Incoming Director Robert Gordon said early this month he believes there are “huge opportunities to improve services through the combination” of agencies that turned the Department of Health and Human Services into a huge 14,000-employee department.

“There are enormous connections between health and human services. People don’t live their lives in bureaucrat boxes,” he said in a telephone press conference today. “. . . I also know it is clear there is much more work to be done to leverage the combination and to get the full benefit.”

Gordon was appointed this month as the new DHHS director by Gov. Gretchen Whitmer. He most recently was senior vice president of finance and global strategy for The College Board. Previously, he served under President Barack Obama as acting deputy director at the U.S. Office of Management and Budget, and was the acting assistant secretary for Planning, Evaluation, and Policy Development at the U.S. Department of Education.

Whitmer said in December she was considering breaking up DHHS and had been concerned with the combination when it was made under former Gov. Rick Snyder.

“I view it as an open question. I should say, I don’t think there is a final decision on this question. But my going in is to look [Read More]

By EWA MATUSZEWSKI
We have a Code of Conduct and a Code of Ethics. Heck, for ONyou history buffs, we even have the Code of Hammurabi. Why don’t we have a Code of Compassion, though? More specifically, a Code of Empathy? It wouldn’t be limited to the healthcare profession, but I can’t think of a better place to begin the codification process.

Actually, a Google search did turn up a video on a code of empathy, but its views are relatively insignificant; plus, it was preceded in search findings by “coding with empathy” and “coding with compassion.” I think that means the door is open for a movement on empathy in healthcare.
Empathy requires an individual to put him or herself into the shoes of another who is vulnerable in some way, perhaps due to illness, surgery, grief, depression, or even embarrassment. We’ve all been vulnerable on occasion. In the hospital or other type of healthcare or rehabilitation setting, we may be at our lowest point of vulnerability. Responding to patient requests, or chastising patients in recovery, with the following comments reveals an utter absence of empathy (these are actual statements made by healthcare professionals to a patient):

• “I haven’t got time for that.”
• “Your cognitive skills are [Read More]

By SARAH HILLEGONDS, ESQ.
Targeted probe and educate (TPE) audits are the latest type of audits facing Medicare providers and suppliers (collectively referred to as “providers”). TPE audits are unique in that providers may be subject to up to three rounds of record reviews. If a provider fails to improve the accuracy of their claims after three rounds, the provider will be referred to CMS for possible further action.

The Centers for Medicare and Medicaid Services initially launched TPE as a pilot program in one Medicare Administrative Contractor (MAC) jurisdiction limited to certain types of claims. In October 2017, CMS expanded TPE audits to all MACs for all Medicare providers and all items and services billed to Medicare. TPE audits focus on providers with a history of high claim error rates or unusual billing practices compared to their peers, and items and services that have high national error rates and are a financial risk to Medicare. Common claim errors include: (1) the signature of the certifying physician was not included; (2) documentation does not meet medical necessity; (3) encounter notes did not support all elements of eligibility; and (4) missing or incomplete initial certifications or recertification.

Providers selected for a TPE audit will receive an initial notification [Read More]

By ALLAN DOBZYNIAK, MD
One of the drivers of increasing health insurance policy premiums, and especially ACA policies, is the so called “community rating.” This is the concept that requires health insurance companies to offer policies within a given territory at the same price to all persons without medical underwriting, regardless of their health status. This does not account for all premium increases such as coverage mandates and increasing provider costs (almost exclusively attributable to hospitals), but it has become increasingly consequential. For the ACA, as the premiums increase fewer healthy people, particularly the younger, can afford the increasing premiums, or they may voluntarily choose not to purchase the more expensive policies. The result is a greater percent of policy holders are high-risk with significant preexisting conditions. Therefore, there are fewer healthy people to defuse the continuing rise in risk and premium costs as the situation persists and worsens. Huge premium increases have been the unfortunate result.

