Tuesday, July 29, 2014

Update: CMS Issues Revised Guidance on
Hospice & Part D Prior Authorization Process

A few weeks ago, we discussed CMS’ newly-issued guidance establishing a prior authorization process for Hospice and Part D providers (read more here). As our previous blog post emphasized, soon after its March 10 implementation, advocacy groups, hospice associations, and members of Congress began urging CMS to suspend the process. According to opponents, the prior authorization requirement creates a barrier for beneficiaries to access necessary medications and leaves them to navigate complicated payor disputes in the midst of their terminal illnesses.

Thursday, July 24, 2014

Labs & Referring Physicians Take Note of OIG’s Special Fraud Alert

Recently, the U.S. Department of Health & Human Services, Office of Inspector General issued a Special Fraud Alert entitled, “Laboratory Payments to Referring Physicians.” The Alert focuses on specimen processing arrangements and registry arrangements. These arrangements, according to the OIG, pose substantial risks for fraud and abuse under the federal Anti-Kickback Statute.

One purpose of the Anti-Kickback Statute is to protect patients from inappropriate medical referrals or recommendations by health care professionals who may be unduly influenced by financial incentives.  When remuneration is paid purposefully to induce or reward referrals of items or services payable by a federal health care program, the statute is violated.  Arrangements between referring physicians and laboratories have long been subject to scrutiny by the OIG for their potential to violate the Anti-Kickback Statute. [1]

Friday, July 18, 2014

New Law Affecting APRNs
Takes Effect July 16, 2014

Senate Bill 7, signed by Governor Beshear on February 26, 2014, becomes effective today. The new law allows for an Advanced Practice Registered Nurse to request to discontinue a Collaborative Agreement for Prescribing Authority for Non-Scheduled drugs after having a CAPA-NS in place for four years. Specifically, the new law states:

After four years of prescribing with a CAPA-NS in collaboration with a physician:

Wednesday, July 16, 2014

New Part D Regulations Face Increased
Scrutiny from Advocacy Groups & Congress

On March 10, 2014, the Centers for Medicare & Medicaid Services issued a memorandum to Part D Plan Sponsors and Medicare Hospice Providers, entitled “Part D Payment for Drugs for Beneficiaries Enrolled in Hospice – Final 2014 Guidance.” The Guidance, effective since May 1, 2014, requires a prior authorization process for Hospice and Part D providers to determine their respective responsibility for drug coverage.  The Guidance followed a 2012 OIG report, entitled “Medicare Could Be Paying Twice for Prescription Drugs for Beneficiaries in Hospice,” which found that Medicare Hospice patients’ medications were sometimes paid for by Part D rather than by the patient’s Hospice program.