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Showing 5 posts in Government Relations & Public Policy.

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 ›

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 ›

On Friday, December 21, 2018, CMS issued a final rule, referred to as “Pathways for Success,” that makes significant changes the Medicare Shared Savings Program. Issued just before the holidays, various stakeholders will likely have varying opinions about whether this final rule constituted an early gift or lump of coal. Among other things, the final rule overhauls the current track system for participating accountable care organizations, or ACOs, and requires a more rapid transition to assumption of downside risk. The two new tracks available to participating ACOs will go into effect for agreement periods commencing on or after July 1, 2019. Read More ›

On October 24, 2018, President Trump signed into law the bipartisan SUPPORT for Patients and Communities Act (H.R. 6 or the “Act”), which aims to combat opioid abuse with increased attention to treatment. The wide-reaching compromise legislation combines elements from a number of opioid bills, addressing issues from access to treatment and prevention programs to expanded law enforcement efforts to curtail drug trafficking. The Act, however, does omit several items that have been part of the national dialogue on opioid abuse. For example, it does not include amendments to 42 U.S.C. § 290dd-2 and the associated regulation at 42 C.F.R. Part 2 (“Part 2”) that would align the Part 2 substance use treatment privacy law with the Health Insurance Portability and Accountability Act (“HIPAA”) privacy rules to better facilitate the sharing of a patient’s substance use disorder information among providers. In addition, the Act does not provide for a significant increase in spending for the opioid crisis. Read More ›

Hooper, Lundy & Bookman, P.C. is pleased to announce that Lisa K. Layman has joined the firm as a principal in the firm's Government Relations and Public Policy Department.  Read More ›

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