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No More Bidding - CMS 2, EGWPs 1

June 2, 2016 | Blog | By Tara E. Dwyer

Under the new payment methodology, EGWPs will no longer be paid based on their bid and applicable benchmark, rather they will be paid an amount established by comparing non-EGWP bids to the applicable benchmark (all adjusted for location, Star Ratings, and risk scores). This change was proposed for 2017, but CMS delayed the full implementation until 2018.
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Study Finds Widespread HIPAA Violations Occurring on Yelp

June 2, 2016 | Blog

It is no secret that the Health Insurance Portability and Accountability Act (HIPAA) is a trap for the unwary. A recent study by the non-profit ProPublica has uncovered that the online review site Yelp (as well as other rating sites) are making it easier for covered entities to be ensnared.
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Research Opens a Door for Disability Policy

June 2, 2016 | Blog

One of the challenges of policy making is that bills must go before the Congressional Budget Office (CBO). CBO has one of the toughest jobs in Washington. Their job is to dispassionately look at policy and evaluate the cost of the bill to the federal treasury. Sometimes that means splashing cold water on the high-minded aspirations of policy makers. 
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FTC Wins Stay of Pennsylvania Hospital Merger Pending Appeal in Third Circuit

May 26, 2016 | Blog | By Dionne Lomax

The Third Circuit granted on Tuesday the Federal Trade Commission’s (“FTC”) request for an injunction pending appeal of the proposed merger between Penn State Hershey Medical Center and Pinnacle Health System. 
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Check Your Inbox: OCR Continues to Verify Entity Contact Information for Phase 2 HIPAA Audits

May 23, 2016 | Blog

Covered Entities need to continue to check their inboxes for emails from the HHS Office for Civil Rights (“OCR”) requesting verification of contact information in connection with Phase 2 of the HIPAA Audit Program. OCR previously indicated that Covered Entities would begin to receive verification emails in May.
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Recap: 2016 Mintz/ML Strategies Pharmacy Industry Summit

May 19, 2016 | Blog | By Theresa Carnegie

The pharmacy industry is under increasing scrutiny from all angles. Whether at the legislative or agency level, Washington as well as many states seem intent on addressing perceived issues surrounding drug pricing, reimbursement and program integrity.
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FDA Releases Draft Guidance for 3D Printed Medical Devices

May 17, 2016 | Blog | By Joanne Hawana

On May 10, 2016, FDA released its first draft guidance for medical device manufacturers who are using additive manufacturing (AM), commonly referred to as 3D printing.
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OIG Issues Favorable GPO Advisory Opinion

May 16, 2016 | Blog | By Ryan Cuthbertson

The OIG recently issued a favorable advisory opinion permitting a health system (the “Health System”) to become the sole owner of a Group Purchasing Organization (“GPO”), some of whose members were also owned by the Health System (the “Proposed Arrangement”).
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FTC Granted 2-Week Reprieve in Effort to Block Pennsylvania Hospital Merger

May 13, 2016 | Blog

The Federal Trade Commission (“FTC”) and the state of Pennsylvania have two weeks to persuade the Court of Appeals for the Third Circuit that the pending merger of Penn State Hershey Medical Center (“Hershey”) and Pinnacle Health System (“Pinnacle”) is anti-competitive. 
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Alternative Payment Models (APMs) Under MACRA Proposed Rule

May 6, 2016 | Blog | By Lauren Moldawer

Continuing our blog series on CMS’s massive proposed rule for the implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), we dedicate this post to examining the Advance Payment Model (APM) provisions of the proposed rule.
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Four Days Until The Mintz/ML Strategies Pharmacy Industry Summit

May 6, 2016 | Blog | By Theresa Carnegie

Here in Washington, it seems everyone has an idea on a drug “fix”:  amendments to the provisions governing Medicare reimbursement, new rebate requirements, changes to price reporting measures, revisions to the 340B Drug Discount Program, etc. Proposals are interesting, but will Congress actually do anything?  If anything is actually going to pass, it has to get through the Senate.
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Already Enormous False Claims Act Penalties Set to Increase

May 6, 2016 | Blog | By Brian Dunphy, Samantha Kingsbury

The already enormous per-claim penalties under the federal False Claims Act (“FCA”) may nearly double by August 1, 2016, ratcheting up the stakes of FCA cases for health care providers, pharmaceutical and medical device manufacturers, and life sciences companies subject to the FCA.
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Five Days Until The Mintz/ML Strategies Pharmacy Industry Summit

May 5, 2016 | Blog | By Theresa Carnegie

Following our first panel discussing Drug Pricing Challenges and Opportunities, the second panel, which Theresa is moderating involves a subject near and dear to the heart of many of our clients: The New Wave of Value-Based Pricing and Contracting.
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CMS Proposes “Advancing Care Information” Program to Replace Meaningful Use

May 5, 2016 | Blog | By Dianne Bourque

The Medicare Access and CHIP Reauthorization Act (MACRA) proposes a new approach, with new branding labels, to paying clinicians for the value and the quality of care that they provide by replacing a patchwork of existing quality-related programs, including the Electronic Health Records (EHRs) Incentive Programs, also known as “Meaningful Use.” 
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Six Days Until The Mintz/ML Strategies Pharmacy Industry Summit

May 4, 2016 | Blog | By Theresa Carnegie

We are thrilled that our inaugural Pharmacy Industry Summit is now less than a week away.  The Summit is next Tuesday May 10th, 2016, here in our DC offices.  Since we started planning for the Summit many months ago, this hottest of topics that we chose to cover, drug pricing, has become even hotter.
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New Compounding Policies from FDA May Affect Hospital and Health System Pharmacy Operations

May 3, 2016 | Blog | By Joanne Hawana

Last month, the FDA released three draft guidance documents that are expected to have significant implications for traditional pharmacy-based compounding and the distribution of those drug products.
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CMS Releases Proposed Rule for MACRA Implementation – Overview and Merit-Based Incentive Payment Systems (MIPS)

May 3, 2016 | Blog

On April 27, 2016, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule that would put in place key parts of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
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CMS Increases Oversight of Medicaid Managed Care Contracts

April 28, 2016 | Blog

As noted in a post published yesterday, CMS issued the final rule regarding Medicaid managed care earlier this week. With this rule, CMS is taking a much more active role in overseeing states’ Medicaid managed care contracts.
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After New York, Florida Curbs Surprise Bills for Emergency and Out-of-Network Services

April 28, 2016 | Blog

It is generally understood that if a managed care member utilizes the services of a non-participating provider, the member could incur significant out of pocket expenses. However, there are instances where a member may unknowingly receive services from an out-of-network provider, such as a radiologist or anesthesiologist, while receiving emergency or non-emergency care at an in-network hospital. 
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The IMD Exclusion: Changes Now and Changes to Come

April 27, 2016 | Blog

On Monday, CMS finalized their long-awaited Medicaid managed care regulation. Deep in the regulation was a change to allow Medicaid reimbursement for facilities that had previously been excluded from receiving payments. Known as the Institution for Mental Disease (IMD) Exclusion, this change has a significant impact on mental health and substance abuse treatment now and in the future.
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