The novel new definition of “reinsurance” as it applies to health care has nothing to do with the classic definition. Reinsurance has meant the purchase of insurance by an insurance company to cover large unanticipated losses that may be greater than its financial reserves. In healthcare, it is a part [Read More]

By FEDERICO MARIONA, MD
The Michigan voters recently approved Proposal 1 by a margin of 56 to 44 percent. Retail for-profit sales of marijuana and related products is now the law in Michigan. Our state is the first state in the Midwest to take this step. Our neighbor Canada already has this in place. There are no neighboring states that have approved the use of marijuana for retail sales, yet.

Marijuana is a product from the flowers, stems, leaves and seeds of the plant (Phyto cannabinoids), and is the most common illicit drug used in the United States. Phyto active elements have been described for centuries. Marijuana’s history as a source of these elements described as having “medical effects” dates to biblical times. The main psychoactive component is the delta-9-tetrahydrocannabinol (THC). Marijuana “extracts” are rich in this element. Industrial “hemp” contains low levels of d-9-THC. Emerging in the United States, specifically in the Midwest, are the “synthetic cannabinoids” that replicate the effects of the natural product, but they induce more severe adverse health effects. In addition, marijuana contains a number of other phytocannabinoids, such as Canabidiol (CBD) without psychoactive effects and, arguably, with [Read More]

By THOMAS MILES, ESQ. & REESA N. BENKOFF, ESQ
On Nov. 26, 2018, the Office for Civil Rights (OCR), a division of the U.S. Department of Health and Human Services, announced that it had entered into a settlement agreement with Allergy Associates of Hartford, P.C. regarding alleged violations of the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule. The settlement requires Allergy Associates to pay the OCR $125,000 and enter into a two-year Corrective Action Plan. Allergy Associates, a physician practice with four office locations in Connecticut, is comprised of four physicians and two mid-level providers. Despite the seemingly low settlement figure, this fine relates to a HIPAA Privacy Rule breach involving only one patient and is, therefore, significant in that it emphasizes the OCR’s focus on investigating smaller covered entities for breaches that affect very few patients. In fact, since 2015, the OCR has placed an emphasis on investigating smaller covered entities as well as breaches that affect less than 500 individuals following a report issued by the HHS Office of Inspector General finding that the OCR had historically focused its investigation efforts on larger covered entities and breaches affecting over 500 individuals.

The incident leading [Read More]

By SERJ MOORADIAN
Healthcare providers balance their time and resources between providing the best possible care to patients and keeping up with their ever-changing regulatory landscape. Providers are often at the mercy of the federal and state agencies that administer healthcare programs, which have significant discretion in interpreting statutes, promulgating rules and guidance that implement those statutes, and their enforcement. Due to the sheer number of applicable requirements, any provider that regularly bills a government healthcare program is likely to have an enforcement action brought against it by a government agency at some point, no matter how strong the provider’s compliance program is.

When an administrative agency takes an enforcement action, successfully challenging that action can be difficult. The same agency usually controls the administrative appeals process, which the provider must exhaust before it can challenge the agency’s decision in court. Then, the court still gives substantial deference to the agency’s decision, on the grounds that government healthcare programs are complex and that the legislature has delegated to the agency to use its wisdom and resources to administer the program.

Because of the deference administrative agencies receive, it is vital for providers challenging an agency’s action to understand how to navigate the [Read More]

By PAUL NATINSKY
Governor-elect Gretchen Whitmer has her work cut out for her. Despite historic gains for Democrats and women in Michigan and national midterm elections, Michigan’s legislature retains its Republican majority, and thus presents the new governor with an uphill challenge on all of her initiatives, including her healthcare plan, titled, “Get It Done: Healthy Michigan, Healthy Economy.”

The 19-page document covers a full range of issues facing a state that has low to middling marks on health status, access to care and the cost of healthcare services.

