Uncertainty Surrounds Low Income Pool (LIP) Funding

Posted in Government Affairs, Licensure & Regulatory, Healthcare Reform Legislation, Hospitals & Health Systems, Medicare & Medicaid

The Centers for Medicare and Medicaid Services (CMS), in an August 3, 2017 letter to Florida’s Medicaid Director, approved a five-year extension of the State’s 1115 demonstration project, the Managed Medical Assistance Program (MMA). As part of this extension, CMS approved low-income pool (LIP) funding of approximately $1.5 billion annually. The LIP was created in 2005 to support hospitals, county health departments (CHD), and federally qualified health centers (FQHC) that provide charity care for the uninsured or underinsured. LIP has both state and federal funding sources. State funding is provided almost entirely through Intergovernmental Transfers (IGT) between counties, taxing districts, municipalities, and qualified institutions on behalf of those providers that receive funds from the LIP. Continue Reading

Issues and Analysis of the State’s Medicaid Managed Assistance ITN

Posted in Government Affairs, Licensure & Regulatory, Health Insurers & Managed Care Organizations, Healthcare Reform Legislation, Medicare & Medicaid

The recently released Invitations to Negotiate (ITN) for Florida’s Statewide Medicaid Managed Care program (SMMC) parallels in large part the State’s initial procurements that were released in 2012 and 2013. Where the current ITN differs, however, should be of interest to all applicants and associated parties. This blog post addresses several of the more significant changes for consideration and may serve as a platform for questions to be addressed to the Agency for Health Care Administration (AHCA). Any such questions should be forwarded to the Agency, per the ITN requirements, no later than 2:00 pm on August 14, 2017. Specifics on this may be found in Attachment A, Instructions and Special Conditions, Section A.10 of the ITN. Given that no specification challenge was raised with the Agency during the 72-hour window after release of the ITN, the Agency’s question period will be the first opportunity for prospective respondents to raise concerns and request feedback on issues that may impact their responses. Continue Reading

Medicare Fraud Strike Force Strikes Again – in a Big Way

Posted in Fraud & Abuse & False Claims Act, Healthcare Law, Medicare & Medicaid

The Medicare Fraud Strike Force initiated its largest ever healthcare enforcement action, charging 412 defendants in July 2017 with approximately $1.3 billion in fraudulent claims. The Strike Force consists of teams that include the Office of Inspector General, the Department of Justice, Offices of the United States Attorneys, the Federal Bureau of Investigation, and local law enforcement, with efforts concentrated in South Florida, Illinois, New York, Texas, Michigan, California, and Louisiana. Continue Reading

State Releases Medicaid Managed Care Invitation to Negotiate

Posted in Government Affairs, Licensure & Regulatory, Health Insurers & Managed Care Organizations, Healthcare Reform Legislation, Medicare & Medicaid

Last Friday, July 14, 2017, the Florida Agency for Health Care Administration (AHCA) released its long awaited Invitation to Negotiate (ITN) for State Wide Medicaid Managed Care services. The ITN, one for each of the 11 regions within the state, may be found on the state Vendor Bid System (VBS), the link for which is provided here. This ITN is a reprocurement of the five year program presently in effect for Medicaid beneficiaries in the 11 designated regions of the State and is open to all managed care plans with an interest in providing care and services in these areas. The opening for review of all ITN responses will be done at AHCA on or about November 1, 2017. Award decisions by the State are anticipated to be announced on April 19, 2018. AHCA reserves the right to reject any and all responses or waive minor irregularities when determined to be in the best interest of the State. Continue Reading

New York State Enforces Data Breach Notification Law

Posted in Healthcare Law, HIPAA, Privacy, and Data Security

Earlier this month, New York Attorney General Eric Schneiderman announced his state had entered into a settlement with CoPilot Provider Support Services, Inc. (CoPilot)—a settlement resulting from CoPilot’s violation of the data breach notification requirements of the New York General Business Law (GBL) that requires companies, among other things, to provide notice of a breach as soon as possible. Under the terms of the settlement, CoPilot, which operates a website physicians use to determine whether certain medications are covered by insurance, must pay a $130,000 fine, update its relevant policies and procedures to ensure compliance with New York’s consumer protection and data security laws, and train all of its officers, managers, and employees as to their duties in making certain CoPilot complies with the GBL and provides timely notice to any consumers affected by a data breach. Continue Reading

Senate Healthcare Bill Released for Public Review

Posted in Affordable Care Act and Other Healthcare Reform Legislation, Government Affairs, Licensure & Regulatory, Health Insurers & Managed Care Organizations, Healthcare Law, Healthcare Reform Legislation, Hospitals & Health Systems, Medicare & Medicaid

Just over four weeks after the Congressional Budget Office (CBO) released its score of the American Healthcare Act (AHCA), the bill passed by a narrow margin in the U.S. House of Representatives, the U.S. Senate released ‘The Better Care Reconciliation Act of 2017’. Upon initial review, we are providing a quick overview of this proposed legislation.  Continue Reading

Repeal of the Affordable Care Act Will Not Include Changes to Tax Exempt Hospitals’ 501(r) Charitable Care Obligations

Posted in Affordable Care Act and Other Healthcare Reform Legislation, Government Affairs, Licensure & Regulatory, Health Insurers & Managed Care Organizations, Healthcare Law, Healthcare Reform Legislation, Hospitals & Health Systems

While the Senate Budget Committee works to draft legislation to reconcile the American Health Care Act, the repeal and replace bill passed by the House, there is no expectation of a repeal of the charitable care obligations imposed on tax exempt hospitals under Section 501(r) of the Internal Revenue Code as part of the Affordable Care Act. Continue Reading

ERISA Exemption Upheld for Religious-Affiliated Hospitals

Posted in Healthcare Law, Hospitals & Health Systems, Tax Exempt

Hospitals that are “church-affiliated” may be breathing easier this week, following the U.S. Supreme Court’s decision on Monday that defined benefit qualified retirement plans (a/k/a pension plans) are not subject to the Employee Retirement Income Security Act (ERISA). The Supreme Court confirmed that ERISA does not require an exempt “church plan” to have actually been established by the church itself.  Rather, certain religious-affiliated healthcare organizations can establish the plans.  Continue Reading

“Sometimes Wrong, Never in Doubt” – A New Perspective?

Posted in Healthcare Law, Healthcare Litigation, Hospitals & Health Systems, Physicians

Two recent studies of medical malpractice claims highlight how patient complaints may identify those surgeons at greater risk for complications, a significant decrease in paid medical malpractice claims since 1992, and the need for greater understanding of the causes of differences in claims experience across medical specialties. Continue Reading

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