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Everything you need to know about BMD and the industry.
Client Alert
DEA and HHS Issue its Third Extension of Telemedicine Flexibilities through 2025
December 2, 2024
The DEA and U.S. Department of Health and Human Services (HHS) have extended telemedicine flexibilities for prescribing controlled medications through December 31, 2025. This extension builds on temporary exceptions made in 2020 due to COVID-19, allowing providers to prescribe Schedule II-V controlled substances based on a telemedicine evaluation alone. The extension ensures continued patient access to necessary prescriptions and provides time for providers to comply with future regulations.
Posted by
Daphne Kackloudis and Kate Crawford
Client Alert
No Surprises Act Compliance (Published by NAMAS, 2/25/22)
March 7, 2022
The Department of Health and Human Services published three parts to the No Surprises Act towards the end of 2021, which took effect January 1, 2022. The Act is intended to protect consumers from “balance billing,” which occurs when a patient receives a bill with a higher price than they may have anticipated because they did not have knowledge that the provider or facility was out-of-network. The purpose of this article is to note certain requirements that compliance employees will need to be aware of at their facilities, including notice and consent, good faith estimates, and public disclosures.
Posted by
Bryan Meek
Client Alert
HHS Provider Relief Funds Reporting Requirements: Important Updates Every Provider Should Know
November 4, 2020
HHS continues to revise its reporting requirements for the use of the Provider Relief Funds. Providers with more than $10,000 in Provider Relief Fund payments must report on the use of the funds through December 31, 2020. The reporting window will begin on January 15, 2021 and providers must complete reporting obligations for FY 2020 by February 15, 2021 through a portal designed by HHS. However, providers that have unexpended funds as of December 31, 2020, will have an additional 6 months to use the remaining funds through June 30, 2021. These providers must submit a second and final report no later than July 31, 2021.
Posted by
Amanda L. Waesch
Client Alert
Should I Apply for Phase 3 Funds? Important Considerations Every Provider Should Know
November 2, 2020
On October 1, 2020, the Department of Health and Human Services (“HHS”) announced an additional $20 billion in new funding for providers through a Phase 3 distribution. Importantly, providers that previously received HHS Provider Relief Funds or already received payments of approximately 2% of annual revenue from patient care are eligible to apply. Eligible providers have until November 6, 2020 to apply for these Phase 3 Funds. However, the question from providers continues to be: Should I Apply for Phase 3 Funds?
Posted by
Amanda L. Waesch
Client Alert
HHS Announces an Additional $20 Billion In Provider Relief Grants
October 5, 2020
The U.S. Department of Health and Human Services (“HHS”) announced an additional $20 billion in new funding for providers on October 1, 2020. Eligible providers include those that have already received Provider Relief Fund payments as well as previously ineligible providers, such as those who began practicing in 2020, and an expanded group of behavioral health providers confronting the emergence of increased mental health and substance use issues exacerbated by the pandemic. The new Phase 3 General Distribution is designed to balance an equitable payment of 2% of annual revenue from patient care for all applicants plus an add-on payment to account for revenue losses and expenses attributable to COVID-19.
Posted by
Ashley Watson
Client Alert
Provider Relief Fund Phase 2 & Reporting Requirement Updates – Deadline to Request Phase 2 Funds is August 28, 2020
August 21, 2020
On July 31, 2020, the Department of Health and Human Services (“HHS”) announced that certain Medicare, Medicaid (managed care and fee-for-service), CHIP, and other providers would be given another opportunity to receive additional Provider Relief Fund payments. HHS has allocated around $15 billion for Phase 2 distribution. Providers are eligible for these new distributions if they fulfill the following criteria and have not yet received a Provider Fund payment equal to approximately 2% of their revenue from patient care.
Posted by
Ashley B. Watson
Client Alert
President Trump Signs Executive Orders that Enable Access to Affordable Meds
July 29, 2020
On Friday, July 24, 2020, President Trump signed four Executive Orders concerning prescription drug pricing which collectively direct the Secretary of the Department of Health and Human Services (HHS) to take following actions: 1. Increase Patient Access to Insulin and Injectable Epinephrine 2. Facilitate the Importation of Certain Prescription Drugs 3. Remove the Anti-Kickback Safe Harbor Protection for Prescription Rebates 4. Implement the “Most Favored Nation” Order to Lower Medicare Part B Drug Cost
Posted by
Jeana M. Singleton, Esq. and Monica B. Andress
Client Alert
Guidance for Employers Receiving HHS Funding During COVID-19 on Civil Rights Protections
July 24, 2020
On July 20, 2020, HHS OCR issued guidance to help employers receiving federal financial assistance understand their requirements to comply with applicable federal civil rights laws and regulations that prohibit discrimination on the basis of race, color, and national origin in HHS-funded programs during COVID-19; specifically, Title VI of the Civil Rights Act of 1964 (“Title VI”). Title VI states that “[n]o person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance.”
Posted by
Ashley B. Watson
Client Alert
HHS Delays Quarterly Reporting for Provider Relief Funds
June 19, 2020
There is good news for providers that received either (1) General Distributions from the HHS Provider Relief Funds [link to my article], or (2) Targeted Distributions from the HHS Provider Relief Funds [link to Ashley’s article]. HHS reversed its stance requiring quarterly reports for providers that received Provider Relief Funds and PPP loan monies. The initial quarterly reports would have been due by July 10, 2020. However, on June 13, 2020, HHS delayed the quarterly reporting requirement.
