On Thursday, April 8, 2021, the Center for Medicare and Medicaid Innovation (the “Innovation Center”) announced its final list of 53 organizations set to participate in the Global and Professional Direct Contracting (“GPDC”) Model (previously named the Direct Contracting Model for Global and Professional Options).  The 53 Direct Contracting Entities (“DCEs”) are participating in the first Performance Year (“PY2021”) of the GPDC Model, which runs from April 1, 2021 through December 31, 2021. The DCEs will serve Medicare fee-for-service (“FFS”) beneficiaries in 38 states as well as in the District of Columbia and Puerto Rico.
Continue Reading CMS Announces Final Organizations for the Global and Professional Direct Contracting Model, Halts Additional Applications and Future Solicitations

With the uptick in the pace of vaccinations and lifting of restrictions in many states over the past few weeks, a clearer picture of the road ahead is coming into focus.  In a timely discussion, Los Angeles’ Association for Corporate Growth (ACG) hosted healthcare industry leaders to share lessons learned over the past year, what’s here to stay, and what’s on the horizon.  ACG dubbed the panel “Coming up for Air: Healthcare Investing and Growth in 2021 and Beyond,” which featured leaders from various healthcare sectors, including Shane Armstrong, President and General Counsel at American Vision Partners (AVP); John DiGiovanni, Investment Partner at Arsenal Capital; and Rob Mahan, CEO at Exer Urgent Care.  The panel was moderated by Aytan Dahukey, Partner and Private Equity Team Leader at Sheppard Mullin and Adam Abramowitz, Managing Director at Intrepid Investment Bankers.
Continue Reading ACG Panel Paints a Bright Future for Healthcare Investment and Growth

On March 10, 2021, President Biden signed into law the American Rescue Plan Act of 2021 (the “Act”). This $1.9 trillion COVID-19 relief package not only includes a whole host
Continue Reading The American Rescue Plan Act of 2021: A New Lease on Life for the Affordable Care Act?

Utah Bill Uses Telehealth to Address Mental Health

On March 2, 2021, Utah Governor, Spencer Cox, signed Senate Bill 41 (“SB41”) into law. The bill, sponsored by State Senator Luz Escamilla, allows coverage for mental health services delivered by telehealth – often referred to as “telemental health” services.  While we have seen many states move to create greater access to telehealth services in efforts to address the current public health crisis (the “Pandemic”), Utah is one of the first states to expand telehealth coverage to address the mental well-being of its citizens.  In a statement to State of Reform, Sen. Escamilla noted that “mental health is becoming a big crisis and in our state we’re seeing an increase in needs, and access has become very limited.”
Continue Reading The “State” of Telehealth: Utah

On March 4th, the U.S. District Court for the District of Maryland struck down four provisions of the Trump Administration’s Notice of Benefit and Payment Parameters for 2019, 83 Fed. Reg. 16930 (April 17, 2018) (the “Rule”), which governs many aspects of Affordable Care Act (“ACA”) insurance markets beginning in the 2019 plan year.  The decision in City of Columbus, et al. v. Norris Cochran comes two and a half years after the cities of Columbus, Baltimore, Cincinnati, Chicago, and Philadelphia, as well as two individuals who rely on health insurance offered on ACA exchanges, filed suit alleging that the actions of the U.S. Department of Health and Human Services (“HHS”) drove up premiums, made enrollment more difficult, and caused more people to go without affordable, high-quality health insurance.
Continue Reading Federal Court Decides ACA “Sabotage” Case

On February 4, 2021, the Department of Justice (“DOJ”), Office of Public Affairs, issued a Press Release (the “DOJ Press Release”) announcing that Kelly Wolfe, President of Regency, Inc., a medical billing company located in Florida, pleaded guilty to conspiracy to commit healthcare fraud through a “pernicious telefraud scheme”[1] involving fraudulent Medicare and CHAMPVA (Civilian Health and Medical Program of the Department of Veterans Affairs) claims for medically unnecessary durable medical equipment (“DME”) supplies.  As a result of Wolfe’s criminal plea, Wolfe could face up to 13 years in federal prison. 
Continue Reading OIG Warns Telehealth Industry: “With Great Power Comes Great Responsibility”

In a February 10, 2021 ruling (the “Garcia Ruling”) out of the District Court for the Central District of California (the “CDCA Court”) in the case of Gilbert Garcia et al v. Welltower OpCo Group LLC, et. al., 20-02250JVS (C.D. Ca. Feb. 10, 2021), the CDCA Court held that the Public Readiness and Emergency Preparedness Act (42 U.S.C. § 247d–6d) (the “PREP Act”) provides senior living facilities with an exemption from civil liability for actions taken by such facilities to protect facility residents from COVID-19.
Continue Reading Senior Living Communities, Liability for COVID-19 Countermeasures, and the PREP Act: Is the Tide Turning for Providers?

Virginia is now the second state, after California, to pass a comprehensive privacy law. The Consumer Data Protection Act (“CDPA”) will come into effect January 1, 2023 (the same time as the modification to California’s Consumer Privacy Act (“CCPA”), i.e., the California Privacy Rights Act (“CPRA”)). While CDPA has fairly broad exemptions for entities regulated by other laws, such as HIPAA, there is also a new “opt-in” requirement for collecting “sensitive data.”
Continue Reading What Virginia’s New Privacy Law Means for Organizations in the Healthcare Industry