Health Care | | Page 11

President Signs Long-Sought Red Flag Rule Exemption Into Law

December 9, 2010

Allowing customers or clients to pay for services and supplies over time will not cause doctors, dentists, hospitals, veterinarians, and other health care providers, lawyers, accountants, consultants and other service providers to be required to comply with the burdensome “Red Flag Rules” of the Fair and Accurate Credit Transactions Act of 2003 (FACTA) after all. President Obama earlier today (December 9, 2010) signed into law the “Red Flag Program Clarification Act of 2010 (S. 3987/H.R. 6420) (Act), which exempts businesses engaging in these limited financing transactions from the obligation to comply with the Red Flag Rule’s identity theft monitoring and prevention requirements.

FACTA’s Red Flag Rules generally require “creditors” to comply with burdensome identity theft prevention and monitoring rules issued by the Federal Trade Commission (FTC). Before the Act became law today, FTC regulations set to take effect December 31, 2010 construed health care providers, attorneys, consultants or other service providers as covered creditors simply if they allowed customers finance and pay charges to the service provider over time. Despite widespread outcry over this interpretation, efforts to overturn this interpretation had proven unsuccessful until recent weeks.

The Act intended by Congress to make clear that doctors, dentists, orthodontists, pharmacists, veterinarians, accountants, nurse practitioners, social workers, other types of health care providers, lawyers and other service providers will no longer be classified as ‘creditors’’ for the purposes of the Red Flags Rules just because they do not receive payment in full from their clients at the time they provide their services, when they don’t offer or maintain accounts that pose a reasonably foreseeable risk of identity theft.

As amended by the Act, the Red Flag Rule’s definition of “creditor” generally will continue to apply to a person who obtains or uses consumer reports in connection with a credit transaction, furnishes information to consumer reporting agencies in connection with credit transactions, or advances funds based on the recipients obligation to repay (or permit the funds to be repaid through specific property of the recipient), or otherwise is a creditor that the Federal Trade Commission (FTC) by rule determines should be covered as a creditor that offers or maintains accounts subject to a reasonably foreseeable risk of identity theft. However, a person that only “advances funds on behalf of a person for expenses incidental to a service provided by the creditor to that person” now is expressly excluded from the definition of “creditor” for purposes of the Red Flag Rules.

Congressional action to overturn the interpretation took wings beginning in November. After the Senate passed S. 3987, on November 30, 2010, the House of Representatives acted quickly to send the Act to the President for signature by approving H.R. 6420 on December 7.

The relief provided under the Act is particularly welcomed by health care providers, who already face significant civil and criminal liability exposures under the health-industry specific privacy and data security requirements of the Health Insurance Portability & Accountability Act (HIPAA). See CVS Settles Privacy Charges; Rite Aid Agrees to Pay $1 Million to Settle HIPAA Privacy Case As Office of Civil Rights Proposes Tighter HIPAA Privacy & Security Regulations; 2 New HIPAA Criminal Actions Highlight Risks From Wrongful Use/Access of Health Information.

While the Act exempts these limited transactions from the Red Flag Rules, businesses should avoid underestimating the scope of relief provided. Even with the new exemption, these and other businesses generally face significant responsibilities and risk under other federal electronic crimes, and other federal and state data security, identity theft and other laws and precedent, as well as pursuant to contractual commitments incorporated into a broad range of agreements in response to FACTA, HIPAA and other risk management concerns. Unless they take action to reform contracts and policies, health industry and other services covered by the new exemption generally may face contractual obligations to continue to comply with many of the Red Flag Rule mandates under contractual commitments incorporated into various agreements in anticipation of the effective date of the Red Flag Rule requirements. Health industry and other businesses expecting to enjoy relief from the Red Flag Rules as a result the Act should review contractual and other obligations to properly understand their continuing legal responsibilities and, where warranted, consider revising contracts and policies to remove or adjust provisions incorporated solely in anticipation of Red Flag Rules mandates. Health care providers and other businesses that fail to take these and other appropriate steps to clean up their contracts and procedures risks unnecessarily obligating themselves to continue to comply with rules despite their exemption from these legal mandates.

For More Information or Assistance

If you need assistance evaluating or responding the health industry or other privacy and data security concerns or other technology and process, compliance, risk management, transactional, operational, enforcement or public policy concerns, please contact the author of this update, Cynthia Marcotte Stamer, at (469) 767-8872, cstamer@Solutionslawyer.net.

