On November 20, 2020, the Centers for Medicare & Medicaid Services (CMS) and the Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) issued two final rules to modernize and clarify the Stark Law and the Anti-Kickback Statute (AKS). The rule changes are part of the larger effort by HHS (of which CMS is part) to modernize and clarify fraud and abuse laws as part of the Regulatory Sprint to Coordinated Care initiative and CMS’s Patients over Paperwork initiative, which are aimed at reducing regulatory barriers and accelerating the transformation of the healthcare system into one that better pays for value and promotes care coordination. This is the first installment in a Health Capital Topics series that will examine these final rules and discuss their impact on healthcare valuation going forward. (Read more...)

On November 10, 2020, the Supreme Court of the United States (SCOTUS) held oral arguments in California v. Texas, a case concerned with whether the central provision of the Patient Protection and Affordable Care Act (ACA) – the Individual Mandate (requiring Americans to have health insurance) – is unconstitutional. During the two-hour teleconference hearing, arguments were presented by California Solicitor General Michael J. Mongan, on behalf of California; former Solicitor General Donald B. Verrilli, Jr., on behalf of the U.S. House of Representatives; Texas Solicitor General Kyle D. Hawkins, on behalf of Texas; and, Acting Solicitor General Jeffrey B. Wall, on behalf of the federal government’s Department of Justice. (Read more...)

On October 29, 2020, the Centers for Medicare & Medicaid Services (CMS) released the Transparency in Coverage final rule. This long-anticipated final rule stems from President Donald Trump’s June 2019 executive order on “Improving Price and Quality Transparency” and builds upon the hospital Outpatient Prospective Payment System (OPPS) price transparency requirements released in November 2019. These requirements came under fire in a lawsuit filed by the American Hospital Association (AHA), Association of American Medical Colleges (AAMC), Children’s Hospital Association (CHA), and Federation of American Hospitals (FAH), against the Department of Health and Human Services (HHS); the requirements were upheld by the courts in June 2020 and the lawsuit is being appealed by the plaintiffs. (Read more...) 

The third installment in this five-part Health Capital Topics series on the valuation of telemedicine will focus on the regulatory environment for telemedicine, with a specific focus on fraud and abuse laws. The first installment in this series introduced telemedicine and its increasing importance to, and popularity among, providers and patients. It also discussed the current and future challenges related to telemedicine, many of which hinge upon reimbursement restrictions and regulations. The second installment took a deeper dive into the growth, new payment rules, and future uncertainties surrounding reimbursement for telemedicine services. (Read more...) 

For more recently published material written by HCC, please visit www.healthcapital.com

On December 8, 2020, HCC President, Todd A. Zigrang, MBA, MHA, FACHE, CVA, ASA, and, HCC Vice President and General Counsel, Jessica Bailey-Wheaton, Esq., will present on the topic of "Regulatory Overview for Valuation Professionals," during the National Association of Certified Valuators and Analysts (NACVA) 2020 Financial Valuation Virtual Conference.

Register HERE.