sector financed health plan.

Medicaid

Medicaid Medicaid Medicare Medicare

Guest Post – CMS Health Care Staff Vaccination Rule Enforceable as Challenges Continue

Drug & Device Law

JANUARY 16, 2022

It concern’s the Supreme Court’s 6-3 decision to permit the government to continue enforcement of its requirement that healthcare workers (at least those in facilities that accept Medicare/Medicaid, which is most of them) be vaccinated to avoid infecting themselves and their patients with COVID-19. Initially the U.S.

Compliance

Compliance COVID-19 Medicaid Medicaid

Health Care Compliance Brief

CMS Issues a Final Rule Requiring Nursing Facilities and Other Providers and Suppliers to Disclose Additional Ownership Information

CMS Issues Contract Year 2023 Final Rule for Medicare Advantage Organizations and Prescription Drug Sponsors

Trending Sources

CMS Issues CY2024 Proposed Rule for Medicare Advantage Organizations and Part D Sponsors

2020 Medicaid Managed Care Rule Summary

HHS Issues Proposed Rule to Provide Clarity on Rights of Conscience in Healthcare

HIPAA Continuity of Care

Skilled Nursing Transactions Update: CMS Enhances Scrutiny of Changes of Ownership for Skilled Nursing Facilities

TAKE TWO: CMS’s Second Attempt to Streamline Breakthrough Device Coverage Limited to 5 Devices Per Year

OIG Issues Information Blocking Penalties Final Rule: Health IT Developers and Health Information Exchanges/Networks Have a Million Reasons to Care

Prescription Drugs in the Pandemic, Year 2: Pricing Rx and Going Direct-to-Consumer

HIPAA Updates and HIPAA Changes in 2023

The 2022 Health Populi TrendCast for Consumers and Health Citizens

FDA Oversight of AI Software Developed by Health Care Providers

Home Health PPS Proposed Rule for CY 2024: Broad Rule Has Something for Everyone

The Cobra Effect & Enforcing Compliance Standards

The Cobra Effect & Enforcing Compliance Standards

A Health-Heavy State of the Union

Costs, Consumerism, Cyber and Care, Everywhere – The 2019 Health Populi TrendCast

GOP House Opens With Abortion Agenda

Gearing up for Immunizations

Universal Health Care and Financial Inclusion – Not Mutually Exclusive

Guest Post – CMS Health Care Staff Vaccination Rule Enforceable as Challenges Continue

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