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Primary Care Providers Win Challenge of CMS Interpretation of Enhanced Payment Law

With the help and support of the Tennessee Medical Association, 21 Tennessee physicians of underserved communities joined together and retained Bass, Berry & Sims to file suit against the Centers for Medicare & Medicaid Services to stop improper collection efforts. Our team, led by David King, was successful in halting efforts to recoup TennCare payments that were used legitimately to expand services in communities that needed them. Read more

Tennessee Medical Association & Bass, Berry & Sims

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Healthcare Private Equity Compliance Checklist

The complex and ever-changing healthcare regulatory and enforcement environment, including increased focus on the role of private equity firms in their portfolio companies, make compliance a top priority for private equity firms investing in healthcare companies. The best way to limit your exposure as a private equity firm is to avoid a compliance misstep in the first place. Additionally, an effective and robust compliance program for your portfolio healthcare company makes it much more attractive to potential buyers and helps you avoid an unexpected and costly investigation or valuation hit down the road. Download the Healthcare Private Equity Compliance Checklist to assess whether your portfolio company's compliance program is up-to-date.

Click here to download the checklist.

CMS Guidance Makes It Easier for Pharmacies to Access Part D Plans' Terms and Conditions

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August 24, 2015

Centers for Medicare and Medicaid (CMS) recently issued guidance setting its expectation that Medicare Part D sponsors make their standard contracting terms and conditions available to requesting pharmacies no later than September 15 of the year preceding the benefit year.1 Requested terms and conditions should be provided to pharmacies within two business days of the request. If a sponsor requires a pharmacy to execute a confidentiality agreement before receiving the terms and conditions, that confidentiality agreement must be provided to the pharmacy within two business days of the request. The terms and conditions must then be provided within two business days of the sponsor's receipt of the confidentiality agreement. Also, sponsors are directed to clearly identify the avenue through which interested pharmacies should make their request (e.g., phone number, e-mail address, website).

CMS indicates that the guidance was prompted by recent reports it received from pharmacies describing issues with sponsors' contracting processes, including the transparency and timing. CMS reasoned that because sponsors should have "standard terms and conditions readily available by September 15, there is no justification for a delay in responding to a pharmacy's AWP [("any willing pharmacy")] request made after that date." CMS warned that sponsors should not cause any undue delay in executing "agreements with eligible and interested pharmacies that would in effect discourage pharmacies from pursuing an AWP contract." The guidance does not change the sponsor's ability to ask pharmacies to demonstrate they are qualified to meet the plan sponsors' standard terms and conditions before executing the contract.


1 CMS Compliance with Any Willing Pharmacy (AWP) Requirements, August 13, 2015 available at http://www.ncpa.co/pdf/any-willing-parmacy-guidance.pdf.

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