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Articles by Carmen Jule
Healthcare Industry Leaders Predict Four Areas To Watch After The U.S. Election: Takeaways From The Business Of Health Care Conference Hosted By The Miami Herbert Business School
SM Sheppard Mullin Richter & Hampton More Sheppard Mullin is a full service Global 100 firm with over 1,000 attorneys in 16 offices located in the United States, Europe and Asia. Since 1927, companies have turned to Sheppard Mullin to handle corporate and technology matters, high stakes litigation and complex financial transactions. In the US, the firm’s clients include more than half of the Fortune 100.
Healthcare Industry Leaders Predict Four Areas to Watch After the U.S. Election: Takeaways from the Business of Health Care Conference Hosted by the Miami Herbert Business School | Sheppard Mullin Richter & Hampton LLP - JDSupra
The recent U.S. election has had profound implications for the healthcare industry, prompting industry leaders to reexamine their strategies and day-to-day operations. At the Miami Herbert Business School’s annual “The Business of Health Care” conference on January 24, 2025, a pivotal forum brought together stakeholders across key sectors—home care, hospital systems, payors, and others—to assess the election’s impact and chart a path forward.
Visa & Immigration Solutions To Nursing Home Staffing Mandates (Video)
Nursing homes across the country are struggling to meet Federal (and often State) nursing staffing levels due to staffing shortages. Join Greg Berk, Lourdes Martinez, Andrew Desposito and Carmen Jule as they provide an overview of different employment-based sponsorship requirements for employers, types of visas (employment based and others), and common visa sponsorship scenarios, considerations and pitfalls. The content of this article is intended to provide a general guide to the subject matter.
No Surprises Here - Providers Win Again In No Surprises Act TMA III Litigation Vacating Independent Dispute Resolution Rule
On August 2, 2024, the United States Fifth Circuit affirmed the rulings in the No Surprises Act litigation brought by the Texas Medical Association and other plaintiffs1 challenging the August 2022 Final Rule that has been issued by the Departments of Labor, Treasury, and Health and Human Services (the "Departments") that applied to the Independent Dispute Resolution ("IDR") process created by the No Surprises Act (the "Act").2 What is the August 2022 Final Rule?
No Surprises Here – Providers Win Again in No Surprises Act TMA III Litigation Vacating Independent Dispute Resolution Rule | JD Supra
On August 2, 2024, the United States Fifth Circuit affirmed the rulings in the No Surprises Act litigation brought by the Texas Medical Association and other plaintiffs[1] challenging the August 2022 Final Rule that has been issued by the Departments of Labor, Treasury, and Health and Human Services (the “Departments”) that applied to the Independent Dispute Resolution (“IDR”) process created by the No Surprises Act (the “Act”).[2] What is the August 2022 Final Rule?
No Surprises Here - Providers Win Again in No Surprises Act TMA III Litigation Vacating Independent Dispute Resolution Rule
On August 2, 2024, the United States Fifth Circuit affirmed the rulings in the No Surprises Act litigation brought by the Texas Medical Association and other plaintiffs[1] challenging the August 2022 Final Rule that has been issued by the Departments of Labor, Treasury, and Health and Human Services (the “Departments”) that applied to the Independent Dispute Resolution (“IDR”) process created by the No Surprises Act (the “Act”).[2] What is the August 2022 Final Rule?
DHHS Bolsters Non-Discrimination Protections for Recipients of Covered Health Care Services and Activities
In a Final Rule issued on May 6, 2024, the U.S. Department of Health and Human Services (“DHHS”) finalized regulations implementing Section 1557 of the Affordable Care Act (“Section 1557”). The Final Rule updates and strengthens protections for individuals who participate in health programs or activities that receive Federal financial assistance (“Covered Entities,” as further defined below).
