Blog: The Healthcare Law Blog

I am fresh back from Baltimore, Maryland, where I was on the faculty of AHLA’s annual Institute on Medicare and Medicaid Payment Issues. I have been on the faculty of this program for a dozen years, and am always thrilled to hear the latest in healthcare payment and reimbursement changes and trends. This year I spoke on Medicare policies on hospital co-location, and presented along with the person who oversaw development of the government policy, David Wright, Director of the Quality, Safety & Oversight Group of the Centers for Medicare & Medicaid Services.

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Certain healthcare transactions closing on or after April 1, 2024 are subject to an advance notice regulatory review and analysis by a newly created Office of Health Care Affordability (“OHCA”) within the California Department of Health Care Access and Information.  The OHCA will prospectively analyze the transactions by conducting a cost and market review of significant transactions and report to the public on the anticipated impacts on the healthcare market.  The information submitted to the OHCA by the parties to the transaction will become public information.

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I have been in healthcare legal practice since the mid-1990s.  During a summer in law school, I worked for the California Legislative Counsel Bureau, which is the agency that serves as legal counsel to the California legislature.  During my stint there, I recall various healthcare licentiates arguing about whether to expand the practice of non-physicians, with physicians generally asserting that such changes would be detrimental to healthcare quality and the other healthcare licentiates arguing that they provide a quality service at a more reasonable price-point.  This same tension has woven its way through legislative and payment policy during the intervening decades with the same arguments being advanced.  However, during that time we have seen the gradual increase in scope of practice of non-physician advanced practice professionals such as nurse practitioners (“NPs”), physician assistants (“PA”) and certified nurse midwives.  These trends are evidenced by several recent legal developments both in Medicare payment policy and California state law.

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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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