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

Published: April 24, 2020

by Jeanne L. Vance

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]

Happy New Year To California’s Rural Hospitals: New Corporate Practice Of Medicine Exception Effective January 1, 2017

Published: January 10, 2017


Healthcare Legal Updates

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.

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.