CMS Finalizes Federal Minimum Staffing Standards For Nursing Homes
In a long-awaited and controversial Final Rule posted on April 22, 2024,1 the Centers for Medicare and Medicaid Services (CMS) adopted new federal minimum staffing requirements that will require long-term care facilities to (1) ensure the presence of a registered nurse (RN) on-site 24 hours per day, seven days per week; and (2) provide a minimum of 3.48 total nurse staffing hours per resident day (HPRD), which includes at least 0.55 HPRD for RNs and 2.45 HPRD for nurse aides (NAs).
EXPERT INSIGHTS-NEW YORK BROADLY REVISES HOSPITAL FINANCIAL ASSISTANCE, MEDICAL DEBT COLLECTION AND RELATED REQUIREMENTS
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New York Broadly Revises Hospital Financial Assistance, Medical Debt Collection And Related Requirements
Effective October 20, 2024, New York hospitals must have in place State-mandated changes to their financial assistance ("FA") programs (including FA eligibility criteria and debt collection practices) and their practices related to consent forms, and patient use of credit cards and medical financial products. The new requirements were enacted as part of the State's health and mental hygiene budget legislation for fiscal year 2024 through 2025, signed into law by Governor Hochul on April 20, 2024.
New York Broadly Revises Hospital Financial Assistance, Medical Debt Collection and Related Requirements
Skip to main content April 26, 2024 Volume XIV, Number 117 Legal Analysis. Expertly Written. Quickly Found.
CMS Finalizes Federal Minimum Staffing Standards for Nursing Homes | JD Supra
In a long-awaited and controversial Final Rule posted on April 22, 2024,[1] the Centers for Medicare and Medicaid Services (CMS) adopted new federal minimum staffing requirements that will require long-term care facilities to (1) ensure the presence of a registered nurse (RN) on-site 24 hours per day, seven days per week; and (2) provide a minimum of 3.48 total nurse staffing hours per resident day (HPRD), which includes at least 0.55 HPRD for RNs and 2.45 HPRD for nurse aides (NAs).
Tips For Evaluating The Effectiveness Of Your Compliance Program (And Why It Matters) (Webinar)
Healthcare provider compliance programs face increasing government scrutiny by a variety of federal and state agencies. Having an effective compliance program can help providers detect and prevent fraud, waste and abuse, and potentially mitigate civil and criminal liability. For these reasons, it is especially important that providers know how to ensure that their compliance programs are effective and working properly.
No Surprises Act Webinar Series Part Three: Payor Obligations Under The No Surprises Act - Healthcare - United States
Click here to view the full article. Join Christine Clements, Carmen Jule and Lotan Helfman as they provide an overview of current group health plan and health insurance issuer obligations under the No Surprises Act and implementing regulations (including requirements and obligations for out-of-network services and post-termination continuity of care) as well as the recently proposed regulations that would impose additional requirements on payors.
Comment Period for the No Surprises Act Proposed Rule, “Federal Independent Dispute Resolution (IDR) Operations,” Will Reopen | JD Supra
On January 17, 2024, the Departments of Health and Human Services, Labor, and the Treasury (collectively, the “Departments”) and the Office of Personnel Management issued a notice that they will reopen the period for submitting comments on the proposed rule, “Federal Independent Dispute Resolution (IDR) Operations” (the “Proposed Rule”) under the No Surprises Act (the “Act”).
CMS Issues A Final Rule Requiring Nursing Facilities And Other Providers And Suppliers To Disclose Additional Ownership Information
Listen to this post On November 17, 2023, the U.S. Department of Health and Human Services' Centers for Medicare and Medicaid Services ("CMS") will publish a final rule requiring Medicare skilled nursing facilities ("SNFs") and Medicaid nursing facilities ("Facilities") to provide more detailed ownership, managerial and other information on Form CMS-855A (the "Final Rule").1 The Final Rule also includes new definitions of "private equity company" and "real estate investment trust" for...
