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Contract Terms Centers for Medicare & Medicaid Services (CMS)

Burr & Forman

Considerations Before Opting Out of Medicare

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In recent years, we have seen an emerging number of physicians and health care providers transitioning to concierge, direct-to-consumer practices. Many providers no longer want to deal with the hassles of billing insurance,...more

Whiteford

Understanding Price Transparency Laws and Gag Clauses: A Guide for Healthcare Providers

Whiteford on

Providers continually struggle to get the fair reimbursement they deserve from payers and often feel powerless to negotiate better rates. However, regulatory changes aimed at increasing price transparency and prohibiting gag...more

Wilson Sonsini Goodrich & Rosati

Key Considerations for Contracting with Healthcare Revenue Cycle Management Companies

Revenue cycle management companies (RCM Companies) help healthcare organizations manage billing, coding, claim submissions, and collections. Partnering with an RCM Company can enhance efficiency, accuracy, and...more

Stotler Hayes Group, LLC

CMS Cracks Down on Responsible Party Liability in LTC Admission Agreements

A nursing facility that participates in the Medicaid or Medicare programs may not require a third party to guarantee payment for a resident’s admission or continued stay. However, facilities are allowed to require a resident...more

Benesch

Dialysis & Nephrology Digest - January 2025

Benesch on

Happy New Year and welcome to our 2024 Trade Secret and Restrictive Covenant Year in Review. 2024 was less stressful and dramatic than most people feared at the start of the year, but there still were some significant rulings...more

BCLP

Selected Recent Developments for Public Companies

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Public companies should take note of several recent developments, including: ..Reversal of the Pegasystems trade secrets lawsuit that nevertheless preserves guidance to take care when describing litigation as “without...more

Mintz - Health Care Viewpoints

The Uncertain Landscape of Medicare Agent/Broker Compensation Rules

In the Proposed Medicare Advantage and Part D Rules for 2025, the Centers for Medicare & Medicaid Services (CMS) proposed significant changes to how Medicare Advantage organizations (MAOs) are allowed to contract with and...more

Sheppard Mullin Richter & Hampton LLP

Texas Court Stays CMS CY2025 Final Rule on Agent and Broker Compensation and Contract Term Restrictions

On July 3, 2024, a federal court in Texas stayed provisions of the Centers for Medicare & Medicaid Services’ (“CMS”) contract year 2025 Final Rule that amended the longstanding Medicare Advantage (“MA”) and Part D agent and...more

Bricker Graydon LLP

Gag Clause Attestations due December 31, 2023

Bricker Graydon LLP on

If you sponsor a group health plan, make sure you set a calendar alert before the winter holidays to submit the annual gag clause prohibition compliance attestation. Under the Consolidated Appropriations Act of 2021 (CAA),...more

Dorsey & Whitney LLP

New Iowa Law Will Impact Health Care Staffing Agencies and Contracts with Health Care Entities

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On March 17, 2022, Iowa Governor Kim Reynolds signed into law House File 2521, “Relating to Health Care Employment Agencies, and Providing Penalties,” which will have its home in Chapter 135Q of the Iowa Code. In general, the...more

Benesch

Dialysis & Nephrology Digest - January 2022

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Benesch reviews state, federal modifications to restrictive covenant laws - In a “Year-End Review,” Benesch points out there was considerable activity in trade secret and restrictive covenant law in 2021. Some of the...more

Butler Snow LLP

Stark Law and Anti-Kickback Statute Waivers Prove to be Useful Measures During the COVID-19 Pandemic … But, Will They Last?

