Saneholtz Quoted in Columbus Business First on Mount Carmel Partnership With HealthSouth

Daphne K. Saneholtz, a partner in Brennan, Manna & Diamond's Columbus, OH office, was recently quoted in a Columbus Business First story on Mount Carmel Health System's planned joint venture with HealthSouth Corp to build a 60-bed rehabilitation hospital in the Columbus suburb of Westerville.

Saneholtz commented on the increasing prevalence of nonprofit hospitals collaborating with for-profit organizations, as well as the stiff competition between hospital systems. Said Saneholtz, "The competition among the nonprofits is significant, so the business relationships that give nonprofits a leg up, or allow them to extend their business lines, allows them to share risk and extend coverage."

The entire article can be accessed on the Columbus Business First website. A subscription is required to view the long version of the article, and a shorter version is available without a subscription.

Webinar - After the SGR: What the permanent doc fix means for your practice

Join Daphne Saneholtz and Part B news tomorrow, Wednesday, April 29, 1-2 pm EST, for a webinar entitled "What the permanent doc fix means for your practice". During the one hour discussion, Daphne will help physician practices understand the new payment and reimbursement structure included in the Medicare Access and CHIP Reauthorization Act (MACRA) and explore CMS' emphasis on quality.

Daphne Saneholtz is a partner in Brennan, Manna & Diamond's Columbus, OH office.

CMS to Release Held Medicare Physician Claims April 15

The Centers for Medicare & Medicaid Services (CMS) announced on April 13 that it will release on April 15 Medicare physician claims with dates of service on or after April 1, 2015, that it has been holding . 

According to CMS' MLN Connects Provider eNews Special Edition:

Beginning on April 15th, 2015, CMS will release held MPFS [Medicare Physician Fee Schedule] claims, paying at the reduced rate, based on the negative update, on a first-in, first-out basis, while continuing to hold new claims as they are received.  CMS will release one day's worth of held claims, processing and paying at the rate that reflects the negative update. At the same time, CMS will hold the receipts for that day, thus, continuing to hold 10 days' worth of claims in total. This is to provide continuing cash flow to providers, albeit at the rate that reflects the negative update. This “rolling hold” will help minimize the number of claims requiring reprocessing should Congress pass legislation changing the negative update.

CMS To Hold Physician Claims Hoping for Action on SGR

The Centers for Medicare & Medicaid Services (CMS) recently announced a short-term change to claims processing policy in order to avoid potential disruption and claims reprocessing in the event of congressional action regarding elimination of the Medicare sustained growth rate (SGR) formula. Specifically, CMS is holding claims “for a short period of time” beginning on April 1st.  According to CMS, “[h]olding claims for a short period of time allows CMS to implement any subsequent congressional action while minimizing claims reprocessing and disruption of physician cash flow in the event of legislation addressing the 21% payment reduction.  Under current law, electronic claims are not paid sooner than 14 calendar days (29 days for paper claims) after the date of receipt.” CMS intends to provide more information about next steps by April 11, 2015. 

Daphne K. Saneholtz is a partner in the Columbus office of Brennan, Manna & Diamond.

New York State Out In Front on Mental Health Parity

New York Attorney General Eric Schneiderman recently settled with Excellus, a Rochester-based health plan, to ensure it covers mental health and substance use disorder (MH/SUD) treatment for its 1.5 million members. Schneiderman has taken an aggressive approach to enforcing state and federal mental health parity laws; this was the fifth settlement by his office since last year.

The federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) is intended to align insured health care benefits for MH/SUD with those for medical and surgical care. The MHPAEA requires certain group health plans to ensure that financial requirements (e.g., copays and deductibles) and treatment limitations (e.g., visit limits) that are applicable to MH/SUD benefits are no more restrictive than the predominant requirements or limitations applied to substantially all medical and surgical benefits. The MHPAEA does not mandate that a plan must provide MH/SUD benefits. Rather, it requires that if a plan provides medical, surgical, and MH/SUD benefits, it must provide them equitably.

According to the Excellus settlement agreement, the plan denied coverage for inpatient mental health and substance use disorder treatment at more than double the denial rate for medical surgical treatment. "Every year, almost one in four New Yorkers has symptoms of a mental disorder," the agreement said, citing state Health Department data. "Lack of access to treatment, which can be caused by health plans' coverage denials, can have serious consequences for consumers, resulting in interrupted treatment, more serious illness and even death."

New York State was an early adopter of mental health parity, passing Timothy’s Law the year before the MHPAEA was enacted. Other states’ enforcement actions, however, are mixed, and application of parity laws generally remains varied across the country. The question is, will New York set a trend for enforcement of the federal law?

Daphne Saneholtz is a partner in the Columbus, OH office of Brennan, Manna & Diamond.