CMS Issues a Final Rule Requiring Nursing Facilities and Other Providers and Suppliers to Disclose Additional Ownership Information | JD Supra
On November 17, 2023, the U.S. Department of Health and Human Services’ Centers for Medicare and Medicaid Services (“CMS”) will publish a final rule requiring Medicare skilled nursing facilities (“SNFs”) and Medicaid nursing facilities (“Facilities”) to provide more detailed ownership, managerial and other information on Form CMS-855A (the “Final Rule”).[1] The Final Rule also includes new definitions of “private equity company” and “real estate investment trust” for Medicare enrollment...
Long Term Care Facilities Face Mandatory Minimum Staffing Requirements | JD Supra
On September 1, 2023, the Centers for Medicare and Medicaid Services (CMS) issued a long-awaited proposal to establish new federal minimum staffing standards for long-term care facilities.[1] If the proposed rule is finalized, CMS estimates that approximately 75% of all nursing homes would have to “strengthen staffing in their facilities” in order to meet the new requirements.[2] Proposed Minimum Staffing Requirements As proposed, nursing homes will be required to provide: A Registered Nurse...
Sheppard Mullin Webinar - No Surprises Act: Litigation Update and Recent Guidance
The status of the independent dispute resolution (IDR) process under the No Surprises Act (NSA) is ever-evolving. Providers are waiting on the sidelines as cases weave their way through the court system. While the IDR process is currently on hold, it is incumbent on providers, payors, and individuals to remain vigilant and stay abreast of the forthcoming changes. Where do things stand now and what can we expect in the future?
Another No Surprises Act Update: Texas Court Vacates Rules And Guidance Related To The
On August 24, 2023, the United States District Court for the Eastern District of Texas again largely ruled in favor of the Texas Medical Association and other plaintiffs (including air ambulance providers) and vacated certain regulations1 and related guidance concerning how the "Qualified Payment Amount" ("QPA") - one of the factors in the arbitration of out-of-network disputes - is calculated under the No Surprises Act (the "Act").2 The Court also vacated certain rules specific to the QPA...
Another No Surprises Act Update: Texas Court Vacates Rules and Guidance Related to the “Qualified Payment Amount” | JD Supra
On August 24, 2023, the United States District Court for the Eastern District of Texas again largely ruled in favor of the Texas Medical Association and other plaintiffs (including air ambulance providers) and vacated certain regulations[1] and related guidance concerning how the “Qualified Payment Amount” (“QPA”) – one of the factors in the arbitration of out-of-network disputes – is calculated under the No Surprises Act (the “Act”).[2] The Court also vacated certain rules specific to the...
Another No Surprises Act Update: Texas Court Vacates Rules and Guidance Related to the “Qualified Payment Amount
Thursday, August 31, 2023 On August 24, 2023, the United States District Court for the Eastern District of Texas again largely ruled in favor of the Texas Medical Association and other plaintiffs (including air ambulance providers) and vacated certain regulations[1] and related guidance concerning how the “Qualified Payment Amount” (“QPA”) – one of the factors in the arbitration of out-of-network disputes – is calculated under the No Surprises Act (the “Act”).[2] The Court also vacated...
New York Medicaid Providers Now Have Two Pathways To Self-Disclose Overpayments To The Office Of The Medicaid Inspector General
On August 21, 2023, the New York State Office of the Medicaid Inspector General (OMIG) announced updates to the Medicaid overpayment self-disclosure program, which now includes an abbreviated process for reporting and explaining overpayments that are considered routine or transactional in nature and have been already voided and adjusted.
New York Medicaid Providers Now Have Two Pathways to Self-Disclose Overpayments to the Office of the Medicaid Inspector General | JD Supra
On August 21, 2023, the New York State Office of the Medicaid Inspector General (OMIG) announced updates to the Medicaid overpayment self-disclosure program, which now includes an abbreviated process for reporting and explaining overpayments that are considered routine or transactional in nature and have been already voided and adjusted.