Vice President of the North Texas Health Care Compliance Professionals Association, Past Chair of the ABA Health Law Section Managed Care & Insurance Section and the former Board Compliance Chair of the National Kidney Foundation of North Texas, Ms. Stamer has more than 23 years experience advising physicians, hospitals and other health industry clients about quality assurance, peer review, licensing and discipline, and other medical staff performance matters. She continuously advises health industry clients about the use of technology, process and other mechanisms to promote compliance and internal controls, workforce and medical staff performance, quality, governance, reimbursement, and other risk management and operational needs. As part of this experience, she has worked extensively with health care providers, payers, health care technology and consulting and other health industry clients, as well as other businesses, on privacy, data security, trade secret and related matters. A popular lecturer and widely published author on health industry concerns, Ms. Stamer also publishes and speaks extensively on health care staffing and human resources, compensation and benefits, technology, medical staff, public policy, reimbursement, privacy, technology, and other health and managed care industry regulatory, and other operations and risk management concerns for medical societies and staffs, hospitals, the HCCA, American Bar Association, American Health Lawyers Association and many other health industry groups and symposia. Her highly popular and information packed programs include many highly regarded publications on HIPAA, FACTA, medical confidentiality, state identity theft and privacy and other many other related matters. Her insights on these and other related matters appear in the Health Care Compliance Association, Atlantic Information Service, Bureau of National Affairs, World At Work, The Wall Street Journal, Business Insurance, the Dallas Morning News, Modern Health Care, Managed Healthcare, Health Leaders, and a many other national and local publications. To review some of her many publications and presentations, or for additional information about Ms. Stamer, her experience, involvements, programs or publications, see here.

For More Information

We hope that this information is useful to you. You can review other recent health care and internal controls resources and additional information about the health industry and other experience of Ms. Stamer here. If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information – including your preferred e-mail – by creating or updating your profile at here or e-mailing this information here.

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Solutions Law Press™ provides business risk management, legal compliance, management effectiveness and other resources, training and education on human resources, employee benefits, compensation, data security and privacy, health care, insurance, and other key compliance, risk management, internal controls and other key operational concerns. If you find this of interest, you also be interested reviewing some of our other Solutions Law Press resources. If you or someone else you know would like to receive future updates and notices about other upcoming Solutions Law Press events, please be sure that we have your current contact information – including your preferred e-mail- by creating or updating your profile here. For important information concerning this communication click here.

Leave a Comment » | Corporate Compliance, Doctor, E-Prescribing, Electronic Health Records, FACTA, Health Care, Health Care Provider, HIPAA, HITECH Act, Hospital, Hospital, Physician | Tagged: Data Security, FACTA, Health Care, Identity Theft, Red Flag Rule | Permalink
Posted by Cynthia Marcotte Stamer

Red Flag Rule Relief For Health Care Providers, Lawyers & Other Service Providers Awaits President’s Signature

December 8, 2010

Congress has approved and sent to the President for signature legislation exempting doctors, dentists, hospitals, veterinarians, and other health care providers, lawyers, accountants, consultants and other service providers that allow customers to pay for their services and supplies over time from the burdensome “Red Flag Rules” of the Fair and Accurate Credit Transactions Act of 2003 (FACTA).

FACTA’s Red Flag Rules generally require “creditors” to comply with burdensome identity theft prevention and monitoring rules issued by the Federal Trade Commission (FTC). Under current FTC regulations set to take effect December 31, 2010, health care providers, attorneys, consultants or other service providers become covered creditors simply by allowing customers finance and pay charges to the service provider over time.

Yesterday (December 7, 2010), the House of Representatives by voice vote passed H.R. 6420, the “Red Flag Program Clarification Act of 2010.: Like the Senate version of the Bill, S. 3987, passed by the Senate on November 30, 2010, the Red Flag Program Clarification Act (“Act”) is intended by Congress to make clear that doctors, dentists, orthodontists, pharmacists, veterinarians, accountants, nurse practitioners, social workers, other types of health care providers, lawyers and other service providers will no longer be classified as ‘creditors’’ for the purposes of the Red Flags Rules just because they do not receive payment in full from their clients when they provide their services, when they don’t offer or maintain accounts that pose a reasonably foreseeable risk of identity theft.

Assuming the President signs the Act into law, the Red Flag Rule’s definition of “creditor” generally would continue to apply to a person who obtains or uses consumer reports in connection with a credit transaction, furnishes information to consumer reporting agencies in connection with credit transactions, or advances funds based on the recipients obligation to repay (or permit the funds to be repaid through specific property of the recipient), or otherwise is a creditor that the Federal Trade Commission (FTC) by rule determines should be covered as a creditor that offers or maintains accounts subject to a reasonably foreseeable risk of identity theft. However, a person that only “advances funds on behalf of a person for expenses incidental to a service provided by the creditor to that person” will be expressly excluded from the definition of “creditor” for purposes of the Red Flag Rules.

