Duane Morris Health Law

October 21, 2011September 10, 2014 by Duane Morris

Final Antitrust Policy Statement Regarding ACOs in Medicare Shared Savings Program

On October 20, 2011, the U.S. Federal Trade Commission and the Department of Justice, which coordinate enforcement of the antitrust laws, issued their final Statement of Antitrust Enforcement Policy Regarding Accountable Care Organizations Participating in the Medicare Shared Savings Program (the “Enforcement Policy”). The fundamental principle of the Enforcement Policy is that the agencies will apply the rule-of-reason analysis to all accountable care organizations applying for or participating in the Shared Savings Program and, if the same services are involved, to commercial insurance products modeled on the Shared Savings Program.

Please read the associated Duane Morris Alert for full details.

October 18, 2011August 18, 2014 by Neville M. Bilimoria

OIG’s 2012 Work Plan For Nursing Facilities: Same Fraud, Different Enforcement

Recently, the United States Department of Health and Human Services Office of Inspector General (“OIG”) published its Work Plan for fiscal year 2012 (“Work Plan”) and delineated focus points for nursing facilities and new enforcement in 2012. The Work Plan is not much different than previous work plans with the exception of increased areas of enforcement, as well as a few new areas to be looked at by OIG.

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October 14, 2011September 10, 2014 by Duane Morris

HHS Suspends ACA’s Class Act for Long-Term Care Insurance

Late this afternoon the Department of Health & Human Services’ (HHS)Secretary Kathleen Sebelius pulled back a long-term care insurance program, the Class Act, that was passed under last year’s Affordable Care Act. The Class Act’s goal was to create an insurance program that could cover the health care costs associated with many activities of daily living, including bathing and toileting. Speaking today, the Health & Human Services Secretary Kathleen Sebelius said that there didn’t appear to be a viable path for the Class Act, in part due to increasing concern that the program would have created substantial long-term costs.

Read Kathleen Sebelius’ full letter to Congress here.

October 3, 2011September 10, 2014 by Duane Morris

Government Accountability Office Reports that 340B Program Needs Greater Oversight

Pursuant to a mandate in the Affordable Care Act, the Government Accountability Office (GAO) recently completed its review of the 340B Drug Pricing Program, which allows certain health care entities such as federal grantees and hospitals to receive discounted outpatient drugs. There are currently over 16,500 entities that participate in the 340B program.

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September 28, 2011September 10, 2014 by Duane Morris

Affordable Care Act Funds Support Healthier Communities

The U.S. Department of Health & Human Services (HHS) recently rolled out its Community Transformation Grants program under the Affordable Care Act, geared towards fighting chronic disease and creating healthier communities. The five year grants will be used to address the “root causes” of chronic diseases through creating tobacco-free living, supporting active lifestyles and healthy eating, and reducing health disparities. 35 of the grantees will receive funding to implement intervention programs, and 26 grantees will receiving funding to build sustainable community prevention efforts.

HHS Announces Launch of Primary Care Bonus Initiative

The U.S. Department of Health & Human Services (HHS) recently announced the launch of its new Primary Care initiative to provide bonuses to primary care doctors for improvement of care coordination and cost efficiency. The goal of the initiative, created under the Affordable Care Act, is to facilitate care that is focused on the patient, coordination, and higher quality. The bonuses will be offered through commercial and state health insurance plans, and will come in the form of monthly fees above and beyond Medicare fees received for patient care. HHS has identified five primary areas that the fees will support including personalized care plans for chronically ill patients, 24-hour access to care and health information, preventive care, patient and family participation in care, and coordination among providers.

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September 28, 2011September 10, 2014 by Duane Morris

CMS Expands Medicaid Money Follows the Person Program

The Centers for Medicaid & Medicare Services (CMS) recently expanded the Money Follows the Person grant program to provide additional assistance to state grantees’ implementation of quality improvement strategies. The Money Follows the Person program was created through the Affordable Care Act (ACA), and fifteen states received funds under the program in January 2011. Due to increases in demand from states and programs under the ACA, additional funds were needed to support the new individuals benefitting from the program including support for quality mechanisms addressing the needs of vulnerable populations. Through its recent notice, CMS announced its $1.2 million expansion of the program to be used for developing technical assistance to grantee staff and subcontractors, home and community-based services programs, CMS staff oversight, and web-based technical assistance.

Access the full notice here.

September 27, 2011September 10, 2014 by Duane Morris

Medicare Advantage Premiums Falling and Enrollment Up for 2012

HHS recently announced its expectation that Medicare Advantage premiums will fall approximately four percent in 2012, with enrollment expected to increase by 10 percent. This drop in premiums has been supported by the Affordable Care Act, which allowed CMS to prevent substantial cost increases or program cuts through elimination of co-pays and deductibles for Medicare-covered preventive services and additional discounts for Medicare beneficiaries that reach the prescription coverage “donut hole.” CMS is also offering high-quality performance incentives, including financial rewards and continuous marketing and enrollment to Five-Star Medicare Advantage and Part D plans.

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September 27, 2011September 10, 2014 by Duane Morris

CMS Asking Providers to Submit Letter of Intent to Participate in Bundled Payments for Care Improvement Initiative

Providers, including hospitals, physicians and non-physician practitioners still have time to contribute to the growing accountable care model by submitting to CMS a Letter of Intent to participate in the Bundled Payments for Care Improvement initiative to CMS. CMS is seeking applicants who are willing to participate in one of the four models for episode-based payment for acute and post-acute care created under the Bundled Payments for Care Improvement initiative. The initiative will start in 2012 and is geared toward aligning incentives between providers to improve coordination throughout episodes of care. The four models are described in detail here: http://innovations.cms.gov/documents/pdf/Fact-Sheet-Bundled-Payment-FINAL82311.pdf.

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September 15, 2011September 10, 2014 by Duane Morris

Accountable Care Act Funding Awarded to Community Health Centers

On September 15, 2011, HHS awarded $10 million in Accountable Care Act funds to 129 organizations seeking to become community health centers, which are geared toward meeting the primary health needs in economically distressed or other vulnerable areas. The funds were specifically directed toward organizations that seek to provide primary healthcare services, or to expand existing services, to vulnerable populations. Likewise, the development of the community health centers will boost local economic growth and support local job markets. For more information on the community health centers program, see http://bphc.hrsa.gov/about/index.html.