{ Banner for HLB Health Law & Policy Blog }

Search

Get updates

Blog Contributors

Archived Blog Posts

Showing 20 posts from 2019.

Hooper, Lundy & Bookman, P.C. (HLB) wants to make hospitals aware of current adjustments being imposed by certain MACs denying pass-through treatment of allied health program costs, including nursing, pharmacy and pastoral care. The denial of pass-through treatment is based on the view of some MACs that any administrative involvement by a home office means that the hospital does not appropriately incur the costs of the allied health program and do not, as a result, comply with 42 C.F.R §413.85(f).  We expect that this improper practice could spread to other MACs.

This is improper because nearly all hospital chains use a home office to perform administrative functions for their hospitals, such as processing payroll, and these costs are allocated to each of the hospitals in the chain.  Such functions, and the allocation of various administrative costs, does not mean that a hospital does not operate, control, or incur the costs of its allied health programs.  The denial of pass-through treatment of allied health programs also is improper because it reverses long-standing agency policy that has been in place since at least 1984, without appropriate authority. Read More ›

A number of our clients have provided medical care to patients covered by the now-defunct Riverstone Capital LLC multiple employer welfare arrangement (the “Riverstone MEWA”) and have still not been paid.

On May 9, 2019, the federal judge handling liquidation proceedings for the Riverstone MEWA issued his final order approving the Independent Fiduciary’s Plan of Liquidation.

Healthcare providers now have until May 28, 2019 to submit all reimbursement claims to the appropriate Third Party Administrators (TPAs) (Hawaii Mainland Administrators and S&S Healthcare Strategies). Read More ›

California’s Department of Managed Health Care (“DMHC”) recently finalized regulations that significantly expand what it means to take on “global risk,” which triggers the requirement to obtain a Knox-Keene license or an exemption. Historically, the requirement to obtain a Knox-Keene license has been reserved for health maintenance organizations (“HMOs”) or other organizations that are paid on a capitated basis in exchange for providing or arranging health care services.

The new regulation will disrupt this status quo by sweeping in a range of value-based payment arrangements – potentially including independent practice association (“IPA”) participation in hospital risk pools and some accountable care organizations (“ACOs”) – that providers have historically entered into without needing to be licensed as a Knox-Keene plan. California-based providers that engage in these types of payment arrangements should therefore pay special attention to these new rules as they are implemented. Read More ›

On Thursday, the President held a White House event to discuss surprise medical bills, calling on Congress to pass bipartisan legislation to increase price transparency and limit patients’ out-of-pocket medical costs.  During his remarks, President Trump outlined the following policy principles to guide Congress in developing potential legislation: Read More ›

A number of our clients have provided medical care to patients covered by the now-defunct Riverstone Capital LLC multiple employer welfare arrangement (the “Riverstone MEWA”) and have still not been paid. This Alert offers an update on the liquidation proceedings in California federal court, and identifies steps that providers should take in order to protect their rights to payment in the coming months.

As background, Bakersfield, CA-based Riverstone Capital LLC was held after an investigation by the U.S. Department of Labor (DOL) to have mismanaged the Riverstone MEWA. Among other things, Riverstone failed to set adequate premiums, commingled funds, and charged excessive fees to over a hundred employers who hired Riverstone to provide healthcare benefits to their employees and dependents. Because there were insufficient assets to pay claims, Riverstone began to delay the payment of approved claims and "cherry-picked" which claims to pay. DOL found these actions to be serious violations of the Employer Retirement Income Security Act (ERISA), which governs the vast majority of the affected employers’ participating plans. Read More ›

For media assistance, please contact Maura Fisher at 202-580-7714.