“The state of Michigan has invested very little in public health—just enough to meet what is needed to draw down federal funding,” stated Whitmer in ‘Get It Done.’”

To remedy that state of affairs, Whitmer pledges to “protect Healthy Michigan gains,” from 2014, when then-Gov. Rick Snyder expanded the state’s Medicaid program and helped cut Michigan’s uninsured rate from 18 percent in 2011 to just over 5 percent in 2017. Whitmer made her legislative cooperation with Snyder on this issue one of the focal points of her campaign.

Overall, Whitmer’s plan addresses four main points:
-Making healthcare more affordable
-Expanding access to healthcare
-Improving quality
-Investing in public health

Whitmer looks to reinsurance to better provide for the financial risk of treating Michigan’s high-risk, low-health-status population. [Read More]

By EMMARIE HUETTEMAN
For the first time since passing the Affordable Care Act, Democrats will soon control the House of Representatives and its powerful health committees. But Republicans’ tightened grip on the Senate means those hoping for another round of dramatic, progressive reforms may be disappointed.

Empowered by voters outraged over Republican attempts to chip away at the law’s protections for the sick, Democrats owe much of their midterm takeback to health care issues. And Democratic leaders say they are ready to get back to work, this time training their sights on skyrocketing drug prices, among other policy conundrums, with a majority of House votes and a slate of new committee chairmanships in hand.

In a few weeks, House Democrats will meet to elect their leaders, including several committee chairs who will be responsible for the nation’s health care policy and spending in the coming years. Hill denizens expect those currently serving as the top Democrat on most House committees to ascend to the chairmanships, with few if any members mounting serious challenges.

Those basking in a post-“blue wave” glow would do well to temper their expectations, recalling that the Republican-controlled House had already voted 54 times to unravel some or all of the Affordable Care Act by its [Read More]

By EWA MATUSZEWSKI
At this risk of entertaining numerous strategic partnership requests following the publication of this blog, I want to explore the benefits of partnerships that may or may not have financial benefits, yet bring the strengths of two or more parties together for the greater good.

What has me thinking of partnerships in general is the soon-to-be launched integrated primary care clinic our PO is opening at the Warren location of the Judson Center. Judson Center provides autism programs, behavioral health services, child and family services including foster care and adoption, and disability support services throughout Southeast Michigan. With the opening of the clinic, they can add primary care to these services, switching up the converse trend of bringing behavioral health into primary care and at the same time supporting the State’s Section 298 initiative to better coordinate physical and behavioral health services.

We first became acquainted with Judson’s work through collective efforts to expand the PCMH neighborhood. At the same time, we were getting to know each other as participants in Oakland County’s ECHO program, one of the best regional examples of a community health-based strategic alliance I have ever experienced. Judson approached us to jointly apply for a health and well-being grant. While the [Read More]

By SARAH HILLEGONDS
In August, the Provider Reimbursement Review Board released 90 pages of updated rules governing its appeals process. The rules were issued with immediate effect and apply to all pending and future appeals. If a provider fails to comply with these new rules, the PRRB has discretion to dismiss the appeal.1 Because appeals before the PRRB are typically high-value cases, it is critical that attorneys and providers that have cases before the PRRB understand the rule changes.

As background, the PRRB is an independent adjudicating body of the United States Department of Health and Human Services to which a Medicare Part A provider may appeal if dissatisfied with a “final determination” by a Medicare contractor of the Center for Medicare & Medicaid Services. A “final determination” for purposes of a Part A appeal include, but are not limited to, notices of program reimbursement, exception determinations, and other determinations issued by CMS or its contractors with regard to the amount of total reimbursement due to the provider.2 In order to appeal a final determination to the PRRB, the amount in controversy for a single provider must be at least $10,000.3 For two or more providers, the amount in controversy must be $50,000 or more.4 Part A [Read More]

By GREGORY W. MOORE & ALEXANDRA A. HALL
Forty-eight thousand Americans were lost to opioid overdoses in 2017. Michigan opioid-related deaths and overdoses rank 18th-highest in the nation. Over the last year, significant attention was dedicated toward combating this widespread issue on both a federal and state level.

