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The Centers for Medicare & Medicaid Services (CMS) has embarked upon landmark payment reform for providers (doctors and clinicians) under its CY 2019 Proposed Physician Fee Schedule.  Decreased physician paperwork and increased doctor/patient relations are CMS's purported objectives.  Even though that sounds reasonable, the impact on disadvantaged populations and providers who serve medically complex patients merits increased scrutiny. Does the CMS CY 2019 Proposed Physician Fee Schedule (i)  reflect the quality of care that specialized providers offer to Medicare beneficiaries with complex medical conditions; (ii) enhance a physician's ability to treat ...
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By: Anthony C. Adamopoulos, Divorce Arbitrator, Mediator and Collaborative Attorney ©2018 In every divorce there are non-law issues. Some are as basic as “Who gets the college chest”? or as complicated as “Where will the children primarily live”? Attorneys and smart parties are now using professional neutrals (also called coaches) to resolve those issues that are not distinctively legal in nature. A Financial Neutral expedites the process by analyzing the unique needs of your family, identifying tax provisions related to those needs and creating realistic plans to preserve family income and property. The Facilitator Neutral expedites the process ...
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Once the federales blocked the health insurance company mega-mergers, it was only a matter of time before alternative approaches to rearranging the three-dimensional chessboard of the healthcare-industrial complex would emerge. The approach du jour is the vertical merger. Horizontal combinations trigger the familiar antitrust reviews of market share and the orthodoxy of antitrust enforcement dictates that two insurers, selling the same product or service into the same market or markets, cannot merge if they will reduce competition as a result. The very idea of collapsing four of the five dominant national health care insurance companies into two was therefore ...
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Lifespan, the largest hospital system in Rhode Island, says it has joined merger discussions between another health system in the state and Boston-based Partners HealthCare. https://www.bizjournals.com/boston/news/2018/02/27/rhode-island-hospital-system-joins-partners-care.html The Largest Employers in Massachusetts Ranked by Total Mass. employees Rank Company Total Mass. employees 1 Partners HealthCare 58,004
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Personal injury settlements in civil litigation are anticipated outcomes of meritorious claims. And, freedom of contract principles offer justifiable reasons for plaintiffs and defendants to work towards confidentiality of the settlement agreement. However, after settlement terms have been reached, subsequent confidentiality clauses unilaterally inserted as “material terms” circumvent quid pro quo, mutual assent, and bargained for consideration.  Generally it is the defendants who demand confidentiality,but purchasing plaintiffs' silence must come at cost. Confidentiality clauses in personal injury settlements should be negotiated as arms-length transactions. ...
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Indianaplois Bankruptcy attorney

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Dear List, Can anyone recommend a bankruptcy attorney for Indianapolis?  TIA Sincerely, Claire J. Constantine, Esq. Law Office of Claire J. Constantine 165 Washington Street Suite 203 Winchester, MA 01890 Tel. 781-729-1011 www.cjconstantinelaw.com The information in this email is confidential and may be legally privileged. It is intended solely for the addressee. Access or use by any other person to this internet email is not authorized and may be unlawful. If you are not the intended recipient, please delete or destroy this email. If you do not wish to receive future emails from this sender, please reply directly to this email requesting you be removed ...
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After over 25 years, the Americans with Disabilities Act (ADA) continues to receive bipartisan support and offers fundamental reform protections that benefit our society and the qualified individuals it safeguards. The ADA is not an entitlement program for eligible individuals, such as Medicaid, Medicare, or Social Security. Even persons living with hearing loss, for example, criticize the use of the terms ‘disabled’ and ‘hearing impaired’ to describe their medical condition, preferring less restrictive quantifiers, such as d/Deaf or hard of hearing.  Whether you have an interest in protecting individuals from discrimination in the work place, ensuring access ...
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Do you have questions about identifying clients who may have mental health issues? While many attorneys do not have a clinical or educational background that focuses on mental health issues, they often find themselves representing clients who suffer from mental health issues. This important program will feature Dr. Judith Edersheim of Massachusetts General Hospital, a joint J.D. and M.D., who will discuss representing and interacting with mentally ill individuals in the courthouse setting. Recently, Dr. Edersheim spoke to Massachusetts judges on this topic. At this program she will discuss practical skills and strategies to use when representing clients with ...
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FDA and Digital Health Regulation

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The FDA had a digital health banner day on December 7, announcing one final guidance and two draft guidance documents (with a 60-day comment period). Collectively, these guidances cover a range of digital health issues, and it is worth reading   FDA Commissioner Scott Gottlieb’s statement   about them as well as each individual document: Clinical and Patient Decision Support Software  (CDS and PDS) (Draft) Changes to Existing Medical Software Policies Resulting From Section 3060 of the 21st Century Cures Act  (Cures Act) (Draft) Software as a Medical Device: Clinical Evaluation  (SaMD) (Final) These publications come as part ...
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HealthcareIT News outlines the case in which Chicago-based Saint Anthony sued Leapfrog in November for giving the hospital an inaccurate grade.  Leapfrog in its response claims the grade is based on self-submitted data the hospital failed to review.  The Leapfrog Group is an independent, non-profit healthcare watchdog, that ranks hospitals for patient safety and other measures. Below is a link to this article. HealthcareIT News Article: Leapfrog Lawsuit
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As printed in Massachusetts Lawyers Weekly on December 4, 2017 Over the week of October 16-20, 2017, lawyers and dispute resolution professional celebrated national Conflict Resolution Week.  The Massachusetts Bar Association's Dispute Resolution Section presented five events with different focuses in different parts of the state.  More than 400 people attended, including judges, lawyers, mediators, arbitrators, students, parents, teachers, coaches, special masters, and interested members of the public.  Governor Charlie Baker issued a Proclamation recognizing October 19 as Dispute Resolution Day in the Commonwealth. The week's events focused on court-connected, ...
