Individuals accustomed to working with surrogate decision makers such as activated power of attorney agents and guardians should prepare for an additional – and different – individual at the table: a supporter. The Supporter’s Role Enacted in April 2018, 2017 Wisconsin ACT 345 provided for supported decision-making agreements. com ruedinger uwalumni Leah Ruedinger, Mitchell Hamline 2013, has worked on the payor and provider side of health care for the past six years. As a party to the supported decision-making agreement, the supporter provides an opportunity for an adult with a functional impairment (the adult) to have assistance in understanding the…

Journey with me back to your 1L contracts law class, to discussions of carbolic smoke balls, offers, acceptance, and the “meeting of the minds.” My contracts law professor had a habit of referencing horses in nearly every hypothetical, which is a topic for another time. She also had a habit of using the language of the Restatement to describe deals between parties as a “bargain.” More on that later. These days, in health care, it seems a bargain is hard to come by. Health care spending continues to outpace economic growth and costs continue to climb. Employers are the…

Many health insurers and the federal government are waiting for the U.S. Supreme Court’s decision involving risk corridors. The issue is whether the federal government is required to pay health insurers money under the risk corridors statute. This case has implications far beyond even the $12 billion in dispute. At stake is whether the government can be a trusted business partner to pay private entities when that entity already performed its statutory obligations and is entitled to payment. This article provides background on the risk corridors statute and government actions that led to both a higher than expected amount of…

The Centers for Medicare & Medicaid Services (CMS) recently published its Proposed Rule, 84 Fed. Reg. 55766 (Oct. 17, 2019), for modernizing the Physician Self-Referral Regulations (Stark). In this article, we focus on the portion of the Proposed Rule in which CMS addresses attacks on compensation practices that until recently have been considered to be perfectly permissible. CMS provides guidance on fundamental terminology regarding compensation arrangements, specifically the definition of “commercial reasonableness,” the “volume or value” standard pertaining to physician referrals, and the definition of “fair market value” (FMV). Here are three key takeaways: Commercial reasonableness of an arrangement does…

Demographics in the U.S. are changing, as 10,000 baby boomers turn 65 each day through the year 2030, says the Pew Research Center. According to the 2015 National Council on Aging’s United States of Aging Survey, 75% of older adults prefer to continue living in their own home as they age. Long-term care services are thus vital to assisting these individuals live in their home for as long as possible. Family Care, a Medicaid long-term care program in Wisconsin, was created in 1999 to offer services to eligible individuals, including older adults, to support independence and quality of…

Editor’s note: This article was published April 23, 2019, in the Legal News blog on the website of von Briesen and Roper. Health care fraud convictions are news. When the convicted parties are the physicians, investors, and staff of a physician-owned surgical hospital who now face up to 65 years in a federal penitentiary, that is big news. And when some of those convictions were based, in part, on a relatively obscure federal law that appears to expand the reach of federal prosecutors to include commercial and private-pay business that many assumed would fall outside of federal jurisdiction, that…

I recently received a question regarding a proposed fitness activity for a workplace wellness program. The very astute wellness professional called me to ask whether she needed to provide a notice under the Americans with Disabilities Act (ADA) before administering the Par-Q+ questionnaire to employees. The Par-Q+ questionnaire is a “physical activity readiness questionnaire” that fitness industry professionals use to assess whether an individual should participate in a physical activity. It asks individuals the following yes/no questions: 1) Has your doctor ever said that you have a heart condition or high blood pressure? 2) Do you feel pain in your…

The already complicated world of health law just got a little more challenging. On April 1, 2019, the Centers for Medicare and Medicaid Services (CMS) Preclusion List went into effect. Thus, Medicare Part C and D plans, PACE organizations, and 1876 cost contract plans (Plans) will be required to deny payment for services rendered or prescriptions ordered by any provider on the Preclusion List.1 com staebel hallrender Scott Taebel, American University 1986, is a shareholder with Hall Render in Milwaukee, where he practices in regulatory compliance matters, serving as primary compliance counsel for many of the firm’s clients. com…