Thursday, February 11, 2021
On 28 December 2020, the federal No Surprises Act (Act)
1 was enacted. The Act seeks to protect patients from so-called “surprise medical bills” in certain emergency and nonemergency settings for out-of-network patients. This alert focuses on the Act’s arbitration provisions but first provides necessary background to those provisions.
Key takeaways include:
The Act, and its arbitration provisions, include both emergent and nonemergent care in certain out-of-network contexts. See Parts I and II.
The Act requires payors to treat out-of-network patients as though they are in-network for purposes of: prior authorizations, coverage limits, cost sharing obligations, and out-of-pocket maximums. See Part III.
Sponsored Content provided by Michealle Gady - Founder and President , Atromitos
In 2015, the North Carolina General Assembly enacted legislation that would fundamentally change the Medicaid program in North Carolina. Since then, the N.C. Department of Health and Human Services has worked to design a transformation model that would move the administration of the program into risk-based comprehensive managed care, shift greater responsibility for population health management to primary care providers, and change the way that health care providers are paid in the Medicaid program.
After what feels like an eternity, Medicaid Transformation will begin July 1, 2021. Yes, it actually will. I know there are some eye rolls out there and “yeah sures” but as far as we at Atromitos can tell, the Department is committed to this start date. We adamantly appeal to providers, Medicaid enrollees, and other stakeholders to educate yourselves on the transformation model and engage in the pr
Fraud, anti-kickback specialist was at Baker Donelson, predecessor before moving into government work
Stewart Kameen
Bass Berry & Sims leaders have added a former senior counsel from the Inspector General office of the U.S. Department of Health and Human Services to their Washington, D.C., office.
Stewart Kameen has joined Bass as counsel and will advise the firm’s clients on various regulatory issues, including the Federal Anti-Kickback Statute and the regulatory elements of building and developing coordinated care systems. He worked in the HHS Office of Inspector General’s Industry Guidance Branch for two and a half years, having joined the agency from Baker Donelson Bearman Caldwell & Berkowitz. He had joined that firm via its predecessor, Baltimore-based Ober Kaler, which merged with Baker in late 2016.
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On Thursday, December 17, 2020, senior representatives of the US Department of Health and Human Services’ Office of Inspector General (“OIG”) and the Centers for Medicare & Medicaid Services (“CMS”) delivered a virtual presentation to American Health Law Association members and other health industry stakeholders to explain and elaborate on significant new regulations that become final on January 19, 2021. OIG Senior Counselor for Policy, Vicki Robinson, OIG Industry Guidance Branch Chief, Susan Edwards, and OIG Senior Counsel, Samantha Flanzer, discussed OIG’s recently issued final rules amending current and adding new safe harbors to the Anti-Kickback Statute (“AKS”). CMS Senior Technical Advisors, Lisa Wilson and Catherine Martin, discussed CMS’s recently issued final rules amending current and adding new exceptions to the Physician Self-Referral Law (“Stark Law”).
Takeaways From AHLA Webinar, CMS, OIG Insights into Stark and AKS Final Rules Part I: Supporting Value-Based Care lexology.com - get the latest breaking news, showbiz & celebrity photos, sport news & rumours, viral videos and top stories from lexology.com Daily Mail and Mail on Sunday newspapers.