New York Medicaid Providers Now Have Two Pathways to Self-Disclose Overpayments to the Office of the Medicaid Inspector General
On August 21, 2023, the New York State Office of the Medicaid Inspector General (OMIG) announced updates to the Medicaid overpayment self-disclosure program, which now includes an abbreviated process for reporting and explaining overpayments that are considered routine or transactional in nature and have been already voided and adjusted.
No Surprises Act Update: Federal IDR Temporarily Suspended After Court Vacates Increased Administrative Fees And Rule For Batching Claims.
Listen to this post On August 3, 2023, the United States District Court for the Eastern District of Texas once again ruled in favor of the Texas Medical Association1 and vacated portions of the guidance related to (i) the administrative fee for the Independent Dispute Resolution ("IDR") process created by the No Surprises Act (the "Act") and (ii) the "batching" of claims for the IDR.2 The Department of Health and Human Services promptly announced that the IDR process is temporarily suspended...
No Surprises Act Update
Thursday, August 10, 2023 On August 3, 2023, the United States District Court for the Eastern District of Texas once again ruled in favor of the Texas Medical Association[1] and vacated portions of the guidance related to (i) the administrative fee for the Independent Dispute Resolution (“IDR”) process created by the No Surprises Act (the “Act”) and (ii) the “batching” of claims for the IDR.[2] The Department of Health and Human Services promptly announced that the IDR process is temporarily...
New NYC Local Law Promotes Health Care Price Transparency
On June, 23, 2023, New York City Mayor Eric Adams signed the Healthcare Accountability and Consumer Protection Act (Intro. 844-A). This local law amends the New York City Charter and directs the Mayor to establish an Office of Healthcare Accountability – the first of its kind in the country. Among other things, the NYC Office of Healthcare Accountability will allow New Yorkers to compare costs charged by NYC hospitals for the same services.
New NYC Local Law Promotes Health Care Price Transparency | JD Supra
On June, 23, 2023, New York City Mayor Eric Adams signed the Healthcare Accountability and Consumer Protection Act (Intro. 844-A). This local law amends the New York City Charter and directs the Mayor to establish an Office of Healthcare Accountability – the first of its kind in the country. Among other things, the NYC Office of Healthcare Accountability will allow New Yorkers to compare costs charged by NYC hospitals for the same services.
New NYC Local Law Promotes Health Care Price Transparency
On June, 23, 2023, New York City Mayor Eric Adams signed the Healthcare Accountability and Consumer Protection Act (Intro. 844-A). This local law amends the New York City Charter and directs the Mayor to establish an Office of Healthcare Accountability – the first of its kind in the country. Among other things, the NYC Office of Healthcare Accountability will allow New Yorkers to compare costs charged by NYC hospitals for the same services.
New NYC Local Law Promotes Health Care Price Transparency
On June, 23, 2023, New York City Mayor Eric Adams signed the Healthcare Accountability and Consumer Protection Act (Intro. 844-A). This local law amends the New York City Charter and directs the Mayor to establish an Office of Healthcare Accountability – the first of its kind in the country. Among other things, the NYC Office of Healthcare Accountability will allow New Yorkers to compare costs charged by NYC hospitals for the same services.
NY Nursing Home Minimum Staffing Assessments Set To Begin
On June 30, 2023, the New York State Department of Health (DOH) issued a notice to nursing home operators and administrators announcing that it will begin conducting assessments on July 10, 2023 of nursing homes' compliance with the State's minimum staffing requirements. Nursing homes that fail to adhere to the three requirements outlined in the minimum staffing standards in any quarterly period face civil penalties of up to $2,000 per day that they are out of compliance.
NY Nursing Home Minimum Staffing Assessments Set to Begin | JD Supra
On June 30, 2023, the New York State Department of Health (DOH) issued a notice to nursing home operators and administrators announcing that it will begin conducting assessments on July 10, 2023 of nursing homes’ compliance with the State’s minimum staffing requirements. Nursing homes that fail to adhere to the three requirements outlined in the minimum staffing standards in any quarterly period face civil penalties of up to $2,000 per day that they are out of compliance.
