Recent Trends in Nursing Home Complaints, Final Regulatory Rule Regarding Identifiers, and a $1.6 Billion Dollar Judgment for ACOs

For more information about this blog post, please contact Khaled J. KleleLatoya Caprice Dawkins, or Ryan M. Magee.

Nursing Home Complaints:   The Office of Inspector General (OIG) previously found that a few states fell short in the timely investigation of the most serious nursing home complaints between 2011 and 2015. To complement this report, the OIG published an interactive map that displays details on nursing home complaint trends between 2011 and 2015.  The OIG then published a new interactive map to update the information for years 2016 through 2018. It includes information such as the number of complaints received and the number of the most serious complaints that a state investigated late.  As you can see from the map, the overall number of complaints for the entire country continues to rise.  To view the interactive map, click here

Common Ground Healthcare Cooperative v. United States, No. 17-877C.  Federal Judge Margaret Sweeney, in the Court of Federal Claims, granted final judgment in this class action case ordering the United States government to reimburse the class of more than 100 Affordable Care Act plan issuers nearly $1.6 billion in unpaid cost-sharing reduction payments owed for the 2017 and the 2018 plan years.   This class action is one of dozens of cases filed against the United States for failing to reimburse issuers for reducing out-of-pocket costs for certain low-income enrollees.  In February, the judge said the government had to make the payments despite the fact that Congress did not appropriate any specific funding for them.  Click here to read the decision. 

84 FR 57621 – Final – The Department of Health & Human Services finalized its rule pertaining to the Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996. This final rule eliminates the regulatory requirement for health plans to obtain and use a health plan identifier (HPID) and eliminates the voluntary acquisition and use of the other entity identifier (OEID). The final rule also simplifies the process for deactivating the existing identifiers to minimize operational costs for covered entities.  The rule becomes effective December 27, 2019.  For the complete final rule, click here.