Court Rules That HHS Must Recalculate Hospitals’ Medicare Pay for Training Physicians

Following a recent federal court ruling, hospitals can expect an increase in Medicare reimbursements for training physicians in their residency programs. 

In Milton S. Hershey Medical Center v. Becerra, No. 19-2680, the United States District Court for the District of Columbia (the “DDC”) ruled that the Department of Health and Human Services (“HHS”) unlawfully changed the statutorily‑assigned weighting factors used to calculate reimbursements to hospitals for resident stipends, supervisory physician salaries, and administrative costs related to training residents and fellows. These reimbursements, known as direct graduate medical education (“DGME”) payments, are, in part, determined by the weighted average number of full-time equivalent (“FTE”) residents employed by the hospital. 

New ADT Guidance from CMS, and Other Federal Updates

Centers for Medicare & Medicaid Services (“CMS”) recently released guidance for hospitals outlining the new requirements for admission, discharge, and transfer (“ADT”) electronic patient event notifications. These requirements originally stemmed from the Interoperability and Patient Access Final Rule published on May 1, 2020, and require health care providers to send electronic patient event notifications of a patient’s admission, discharge, and/or transfer to another healthcare facility or to another community provider or practitioner.

New Jersey Update, Including Provider Immunity and New Nursing Home Laws

As COVID-19 restrictions are being lifted on national and state levels, health care providers have to start considering that the immunity provided to them regarding COVID-19 may be lifted in the near future. New York already abrogated its immunity and New Jersey is starting to consider doing the same.

In addition, New Jersey has added even more reporting requirements on nursing homes, has made the process for transferring ownership more burdensome, and has increased the restrictions for a third party to manage the nursing home.

New Jersey Federal Court Extends New Jersey Patient Safety Act Privilege to Near-Miss Event Involving Non-Patient Employee

Lawson v. Praxair, Inc., Case No. 3:16-cv-2435 (BRM)(DEA)

This case involved a Defendant’s appeal from a magistrate’s order affirming in part and reversing in part a special master’s discovery decision involving invocation of privilege under the New Jersey Patient Safety Act ("NJPSA"). The NJPSA is intended to encourage the disclosure of adverse events and near-misses that threaten the safety of patients in a health care facility by creating a non-punitive culture focused on improvement over blame. To effect this purpose, the NJPSA establishes an absolute privilege for (a) documents received by the Department of Health ("DOH") pursuant to a mandatory requirement or voluntary disclosure, and (b) documents developed by a health care facility as part of a self-critical analysis conducted regarding a preventable or near-miss event

Is the Transparency Rule on Its Way Out? And Other Federal Updates

CMS Scales Back Part of the Transparency Rule

The Centers for Medicare & Medicaid Services ("CMS") issued its annual proposed Hospital Inpatient Prospective Payment Systems. Under the proposed rule, CMS seeks to repeal the requirement that acute care hospitals report median payer-specific negotiated rates with Medicare Advantage insurers, which was finalized in 85 FR 58432. This has created some excitement in the industry that CMS may be pulling back its transparency rules.

New OIG Advisory Opinion on Ambulatory Surgery Centers and the One-Third Test

On April 29, 2021, the Health and Human Services Office of Inspector General ("OIG") issued Advisory Opinion 21-02. The Advisory Opinion addresses a proposed arrangement involving a health system, certain orthopedic surgeons and neurosurgeons employed by that health system, and a management company seeking to invest in an ambulatory surgery center ("ASC").

New York Lifts Immunity, CMS Updates and Proposed Rules

Governor Cuomo Signs Law Lifting Liability Protections for Health Facilities

Governor Cuomo recently signed S5177 into law, repealing the Treatment Protection Act, which prevented health care facilities, like nursing homes and hospitals, as well as their administrators and executives, from being held accountable for harm in connection with their treatment of patients with COVID‑19. 

New Jersey Legislation Update

Every year, New Jersey proposes dozens of statutes that impact health care. The statutes in this post have already passed both the State Senate and Assembly and are on their way to become law unless vetoed by the Governor, with the exception of one statute that has already been approved and is now law.