Michigan

Recently enacted Michigan opioid laws were executed with the intent to save lives and decrease misuse of controlled substances. In effect, the laws have imposed significant administrative hurdles and led to some confusion among prescribers, pharmacists, and patients.

The new laws impose substantial obstacles for prescribers prior to writing a prescription for opioids. Among such obstacles include the requirement that when a prescriber issues the first prescription for a controlled substance containing an opioid to a minor, he or she must discuss various risks of addiction and overdose with the minor and the minor’s parent or guardian and obtain the signature of the minor’s guardian on a form issued by the state. Certain exceptions to this general rule include treatment associated with a medical emergency or surgery, if compliance would be detrimental to the minor, or if consent of the minor’s guardian is not required for the treatment. To complicate it more, if the individual signing the form [Read More]

Enviro Groups Call Out Schuette For PFAS Response
Environmental groups took Attorney General Bill Schuette to task last month for “dragging his feet” on per- and polyfluoralkyl substances (PFAS) contamination in Michigan—behavior they compare to his response to the Flint water crisis.

Sierra Club Michigan Chapter Chair David Holtz said Schuette “is failing communities all across Michigan” and Bob Allison, deputy director at the Michigan League of Conservation Voters, called it “yet another example of inaction from our government—despite multiple warnings.”

“He’s sitting on PFAS contamination complaints just like he chose not to act on reports of lead in Flint’s drinking water,” Holtz said. “Attorney General Schuette had the authority to take legal action, but instead he chose to delay holding the Air Force accountable for their toxic mess.”

Allison added: “We learned earlier this year that the state ignored and shelved a report six years ago that raised alarms about this crisis. The state House, led by Tom Leonard, who now wants to be the next Attorney General, has shirked its responsibility for nearly a year in passing a tough, safe PFAS drinking water standard.”

The reaction came after the Detroit Free Press published an article quoting Troy attorney Anthony Spaniola, who owns property near the former Wurtsmith Air [Read More]

By EWA MATUSZEWSKI
Did you hear my heart go thud? As I write this, I just read of Beaumont’s plan to open 30 urgent care centers in Metro Detroit by the end of 2019 with an out-of-state urgent care clinic operator. It’s not a new concept, just more of the same; yet I fear the proliferation of urgent care clinics may lead to the demise of the Patient Centered Medical Home and its focus on patent-centric, whole person coordinated care.

We want everything fast: our information, our food, our relationships… but should we slow down just a bit here and think about the patient/physician bond that is formed through the years, through primary care physicians who sometimes take care of entire families, even multi-generations of families? What’s the likelihood of replicating the health benefits of a primary care physician/patient relationship in an urgent care setting? How about the multi-disciplinary team efforts offered by many PCP practices as an effective means of controlling and or preventing chronic conditions? That’s not on the urgent care menu. (Or should I say “Immediate Care?” I see signs, literally, that this segment of the industry is morphing into a drive-through type healthcare approach.)

Interoperability, one of my crusading initiatives, (Yes, I have many), [Read More]

By PAUL NATINSKY
This summer featured continued disruption in aspects of the Affordable Care Act. This time, the vehicle was suspended risk adjustment payments to health plans. The payments have since resumed, but the methodology used to determine them has come under question.

So-called “risk adjustment” payments were established in the ACA to stabilize the health insurance market by transferring money to plans serving higher risk patients from those serving lower risk patients. The total in transfers for 2017 is $10.4 billion.

Two lawsuits, one in Massachusetts and one in New Mexico, declared the methodology used to determine payments respectively legal and then illegal. These lawsuits prompted CMS to issue a final rule in late July intended to address concern about the methodology used for the payments.

