By Philip FitzGerald, Class of 2019; Colin H. Luke, Partner at Waller In late March, the Department of Justice (“DOJ”) issued a letter to the U.S. Court of Appeals for the Fifth Circuit supporting the holding by District Court Judge Reed O’Connor that the Affordable Care Act’s (“ACA’s”) individual mandate is unconstitutional and therefore the …
Several Southeastern states seek to eliminate or relax Certificate of Need laws
Philip FitzGerald, Class of 2019; Kim Harvey Looney, Partner at Waller; Zachary D. Trotter, Associate at Waller State certificate of need (“CON”) programs regulate the building and expansion of health care facilities and the acquisition of health care equipment. In our region, the states of Tennessee, Georgia, South Carolina, and North Carolina have bills working …
HHS launches innovative payment model for ambulance providers
Curtis Campbell, Class of 2019; Kim Harvey Looney, Partner at Waller The United States Department of Health and Human Services (HHS) recently announced a new payment model for emergency ambulance services that will permit Medicare patients to be transported to healthcare facilities other than hospital emergency departments. The Emergency Triage, Treat and Transport (ET3) model …
The Amazon-Berkshire Hathaway-JPMorgan Chase healthcare venture remains a mystery
Seth Carver, Class of 2020; Neil B. Krugman, Partner at Waller In early 2018, Amazon announced a joint healthcare venture with Berkshire Hathaway and JPMorgan Chase to build an independent, nonprofit healthcare company targeted at improving care and reducing costs for its employees. Since then, the joint venture has continued to form and develop, hiring …
New access standards for veterans to receive community care
Philip FitzGerald, Class of 2019; Colin H. Luke, Partner at Waller Last month, the Department of Veterans Affairs (“VA”) proposed new access standards for community care as part of the implementation of the MISSION Act, which President Trump signed into law last June. One goal of the MISSION Act is to provide veterans with greater …
OIG advisory opinion approving smartphone initiative
By Clay Brewer, Class of 2020; Caitlyn W. Page, Partner at Waller An advisory opinion issued recently by the Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) provides some insight into the growing relationship between access to technology and access to patient care. The OIG issued Advisory Opinion No. …
Fifth Circuit resumes consideration of district court decision invalidating the Affordable Care Act
By Philip FitzGerald, Class of 2019; Colin H. Luke, Partner at Waller In late 2018, federal District Court Judge Reed O’Connor held that the Patient Protection and Affordable Care Act (the “ACA”) was invalid. The lawsuit was filed by a coalition of Republican attorneys general and governors, and was based upon the Tax Cuts and …
Trump Administration Opens Door for Broader Contraceptive Mandate Exemptions
By Matthew Byron, Class of 2019 The Affordable Care Act (ACA) does not currently mandate that insurers cover contraceptives under their respective plans. However, in 2011, the Departments of Health and Human Services, Treasury, and Labor (the Departments) issued regulations requiring non-grandfathered group health plans and health insurers to cover all FDA-approved contraceptives. Under those …
CMS Proposed Rule Change for ACO Payments
By Curtis Campbell, Class of 2019; Andrew F. Solinger, Attorney at Waller The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule that would overhaul the Medicare Shared Savings Program, which was established by the Affordable Care Act (ACA). Currently, the vast majority of Medicare’s Accountable Care Organizations (ACOs) operate under the Medicare Shared …
2017 MIPS Performance Feedback Reports may erroneously report 2019 Medicare payment adjustments
By Tayler Chambless, Class of 2020; Elizabeth N. Pitman, Counsel at Waller 2017 was the first year for participation in the Merit-based Incentive Payment System (MIPS), a Quality Payment Program (QPP) implemented by CMS, to award or penalize participating clinicians with regard to future Medicare reimbursements based upon reporting under four categories: Quality Improvement Activities …