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On September 19, 2017, the Tennessee Department of Health (“TDOH”) granted the request for a Certificate of Public Advantage (“COPA”) from Wellmont Health System and Mountain States Health Alliance.  This approval paves the way for the two entities to form a single corporate entity called Ballad Health.  According to the TDOH, both health systems “agreed through the legislative process to meet a clear and convincing standard that their merger would create a public benefit to the residents of Northeast Tennessee that would outweigh any downsides of a monopoly of services.”  Notably, the Department observed that a Terms of Certification document accompanying the approval “includes how active supervision by the state of the new entity will look.”  This fact is important because the Federal Trade Commission (“FTC”), which is not a fan of COPA regulations, has made clear that it will closely analyze and challenge defenses based on asserted state action immunity where the state fails to provide adequate active supervision.
Continue Reading Tennessee Department of Health Grants COPA Request for Health Care Alliance

Our colleagues at ML Strategies have provided their Health Care Weekly Preview for the week of September 11, 2017.  This week’s preview focuses on Congress’ efforts to stabilize the ACA marketplaces, as well as the proposal from Senators Lindsey Graham (SC) and Bill Cassidy (LA) to use block grants to fund Medicaid expansion and private insurance subsidies.

Our colleagues at ML Strategies have provided their Fall Health Care Preview for Fall 2017.  This preview focuses on what to expect for the rest of 2017 by examining the following questions:

  1. How will the health care minibus provisions move?
  2. Will a market stabilization package come together?
  3. Will cost-sharing reductions (CSR) payments continue to be made or formally authorized?
  4. Will ACA “repeal and replace” be resurrected yet again?

This preview is a must read for those seeking to navigate the health care policy landscape in the remaining months of 2017.

The U.S. Centers for Medicare & Medicaid Services (CMS) published a proposed rule last week regarding the cancellation of three bundled payment models and an incentive payment model while also reducing the scope of a third type of payment model. These models were mandatory for hospitals in certain geographic areas. The current administration had delayed the implementation of these models until January 1, 2018.   Continue Reading CMS Proposes to Cancel Bundled Payment and Incentive Models

Our colleagues at ML Strategies have provided their Health Care Weekly Preview for the week of July 31, 2017.  This week’s preview focuses on the fallout from the failed vote to repeal the Affordable Care Act (ACA), including the issue of whether the federal government will continue to pay cost-sharing reduction subsidies (CSRs), as well a new proposal by Senators Lindsey Graham (SC), Bill Cassidy (LA) and Dean Heller (NV).

On July 18, 2017, just days after CMS went public with its proposal to reduce Medicare Part B reimbursement to certain 340B covered entities, Congress held its first hearing on 340B Program Oversight since March 2015.  A common thread ran through the testimony of the three testifying witnesses:  Erin Bliss, Assistant Inspector General with HHS-OIG; Dr. Debra Draper, Director of Health Care at the GAO; and, Captain Krista Pedley, Director of the Office of Pharmacy Affairs at HRSA:  Congress needs to legislatively grant HRSA more administrative authority over the 340B Drug Discount Program.  Continue Reading Witnesses at Congressional Hearing on 340B Urge Congress To Give HRSA Broader Regulatory Authority

Our colleagues at ML Strategies have provided their Health Care Weekly Preview for the week of July 24, 2017.  This week’s preview focuses on the Better Care Reconciliation Act and Senate parliamentary rules.  The preview also addresses Wednesday’s House Energy & Commerce Health Subcommittee’s hearing on Special Needs Plans, FDA User Fee Reauthorizations, and the health care minibus.

Stay tuned for additional updates from ML Strategies!

Our colleagues at ML Strategies have provided a Health Care Weekly Preview.  This week’s preview describes the Better Care Reconciliation Act (BCRA), the User Fee Acts (UFAs), the National Defense Authorization Act (NDAA), and the health care Minibus.

Stay tuned for additional updates and analysis from ML Strategies.

In March, I posted about the Uncertain Future of the 340B Drug Discount Program.  When opining about What Could Happen Next I speculated about possible changes to government reimbursement for 340B drugs “so that government safety net programs share in 340B savings.”

I reasoned that CMS already knew that “Medicare pays more for 340B drugs than the covered entities’ acquisitions cost.”   Continue Reading Six Questions and Answers About CMS’ Recommended Changes to 340B Medicare Reimbursement

Our colleagues at ML Strategies have provided a Health Care Weekly Preview.  This week’s preview describes the ongoing wrangling in the Senate over health care reform as well as highlighting the upcoming need to address FDA User Fees and the health care minibus. 

Stay tuned for additional updates and analysis from ML Strategies.