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One week remains for the 2018 Medicare Open Enrollment process. Medicare Part A (inpatient hospital insurance) and Part B (medical insurance) beneficiaries may opt to enroll into a privately managed Medicare Advantage plan, e.g., health maintenance organizations (HMOs) and preferred provider organizations (PPOs) or private fee-for-service plans. Medicare is a federal healthcare program that benefits seniors and certain Congressionally recognized needy populations, such as persons living with a disability regardless of age. Although exceptions may apply for additional Medicare Advantage plan changes, as permitted by law under special enrollment or certain special ...
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“Marital station, when?” In this entry, we will begin discussing how the   Young   case determines “need” in the context of alimony. We have long known that need is a relative term. “The standard of need is measured by the ‘station’ of the parties -- by what is required to maintain a standard of living comparable to the one enjoyed during the marriage.”   Grubert v. Grubert, 20 Mass. Ap.   Ct. 811, 819 (1985). This is sensible, given that marital station is fueled by the parties’ financial resources, generally income from employment or self-employment. For one couple, subsistence may characterize the marital standard; while country clubs, international ...
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The House GOP seems to think that repealing §215 of the Internal Revenue Code is a good idea. We have long believed that there are probably too many alimony-paying lawyers in Congress to let this day ever come. It probably won’t, but if it does, it will plunge the Alimony Reform Act (ARA) (eff. 3.1.12) into crisis. Either way, the legislature needs to respond. M.G.L., ch. 208, §48 defines “alimony” as: “the payment of support from a spouse, who has the ability to pay, to a spouse in need of support for a reasonable length of time, under a court order”. Nothing about tax impact. The drafters, like us, clearly took deductibility under federal and state law ...
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What did the court decide and why; and might it have decided differently? Here, we delve into the SJC’s analysis in   Young v. Young. Young was high income case, in which the husband’s executive compensation fueled a persistently rising lifestyle (“affluent, upper class”) for the parties during a 24-year marriage. Both parties sought fixed sum alimony in the wife’s favor, but at broadly disparate levels. After trial, the Probate and Family Court judge concluded that the wife’s sworn representation of the costs required to maintain the marital station (i.e., her “need”) was unreliable; and that the husband’s compensation scheme (i.e., his capacity ...
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We introduce the subject that the Supreme Judicial Court (SJC) addressed in   Young v. Young   by examining the kinds of orders from which the case arose: variable or self-adjusting support orders. Here, we address the basics. What are self-adjusting support orders?   They are alimony orders expressed by a formula rather than a sum. The payor computes alimony periodically by applying a percentage to his or her defined income. Sometimes, different (usually declining) percentages apply to different tiers of income, and increasingly, thanks to M.G.L., ch, 208, § 53(b) (of the Alimony Reform Act (ARA) of 2011, eff. 3.1.12) the percentage(s) may apply to the ...
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With the long-awaited case Young v. Young, the Massachusetts Supreme Judicial Court (SJC) has revisited the important question of when may a trial court originate self-adjusting support orders, a subject that we have addressed here twice before. See,   http://levinedisputeresolution.com/docs/Variable-Support-orders-3-28-16.pdf   and   http://levinedisputeresolution.com/divorce-mediation-blog/need-and-variable-support-orders-they-are-not-mutually-exclusive . While the case does not address the situation where there is insufficient income to keep both parties living at the former marital standard of living, it does review and elaborate on existing precedent. ...
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With this month’s U.S. Senate passage of the Over-the-Counter Hearing Aid Act, pursuant to the Food and Drug Administration (FDA) Reauthorization Act of 2017 (S. 934; H.R. 2430), legislators validate what consumers have long acknowledged -- the increased frequency of hearing loss and its significant impact on an individual’s safety, health, and quality of life, including access to medical care. https://www.warren.senate.gov/files/documents/3_21_17_Hearing_Aids_Bill_Text.pdf Section 520 of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 360j) was amended, effective 8/18/17, to regulate OTC hearing aids and permit direct access by consumers without prescription ...
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NEW CHILD SUPPORT GUIDELINES BRING CHANGE TO PAYING FOR COLLEGE EXPENSES Posted on   August 23, 2017 The new Child Support Guidelines (Guidelines) include a new section to deal exclusively with college or other post-secondary educational expenses. While the Guidelines officially go into effect on September 15th, they are already being used by attorneys, mediators and others. At the outset, the Guidelines remind litigants that the divorce judge has discretion to order or not order a parent to contribute to college costs. In other words, it is not a given that a parent will be ordered to pay for all or part of college ...
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The Massachusetts Bar Association recently endorsed a set of “Civility Guidelines for Family Law Attorneys”. It is amazing to us that in 2017 this project should have been necessary, but we have no doubt of it; and the ten points are both simple and profound. Moreover, these tenets don’t just apply to the courtroom. They are equally applicable to the arbitration or mediation room, the four-way meeting, attorney correspondence, and the ongoing processing of every case, including negotiation. In truncated form the ten commandments of civility are: Dress appropriately. Be on time and prepared. Treat people with courtesy and respect. Wait your ...
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