Blog Archives

Home Health Providers Face Additional Cuts and Scrutiny for Therapy Services, but Gain Some Flexibility in Face-to-Face Encounter Requirements

In a final rule published in the Federal Register on November 4, 2011,[1] the Centers for Medicare & Medicaid Services (“CMS”) announced it will decrease payments to home health agencies (“HHAs”) by $430 million in 2012. The home health prospective payment system (“HH PPS”) final rule also revises case-mix weights in response to concerns that HHAs are overcompensated for therapy services and incentivized to provide unnecessary therapy services, and adds flexibility to the face-to-face encounter requirement for patients discharged to home health from hospitals or post-acute facilities.

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HEALTH REFORM: Health Care Innovation in the Medicare Program: Value-Based Initiatives Beyond Accountable Care Organizations

As the health care industry analyzes the recently released final rule and related guidance regarding the Medicare Shared Savings Program (“MSSP”) for accountable care organizations (“ACOs”) (see Epstein Becker Green’s Implementing Health and Insurance Reform alert of October 27, 2011, here), it is important for the industry to also pay attention to key deadlines related to initiatives being implemented by the Center for Medicare and Medicare Innovation (“CMMI” or “Innovation Center”) within the Centers for Medicare & Medicaid Services (“CMS”).

By way of background, the MSSP is being implemented under the Center for Medicare within CMS. The Innovation Center is a new center organized under CMS, and has a different mission, organizational structure, and leadership than the Center for Medicare. The Innovation Center was created under the 2010 Patient Protection and Affordable Care Act (“ACA”) to test innovative payment and service delivery models to reduce program costs, while also preserving the quality of care for Medicare, Medicaid, and CHIP beneficiaries. Funding in the amount of $10 billion already was provided to the Innovation Center through fiscal year 2019.

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The Importance of Storytelling

Storytelling. It is an important component of a successful professional woman’s life – in the boardroom, courtroom, or classroom, in theater and the arts, in research labs, and in any place we find ourselves imparting information. Recognizing the impact and art of articulating a cogent, comprehensive, and powerful presentation in any of these forums,the Epstein Becker Green Women’s Initiative (WI) recently hosted 2011 Pulitzer Prize-winning author Amy Nutt to share with us some insights from her own successful career as a journalist on enhancing our natural ability as women to weave a set of facts into a compelling narrative. (For more information about the WI event and Ms. Nutt’s book, Shadows Bright as Glass, click here.)

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HEALTH REFORM: Revisiting the Medicare Shared Savings Program: An Interagency Effort to Promote Accountable Care

On October 20, 2011, the Centers for Medicare & Medicaid Services (“CMS”) released its final rule (“Final Rule”) implementing the voluntary Medicare Shared Savings Program (“Program”) for accountable care organizations (“ACOs”). The Program was established by Section 3022 of the Patient Protection and Affordable Care Act. The Final Rule was released in conjunction with revised antitrust guidance from the Federal Trade Commission (“FTC”) and the Department of Justice (“DOJ”), as well as with the establishment by CMS and the Department of Health and Human Services’ Office of Inspector General (“OIG”) of several waivers from various fraud and abuse laws. As part of this interagency effort to facilitate participation in the Program, the Internal Revenue Service (“IRS”) also issued a fact sheet regarding nonprofit organizations’ participation in ACOs.

Click here to download the entire alert in PDF format.

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Another Instance of Alleged Trade Secret Misappropriation Results in Federal Criminal Indictment

Co-authored by Viktoria Lovei.

Following up on a recent post, U.S. v. Pu presents another instance of a trade secret theft case with an international component that the federal authorities have decided to prosecute. Yihao Pu, a former quantitative financial engineer for Citadel LLC, was arrested last Wednesday for allegedly stealing proprietary information related to the Chicago-based company’s trading system as part of a plan to launch his own hedge fund in China. After filing its own civil suit against Pu on August 29, 2011 and obtaining a temporary restraining order, Citadel brought the matter to the federal authorities. In this instance, the company chose both to take rapid action on its own to protect its trade secrets as well as to refer the matter to federal law enforcement authorities. The civil case is Citadel LLC v. Yihao Ben Pu, 11CH30493, Cook County, Illinois and the federal case is U.S. v. Pu in the Northern District of Illinois.

