Blog: Healthcare Legal Updates

The Centers for Medicare and & Medicaid (“CMS”) have issued the following COVID-19 emergency blanket waivers for health care providers associated with provider enrollment.

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On June 9, 2020, the U.S. Department of Health and Human Services (HHS) announced that it will allocate approximately $15 billion to providers who participate in state Medicaid program and Children’s Health Insurance Program (CHIP) and who did not receive payments from the initial $50 billion in general allocations from the Provider Relief Fund under the Coronavirus Aid, Relief, and Economic Security (CARES) Act. This funding is intended to provide relief to Medicaid and CHIP providers experiencing lost revenues or increased expenses due to COVID‑19.

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Effective January 1, 2017, certain rural hospitals joined the list of providers specifically exempted from the Corporate Practice of Medicine (“CPM”) ban in California, which otherwise prohibits the employment of physicians and other medical professionals by corporations and other artificial legal entities. By signing AB 2024 on September 23, 2016, Governor Jerry Brown amended California Business and Professions Code Section 2401, allowing applicable hospitals to directly employ physicians and bill for their services. According to the bill’s lead author, Assemblymember Jim Wood, the exception purports to create a pathway and incentive for physicians to practice in underserved rural communities.

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On October 10, the Centers for Medicare & Medicaid Services (CMS) issued a memorandum to State Survey Agency directors regarding implementation of a moratorium on the establishment of new long-term care hospitals (LTCHs) and LTCH satellites as well as bed increases to such facilities.

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California Medi-Cal enrollment has undergone significant changes, effective January 1, 2013. The California Department of Healthcare Services (“DHCS”) implemented new Medicaid enrollment requirements as part of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010 (“PPACA”).

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This piece is part of a series that will appear in the RAP Sheet over its next several issues that summarize hot topics in Medicaid enrollment on a state-by-state basis. In this issue, we bring you California, Florida, North Carolina, Virginia, and West Virginia.

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The Centers for Medicare & Medicaid Services (“CMS”) recently announced that it awarded Noridian Administrative Services the contract for administration of Medicare Part A and Part B fee-for-service claims for California, Nevada, Hawaii and the American territories of American Samoa, Guam and the Northern Mariana Islands. Noridian will also take over additional Medicare operational functions, including provider enrollment functions. According to CMS, the workload transfer is to be complete by early 2013. However, if Palmetto GBA protests the bid award, this could significantly delay implementation.

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The Centers for Medicare & Medicaid Services (“CMS”) has begun the process of revalidating most Medicare provider and supplier enrollments, which must be completed by 2015. This effort began making waves in the provider and supplier community when letters sent last fall from the Medicare Administrative Contractors (“MACs”) gave recipients 60 days to respond with a complete Medicare revalidation application. The consequences of failure to comply with a MAC request to revalidate include deactivation of a provider or supplier’s enrollment, which means that the Medicare revenue stream ceases.

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The Centers for Medicare & Medicaid Services (CMS) finalized changes for Medicare skilled nursing facility (SNF) payments for calendar year (CY) 2012. The final rule will be published in the August 8, 2011, Federal Register. CMS finalized an 11.1% decrease to SNF Medicare payments, reflecting the net effects of a downward recalibration of case-mix indexes, a market basket increase and a multi-factor productivity adjustment to the SNF prospective payment system (PPS) rates. In addition, CMS revised several SNF payment policies effective October 1, 2011.

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