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Pullman & Comley - Connecticut Health Law

New Billing Codes for At-Home Acute Kidney Injury Renal Dialysis

Earlier this year, the Centers for Medicare and Medicaid Services (CMS) confirmed that, effective January 1, 2025, CMS will pay for acute kidney injury (AKI) renal dialysis treatments at-home at the daily rate based on...more

Jones Day

Coming January 2026: CMS Launches AI Program to Screen Prior Authorization Requests for Treatments

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New CMS program, WISeR, will leverage third parties to screen prior authorization requests using technologically enhanced processes....more

Stevens & Lee

New Jersey’s Medical Debt Relief Act Now Fully in Effect

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In July 2024, New Jersey Governor Phil Murphy signed the Louisa Carman Medical Debt Relief Act into law (the Act). The Act protects patients from certain medical debt collection actions and contains several restrictions on...more

Benesch

Dental/DSO Intelligence Monthly Report: July 2025

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As government scrutiny of the healthcare industry intensifies, enforcement agencies are casting wider nets to recover funds based on narrowly interpreted violations. This puts not only healthcare providers but also those...more

McDermott+

Back for seconds: digital health policies in the CY 2026 PFS proposed rule

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It’s been more than two weeks since the release of the CY 2026 Medicare Physician Fee Schedule (PFS) proposed rule. We’ve had a chance to digest our initial helping and now we’re ready for seconds. We thought we would see...more

Pullman & Comley, LLC

Deadline Reminder: BCBS Settlement Claims Due by July 29, 2025

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Health care providers who have treated or provided services, equipment, or supplies to patients insured by Blue Cross Blue Shield (BCBS) between July 24, 2008 and October 4, 2024 may be entitled to compensation under a $2.67...more

Ropes & Gray LLP

Hospital and Health Systems Reimbursement Check July 2025

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In the early days of the second Trump Administration, several federal funding agencies announced caps to indirect cost (“IDC”) rates for federally funded research awards. In many cases, these caps would substantially reduce...more

Roetzel & Andress

One Big Beautiful Bill: A Boon for Concierge Medicine

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President Trump’s signing of the “One Big Beautiful Bill Act” on July 4, 2025, was a big win for concierge medicine practices, often called direct primary care (DPC). The new law allows favorable treatment for DPC...more

Stevens & Lee

New Changes to Medicare and Private Prior Authorization Processes

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Both the Centers for Medicare & Medicaid Services (CMS) and dozens of the nation’s largest insurance companies have revealed upcoming changes to their prior authorization processes. These changes aim to reduce the prevalence...more

Phelps Dunbar

Medicare’s New AI Payment Review Model: What Providers Need to Know

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CMS announced the rollout of the WISeR (Wasteful and Inappropriate Service Reduction) model in June. It aims to use technologies like artificial intelligence (AI) to “ensure timely and appropriate Medicare payment for select...more

Jones Day

CMS Updates Kidney Care Choices Model

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The Center for Medicare and Medicaid Innovation ("CMMI") announced sweeping changes to the Kidney Care Choices Model ("KCC Model"), a key set of value-based programs....more

Troutman Pepper Locke

Litigation Heats Up Over Air Ambulance Billing Practices Under the No Surprises Act

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There has been a flurry of recent activity in a case originally filed by six air ambulance companies claiming $20 million in unpaid emergency services invoices. ...more

Proskauer - Health Care Law Brief

No Surprises Here! Fifth Circuit Holds NSA Provides No Private Right of Action to Enforce IDR Awards, Deepening Judicial Divide...

In a recently issued opinion, the Fifth Circuit has added yet another chapter to the growing debate over whether providers may seek judicial enforcement of Independent Dispute Resolution (“IDR”) awards issued under the No...more

Troutman Pepper Locke

U.S. Supreme Court Holds Medicaid’s Any-Qualified-Provider Provision Does Not Confer Enforceable Rights

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The U.S. Supreme Court, in a 6-3 decision, ruled that the Medicaid Act’s any-qualified-provider provision does not confer individual rights enforceable under 42 U.S.C. §1983. This decision reverses the Fourth Circuit’s...more

Troutman Pepper Locke

Fifth Circuit Clarifies Enforcement of IDR Awards Under the No Surprises Act

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On June 12, the U.S. Court of Appeals for the Fifth Circuit issued a significant opinion in the case involving Guardian Flight, LLC and Med-Trans Corporation, two air ambulance providers, against the defendant insurance...more

Jones Day

Medicare's Innovation Center Charts New Direction: Part 1 - Providers

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The Center for Medicare and Medicaid Innovation ("CMMI") is set to reshape value-based care. In the first of a three-part series highlighting this new direction, this summary is focused on CMMI's efforts regarding health care...more

Troutman Pepper Locke

Connecticut Dentists Bite Off More Than They Can Chew; Settle False Claims Allegations for Nearly $500,000

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On May 9, Connecticut Attorney General (AG) William Tong, in collaboration with the U.S. Attorney’s Office for the District of Connecticut, announced a $495,721 false claims settlement with Advanced Dental Center PC (Advanced...more

Pullman & Comley - Connecticut Health Law

Head of Connecticut OHS to Resign

Late last week, Governor Lamont announced that the Commissioner of the Office of Health Strategy (OHS), Deidre Gifford, plans to retire from state service in June. No successor was named. ...more

Bass, Berry & Sims PLC

Healthcare Regulatory & Compliance Summit 2025 Recap

Health Policy Fireside Chat: What to Expect from the New Administration - Bill Mathias, Member at Bass, Berry & Sims, engaged in a fireside chat with Colin Roskey, Principal at FHP Strategies, former Deputy Assistant...more

Pullman & Comley - Connecticut Health Law

Considering a Direct Primary Care Practice? Don’t Ignore State Law!

Our recent article in Physicians Practice outlines 10 Dos and Don’ts for physicians and other practitioners to take into account when deciding whether to establish a direct primary care (DPC) practice. ...more

Dentons

Ep. 59 – Treating Medicare Beneficiaries as a Cash-Based Practice

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Cash-based practices, or providers who neither participate with nor bill insurers, are becoming increasingly common, especially in certain specialties such as primary care, women’s health, and mental health. While providers...more

Troutman Pepper Locke

Massachusetts AG Indicts Health Care Providers and Owners for Submission of Allegedly False Medicaid Claims

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The Office of Massachusetts Attorney General (AG) Andrea Campbell announced the criminal indictment of several Massachusetts-based health care providers and their owners in connection with allegedly false claims they...more

Whiteford

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

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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

Pullman & Comley, LLC

Is a Civil Rights Lawsuit by Private Parties a Means to Enforce a Federal Free Choice of Medicaid Provider Provision? A Spending...

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CASE AT A GLANCE - In 2018, Planned Parenthood South Atlantic (PPSAT) and one of its patients, Julie Edwards, sued the administrator of South Carolina’s Medicaid program to enforce the “free choice of Medicaid provider”...more

Pullman & Comley - Connecticut Health Law

OHS Issues 2025 Statewide Health Care Facilities and Services Plan

On March 14, 2025, the Connecticut Office of Health Strategy (OHS) issued its biennial Statewide Health Care Facilities and Services Plan (the “Plan”), with an effective date of March 15, 2025....more

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