The Act’s passage follows a multi-year battle by health care providers and other professional services providers to reverse the FTC’s interpretation of the Red Flag Rules as applicable to service providers that allow customers and clients to pay for services and supplies over time. The outcry about the FTC’s interpretation of the scope of the rules and the perceived cost and complexity of their provisions lead the FTC to delay implementation several times. See e.g., Health Care Red Flag Rule Compliance Deadline Extended To August 1; Prompt Action Still Required. The relief provided under the Act is particularly welcomed by health care providers, who already face significant civil and criminal liability exposures under the health-industry specific privacy and data security requirements of the Health Insurance Portability & Accountability Act (HIPAA). See CVS Settles Privacy Charges; Rite Aid Agrees to Pay $1 Million to Settle HIPAA Privacy Case As Office of Civil Rights Proposes Tighter HIPAA Privacy & Security Regulations; 2 New HIPAA Criminal Actions Highlight Risks From Wrongful Use/Access of Health Information.

While when signed into law the Act will the technical burdens that health care providers and other service industry businesses by exempting them from FACTA’s Red Flag Rules, these and other businesses generally face significant responsibilities and risk under other federal electronic crimes, and other federal and state data security, identity theft and other laws and precedent, as well as pursuant to contractual commitments incorporated into a broad range of agreements in response to FACTA, HIPAA and other risk management concerns. Even after the President signs the Act into law, however, health industry and other businesses still may face contractual obligations to continue to comply with many of its mandates under contractual commitments incorporated into various agreements in anticipation of the effective date of the Red Flag Rule requirements. Health industry and other businesses expecting to enjoy relief from the Red Flag Rules as a result the Act should review contractual and other obligations to properly understand their continuing legal responsibilities and, where warranted, consider seeking the removal of contract amendments to remove provisions incorporated into contracts solely in anticipation of Red Flag Rules mandates to the extent this limited relief permits. Since the relief granted under the terms of the statute is quite narrow and limited, however, organizations should review carefully their operations to verify that their operations do not encompass other activities that would cause them to continue to qualify as creditors for purposes of the Red Flag Rules to avoid compliance exposures from over-estimating the scope of relief.

For More Information or Assistance

For More Information

We hope that this information is useful to you. You can review other recent health care and internal controls resources and additional information about the health industry and other experience of Ms. Stamer here. If you find this of interest, you also be interested reviewing some of our other Solutions Law Press resources. If you or someone else you know would like to receive future updates and notices about other upcoming Solutions Law Press events, please be sure that we have your current contact information – including your preferred e-mail- by creating or updating your profile here.

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Leave a Comment » | Corporate Compliance, Electronic Health Records, Electronic Medical Records, FACTA, Federal Sentencing Guidelines, Health Care, Health IT, HIPAA, HITECH Act | Tagged: FACTA, H.R. 6420, Health Care, HIPAA, Red Flag Program Clarification Act, Red Flag Rules, S. 3987 | Permalink
Posted by Cynthia Marcotte Stamer

Quality, Recordkeeping & Unprofessional Conduct Lead Reasons For Medical Board Discipline of Physicians

December 2, 2010

Quality, unprofessional conduct and recordkeeping issues were the most common reason for discipline among the 77 physicians disciplined by the Texas Medical Board (TMB) since August. The reported actions highlight the need for physicians and the hospitals, practices and other entities dealing with them to take appropriate steps to manage these and other related risks.

Data recently disclosed by the TMB reveals that among the 77 licensed physicians disciplined, the violations included:

11 violations based on quality of care;
10 based on inadequate medical records
9 violations based on unprofessional conduct;
4 based on other states’ action;
1 based on inadequate supervision
1 based on peer review actions;
1 based on criminal convictions; and
10 orders for minor statutory violations.

The disciplinary actions imposed varied based on the nature and circumstances of the offense. It included 8 voluntary surrenders; 1 suspension; 3 revocations; 18 corrective orders and one cease and desist order.

A review of the TMB statistics and reports about these actions demonstrates the continuing need for physicians and the practices, hospitals, insurers, and others with liability or responsibility for monitoring, reporting or insuring their conduct to provide and administer effective training, quality and performance management and oversight to monitor and promote appropriate physician performance in these and other performance areas that may give rise to discipline or disciplinary reporting obligations. Additionally, a review of the circumstances of the reported circumstances also highlights the advisability of strengthening stress and substance abuse monitoring, education and intervention processes and procedures to head off or minimize potential licensing board and other risks.

