Inpatient & Outpatient Psychiatric Care/ Behavioral Health

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We counsel inpatient psychiatric hospitals (IPFs) and hospital units, as well as outpatient psychiatric and behavioral health providers, on federal and state legal matters, including: legislation, regulation, compliance, reimbursement, litigation, development, transactions and other issues.

• Regularly counsel inpatient and outpatient psychiatric and behavioral health providers on the impact of proposed and enacted legislation on their business

• Prepare written comments to IPF Medicare payment updates and other rulemakings on behalf of IPF companies
• Advise inpatient and outpatient psychiatric and behavioral health providers on Medicare and Medicaid regulations and policies, including rules concerning: coverage of behavioral health and substance use disorder (SUD) treatment provided by group practices and other community-based providers, residential treatment, partial hospitalization programs (PHPs), intensive outpatient programs (IOPs), opioid treatment programs (OTPs), Substance Abuse and Mental Health Services Administration (SAMHSA) certification, provider-based entities, telehealth, and medical staff (e.g., advance practice registered nurses (APRNs)) 
• Counsel IPFs on Medicare regulations with the hospital conditions of participation, including the special requirements for IPFs

• Assist inpatient and outpatient psychiatric and behavioral health providers with compliance programs, legal reviews of compliance issues, internal audits, and legally privileged independent audits
• Advise and assist with overpayment and other compliance disclosures to government agencies
• Advise inpatient and outpatient psychiatric and behavioral health providers on corporate integrity agreement compliance and disclosures 
• Counsel inpatient and outpatient psychiatric and behavioral health providers on responses to compliance surveys by state agencies and accrediting organizations, including assisting with development and implementation of plans of correction
• Advise IPFs on compliance with state laws concerning involuntary examinations for psychiatric care
• Assist inpatient and outpatient psychiatric and behavioral health providers on compliance with state licensing requirements for inpatient and outpatient programs, including SUD treatment
• Counsel providers on federal and state requirements applicable to institutional and outpatient pharmacies, including Clinical Laboratory Improvement Amendments (CLIA) certificates and DEA registration 

• Counsel inpatient psychiatric care and behavioral health providers on the IPF prospective payment system (IPF PPS) and its payment adjustments, including high cost outliers, comorbidity adjustments, interrupted stays, rural adjustment, and teaching status adjustment
• Advise IPFs on outlier reconciliation
• Assist inpatient and outpatient psychiatric care and behavioral health providers in obtaining written guidance from CMS and its components on regulatory issues
• Work with IPFs on proposed cost report adjustments and other reimbursement disputes to avoid the need for appeal
• Counsel inpatient and outpatient psychiatric care and behavioral health providers on Medicaid reimbursement of behavioral health and SUD treatment  

• Federal and state court challenges to hospital regulations and reimbursement determinations
• Represent providers in administrative appeals of Medicare reimbursement disputes on cost report determinations before the Provider Reimbursement Appeals Board and CMS Administrator, and on claims determinations before Administrative Law Judges and the Departmental Appeals Board
• Represent providers in appeals challenging Medicare contractor claim reviews and audits
• Represent hospitals and other providers in Medicare decertification appeals to the Departmental Appeals Board 

• Negotiated lease agreements and ancillary services agreements for new hospitals-within-hospitals and satellite facilities

• Perform regulatory due diligence for buyers and sellers in hospital transactions with an emphasis on IPF-specific regulatory and compliance issues
• Provide written opinions of relative risk associated with regulatory issues identified for target companies
• Advise and assist inpatient and outpatient psychiatric care and behavioral health providers with government approvals and notifications in connection with licensure, certification, and accreditation requirements