An Overview of the New Rural Emergency Hospital Medicare Designation

Over 135 rural hospitals have closed since 2010 with hundreds more identified as vulnerable based on performance levels. Despite the challenge’s rural facilities face, access to emergency services and higher-level outpatient services are necessary. A new model for rural hospitals developed by Congress aims to provide an alternative model for these hospitals.

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HHS Releases New Requirements Related to Surprise Billing

On July 1, 2021, the Department of Health and Human Services (HHS) released an interim final rule that aims to give patients additional protections from surprise medical bills. Specifically, the interim rule established protections from “surprise billing and excessive cost-sharing” for consumers receiving health care items and services. It also prohibits out-of-network charges for ancillary services without advance notice. The initial round of regulations applies to group health plans, health insurance issuers, health care providers and facilities, air ambulance services, among others. Most of the consumer protections included in the interim final rule take effect on January 1, 2022.

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Enforcement Trends to Expect Post-Lockdown

With the COVID lockdown, the law enforcement agencies, including the United States Department of Justice (DOJ), the local US Attorneys’ Offices, and the state enforcement agencies worked on a limited basis for much of 2020 and 2021 to present date. The slowdown in enforcement in 2020 due to the pandemic was reflected in the civil fraud recoveries for that year. The DOJ reported $2.2 billion in settlement and judgments for civil cases in the fiscal year 2020 (from October 1, 2019, to September 30, 2020), which was down from the over $3 billion recovered in the fiscal year 2019 and was the lowest civil fraud recovery in a decade. The percentage of healthcare recovery was higher, totaling approximately $1.8 billion in 2020, or over 80% of the recovery of all civil fraud cases.

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Recent Settlement Highlights OCR’s Continued Enforcement Under HIPAA’s Right of Access

The U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) recently settled its ninth enforcement action under HIPAA’s right of access provisions.  This settlement demonstrates OCR’s continued focus on ensuring covered entities provide patients timely access to their medical records at a reasonable cost.

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CMS Withdraws Proposed MFAR Rule

The Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma announced on Monday, September 14, 2020 that CMS is officially withdrawing the controversial proposed Medicaid Fiscal Accountability Regulation (MFAR).  If finalized, MFAR would have drastically altered the way states are able to finance their share of Medicaid.  MFAR was opposed by a variety of stakeholders, including hospitals, physicians, national healthcare associations, governors, and state health departments.  Verma cited that these stakeholders raised concerns about “unintended consequences” of MFAR.

Written by: Catherine Moore