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The Department of Health and Human Services Requests Comments on Proposed Changes to the "Common Rule"

On July 26, 2011, the U.S. Department of Health and Human Services (“DHHS” or the “Department”) published an advance notice of proposed rulemaking (“ANPRM”) soliciting comments on proposed changes to the “Common Rule.”[1] The Common Rule, more formally known as the Federal Policy for the Protection of Human Subjects, is a uniform set of regulations governing the protection of human subjects involved in research that is conducted or supported by certain federal agencies, including, by way of example, DHHS and the Departments of Defense, Education, Agriculture, Commerce, and Veterans Affairs, among others. In addition, many institutions that conduct research under a Federalwide Assurance (“FWA”) voluntarily adopt the Common Rule’s protection for all research performed at the institution, regardless of funding source, including FDA-regulated research.

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When It Comes to Non-Compete Agreements, It’s Best to Know Exactly What Your Company Is Acquiring

Restrictive covenants such as non-compete and non-solicitation agreements are frequently used in connection with acquisitions to protect the underlying value of the transaction. After all, an acquiring company typically values the target company based in part on the revenue it generates from its stable of customers. Therefore, the acquiring company often requires the target company’s employees to execute restrictive covenants that limit their ability to “jump ship” after the acquisition closes and erode the value of the transaction by luring away customers. Recently, the United States Court of Appeals for the First Circuit issued a decision which underscores the importance of carefully examining and understanding any restrictive covenant that may be acquired through a transaction.

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Get Ready for the Summary of Benefits Coverage under PPACA

On March 23, 2012, another requirement under the Patient Protection and Affordable Care Act (the “Act”)  will be effective-the requirement to provide group health plan participants and beneficiaries with a summary of benefits coverage that accurately describes the benefits and coverage available under the plan and a uniform glossary of terms (“SBC”).  These requirements were incorporated under the Internal Revenue Code and ERISA (in addition to existing summary plan description requirements).  Under currently proposed regulations, health insurance issuers will also be required to provide this type of information to group health plan sponsors at the time of application or request for information regarding coverage within seven days of the request (including an obligation to update such information should it change); this information must also be provided upon renewal (30 days in advance of a new policy year in a case of an automatic renewal).  

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Special Immigration Alert: 2013 Diversity Visa Lottery Begins on October 4, 2011, and Ends on November 5, 2011!

The Department of State (“DOS”) announced on September 13, 2011, the opening of the registration period for the DV-2013 Diversity Visa (“DV-2013”) lottery. The online registration period for the DV-2013 lottery will begin on Tuesday, October 4, 2011, at 12:00 p.m. EDT (GMT-4), and conclude on Saturday, November 5, 2011, at 12:00 p.m. EDT (GMT-4).

It is strongly recommended that applicants not wait until the last week of this registration period to enter because heavy demands could result in website delays. No entries will be accepted after 12:00 p.m. EDT on November 5, 2011. During the registration period, information, instructions, and the Electronic Diversity Visa Entry Form for the DV-2013 lottery will appear at www.dvlottery.state.gov.

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New York State Initiates Efforts to Regulate Executive Compensation by Not-for-Profits

New York State Governor Andrew Cuomo has formed the Task Force on Not-for-Profit Entities (the “Task Force”) to investigate executive compensation by not-for-profit organizations that receive state funding.[1] Governor Cuomo announced the Task Force on August 3, 2011, and it quickly took its first action on August 25, 2011, by sending a letter requesting extensive compensation information from many organizations that receive state funds.

This Client Alert describes (i) the Task Force’s mandate, (ii) the compensation information requested in the Task Force’s letter, (iii) several key points to note about the information requested in the letter, and (iv) certain additional insights.

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