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In June 2016, AmSurg Corp. and Envision Healthcare Holdings, Inc. (Envision) announced they have signed a definitive merger agreement pursuant to which the companies will combine in an all-stock transaction. Upon completion of the merger, which is expected to be tax-free to the shareholders of both organizations, the combined company will be named Envision Healthcare Corporation and co-headquartered in Nashville, Tennessee and Greenwood Village, Colorado. The company's common stock is expected to trade on the New York Stock Exchange under the ticker symbol: EVHC. Bass, Berry & Sims served as lead counsel on the transaction, led by Jim Jenkins. Read more.

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Inside the FCA blogInside the FCA blog features ongoing updates related to the False Claims Act (FCA), including insight on the latest legal decisions, regulatory developments and FCA settlements. The blog provides timely updates for corporate boards, directors, compliance managers, general counsel and other parties interested in the organizational impact and legal developments stemming from issues potentially giving rise to FCA liability.

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HACs Come To Medicaid: Another Quality Payment Adjustment


March 24, 2011

On February 17, 2011, the Centers for Medicare & Medicaid Services ("CMS") published a proposed rule (the "Proposed Rule")1 to implement the provision of the Patient Protection and Affordable Care Act ("PPACA")2 requiring Medicaid payment adjustments for hospital-acquired conditions (“HACs”) and for other healthcare-acquired conditions ("HCACs").3 If finalized, the Proposed Rule will go into effect July 1, 2011, and would require state Medicaid programs to implement systems to identify HCAC claims for nonpayment and also implement requirements for provider self-reporting of HCACs in the Medicaid claims payment process.

In 2008, under the Medicare program, CMS stopped paying hospitals additional amounts for the treatment of certain HACs, which are specific preventable adverse conditions that were not present upon admission of the patient. Although CMS encouraged states to adopt Medicaid payment prohibitions on provider claims for HACs, CMS did not require that states implement nonpayment policies for HACs. As a result, a recent review by CMS revealed that 29 states are currently without HAC-related nonpayment policies. In states with existing HAC-related nonpayment policies, the review found that the policies vary tremendously from state to state. In an effort to provide consistency across Medicare and Medicaid, the Proposed Rule requires states to adopt, at a minimum, the current list of Medicare HACs.4 The Proposed Rule also requires that states review and update its HCAC list to ensure continued consistency with the Medicare HAC list.

At the same time, the Proposed Rule attempts to offer states flexibility to design individual HCAC policies for nonpayment and to create quality-related programs suitable for their own Medicaid program and health marketplace by allowing states to exceed the federally established minimum HAC standards. To accommodate this goal, the Proposed Rule introduces a new "catch-all" term – Provider Preventable Condition ("PPC") – designed to allow states to include conditions and provider types other than those identified as HACs for Medicare.

1 76 Fed. Reg. 9283 (Feb. 17, 2011).
2 Pub. L. 111-148, Section 2702 of the Health Reform Legislation.
3 Note that, in the context of Medicaid, the health reform legislation and regulations refer to HACs as "healthcare-acquired conditions" instead of "hospital-acquired conditions."
4 The list of HACs includes, among other conditions, catheter-associated urinary tract infections and vascular catheter-associated blood stream infections.

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