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 …
Cigna-Express Scripts, CVS-Aetna deals continue vertical integration in healthcare
By Curtis Campbell, Class of 2019; Kim Looney, Partner at Waller The Cigna-Express Scripts and the CVS Health-Aetna mergers are among the most significant healthcare mergers of the past decade and are anticipated to transform the U.S. healthcare business. Both of these vertical deals have successfully shown how they can provide consumer benefits in order …
Requesting EMTALA waivers during a natural disaster
By Seth Carver, Class of 2020; Andrew F. Solinger, Associate at Waller With the start of hurricane season, and the recent destruction caused by Hurricane Florence on the Carolinas and beyond, hospitals must review and update their policies and procedures to ensure that proper care can be provided to patients following surges caused by natural …
Federal government tightening enforcement for hospice, post-acute care providers
By Curtis Campbell, Class of 2019; Jessie C. Neil, Partner at Waller; J. Logan Wilson, Associate at Waller The Department of Health and Human Services’ Office of Inspector General (OIG) recently announced that it had found several vulnerabilities in the Medicare hospice program while examining practices between 2006 and 2016. The number of beneficiaries in the program …
Pathways to Success: CMS proposes accelerated shift to provider risk in ACOs
By Clay Brewer, Class of 2020; Jesse C. Neil, Partner at Waller In an effort to facilitate the American healthcare system’s transformation from volume-based to value-based payment, the Centers for Medicare and Medicaid Services (CMS) is requesting public comment regarding its newly proposed rule that would shift the amount of risk participants in Accountable Care …
10 ways you can protect your company from a cyberattack
By Emmie Futrell, Class of 2018; Robb S. Harvey, Partner at Waller; Elizabeth N. Pitman, Counsel at Waller The government, through the United States Department of Justice, has increased its efforts to respond to cyberattacks, a hot-button issue that extended across disciplines in 2017. The newly created Cyber-Digital Task Force has been charged with developing policies to combat global …