California Healthcare Transactions to Undergo Additional Advance Regulatory Scrutiny as New Office of Health Care Affordability Scrutinizes Cost and Market Impact of Transaction

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.

Use of Non-Physician Healthcare Practitioners Expanding in California

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.

Healthcare Transactions With Licensed Healthcare Professionals Trigger Corporate Practice Issues In California

This second transactions series installment involves consideration of professional licensing issues that arise in certain healthcare transactions with licensed professionals (including physicians), or so-called “corporate practice” issues. This series responds to the active transactional market for 2021 and the forecast for robust activity due to the interest of venture capital and private equity funds in healthcare investments.

Revenue Cycle Impact On Healthcare M&A Transactions: Medicare Provider Agreement Assumption Choices Can Drive Transaction Structure

The past year in healthcare transactions has been one of the more interesting of my career, with the complete shutdown of certain industry segments for a period due to the COVID-19 public health emergency, modified business climate and reopenings, government stimulus payments through the CARES Act, Payroll Protection Program and Accelerated Payment Programs, ongoing tax changes (including potential for higher capital gain tax rates), high enterprise valuations and low borrowing costs. We view 2021 as an active market for acquisitions, including in healthcare. We note that increasingly we are seeing buying side activity from venture capital or private equity funds, where pro forma post-closing cash flow considerations are critical drivers of decisions.

A Summary Of Cares Act Provider Relief Efforts

As part of the Coronavirus Aid, Relief, and Economic Security Act (CARES Act), the federal government allocated $175 billion in payments to be distributed to health care providers through the Provider Relief Fund (PRF) for expenses related to health care or lost revenue due to COVID-19. These distributions are grants, not loans, and do not need to be repaid so long as recipient providers comply with the applicable terms and conditions.

Read full publication on AHLA website.

Cares Act Provider Relief Funds: Reporting Set To Begin In 2021; New Reporting Requirements

The Health Resources and Services Administration (“HRSA”) has completed review of Phase 3 applications for the CARES Act Provider Relief Fund (“PRF”) and expects to distribute $24.5 billion to over 70,000 health care providers by the end of this month. These payments are intended to cover loss revenues attributable to the COVID-19 pandemic. According to HRSA, over 35,000 Phase 3 applicants will not receive any additional payment because they either experienced no change in revenues or net expenses attributable to COVID-19, or those that have already received funds that equal or exceed reimbursement of 88% of reported losses.1

New Cares Funding Available For Medicaid Providers

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.

California Attorney General Clarifies Effective Date For Filing Adverse Action 805 Report By Health Care Peer Review Bodies

On April 20, 2020, the California Attorney General (“AG”) issued a published opinion clarifying that the “effective date” for purposes of filing a Business and Professions Code 805 report is the date on which a peer review body’s decision becomes final, following the conclusion of a licentiate’s appeal to the body of its proposed final action, and not the date of the peer review body’s final proposed decision. Section 805 requires a report to be filed with the relevant state healing arts licensing agency “within 15 days after the effective date” of certain actions taken by a peer review body against specified health care licentiates, including denial or rejection of a licentiate’s application for membership or staff privileges; termination or revocation of a licentiate’s membership, staff privileges, or employment; or imposition of restrictions (or voluntary acceptance of restrictions) on staff privileges, membership, or employment for a cumulative total of 30 days or more in a 12-month period. A peer review body consists of medical or professional staff of licensed health care facilities or professions that review the basic qualifications, staff privileges, employment, medical outcomes, or professional conduct of licentiates.

Postponing Elective Surgeries To Contain Covid-19 Spread And Conserve Resources Presents Challenges For Healthcare Providers

The World Health Organization (WHO) declared the COVID-19 pandemic on March 11, 2020.[1] As a result, there are more patients in need of immediate and attentive care, and many practices now have to consider how to continue providing necessary services while containing the spread of COVID-19 with balancing current and future needs for clinician services, medical supplies and access to personal protective equipment (PPE). In response to this, the Centers for Disease Control and Prevention have recommended the postponement of non-essential adult elective surgeries and medical and surgical procedures to conserve resources,[2] and the Centers for Medicare & Medicaid Services (CMS) and the American College of Surgeons (ACS) have provided guidelines for same.[3] Factors to be considered include patient risk factors, availability of beds, the number of staff and PPE, as well as urgency of the procedure.[4]