Like other players in the healthcare industry, physician groups are facing increased antitrust scrutiny from the Biden administration, with the Federal Trade Commission (the “FTC”) and Department of Justice, Antitrust Division (the “DOJ”) (together the “Agencies”) continuing to expand their enforcement focus to include all types of transactions involving physician groups, including both traditional combinations, as well as so-called vertical combinations with health systems, payors, and private equity investors.…
Continue Reading Healthcare Antitrust Update: Key Antitrust Takeaways for Physician Groups

On May 30, 2021, Illinois lawmakers passed House Bill 3308 (“HB3308” or the “Bill”) aimed at expanding the use of telehealth services in the state. The Bill would increase access and coverage to telehealth by establishing payment parity for behavioral health and substance abuse services and by establishing a panel to study payment parity for all telehealth services.…
Continue Reading The “State” of Telehealth: Illinois Moves to Expand Telehealth Coverage

On May 13, 2021, MITRE Corporation, a non-profit that provides engineering and technical guidance for the federal government, published a long-awaited report proposing a National Strategy for Digital Health (the “Report”).  The proposed strategy provides a framework and prescribes tangible action items in order to revolutionize the American healthcare system through digital tools and technology.  The underlying premise is that harnessing the power of research, data, and innovation can further shared goals and accomplish priority outcomes to transform not only the digital plane of the healthcare system, but every facet of modern American healthcare.…
Continue Reading MITRE Corporation Outlines a Proposal for a Digital Health Revolution in New Report

On May 21, 2021, the Centers for Medicare and Medicaid Services (“CMS”) announced that the Next Generation Accountable Care Organization (“ACO”) Model (“NGACO Model” or “Model”), set to end December 31, 2021, will not be extended after receiving a one-year extension due to COVID-19.  The decision comes as a surprise to NGACO participants and other industry groups who have been calling on CMS to revisit its decision and closely consider the Model’s merits and potential as a permanent program option.  Industry stakeholders, such as the National Association of ACOs (“NAACOS”), expressed initial disappointment with CMS’ decision to end the program, but were later able to find some reprieve with CMS’ decision to “allow Next Gen ACOs a limited opportunity to apply for Direct Contracting . . . . starting next year.”
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Continue Reading CMS’ Next Generation Accountable Care Organization (NGACO) Model Set To End in December 2021

In our January 26, 2021 blog post “Permanency for Out of State Telehealth Services? Arizona Seeks to Make Permanent Changes to Licensure Requirements”, we discussed Arizona’s push to make permanent resolutions to the temporary telehealth exceptions issued in connection with the public health emergency (the “Pandemic”). In that article, we also noted that Arizona Governor, Doug Ducey, as part of his “State of the State” address, proposed permanent changes to healthcare access which would allow Arizona residents to access healthcare providers through the use of telemedicine.  As of May 5th, we have begun to see the first steps in implementing those changes.…
Continue Reading The “State” of Telehealth: Arizona (Part 2) Arizona Is All-in On Telehealth

On May 6, 2021, the comment period for the proposed modification to regulations implementing the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) Privacy Rule and Health Information Technology for Economic and Clinical Health Act of 2009 (“HITECH”) closed.  The Office for Civil Rights (“OCR”) at the Department of Health and Human Services (“HHS”) issued its initial request for information in December 2018, subsequently released the Notice of Proposed Rulemaking (“NPRM”) to the public on December 10, 2020, and published the Proposed Rule in the Federal Register on January 21, 2021 (the “Proposed Rule”).  After a significant degree of public interest in providing input on the proposals, OCR extended the comment period from its original end date of March 22, 2021 to May 6, 2021. …
Continue Reading HIPAA Privacy Rule Modification – Removing Barriers and Promoting Coordinated Care at What Cost?

On April 27, 2021, the Centers for Medicare and Medicaid Services (“CMS”) released the Hospital Inpatient Prospective Payment System (“IPPS”) and Long-Term Care Hospital (“LTCH”) unpublished Proposed Rule for 2022 (“Proposed Rule”). The Proposed Rule, if enacted, would eliminate the requirement from the Hospital IPPS and LTCH Final Rule for 2021 (“IPPS Final Rule for 2021”), as discussed in our September 11, 2020 blog post, that hospitals report the median payer-specific negotiated charge with Medicare Advantage (“MA”) payers, by MS-DRG, on its Medicare cost reports for cost reporting periods ending on or after January 1, 2021. CMS estimates that this will reduce the administrative burden on hospitals by approximately 64,000 hours.…
Continue Reading CMS Proposes Repeal of Certain Cost Reporting Requirements from the IPPS Final Rule for 2021

The Biden Administration’s American Rescue Plan Act of 2021 (H.R. 1319) (the “Act”) could present an opportunity for the growth of utilization of ambulatory surgery centers (“ASCs”), continuing the trend of migration of inpatient procedures to the outpatient setting.  This shift toward the outpatient setting initially began prior to the COVID-19 public health emergency, but was accelerated by the pandemic’s effect on hospitals, likely continuing the substantial increase in investment in the ASC marketplace.…
Continue Reading Biden’s American Rescue Plan Follows Trend Toward Outpatient Setting, Increase in ASC Investment