NY Nursing Home Minimum Staffing Assessments Set to Begin
On June 30, 2023, the New York State Department of Health (DOH) issued a notice to nursing home operators and administrators announcing that it will begin conducting assessments on July 10, 2023 of nursing homes’ compliance with the State’s minimum staffing requirements. Nursing homes that fail to adhere to the three requirements outlined in the minimum staffing standards in any quarterly period face civil penalties of up to $2,000 per day that they are out of compliance.
CMS Takes Steps to Lower SNF Medicare Payment Error Rates | JD Supra
With the Medicare Comprehensive Error Rate Testing program projected error rate for skilled nursing facilities (SNFs) showing a significant increase in 2022 (15.1%, up from 7.9% in 2021), the Centers for Medicare and Medicaid Services (CMS) has instructed each of its Medicare Administrative Contractors (MACs) that review SNF Medicare claims to initiate a five-claim probe and educate medical review for each SNF in the MAC’s jurisdiction.
CMS Takes Steps to Lower SNF Medicare Payment Error Rates
With the Medicare Comprehensive Error Rate Testing program projected error rate for skilled nursing facilities (SNFs) showing a significant increase in 2022 (15.1%, up from 7.9% in 2021), the Centers for Medicare and Medicaid Services (CMS) has instructed each of its Medicare Administrative Contractors (MACs) that review SNF Medicare claims to initiate a five-claim probe and educate medical review for each SNF in the MAC’s jurisdiction.
CMS Takes Steps to Lower SNF Medicare Payment Error Rates
With the Medicare Comprehensive Error Rate Testing program projected error rate for skilled nursing facilities (SNFs) showing a significant increase in 2022 (15.1%, up from 7.9% in 2021), the Centers for Medicare and Medicaid Services (CMS) has instructed each of its Medicare Administrative Contractors (MACs) that review SNF Medicare claims to initiate a five-claim probe and educate medical review for each SNF in the MAC’s jurisdiction.
OIG’s Modernization of Compliance Program Guidance: What to Expect | JD Supra
The Department of Health and Human Services Office of Inspector General (OIG) recently announced changes to its process for informing healthcare industry stakeholders of new or updated Compliance Program Guidance (CPG). Historically, sector-specific CPG has been published in the Federal Register. Going forward, the OIG will publish all current and updated CPG on its website.
OIG’s Modernization of Compliance Program Guidance: What to Expect
The Department of Health and Human Services Office of Inspector General (OIG) recently announced changes to its process for informing healthcare industry stakeholders of new or updated Compliance Program Guidance (CPG). Historically, sector-specific CPG has been published in the Federal Register. Going forward, the OIG will publish all current and updated CPG on its website.
No Surprises Act Update: Certified IDR Entities to Resume Payment Determinations for Services Furnished Before October 25, 2022 | JD Supra
Earlier today, the Department of Labor, the Treasury, and the Department Health and Human Services Centers for Medicare and Medicaid Services (the “Departments”) issued a new directive to Certified Independent Dispute Resolution (IDR) Entities regarding issuing payment determinations for certain pending out-of-network (OON) disputes.
No Surprises Act Update: Certified IDR Entities to Resume Payment Determinations for Services Furnished Before October 25, 2022
Saturday, February 25, 2023 Earlier today on February 24, the Department of Labor, the Treasury, and the Department Health and Human Services Centers for Medicare and Medicaid Services (the “Departments”) issued a new directive to Certified Independent Dispute Resolution (IDR) Entities regarding issuing payment determinations for certain pending out-of-network (OON) disputes.
No Surprises Act Update: Certified IDR Entities to Resume Payment Determinations for Services Furnished Before October 25, 2022
Earlier today, the Department of Labor, the Treasury, and the Department Health and Human Services Centers for Medicare and Medicaid Services (the “Departments”) issued a new directive to Certified Independent Dispute Resolution (IDR) Entities regarding issuing payment determinations for certain pending out-of-network (OON) disputes.
