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Photo of Posts by Martin A. Corry Martin A. Corry
Chair of Government Relations & Public Policy
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Showing 4 posts by Martin A. Corry.

On Friday, April 5, 2019, the Centers for Medicare & Medicaid Services (“CMS”) finalized its fall 2018 proposal to expand coverage of telehealth benefits for Medicare Advantage beneficiaries, creating a new category of benefits entitled “additional telehealth benefits.” This brief alert highlights what this development means for healthcare providers, before reviewing the various ways in which Congress and CMS have expanded the telehealth benefits available to Medicare beneficiaries throughout 2018 and 2019.

Background: Telehealth Coverage by Medicare and Medicare Advantage

Medicare Coverage of Telehealth. Historically, Medicare has only covered telehealth services delivered to Medicare fee-for-service (“FFS”) beneficiaries when the services at issue satisfy the requirements for “Medicare telehealth services” set forth in § 1834(m) of the Social Security Act, and codified at 42 U.S.C. § 1395m(m). In order to be eligible for payment, such services must satisfy five requirements: the services must be rendered to a patient in a rural health professional shortage area (“HPSA”) or in a county which is not included in a metropolitan statistical area (“MSA”) (unless an exception applies); the patient must be located at an approved “originating site;” the services must be delivered through an approved telecommunications system; the service must be rendered by an approved type of provider; and the service provided must be included on CMS’ list of approved “Medicare telehealth services,” which it updates annually. In the past few years, Congress and CMS have broadened the authority to offer telehealth based services both in Medicare FFS and in Medicare Advantage. Read More ›

Hooper, Lundy & Bookman, PC, has joined forces with ECG Management Consultants, Inc. to produce a multipart series exploring the impact of MACRA as it unfolds and highlighting ways for hospitals and other providers to stay ahead of the curve.  

In this second article we explore the two track physician reimbursement methodology under MACRA: the Merit-Based Incentive Payment System (MIPS) and the Alternative Payment Model (APM).

 The first article in the series is available here.

On June 25, 2015, the U.S. Supreme Court issued its decision in King v. Burwell, concluding that Congress made premium tax credits available nationwide-on both state-run and HHS-established Exchanges. This is the second challenge to the individual health insurance market reforms of the Affordable Care Act (ACA) to reach the Court and the second ACA opinion to be authored by Chief Justice John Roberts. Previously, in NFIB v. Sebelius, Chief Justice Roberts wrote for the Court in concluding that the ACA's individual mandate was a constitutional exercise of Congress' taxing power. Read More ›

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