“The final rule will restore the operation of the risk adjustment program and mitigate some of the uncertainty caused by the New Mexico litigation,” CMS Administrator Seema Verma said in a statement. “Issuers that had expressed concern about having to withdraw from markets or becoming insolvent should be assured by our actions.”

And some issuers were glad to see the payments resume. “The risk adjustment program is an important tool that ultimately protects consumers and helps lower costs for members,” said Andy Hetzel, [Read More]

Editor:

Read your paper for the first time (Sept., 2018 issue), picked it up at U of M hospital.
Interesting letter to the editor by Allan Dobzyniak, MD. Apparently, he needs to research exactly what Medicare for all means. If he seriously thinks that doctors and other providers won’t be paid, he is mistaken. He also claims that socialized medicine, as he refers to it does not work and is akin to slavery. Funny, I don’t see any ofthe countries that have socialized medicine taking steps to get rid of it. Socialized medicine is a term some like to use to scare people and whether we admit it or not, we already have some types of socialized medicine in the United States.

His letter to the editor was quite clear concerning his thoughts. He thinks doctors will be giving away care for free, “That someone would expect a service from another without payment seems much like the scourge of slavery that was belatedly banished from this country in the mid-19th century. There seems a hypocrisy here as the loud screams of the
virtue signalers for social justice are joined by equally loud screams for physician services on demand for “free.” Medicare for all in no way would force physicians [Read More]

Erin Diesel Roumayah, Esq.
Wachler & Associates, P.C.

In June, the Office of Medicare Hearings and Appeals (OMHA) publicly implemented an expanded Settlement Conference Facilitation program. SCF is an alternative dispute resolution process which provides appellants and the Center for Medicare and Medicaid Services an opportunity to discuss a mutually agreeable resolution for claims appealed to the Administrative Law Judge (ALJ) or Medicare Appeals Council levels of appeal. This program applies mediation principles to resolve eligible Medicare appeals in an expedient and efficient manner. Through this program, an OMHA senior attorney or program analyst trained in mediation techniques acts as a neutral facilitator between the appellant and CMS in a one-day mediation, to negotiate a lump-sum settlement on eligible appeals.

OMHA has significantly modified the eligibility criteria for appellants and appeals under the expanded program. This program was first released in the summer of 2014 and was restricted to Medicare Part B providers and suppliers. Nearly two years later, given wide support and interest in the program, it was expanded to Medicare Part A providers. As of December 31, 2017, OMHA resolved 70,785 appeals through the various phases of the SCF program. Notably, this is the equivalent of almost an entire year’s disposition capacity for all of [Read More]

By ERICA MORRIS, GREGORY MOORE AND RUSSELL KOLSRUD
Mental Health Parity Really Does Mean Equal Benefits
By Erica Morris, Gregory Moore and Russell Kolsrud

In Danny P. v. Catholic Health Initiatives, 891 F.3d 1155 (9th Cir. 2018), the Ninth Circuit clarified the full extent of the “parity” required in the federal mental health parity law1 which has been in place since 2008.

In Danny P., the Ninth Circuit held that a particular group health plan (the Catholic Health Initiatives Medical Plan—Blue Cross Blue Shield) was prohibited from denying the same or equivalent room and board coverage in behavioral health facilities that it provided in non-behavioral health facilities, overturning the district court’s decision in favor of the plan. Specifically, the Court held the plan could not be permitted to deny inpatient room and board costs at a behavioral health inpatient residential treatment facility while simultaneously allowing coverage for non-behavioral health (medical and surgical) inpatient room and board costs at a skilled nursing facility.

The plan at issue was a self-funded group health benefit plan covering Catholic Health Initiatives employees and their dependents, and provided for coverage of “mental health services,” bed, board, and general nursing care, ancillary services provided at skilled nursing facilities, and also provided coverage for [Read More]

He’s Running As A Doctor But Can’t Practice . . . Does It Matter?
Matt Longjohn’s chief selling point in his Michigan 6th Congressional district run is that he’s a medical doctor. But he can’t practice medicine in Michigan because he isn’t professionally licensed in this state or in Illinois, where he formerly worked.

