Senate Passes Post-Acute Care Reform Bill; OIG Issues Special Advisory Bulletin on Drug Copayment Coupons

    Senate Passes Post-Acute Care Reform Bill

    On September 18, 2014, the U.S. Senate passed legislation intended to strengthen and improve the Medicare post-acute care system. The Improving Medicare Post-Acute Care Transformation Act of 2014 (“IMPACT Act”) would standardize data assessments across the various post-acute care (“PAC”) providers by requiring long-term care hospitals, inpatient rehabilitation facilities, skilled nursing facilities and home health agencies to report standardized patient assessment data and quality and resource use measures. This alignment would enable Medicare to compare quality across different PAC settings and lay the groundwork for future payment reform, including site-neutral and bundled payment initiatives.

    If enacted, the reporting requirements of the IMPACT Act are scheduled to be phased in over time and would not begin until October 1, 2016.

    The legislation passed in the House on September 16, 2014, and moves next to the White House and awaits signature from the President.

    OIG Issues Special Advisory Bulletin on Drug Copayment Coupons

    The U.S. Department of Health and Human Services Office of Inspector General (“OIG”) released a Special Advisory Bulletin (“Bulletin”) on September 19, 2014, warning pharmaceutical manufacturers of the implications under the federal Anti-Kickback Statute should the manufacturer fail to take appropriate safeguards to adequately prevent federal health care beneficiaries from using manufacturer copayment coupons to purchase prescription drugs.

    Under the copayment coupon programs, pharmaceutical manufacturers pay all or some of the consumer’s copayment obligations when filling an order for a prescription drug. Because the pharmaceutical industry is generally aware of the Anti-Kickback Statute and its application to copayment coupons, manufacturers typically place a written statement on the coupon informing individuals that the coupon cannot be used by beneficiaries of Federal health care programs. However, in an OIG report released in conjunction with the Bulletin, OIG expressed concerns that some Medicare Part D beneficiaries are still using the coupons.

    The Bulletin reminds pharmaceutical manufacturers that if they offer coupons they bear the ultimate responsibility for operating these programs in compliance with Federal law.


    Edwards Wildman’s Healthcare Practice Group will continue to monitor healthcare news from Capitol Hill, CMS, HHS, and other federal and state agencies, and will bring you timely updates as new developments occur.

    Edwards Wildman Palmer LLP is pleased to provide regular updates on issues affecting the Healthcare industry. Our lawyers not only provide sophisticated legal services to a broad array of clients in the healthcare industry, we also monitor and analyze federal and state legislative and regulatory processes to ensure that our clients are informed of government actions and initiatives.

    Should you have any questions on the content of this advisory, or wish to discuss any other healthcare related issue, please contact those linked above or call the Edwards Wildman Palmer LLP attorney responsible for your affairs.

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