Sequestration May Affect Medicare Contractor Provider Payments

Date: 08/25/2014
Publication: Website
CooperLevenson Publication: Website
Summary: Since April 1, 2013, payments made by the Center for Medicare & Medicaid Services (“CMS”) to Medicare Advantage Organizations (“MAO”), Medicare Part D, and other managed Medicare payment programs have been reduced by 2% in accordance with the sequestration order of the Balanced Budget and Emergency Deficit Control Act of 2011. Because the sequestration reductions are only effective for dates of discharge or dates or services provided on or after April 1, 2013, hospitals and other contract providers may just now be realizing the effects of such reduction, as third-party payers such as insurance companies make efforts to pass the reductions on to contract providers. This is so despite guidance issued by CMS that such reductions may be passed through only if the contract between parties explicitly permits such a pass through.
Article: Sequestration May Affect Medicare Contract Provider Payments.pdf

CMS issues final rules affecting medical staff, membership, hospital governing bodies, and hospital outpatient orders

Date: 05/20/2014
Publication: Website
CooperLevenson Publication: Website
Summary: On May 7, 2014, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that brings important revisions and clarifications to the Conditions of Participation (CoP) affecting hospitals and other healthcare providers. Some of the most important changes, which will take effect July 11, 2014

POLST: The Form That Permits Patients To Make Decisions With Their Physician Regarding Medical Intervention

On February 22, 2013, representatives of the New Jersey Department of Health and Senior Services released a healthcare treatment planning device to more efficiently execute a patient’s treatment goals and desires. The Practitioner Orders for Life Sustaining Treatment (POLST) form was created by legislation that was signed by Governor Chris Christie on December 21, 2011. The form is designed to be completed concurrently by patients and their attending physician or advanced practice nurse. The form permits individuals to make decisions in consultation with their physician regarding medical interventions, such as whether a patient desires to receive certain types of medical interventions, including artificially administered fluids and nutrition, as well as CPR/intubation/artificial ventilation. The creation of the POLST form is specifically recommended for those who are seriously ill, frail and/or who live in a nursing home or hospice, although anyone may complete the form.

A patient who executes a POLST form may modify or revoke the POLST form at any time. The patient may also designate a surrogate decision maker, who may modify or revoke the patient’s previously executed POLST orders in conjunction with the patient’s treating practitioner if the patient loses capacity to make decisions. The POLST form also permits individuals to dictate whether they wish to make an anatomical gift.

Properly executed POLST forms are valid medical orders which become part of a patient’s medical records and may be transferred with the patient. The form follows patients throughout various levels of care, including ambulance transportation and visits to a hospital and nursing home. The form is available at hospitals and nursing homes across the state and it is valid in all treatment facilities in New Jersey. The form is meant to complement and not replace an Advanced Healthcare Directive or Living Will, which requires a designated legal health care decision maker.

Patients and family members often fear that their wishes will not be followed, such as when a patient is brought to an emergency room and hospital personnel are unaware that that the patient has requested a “do not resuscitate” order. The POLST form will go a long way toward allaying those fears.

For answers to any questions contact Michael Salad at or call 609.572.7616.

Michael is a partner in the firm’s Business and Tax Practice Group. He has an LL.M. in Estate Planning and Elder Law.