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The novel Coronavirus (“COVID-19”) pandemic has brought about unprecedented applications of certain federal healthcare laws and regulations, including the federal physician self-referral law (the “Stark Law”) and the federal...more

Baker Donelson

Arbitration Agreements in Your Long Term Care Community – CMS Says It's Mandatory to Be Optional

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The Centers for Medicare & Medicaid Services (CMS) issued a final rule last month advising that arbitration agreements are permissible in long term care communities that receive federal funding, but there's a catch: CMS...more

Robinson+Cole Health Law Diagnosis

CMS Issues Final Rule Restricting Arbitration Agreements with Long Term Care Facilities

On July 18, 2019, the Centers for Medicare & Medicaid Services (CMS) published a Final Rule establishing requirements for arbitration agreements between long-term care (LTC) facilities and their residents. The Final Rule...more

Pillsbury Winthrop Shaw Pittman LLP

FAR’s Professional Compensation Clause and Keeping Things Real

Court rules agencies must evaluate the realism of compensation in fixed-price professional services contracts. An agency must evaluate the risk of whether an offeror’s proposed professional compensation is too low to...more

King & Spalding

Federal Judge Blocks CMS Rule Banning Arbitration In Nursing Home Disputes

King & Spalding on

In September, CMS announced a final rule that bans pre-dispute binding arbitration agreements related to care received in long-term care facilities. Among other things, the rule preserves the right of patients and their...more

Cadwalader, Wickersham & Taft LLP

Federal Court Blocks CMS Ban on Pre-Dispute Nursing Home Arbitration Agreements Pending Legal Challenge: What the Ruling Means for...

Earlier this week, a federal court enjoined the federal Centers for Medicare and Medicaid Services (“CMS”) from enforcing a rule, promulgated on September 28, 2016, which barred pre-dispute arbitration agreements between...more

Ballard Spahr LLP

Federal Court Enjoins U.S. Agency’s Nursing Home Arbitration Agreement Ban

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The Centers for Medicare and Medicaid Services (CMS), an agency within the U.S. Health and Human Services Department, recently issued a final rule prohibiting nursing homes and other long-term care facilities from utilizing...more

Polsinelli

Catching Up With the Times: CMS Reforms Long-Term Care Facility Requirements - Part II

Polsinelli on

Following CMS publishing the biggest overhaul to federal long-term care regulations in 25 years, affected facilities must take steps to ensure they are prepared for the pending changes. On Oct. 4, CMS published the...more

Holland & Knight LLP

Ten Things to Know About the CMS Long-Term Care Requirements Final Rule

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Deadlines are looming to come into compliance with sweeping changes to the Centers for Medicare & Medicaid Services (CMS) requirements for long-term care facilities (LTC) participating in Medicare and Medicaid. The CMS final...more

Polsinelli

Catching Up With the Times: CMS Reforms Long-Term Care Facility Requirements - Part I

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On Oct. 4, CMS published the biggest overhaul to federal long-term care regulations since 1991. The lengthy Final Rule reforms the requirements for long-term care facilities participating in Medicare and Medicaid. CMS...more

Cadwalader, Wickersham & Taft LLP

In Final Rule, CMS Acts to Bar Pre-Dispute Binding Arbitration Agreements With Nursing Home Residents Effective November 28, 2016

On September 28, 2016, the federal Centers for Medicare and Medicaid Services (“CMS”) issued its long-awaited final rule that, among other things, prohibits skilled nursing facilities (“SNFs”) and nursing facilities (“NFs”)...more

Ballard Spahr LLP

U.S. Agency Prohibits Nursing Home Arbitration Agreements

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The Centers for Medicare and Medicaid Services (CMS), an agency within the U.S. Health and Human Services Department, has issued a final rule that includes prohibiting nursing homes and other long-term care facilities from...more

Poyner Spruill LLP

Proposed Changes to Stark Rule Would Create New Hospital Exceptions and Lessen Burden of Self-Disclosures

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In a development that is limited in scope but still welcomed by hospitals, the proposed 2016 Physician Fee Schedule proposes a number of new exceptions to the physician self-referral or Stark law and other refinements that...more

Benesch

CMS Proposed Stark Law Revisions

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On July 15, 2015, the Centers for Medicare and Medicaid Services (“CMS”) published proposed revisions to the regulations implementing the physician self-referral law, or Stark Law. The Stark Law is a key regulatory...more

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