For More Information or Assistance

If you need help evaluating or responding to this development of other health care reimbursement, technology and process, compliance, risk management, transactional, operational, enforcement or public policy concerns, please contact the author of this update, Cynthia Marcotte Stamer, at (469) 767-8872, or via e-mail to cstamer@solutionslawyer.net.

Vice President of the North Texas Health Care Compliance Professionals Association, Past Chair of the ABA Health Law Section Managed Care & Insurance Section and the former Board Compliance Chair of the National Kidney Foundation of North Texas, Ms. Stamer has more than 23 years experience advising physicians, hospitals and other health industry clients about quality assurance, peer review, licensing and discipline, and other medical staff performance matters. She continuously advises health industry clients about the use of technology, process and other mechanisms to promote compliance and internal controls, workforce and medical staff performance, quality, governance, reimbursement, and other risk management and operational needs. As part of this experience, she has worked extensively with health care providers, payers, health care technology and consulting and other health industry clients to investigate, address and defend physician and other health care workforce conduct, quality, communication and other concerns. A popular lecturer and widely published author on health industry concerns, Ms. Stamer also publishes and speaks extensively on health care staffing and human resources, compensation and benefits, technology, medical staff, public policy, reimbursement, privacy, technology, and other health and managed care industry regulatory, and other operations and risk management concerns for medical societies and staffs, hospitals, the HCCA, American Bar Association, American Health Lawyers Association and many other health industry groups and symposia. Her highly popular and information packed programs include specific training for physicians and other health industry leaders on “Sex, Drugs & Rock ‘N Role: Personal Misconduct In Health Care,” “Managing Physician Performance,” “Physician Gainsharing,” improving health care communication and collaboration and many other related matters. Her insights on these and other related matters appear in the Health Care Compliance Association, Atlantic Information Service, Bureau of National Affairs, World At Work, The Wall Street Journal, Business Insurance, the Dallas Morning News, Modern Health Care, Managed Healthcare, Health Leaders, and a many other national and local publications. To review some of her many publications and presentations, or for more information about Ms. Stamer, her experience, involvements, programs or publications, see here.

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Posted by Cynthia Marcotte Stamer

12/15 Deadline For Input on New Joint Commission Heart Failure Certification

December 2, 2010

December 15, 2010 is the deadline to share your comments with the Joint Commission on proposed requirements for Advanced Certification in Heart Failure from health care professionals who care for individuals with heart failure.
The Joint Commission drives much of how hospitals and a growing number of health care providers are judged and ultimately paid. Since the cost of meeting these standards ultimately will be passed on in the charges made by health care providers, health plans and employers should evaluate these credentials and provide appropriate comments when the demonstrated benefits of added conditions or paperwork drive up costs unnecessarily, divert resources from more important patient care goals, or promote other inefficiencies.

The Joint Commission is a leading quality accreditation agency, whose reach now extends to almost all health care organizations and providers. While acknowledging that the Joint Commission has and continues to do much to promote health care quality, health care providers increasingly complain the Joint Commission requirements increasingly are becoming overkill that unnecessarily adds costs and recordkeeping burden in a way that puts measurement before patient care, but feel pressure to comply. Supporters say the standards are necessary to maintain and demonstrate quality.

Striking the proper balance between quality and cost is at the heart of much of the current national initiative to control costs, as well as the efforts of almost all health care providers and payers. To promote proper standards, share comments before the standards are adopted. In the meanwhile, what is your experience about the Joint Commission and the impact of their growing involvement in health care?

The Joint Commission is expanding its Advanced Heart Failure Certification program to encompass the care provided to individuals with heart failure in outpatient settings. The Joint Commission and the American Heart Association (AHA) have established a strategic alliance to recognize programs that demonstrate excellence in the care of individuals with heart failure in both inpatient and outpatient care settings. To receive this certification, an organization must demonstrate compliance with Joint Commission standards, including use of the American Heart Association’s Get With The Guidelines®, and ongoing performance improvement. This new advanced certification is projected to launch in July 2011.