Longjohn, the Democrats’ nominee in the southwest Michigan district, has made a career on the administrative side of health care, most significantly as the first-ever National Health Officer for the 2,700 YMCAs in the United States when he worked in Chicago.

In campaign materials, he refers to himself as Dr. Matt Longjohn, MD, and uses the squiggly heartbeat signal to punctuate the point. But according to the Department of Licensing and Regulatory Affairs, he’s never been licensed as a health professional in Michigan.

And whether he’s allowed to describe himself as such under the Michigan Public Health Code is an open question in the legal community.

The Public Health Code (333.16261) reads “an individual who is not licensed or registered under this article shall not use an insignia, title or letter . . . to induce the belief that the person is licensed or registered in this state.” Asked if that means Longjohn is in violation [Read More]

By SARAH JANE TRIBBLE
David Herzberg was alarmed when he heard that Richard Sackler, former chairman of opioid giant Purdue Pharma, was listed as an inventor on a new patent for an opioid addiction treatment.

Patent No. 9861628 is for a fast-dissolving wafer containing buprenorphine, a generic drug that has been around since the 1970s. Herzberg, a historian who focuses on the opioid epidemic and the history of prescription drugs, said he fears the patent could keep prices high and make it more difficult for poor addicts to get treatment.

“It’s hard not to have that reaction of, like … these vultures,” said Herzberg, an associate professor at the University at Buffalo.
James Doyle, vice president and general counsel of Rhodes Pharmaceuticals, the Purdue subsidiary that holds the patent, said in an email statement that the company does not have a developed or approved product and “therefore no money has been made from this technology.”
“The invention behind the buprenorphine patent in question was developed more than a dozen years ago,” he wrote. “If a product is developed under this patent, it will not be commercialized for profit.”
Yet, the patenting of a small change in how an existing drug is made or taken by patients is part of a tried-and-true [Read More]

House Democrats called on Republicans to hold hearings this week, specifically in the Natural Resources and Oversight committees, to have the Department of Environmental Quality present what it knows about PFAS contamination and how extensive the problem is in Michigan.

Eight Democrats, led by Minority Floor Leader Christine Greig (D-Farmington Hills), held a press conference Sept. 4 to demand the hearings and that lawmakers take immediate action to strengthen water quality standards for perfluoroalkyl and polyfluoroalkyl substances (PFAS), a diverse group of compounds resistant to heat, water and oil. Such chemicals have been used in hundreds of consumer products and industrial applications including carpeting, apparels, upholstery, food paper wrappings, fire-fighting foams and metal plating.

The chairs of those committees, Rep. Gary Howell (R-North Branch) and Rep. Joseph Graves (R-Linden), called the press conference “political” and said hearings won’t be happening in early September. Howell said he is committed to holding hearings, but will wait until after the election.

“It is a pattern of indifference. That’s why we need the public pressure right now to call for hearings, call for oversight, and get back to an empowered DEQ that understands the issue, listens to the scientific data, listens to the public health concerns, and actually takes action,” Greig said [Read More]

By GERALD NATZKE, JR., DO
Do you remember Polybrominated Biphenyls (PBBs) sowing fear and disease into the lives of Michigan citizens approximately 43 years ago? Those PBB’s entered the larger food chain through a single error made by a Gratiot County chemical company worker when a ton of Firemaster (a toxic fire retardant) was added to cattle feed. PBB’s were ingested by cattle throughout this area and spread throughout Michigan and the Midwest, producing one of the largest chemical poisonings in the Western world. Another much larger and more dangerous toxic chemical exposure has been discovered. This family of toxins, through ignorance, and poor oversight has been introduced to Michigan’s and U.S. citizens in multiple insidious ways. These chemicals are called Per- and Polyfluoroalkyl Substances (or PFAS and PFOS).

