80 Attorneys • 45 Practice Areas • 5 Locations

Welcome to the Weintraub Tobin Resources Page

Browse below for news, legal insights, information on presentations and events, and other resources from the Weintraub Tobin legal team.

California Implements Provider Enrollment Fingerprinting Requirements Effective October 2

Published: September 12, 2014

by Jeanne L. Vance

On September 10, 2104, the California Department of Health Care Services (“DHCS”) announced that it will implement federal requirements for fingerprinting in the Medi-Cal provider enrollment process starting October 2, 2014. This new process implements a portion of the federal Patient Protection and Affordable Care Act that requires DHCS to establish categorical risk levels for certain providers determined to have a high risk of program abuse. Provider types that are categorically determined to be “high risk” are newly enrolling home health agencies, newly enrolling durable medical equipment suppliers, and newly enrolling and revalidating Drug Medi-Cal Clinics. In addition, providers not considered high risk by enrollment category may also be subject to fingerprinting if they are currently experiencing a Medi-Cal payment suspension based on a credible allegation of fraud, the applicant has an existing Medicaid overpayment based on fraud, the applicant has been excluded from participation in federal healthcare programs by the federal Office of Inspector General or another State’s Medicaid program within the previous 10 years, or CMS has lifted a temporary enrollment moratorium in the enrollment category sought within the past six months.

Fundamentals of Provider Enrollment 2013

Published: March 20, 2013

American Health Lawyers Association, Institute on Medicare and Medicaid Payment Issues Conference, Fundamentals of Provider Enrollment.

When: March 20–22, 2013

Where: Baltimore, Maryland.

Brace For The Transition — Enrollment Tips; CMS Changes California Mac Award Contract From Palmetto GBA To Noridian

Published: October 3, 2012

by Jeanne L. Vance
Healthcare Legal Updates

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.

SCOTUS Hands Employers Huge Health Care Obligations

Published: June 29, 2012

Yesterday, the Supreme Court of the United States ruled that the Patient Protection and Affordable Care Act of 2010 as amended by the Health Care and Education Reconciliation Act of 2010 is constitutional. The decision came down in the cases entitled, National Federation of Independent Business et al. v. Sebelius, No. 11-393 (June 28, 2012), Department of Health and Human Services et al. v. Florida et al., No. 11-398, and Florida et al. v. Department of Health and Human Services et al., No. 11-400). There, the 5 to 4 majority decided that the law is constitutional as an exercise of Congress’ power to tax, despite the congressional record stating it is not a tax. In California, where statutes that say “penalty” are later determined by courts to be “wages” these types of word games come as no surprise.

The overall effect of the Court’s decision: all existing provisions of the Act, such as the coverage of adult children up to age 26 and the prohibitions on lifetime benefit limits, remain in effect. More importantly, the penalties on larger employers for failing to provide minimum essential coverage and availability of coverage through government-sponsored exchanges will become effective as scheduled, on January 1, 2014.

Fundamentals of Provider Enrollment 2012

Published: March 30, 2012

American Health Lawyers Association, Institute on Medicare and Medicaid Payment Issues Conference, Fundamentals of Provider Enrollment.

When: March 28–30, 2012

Where: Baltimore, Maryland.

Medicare-Enrolled Providers And Suppliers To Revalidate By 2015

Published: February 7, 2012

by Jeanne L. Vance
Healthcare Legal Updates

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.

CMS Finalizes 2012 Skilled Nursing Facility Payment Changes

Published: August 3, 2011

by Jeanne L. Vance
Healthcare Legal Updates

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.