For More Information or Assistance

For a link to the proposed standards or other information, see here. If you need help evaluating or responding to this development of other health care reimbursement, technology and process, compliance, risk management, transactional, operational, enforcement or public policy concerns, please contact the author of this update, Cynthia Marcotte Stamer, at (469) 767-8872, cstamer@Solutionslawyer.net.
Vice President of the North Texas Health Care Compliance Professionals Association, Past Chair of the ABA Health Law Section Managed Care & Insurance Section and the former Board Compliance Chair of the National Kidney Foundation of North Texas, Ms. Stamer has more than 23 years experience advising health industry clients about these and other matters. She continuously advises health industry clients about the use of technology, process and other mechanisms to promote compliance and internal controls, workforce and medical staff performance, quality, governance, reimbursement, and other risk management and operational needs. As part of this experience, she has worked extensively with health care providers, payers, health care technology and consulting and other health industry clients on the design and use of health information systems, technology, privacy and other related. A popular lecturer and widely published author on health industry concerns, Ms. Stamer also publishes and speaks extensively on health care privacy, technology, and other health and managed care industry regulatory, staffing and human resources, compensation and benefits, technology, public policy, reimbursement and other operations and risk management concerns. Her insights on these and other related matters appear in the Health Care Compliance Association, Atlantic Information Service, Bureau of National Affairs, World At Work, The Wall Street Journal, Business Insurance, the Dallas Morning News, Modern Health Care, Managed Healthcare, Health Leaders, and a many other national and local publications. To review some of her many publications and presentations, or for additional information about Ms. Stamer, her experience, involvements, programs or publications, see here.

About Solutions Law Press

Leave a Comment » | Consumer Driven Health Care, Disease Management, DME, Doctor, Evidence Based Medicine, Health Care, Health Care Finance, Health Care Provider, Health Care Quality, Hospital, Medicaid, Peer Review, Reimbursement | Tagged: Cardiology, Certification, Health Care, Heart, Joint Commission, outpatient, Wellness | Permalink
Posted by Cynthia Marcotte Stamer

DEA Cautions Practitioners Must Restrict Delegation of Controlled Substance Prescribing Functions, Urges Adoption of Written Policies & Agreements

November 2, 2010

Physicians, dentists, veterinarians, hospitals, and other persons prescribing or managing practitioners that prescribe controlled substances should require written agreements with staff and others communicating controlled substance prescriptions on their behalf and implement other suitable controls to ensure compliance with Drug Enforcement Administration requirements for prescribing controlled substances according to a new DEA Statement of Policy On Role of Authorized Agents in Communicating Controlled Substance Prescriptions To Pharmacies (Statement) published by the Department of Justice Drug Enforcement Administration (DEA) on October 6, 2010.

The Statement reflects that the DEA is concerned that about practitioners improperly delegating medical need determinations and other responsibilities for prescribing controlled substances. The Statement indicates that practitioners using agents to communicate controlled substance prescriptions should ensure that their delegations are appropriately documented by written agreements with the agents detailing the scope of their authority and implement background checks, monitoring, written and operational policies and procedures governing delegations and other controlled substance prescribing and other controls to appropriately comply with DEA controlled substance prescription mandates.

Under the Comprehensive Drug Abuse Prevention and Control Act of 1970 (CSA) and the Controlled Substances Import and Export Act (CSIEA) (21 U.S.C. 801-971), a valid prescription issued by a DEA-registered practitioner is required for dispensing a controlled substance. Existing rules prohibit DEA-registered practitioners from delegating their authority to prescribe controlled substances. To be effective (i.e., valid), a DEA-registered practitioner must issue the required prescription for a controlled substance for a legitimate medical purpose as determined by the practitioner acting in the usual course of professional practice. The registered practitioner actually must make the required determination of legitimate medical purpose underlying a controlled substance prescription. He cannot delegate responsibility for determining the legitimacy of the medical purpose for a controlled substance prescription or other core responsibilities.

While DEA rules prohibit a registered practitioner from delegating his core responsibilities pertaining to prescribing controlled substances to anyone else, DEA rules allow an individual practitioner to authorize an agent to perform a limited role in communicating controlled substance prescriptions to a pharmacy in order to make the prescription process more efficient. The ability to delegate these communication responsibilities is very restricted and requires that the practitioners apply appropriate controls to prevent delegation of core prescribing responsibilities.

