Archive for category: Legislation

CMS Issues Final Rule on Price Transparency by Healthcare Facilities

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By Little V. West, Kaitlyn Luck, and Lisa Carlson

On November 15, 2019, CMS issued a final rule pursuant to President Trump’s June 24, 2019, Executive Order to ensure price transparency by healthcare facilities. This price transparency rule will go into effect January 1, 2021, and will require hospitals operating within the United States to establish, update, and publicize all standard charges for all items and services provided by the hospital. Hospitals will also be required to display, in a consumer-friendly manner, standard charges for at least 300 shoppable services provided by the hospital. The stated purpose of this rule is to “increase market competition, and ultimately drive down the cost of healthcare services, making them more affordable for all patients.”

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New Patient Rights Rules for Idaho Hospitals

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by Kim Stanger

The Idaho Department of Health and Welfare has implemented new patient rights rules for hospitals effective July 1, 2019.  (See IDAPA 16.03.14.220 to .350).  The rules were advanced by patient advocacy groups and, to a large degree, incorporate standards that parallel—but do not exactly mirror—existing law and/or Medicare conditions of participation for hospitals.  Because many of those regulatory conditions did not apply to critical access hospitals (“CAHs”), CAHs may need to implement new policies and procedures to satisfy the rules.  All Idaho hospitals as well as providers rendering services in hospitals should check their existing policies and practices against the new rules, including the following:

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2019 New Mexico Legislative Update: What All Healthcare Providers Should Know

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By Little V. West

In 2019, the Legislature enacted several bills affecting healthcare practitioners in New Mexico. Although some bills have a general applicability to health care providers, others address more specific medical practices. Following is a summary of several bills impacting health facilities and providers. Read more

2019 Utah Legislative Update: What All Healthcare Providers Should Know

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by Kristy Kimball

In the last Utah legislative session, several bills were passed that affect the obligations of healthcare facilities and providers. Following is a summary of three important bills that went into effect on May 14, 2019, of which all health facilities and providers should be aware.

Mandatory Reporting of Drug Diversion to Law Enforcement

House Bill 251 requires mandatory reporting to law enforcement when one has knowledge of drug diversion. Specifically, Utah law now holds that an individual is guilty of a class B misdemeanor if they: (i) know that a Practitioner is diverting 500 or more morphine milligram equivalents to another person for an unlawful purpose; and (ii) fail to report to law enforcement. The bill defines “Practitioner” as an individual who is either (i) allowed to “administer, dispense, distribute, or prescribe a drug in the course of professional practice;” or (ii) who is employed by such an individual. The law broadly applies to those involved in providing medications to patients in any manner (e.g., nurses, physicians, nurse practitioners, physician assistants, and pharmacists) as well as those working for such individuals. Utah Code Ann. § 76-10-2204.

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Group Compensation Arrangements: Stark Requirements

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by Kim Stanger

Physician practices must ensure that their group compensation structures comply with the federal Ethics in Patient Referrals Act (“Stark”) if they intend to bill Medicare or Medicaid for services rendered or referred by the group physicians. Under Stark, if a physician1 (or a member of the physician’s family) has a financial relationship with an entity, the physician may not refer patients to the entity for certain designated health services (“DHS”)2 payable by Medicare and Medicaid unless the financial relationship is structured to fit within a regulatory safe harbor. (42 CFR § 411.353). Stark applies to DHS referrals within the group, so the physician’s compensation arrangement must be structured to comply with Stark; otherwise, the group may not bill Medicare and Medicaid for DHS that were referred improperly, and, if they were improperly billed, the entity must repay amounts improperly received. Failure to report and repay within 60 days may result in additional civil penalties of $15,000 per claim as well as False Claims Act liability. Repayments may easily run into hundreds of thousands of dollars. Given the potential liability, it is critical that physician group compensation arrangements be structured to fit within one of the following regulatory safe harbors if they intend to participate in Medicare or Medicaid. Read more