U.S. Rep. Dan Kildee said that “the seriousness of PFAS contamination cannot be overstated.” Frankly, like the PBB issue in the ‘70s the PFAS poisoning ushers in another era of ecologic crisis. These perfluorinated compounds are linked to cancer, liver damage, birth defects, infertility, thyroid and autoimmune disease, neurologic disorders and hypercholesterolemia. According to Kildee at a recent meeting with physicians, these compounds have been found in more than 30 sites throughout Michigan and are entering aquifers and [Read More]

By EWA MATUSZEWSKI
We know that “Fix the Damn Roads” is a critical imperative for one of Michigan’s gubernatorial candidates—and hopefully for both. But is “Fix the damn interoperability problem with electronic health records” another? The intersection of healthcare and politics is obviously not new. I would contend it’s more visible—and viscious—than ever. Still, the focus tends to be on access to care and delivery of care, and I understand that. Interoperability of EHR hardly pulls at the heartstrings or incites passionate conversation from either side of the aisle. Accordingly, it doesn’t garner much attention from the consumer media either. That is why it is important for healthcare decision makers to individually and collectively raise awareness of the issue, not just in the healthcare community, but with our elected officials.

To make sure we’re clear on the topic (and in case some politicians are reading this,) interoperability in this context refers to the ability to share and interpret patient data and information electronically across systems and devices among hospitals, insurers, clinics and private practice physicians.

I’ve said it before, and I’ll say it again: there ought to be a law. While I disdain the proliferation of excessive laws that seemingly aim to control our every move, legislation embraced [Read More]

By JESSE A. MARKOS, ESQ.
Wachler & Associates, P.C.
The Michigan Opioid Laws include a 10-bill package of legislation passed in December, 2017, to help curb Michigan’s increasing substance abuse and drug diversion problem. The majority of these provisions came into effect on June 1, 2018 and healthcare providers must become familiar with and incorporate these provisions in to their practice to ensure they are compliant with the changes.

Healthcare providers use the Michigan Automated Prescription System (MAPS) to review a history of any Schedule 2-5 controlled substances that a patient has legally obtained. Not only does MAPS list the prescriber and type of controlled substance that has been prescribed, but it also lists the location of the pharmacy it has been dispensed at. MAPS data assists healthcare providers in identifying evidence of potential diversion such as: obtaining controlled substance prescriptions from more than one provider, filling prescriptions early, filling prescriptions at multiple different pharmacies, and filling prescriptions at distant pharmacies. In the past, providers were not required to register for or use MAPS, although it was highly encouraged and likely to be considered the standard of care when prescribing a controlled substance. Nevertheless, while it was largely considered the standard of care to run and review a [Read More]

By RALPH LEVY
In early August, the Internal Revenue Service issued proposed regulations that provide guidance to owners of pass-through businesses as to eligibility for a federal tax deduction of 20 percent of the income generated by the businesses. This deduction was part of the Tax Cuts and Jobs Act (TCJA). Although the stated purpose of the proposed regulations is to provide clarity on eligibility for and the means to compute the deduction, this guidance is lengthy and complex. However, for healthcare providers, there are two important takeaways.

Takeaway No. 1: Guidance on whether a healthcare business is a “specified service trade or business.”

One of the important limitations to the pass-through deduction in the TCJA is that owners of pass-through businesses that conduct a specified service trade or business (SSTB) and whose income exceed the so-called income limitation ($207,500 for single taxpayers and $415,000 for married taxpayers who file jointly) are not entitled to claim the 20 percent deduction. The TCJA provides that a SSTB includes a trade or business that involves the performance of services in the health field.

The proposed regulations provide guidance as to what types of businesses involve the performance of health services:

The performance of services in the field of health means the [Read More]