In the Statement, the DEA cautions that DEA requires that DEA registered practitioners must be prepared to demonstrate that the registered practitioner alone makes all required medical determinations to prescribe the communicated controlled substances when delegating responsibility to communicate controlled substance prescriptions to pharmacies on their behalf to nurse or other person acting as the practitioner’s agent. The Statement warns that delegation must be limited to participation in the communication of the prescription in accordance with DEA requirements. The Statement urges practitioners allowing agents to participate in the communication of controlled substance prescriptions to make those delegations pursuant to written agreements with t he agent and to adopt other safeguards to maintain compliance with DEA rules. To learn more, see here

For More Information Or Assistance

If you need assistance reviewing or responding to the DEA prescribing guidance contained in the Statement or addressing other health care related risk management or compliance concerns, the author of this update, attorney Cynthia Marcotte Stamer, may be able to help. Vice President of the North Texas Health Care Compliance Professionals Association, Past Chair of the ABA Health Law Section Managed Care & Insurance Section and the former Board Compliance Chair of the National Kidney Foundation of North Texas, Ms. Stamer has more than 23 years experience advising health industry clients about these and other matters. Ms. Stamer has extensive experience advising and assisting health care providers and other health industry clients to establish and administer compliance and risk management policies and to respond to DEA and other health care industry investigation, enforcement and other compliance, public policy, regulatory, staffing, and other operations and risk management concerns. A popular lecturer and widely published author on health industry concerns, Ms. Stamer continuously advises health industry clients about compliance and internal controls, workforce and medical staff performance, quality, governance, reimbursement, and other risk management and operational matters. Ms. Stamer also publishes and speaks extensively on health and managed care industry regulatory, staffing and human resources, compensation and benefits, technology, public policy, reimbursement and other operations and risk management concerns. Her insights on these and other related matters appear in the Health Care Compliance Association, Atlantic Information Service, Bureau of National Affairs, World At Work, The Wall Street Journal, Business Insurance, the Dallas Morning News, Modern Health Care, Managed Healthcare, Health Leaders, and a many other national and local publications. You can get more information about her health industry experience here. If you need assistance with these or other compliance concerns, wish to inquire about arranging for compliance audit or training, or need legal representation on other matters please contact Ms. Stamer at (469) 767-8872 or via e-mail here

Other Recent Developments

If you found this information of interest, you also may be interested in reviewing some of the following recent Updates available online by clicking on the article title:

For More Information

We hope that this information is useful to you. If you need assistance evaluating or responding to the Health Care Reform Law or health care compliance, risk management, transactional, operational, reimbursement, or public policy concerns, please contact the author of this update, Cynthia Marcotte Stamer, at (469) 767-8872, cstamer@Solutionslawyer.net.

You can review other recent health care and internal controls resources and additional information about the health industry and other experience of Ms. Stamer here. If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information – including your preferred e-mail – by creating or updating your profile at here or e-mailing this information here. To unsubscribe, e-mail here.

Leave a Comment » | Controlled Substances, Corporate Compliance, DEA, Doctor, Electronic Medical Records, Health Care, Health Care Provider, Health Care Quality, Hospital, Licensing, Medical Licensure, Medical Malpractice, Physician, Physician Licensing, Prescription Drugs, Substance Abuse | Tagged: Controlled Substances, DEA, Health Care, Physicians, practitioners, prescribing, prescriptions | Permalink
Posted by Cynthia Marcotte Stamer

Health Providers, Plans Make Recommendations To ONC Working Group On Governance Mechanisms By 11/3

October 26, 2010

The Office of the National Coordinator for Health Information Technology (ONC) Governance Workgroup (Workgroup) is developing recommendations on governance mechanisms for the nationwide health information network.

The Workgroup identified overarching objectives, key principles, and core functions for governance in its Preliminary Report and Recommendations on the Scope of Governance presented to the Health Information Technology (HIT) Policy Committee on October 20^th. The Workgroup is now preparing final recommendations on how governance functions should be implemented and by whom.

As a first step, the Workgroup would like to identify:

Existing mechanisms that might be appropriate, with or without modifications, and with or without some added coordination; and
Whether and what new mechanisms are needed.

The Workgroup would like public input on these issues and has created a table listing the core functions and questions to frame the input.

Submit your comments here by November 3, 2010.

For More Information or Assistance

If you need assistance evaluating or responding to this development of other health care technology and process, compliance, risk management, transactional, operational, reimbursement, enforcement or public policy concerns, please contact the author of this update, Cynthia Marcotte Stamer, at (469) 767-8872, cstamer@Solutionslawyer.net.