Posted by
Amanda L. Waesch
Client Alert
July 20 is Important Deadline for HHS Fund Distributions to Medicaid and CHIP Providers
June 19, 2020
On June 10, 2020, the U.S. Department of Health and Human Services (“HHS”) released details on the distribution of more CARES Act Provider Relief Fund payments. After allocating $50 billion to Medicare providers through its General Distribution fund, HHS has now announced that it will distribute $15 billion to eligible Medicaid and CHIP providers who apply by the deadline through a Targeted Distribution. Applicants must apply through the Enhanced Provider Relief Fund Payment Portal. The application form itself can be found on the HHS website and is due by July 20, 2020.
Posted by
Ashley Watson & Amanda Waesch
Client Alert
HHS Addresses Drug Manufacturer Coupons on Out-of-Pocket Limits
May 25, 2020
On May 7, 2020, the US Department of Health and Human Services (“HHS”) announced their Notice of Benefit Parameters for 2021 in which HHS addressed the application of prescription drug manufacturer copay coupons towards a patient’s out-of-pocket limit. Under this guidance, HHS will permit, but not require, plans and insurers to count direct support offered to enrollees by drug manufacturers (i.e., coupons) for specific prescription drugs toward the annual limits on cost-sharing, regardless of whether a generic equivalent is available.
Posted by
Kevin M. Cripe
Client Alert
Important Updates, Deadlines, and Clarifications for the HHS Provider Relief Funds
May 22, 2020
On May 20, 2020, HHS made important updates and clarifications regarding the General Distribution payments to providers. Between April 10, 2020 and April 24, 2020, HHS distributed an initial $30 billion to providers based on the provider’s 2019 Medicare fee-for-service receipts. These funds were distributed automatically and providers did not need to submit an application in order to receive these funds. The funds were originally touted as a “no strings attached” stimulus payment reserved for healthcare providers. But HHS issued a 10-page Terms and Conditions and required that providers sign an attestation confirming receipt of the funds and agreeing to the Terms and Conditions.
Posted by
Amanda L. Waesch
Client Alert
Congress Passes Another Round of Coronavirus Relief for Small Businesses
April 24, 2020
On April 24, 2020, President Trump signed into law another round of coronavirus relief aimed at helping small businesses during this public health emergency. The bill contains a total of $484 billion in additional aid. The majority of funds in this bill are dedicated to replenishing the Paycheck Protection Program (“PPP”), which gives small businesses loans to cover payroll costs that could be forgiven if specific requirements are followed. Congress initially funded the PPP in March with $350 billion, but this amount was exhausted as of April 16, 2020.
Posted by
Kevin Cripe
Client Alert
The $70 Billion Question – CARES Act Provider Relief Fund Helping Hardest Hit Hospitals First
April 23, 2020
HHS finally unveiled its preliminary plan for disbursement of the remaining $70 billion of CARES Act Provider Relief Funds. The initial $30 billion was disbursed to providers based on 2019 Medicare fee-for-service payments. HHS indicated that the remaining $70 billion would be disbursed to (1) providers that incurred COVID-19 expenses, (2) rural providers, (3) providers that primarily receive payments from other sources (such as Medicaid), and (4) providers that treat uninsured Americans.
Posted by
Amanda L. Waesch
Client Alert
Important Items Every Provider Should Know if Accepting the HHS Provider Relief Funds
April 22, 2020
On April 10, 2020, the Department of Health and Human Services (HHS) issued $30 billion to healthcare providers as part of the Provider Relief Fund under the CARES Act. Providers will have 30 days from the date of receipt to access the HHS portal, attest to the payment, and accept the Terms and Conditions. The Terms and Conditions require providers to take substantial steps to ensure compliance.
Posted by
Amanda Waesch
Client Alert
Pondering Over Patient Billing: CARES Act and Provider Relief Fund Lead to More Questions
April 16, 2020
On April 11, 2020, HHS, along with the Department of Labor and Department of the Treasury, issued jointly prepared FAQs regarding the FFCRA, the CARES Act, and other health coverage issues. The FFCRA was enacted on March 18, 2020 and requires group health plans and health insurance issuers to provide benefits for certain items and services related to diagnostic testing for COVID-19. Additionally, plans and issuers must provide coverage without imposing any cost-sharing requirements (deductibles, copayments, and coinsurance), prior authorization, or other medical management requirements.
Posted by
Amanda L. Waesch
Client Alert
Important Update and FAQs: HHS Tweaks Guidance on The CARES Act Provider Relief Fund Terms and Conditions
April 16, 2020
On April 10, 2020, many providers awoke to find electronic payment deposits from Department of Health and Human Services (HHS) in their bank accounts. This was the first round of $30 billion of payments from the HHS Provider Relief Fund as a result of the CARES Act, which was signed into law on March 27, 2020. All healthcare providers that received Medicare fee-for-service payments in 2019 should have received a payment.
Posted by
Amanda L. Waesch
Client Alert
The CARES Act Provider Relief Fund: What We Know So Far…
April 10, 2020
The CARES Act that was signed into law of March 27, 2020 provides for the Provider Relief Fund, which set aside $100 billion in relief funds for healthcare providers with expenses or lost revenue attributable to COVID-19. On April 9, 2020, the Department of Health and Human Services (“HHS”) released the first round of $30 billion of funding. All healthcare providers that received Medicare fee-for-service reimbursements in 2019 should have received a distribution. Payments will be made via electronic payment. Providers that do not receive electronic payment will receive paper checks over the next few weeks.
Posted by
Amanda L. Waesch
Client Alert
OCR, HHS Issue 2020 HIPAA and Coronavirus Bulletin
March 6, 2020
The Office of Civil Rights and the U.S. Department of Health and Human Services has issued a bulletin on HIPAA Privacy and Novel Coronavirus, including important insights around sharing patient information if an outbreak of infectious disease or other emergency situation arises. Note that the protections of the Privacy Rule are not void during an emergency.
Posted by
BMD