Ross D. Margulies, JD, MPH

Health Policy Specialist, Foley Hoag, LLP

Authored Items

The Affordable Care Act: The Day of Reckoning Arrives

July 2012, Vol 3, No 5 - Health Policy

Over the past 2 years, we have written about the impact of accountable care organizations, value-based purchasing, health insurance exchanges, and other programs relevant to the oncology community. These initiatives were all born out of the Affordable Care Act (ACA), which, on June 28, 2012, had its major day of reckoning. In a 5 to 4 decision authored by Chief Justice John Roberts, the US Supreme Court upheld the ACA’s individual mandate—the requirement that most Americans obtain health insurance that meets the definition of minimum essential coverage.

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Medicare Proposes Rewarding Quality, Cutting Payments for Oncology Providers

September 2012, Vol 3, No 6 - Health Policy

On July 6, 2012, the Centers for Medicare & Medicaid Services (CMS) issued the Physician Fee Schedule (PFS) and Hospital Out­patient Prospective Pay­ment System (HOPPS) proposed rules for fiscal year 2013. These rules include a number of proposed changes aimed at improving quality and promoting value in cancer care in the Medicare program. Although many of these changes are positive, a number of proposed cuts to payment rates, particularly to services performed by radiation oncologists, could have a devastating impact on oncology providers and patients.

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CMS Finalizes Payment Policies for 2013, Signaling a Shift toward Paying for Value

November 2012, Vol 3, No 8 - Health Policy

?In this article we address the final payment rules issued on November 1, 2012, by the Centers for Medicare & Medicaid Services (CMS), the Physician Fee Schedule (PFS), and the Hospital Outpatient Prospective Pay­ment System. These annual updates to Medicare payment rates for physicians and hospitals can have a dramatic impact on reimbursement and incentives within the Medicare program, but they also tend to impact trends in the commercial insurance market.

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Time to Review Practice Policies: HIPAA Privacy and Security Regulations Released

February 2013, Vol 4, No 2 - Health Policy

On January 17, 2013, nearly 3 years after its initial proposed rule, the US Department of Health and Human Services (HHS) issued the long-awaited and much- anticipated HIPAA “omnibus” rule, extending the scope of the privacy law beyond providers to their business associates and subcontractors and adding increased penalties.1 Regulated entities must be in compliance with the new rules by September 22, 2013, although covered entities and business associates will have up to 1 year after the 180-day compliance date to modify existing contracts to comply with these revised [ Read More ]

Yet Another Blow to the Medicaid Expansion

September 2013, Vol 4, No 7 - Health Policy

The Affordable Care Act extends and simplifies Medicaid eligi­bility beginning January 1, 2014, by replacing Medicaid’s previous multiple categorical groupings and limitations with one simplified overarching rule: all individuals aged <65 years with incomes less than 138% of the federal poverty level ($15,415 for an individual or $26,344 for a family of 3 in 2012) who meet citizenship/lawful US status and state residency requirements are entitled to Medicaid benefits.

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Up Next for the Center for Medicare and Medicaid Innovation: Cancer

May 2014, Vol 5, No 4 - Health Policy

In passing the Affordable Care Act (ACA) in 2010, Congress had as one of its central goals the creation of new, innovative ways of paying for and delivering healthcare services. With this goal in mind, the ACA established the Center for Medicare and Medicaid Innovation (CMMI), which is tasked with developing new payment and service delivery models to “demo” and, if successful, to eventually roll out nationwide. [ Read More ]