Vice President of the North Texas Health Care Compliance Professionals Association, Past Chair of the ABA Health Law Section Managed Care & Insurance Section and the former Board Compliance Chair of the National Kidney Foundation of North Texas, Ms. Stamer has more than 23 years experience advising health industry clients about these and other matters. She continuously advises health industry clients about the use of technology, process and other mechanisms to promote compliance and internal controls, workforce and medical staff performance, quality, governance, reimbursement, and other risk management and operational needs. As part of this experience, she has worked extensively with health care providers, payers, health care technology and consulting and other health industry clients on the design and use of health information systems, technology, privacy and other related. A popular lecturer and widely published author on health industry concerns, Ms. Stamer also publishes and speaks extensively on health care privacy, technology, and other health and managed care industry regulatory, staffing and human resources, compensation and benefits, technology, public policy, reimbursement and other operations and risk management concerns. Her insights on these and other related matters appear in the Health Care Compliance Association, Atlantic Information Service, Bureau of National Affairs, World At Work, The Wall Street Journal, Business Insurance, the Dallas Morning News, Modern Health Care, Managed Healthcare, Health Leaders, and a many other national and local publications. To review some of her many publications and presentations, or for additional information about Ms. Stamer, her experience, involvements, programs or publications, see here.

Other Recent Developments

If you found this information of interest, you also may be interested in reviewing some of the following recent Updates available online by clicking on the article title:

OIG Shares Key Insights On When Owners, Officers & Managers Face OIG Program Exclusion Based On Health Care Entity Misconduct

HHS to Host Regional 11/18 Meeting in LA as Part of HITECH Act Psychotherapy Notes &Testing Data Study

CMS Delegated Lead Responsibility For Development of New Affordable Care Act-Required Medicare Self-Referral Disclosure Protocol

HHS announces Rules Implementing Tools Added By Affordable Care Act to Prevent Federal Health Program Fraud

Monday 9/13 Deadline To Comment Proposed HITECH Act HIPAA Privacy Rules; 9/14 Meeting Studies Proposed Changes

DMEPOS Suppliers Face 9/27 Deadline To Meet Tightened Medicare Standards Initial EHR Certification Bodies Named

HHS Announces Adjustments to Federal Medical Assistance Percentage (FMAP) Rates

CMS Publishes Corrections To Proposed 2011 Physician Fee Schedule Rules

Medicare Changing How It Pays For Outpatient Dialysis

Rite Aid Agrees to Pay $1 Million to Settle HIPAA Privacy Case As OCR Moves To Tighten Privacy Rules

HHS Invites Input On Medicaid Changes To Promote Children’s Health Quality

CMS Adopts ESRD Facility Prospective Payment System & Proposes New Quality Incentive Program

CMS Rule Clarifies When Outpatient Services Subject to 3-Day Rule & Finalizes FY 2011 Inpatient Payment Rates

New Affordable Care Act Mandated High Risk Pre-Existing Condition Insurance Pool Program Regulations Set Program Rules, Prohibit Plan Dumping of High Risk Members

CMS Proposes Changes To Civil Monetary Penalty Rules For Nursing Homes

For More Information

Leave a Comment » | Affordable Care Act, ARRA, Electronic Health Records, Health Care, Health IT, Health Policy, Patient Protection and Affordable Care Act, Privacy, Public Policy, Technology | Tagged: ARRA, Corporate Governance, Governance, health information network, Health IT, HIPAA, internal controls, ONC | Permalink
Posted by Cynthia Marcotte Stamer

OIG Shares Key Insights On When Owners, Officers & Managers Face OIG Program Exclusion Based On Health Care Entity Misconduct

October 21, 2010

The Department of Health & Human Services Office of Inspector General (OIG) this morning (October 21, 2010) posted to its website key guidance about when OIG will exercise its authority under the permissive exclusion rules of Social Security Act (Act) § 1128(b)(15)(A)(ii) to exclude from Federal health program participation owners, officers or managing employees of health care organizations based on their role, involvement or ownership interest in a health industry company convicted of certain offenses or excluded from Federal health program participation.

The Guidance For Implementing Permissive Exclusion of Authority under Section 1128(b)(15) of the Social Security Act (Guidance) provides valuable insights for health care organizations, their owners, officers and managers about how OIG expects them to act and the evidence that OIG likely will require should OIG bring an OIG exclusion action against them personally following the conviction or OIG exclusion of their health care organization for misconduct. To position themselves to survive OIG or related exclusion or prosecution, health care organizations and their owners, officers and management use the Guidance as a guide to help strengthen the defensibility of their daily actions against potential OIG scrutiny and consider the advisability of updating their personal and organizational practices, policies and leadership training in response to this Guidance.

