Judith Waltz, partner at Foley & Lardner LLP and co-chair of the firm’s Health Care Practice Group and Health Care Industry Team, is featured in an American Health Law Association’s Speaking of Health Law podcast episode discussing key health law developments in 2023 and what to expect in 2024.
Waltz is co-editor of AHLA’s book, “Federal Health Care Laws and Regulations.” In the podcast, she focuses on issues covered in the book relating to Medicare and Medicaid and drug development and reimbursement. Significant Medicare developments from the last year that she touches on include:
- CMS’s approach to enrollment and enforcement, which “needs to be watched very carefully” and there are “additional provisions that are coming in through enrollment that need to be factored into a strategy in terms of enforcement and compliance.”
- Additional categories of mental health professionals to be billing providers, including marriage and family therapists, which is a “huge recognition of both the need for these services and the ability of these people to provide services that are needed.”
- Medicare Advantage, saying that CMS has indicated it is going to require and expect Medicare Advantage plans to provide services in the same way that they would be provided to Medicare Part A and Part B beneficiaries, including particular services and certain levels of practitioners; this “really will constrain some Advantage plans in terms of their innovation and cost cutting.”
Looking forward, Waltz is watching these priorities for the upcoming year:
- Private equity investment in health care, noting that the “intensity seems to grow in quite a respectable trajectory” and CMS is requiring more transparency in terms of who is in an ownership or controlling position, with respect to nursing homes in particular, and the quality of care in facilities that are owned or operated by private equity firms.
- The Department of Justice’s and Office of Inspector General’s watch over certain business structures and relationships and scrutiny for potential kickbacks, which although “we all recognize that health care is changing its delivery process… and some of these structures have come up to address certain problems… there has been a real focus on the physician patient relationship.”
Cost controls, remarking that “Medicare historically has not based coverage determinations on cost, and is still not doing that directly, [but] there are a lot of things going on right now where Medicare is struggling with how to control these huge costs” and “what products CMS will cover and then what they will pay for is a real struggle.”