Another Win for Providers: Texas Federal District Court Again Vacates Independent Dispute Resolution Rule for the No Surprises Act | JD Supra
On February 6, 2023, the United States District Court for the Eastern District of Texas ruled in favor of the Texas Medical Association[1] and vacated portions of the final rule adopted in August 2022 (the “August 2022 Final Rule”) that applied to the Independent Dispute Resolution (“IDR”) process created by the No Surprises Act (the “Act”).
Another Win for Providers: Texas Federal District Court Again Vacates Independent Dispute Resolution Rule for the No Surprises Act
Friday, February 10, 2023 On February 6, 2023, the United States District Court for the Eastern District of Texas ruled in favor of the Texas Medical Association[1] and vacated portions of the final rule adopted in August 2022 (the “August 2022 Final Rule”) that applied to the Independent Dispute Resolution (“IDR”) process created by the No Surprises Act (the “Act”).
Another Win for Providers: Texas Federal District Court Again Vacates Independent Dispute Resolution Rule for the No Surprises Act
On February 6, 2023, the United States District Court for the Eastern District of Texas ruled in favor of the Texas Medical Association[1] and vacated portions of the final rule adopted in August 2022 (the “August 2022 Final Rule”) that applied to the Independent Dispute Resolution (“IDR”) process created by the No Surprises Act (the “Act”).[2] The August 2022 Final Rule was adopted by the Departments of Labor, Treasury and Health and Human Services (the “Departments”) and addressed, in part,...
Another Win for Providers: Texas Federal District Court Again Vacates Independent Dispute Resolution Rule for the No Surprises Act
On February 6, 2023, the United States District Court for the Eastern District of Texas ruled in favor of the Texas Medical Association[1] and vacated portions of the final rule adopted in August 2022 (the “August 2022 Final Rule”) that applied to the Independent Dispute Resolution (“IDR”) process created by the No Surprises Act (the “Act”).
Attention New York Medicaid Providers: It’s Time to Upgrade Your Compliance Program | JD Supra
On January 31, 2023, the New York State Office of the Medicaid Inspector General (OMIG) released three guidance documents to assist Medicaid providers in meeting the requirements of recently adopted regulations governing (i) the implementation and maintenance of an effective compliance program for certain providers; (ii) Medicaid managed care fraud, waste and abuse prevention programs; and (iii) OMIG’s Self-Disclosure Program for overpayments.
Attention New York Medicaid Providers: It’s Time to Upgrade Your Compliance Program
On January 31, 2023, the New York State Office of the Medicaid Inspector General (OMIG) released three guidance documents to assist Medicaid providers in meeting the requirements of recently adopted regulations governing (i) the implementation and maintenance of an effective compliance program for certain providers; (ii) Medicaid managed care fraud, waste and abuse prevention programs; and (iii) OMIG’s Self-Disclosure Program for overpayments.
Attention New York Medicaid Providers: It’s Time to Upgrade Your Compliance Program
On January 31, 2023, the New York State Office of the Medicaid Inspector General (OMIG) released three guidance documents to assist Medicaid providers in meeting the requirements of recently adopted regulations governing (i) the implementation and maintenance of an effective compliance program for certain providers; (ii) Medicaid managed care fraud, waste and abuse prevention programs; and (iii) OMIG’s Self-Disclosure Program for overpayments.
Long Term Care Update: As Winter Arrives, CMS Renews its Emphasis on COVID-19 Vaccinations, Bivalent Boosters and Timely Therapeutic Treatments
Monday, December 19, 2022 As surges in various respiratory illnesses – including COVID-19 – loom over holiday gatherings, the Centers for Medicare & Medicaid Services (“CMS”) held an Open Door Forum for skilled nursing facility (“SNF”) providers addressing their obligations to offer/provide COVID-19 vaccinations, vaccination education and COVID-19 treatments, and gave providers the opportunity to bring up questions about obstacles they are facing in achieving compliance with the federal...
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