Who are the relevant state entities? The Division of Developmental Disabilities (“DDD”) operates under the Arizona Department of Economic Security (“ADES”).[1]  The DDD provides services to qualifying Arizona children with developmental disabilities. The Arizona Long Term Care System (“ALTCS”) is Arizona’s Medicaid program that provides long-term care services to DDD members. ALTCS operates under the Arizona Health Care Cost Containment System (“AHCCCS”). Eligibility requirements for children with ASD differ based on the child’s…
Healthcare industry mergers and acquisitions can take on many shapes and sizes dictated by various regulatory and business law issues, but common to all such transactions is the Target’s obligation to make healthcare representations and warranties to the Acquiror.    Representations and warranties (R&Ws) in general are heavily negotiated aspects of the parties’ agreement, and their healthcare specific portions are oftentimes more heavily negotiated than others.  A close review of these healthcare portions is necessary to…
What is Autism Spectrum Disorder (“ASD”)? Autism spectrum disorder (“ASD”) is a developmental disability.[1] Children with ASD may experience social, communication, learning, and behavioral challenges. The severity of ASD varies and some children require more assistance than others. There is no cure for ASD, but early intervention treatment for children between birth and 36 months can have significant results on a child’s development. As of 2016, one in every 63 eight-year-old children in Arizona…
We owe a tremendous debt to the healthcare worker battalion, who fought, and continues to fight, to save lives globally during this pandemic.  It is important to consider that while the COVID-19 pandemic has underscored the severe healthcare worker shortages globally, we are now facing an increasing percentage of burnout departures in the industry.  For example, a survey conducted by the International Council of Nurses (ICN) found that, “20 percent of national nurse associations reported…
For the majority of the 2010s, the Medicare appeals process had become extremely backlogged. The Office of Medicare Hearings and Appeals (“OMHA”) is in charge of administering the Administrative Law Judge (“ALJ”) hearing program for appeals arising from Medicare claims and disputes. Pursuant to 42 U.S.C. § 1395ff(d)(1)(A), an ALJ is statutorily required to provide an appellant a hearing within ninety (90) days of the hearing being requested. However, due to a large backlog of…
On May 3, 2021, the U.S. Department of Health & Human Services (“HHS”) announced the creation of the COVID-19 Coverage Assistance Fund (“CAF”).[i] Providers who administered the vaccine to patients on or after December 14, 2020, can now seek reimbursement for certain amounts they were unable to bill to patients for administering the vaccine. For providers to administer a COVID-19 vaccine, providers must be enrolled in the CDC COVID-19 Vaccination Program.  As of February…
In March 2020, Congress passed the Coronavirus Aid, Relief and Economic Security (“CARES”) Act, which provided $2.2 trillion in economic relief.  The Act was designed to quickly get money to millions of Americans suffering from the pandemic.  Unfortunately, this relief provided ample opportunity for fraud.  As the COVID pandemic begins to ease, the Department of Justice’s efforts to prosecute this COVID-19 fraud is intensifying.  To date, the Department has charged nearly 500 defendants with criminal…
Taxpayer losses in two recent Tax Court cases serve as reminders that physician and other incorporated medical practice groups should take care in the “zero out” approach to the payment of compensation to the group’s owners and that success in this area may depend on whether the practice is organized as a “C” corporation or has elected to be taxed as an “S” corporation and if the practice group is owned by one or more…
The American Rescue Plan (ARP) provides $1.9 trillion dollars in economic stimulus for individuals, certain companies, and municipalities. This blog focuses specifically on what the ARP means for employers. First Coronavirus Response Act (FFCRA) As of January 1, 2021, employers who were originally covered under the FFCRA (employers with fewer than 500 employees) were no longer required to provide FFCRA emergency paid sick leave (EPSL) and emergency family medical leave (EFMLA) to covered employees. However,…
One year ago, in March of 2020, the Secretary of the U.S. Department of Health and Human Services (Secretary) declared that, because of the public health emergency resulting from the number of confirmed cases of 2019 Novel Coronavirus (COVID), circumstances exist to justify the authorization by the Food and Drug Administration (FDA) of emergency use of drugs and biological products during the COVID-19 pandemic. This action followed similar declarations permitting so-called “Emergency Use Authorizations” or…