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Health Care Counsel Blog

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The Sixth Circuit has issued an important decision that condemns plan provisions that provide different benefits based on a patient’s need for continued dialysis, even if the provision applies to all dialysis patients and not just those with end-stage renal disease (ESRD). 
Three organizations serving primarily HIV and AIDS patients and who each are also considered “Covered Entities”.
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Home health is a $100 billion industry in the U.S., spanning more than 33,000 provider organizations.
With increased financial pressure on the health care delivery system, there is likely to be an increase in health care provider financial restructurings.
On September 24, 2020, the California Court of Appeal shed additional light on meeting the public interest requirements in anti-SLAPP motions in its opinion of Murray v. Tran (Cal. Ct. App., Sept. 24, 2020, No. D076104).
California Governor Newsom signed Senate Bill 1237 (SB 1237), broadening the certified nurse midwife (CNM) scope of practice, among other changes to the Nursing Practice Act and other Sections of the Business and Professions Code. 
For the first time, California has granted nurse practitioners who meet certain qualifications a separate scope of practice. This eventually will allow them to practice specified medical functions independently, without standardized procedures.
Arent Fox Partner David Greenberg is presenting on health care policy issues at Gallagher’s ‘2020 Election: Healthcare Policy Outcomes & Impacts to Plan Sponsors’ virtual town hall.
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HHS has finalized the CARES Act provider reporting and recoupment rules and they are different from those put forth in the proposed form. Providers should take careful note — the new requirements are significant and detailed.
On September 18, 2020, under the authority of the Center for Medicare and Medicaid Innovation, CMS finalized the new Radiation Oncology Alternative Payment Model (Model), with a new payment methodology for radiation therapy (RT) services.
In recent years, the US health care system has experienced unprecedented challenges, an increasing pace of change, and ever-growing complexity.
Following up on the recent New York State Executive Order the New York City Department of Health and Mental Hygiene issued an alert advising providers that all point-of-care COVID-19 test results must be reported electronically via the New York State Electronic Clinical Laboratory Reporting.
The Centers for Medicare and Medicaid Services (CMS) has withdrawn its proposed Medicaid Fiscal Accountability Regulation (MFAR), according to a September 14, 2020, announcement via Twitter by Administrator Seema Verma.
Multiple members of Congress issued a letter to HHS Secretary Alex Azar on September 14, 2020, urging him to use his authority to compel pharmaceutical manufacturers to comply with the laws and regulations governing the 340B Drug Pricing Program.
The White House released a new Executive Order on September 13, 2020, related to drug prices titled “Lowering Drug Prices by Putting America First” the September Order), whose stated purpose is to address reimbursement for prescription drugs under both the Medicare Part B and Medicare Part D program
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The FCC’s Connected Care Pilot Program is poised to defray eligible health care providers’ costs of providing certain telehealth services. On September 3, 2020, the FCC issued additional information and guidance for potential applicants.
Medical providers treating patients covered by ERISA-governed health plans on an out-of-network basis can assert state-law claims to hold plans to their payment promises without running afoul of ERISA’s preemption provision (ERISA § 514(a), 29 U.S.C. § 1144(a)).
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In a move with far reaching implications for the health care industry, the Department of Health and Human Services (HHS) recently released a proposed rule that would codify into regulation specific requirements that it and its related agencies must follow when issuing guidance to the public or regul
CMS is soliciting comments on whether future payments for devices that may have been impacted by the COVID-19 PHE should be adjusted.
Due to the broader spread of COVID-19 in California, the Department of Consumer Affairs (DCA) has extended numerous professional licensing waivers to facilitate the delivery of patient care during the state of emergency.
On August 17, 2020, the Centers for Medicare and Medicaid Services (CMS) issued a Guidance Memorandum (Guidance) setting forth revised state survey agency priorities as well as providing information regarding the resumption of enforcement activities and resolution of open enforcement cases.
On August 17, 2020, CMS encouraged State Survey Agencies to resume some of their normal enforcement activities.
After a four-month hold, CMS announced on August 6 that it would resume Medicare Fee-For Service (FFS) medical reviews.
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Members of the industry should be on the lookout for proposed rules related to this Order and take advantage of all public comment periods.
Pharmaceutical manufacturers and other stakeholders should submit comments on the Proposed Rule by July 20, 2020.