The Guidance discusses the guiding principles and core factors and presumptions that OIG generally will apply to decide if the OIG will should exclude an individual from Federal health program participation based on the involvement of the individual as an owner, officer or manager of company that has been excluded from Federal program participation or convicted of certain health care crimes.. Because these OIG has identified these factors as core considerations in its exclusion analysis, the Guidance provides invaluable guidance for health care entities, their owners, officers and management employees about opportunities position their conduct for defensibility against OIG enforcement exposures. Consequently, owners, officers and managers alike concerned about their exposure to Federal program exclusion or other personal liability under Federal health care fraud laws should use the Guidance to help strengthen their ability to avoid personal exclusion or other prosecution by the OIG as a result of their involvement with a health care organization excluded from Federal program participation or convicted of other crimes. For a more detailed discussion of the Guidance, see here

For More Information or Assistance

If you need assistance evaluating or responding to this development of other health care compliance, risk management, transactional, operational, reimbursement, enforcement or public policy concerns, please contact the author of this update, Cynthia Marcotte Stamer, at (469) 767-8872, cstamer@Solutionslawyer.net.

Other Resources

We hope that this information is useful to you. If you found this information of interest, you also may be interested in reviewing some of the following recent Updates available online by clicking on the article title:

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Posted by Cynthia Marcotte Stamer

HHS to Host Regional 11/18 Meeting in LA as Part of HITECH Act Psychotherapy Notes &Testing Data Study

October 19, 2010

The Substance Abuse and Mental Health Services Administration (SAMHSA) in cooperation with the Office for Civil Rights (OCR) is conducting a Confidentiality and Privacy Issues Related to Psychological Testing Data study pursuant to section 13424 of the Health Information Technology for Economic and Clinical Health (HITECH) Act, a component of the American Recovery and Reinvestment Act (ARRA) (P.L. 111-5) to assess whether the HIPAA Privacy Rule’s special protections relating to the use and disclosure of psychotherapy notes should also be applied to “test data that is related to direct responses, scores, items, forms, protocols, manuals or other materials that are part of a mental health evaluation.”

As part of this study, SAMHSA is hosting public meetings to bring together professionals in the areas of mental health and privacy protection to discuss current practices and the policy implications surrounding this very important issue. The next regional public meeting will be held at the Sheraton Los Angeles Gateway Hotel in Los Angeles, California on November 18, 2010. The details of this meeting, as well as the project staff contact information, are contained in the embedded brochure below.

You can register for this meeting directly: here , or via the same announcement on OCR’s website here.

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Posted by Cynthia Marcotte Stamer

CMS Delegated Lead Responsibility For Development of New Affordable Care Act-Required Medicare Self-Referral Disclosure Protocol

October 15, 2010

The Centers for Medicare & Medicaid Services (CMS) has been assigned responsibility for the development of the Medicare self-referral disclosure protocol required by Section 6409(a) and (b) of the Patient Protection and Affordable Care Act (ACA), Public Law 111–148, and the rules governing when HHS will exercise its discretion under Section 1877(g) of the Social Security Act to reduce sanction otherwise due and owing by provider for engaging in self-referral violations. Health & Human Services (HHS) Secretary Kathleen Sebelius announced her delegation of responsibility for the development of these new programs to the Administrator of CMS in the October 15, 2010 Federal Register here.

Under ACA Section 6402, Medicare providers and suppliers generally must report and return Medicare overpayments by the later of:

60 days after the date on which the overpayment was identified; or
The date any corresponding cost report is due, if applicable.

To encourage providers to self-disclose self-referral violations, however, Section 6409 of ACA dictates that HHS in cooperation with its Inspector General establish a Medicare self-referral disclosure protocol (SRDP) that Medicare providers may use to self-disclose actual or potential violations of the physician self-referral prohibitions of Section 1877 of the Social Security Act. Where a Medicare provider or supplier electronically submits a disclosure in accordance with the SRDP and receives email confirmation of receipt of the disclosure from CMS, the provider’s otherwise applicable obligation to return a potential overpayment within 60 days under ACA Section 6402 will be tolled until:

CMS and the provider enter into a settlement agreement;
The provider withdraws from the SRDP, or
CMS removes the provider of services or supplier from the SRDP.

In addition to delaying the deadline for returning overpayments, ACA also includes timely self-disclosure as one of the criteria that HHS can take into account when deciding whether to exercise its discretion to abate sanctions for violation of the self-referral prohibition. Unfortunately, Section 6409(a)(3) of ACA also expressly requires that the SRDP be distinct and separate from the advisory opinion process under 42 C.F.R. §§ 411.370 through 411.389. As a consequence, Medicare providers concerned about potential exposure under the self-referral rules generally should not expect to be allowed to seek protection under the SRDP while simultaneously seeking an advisory opinion for conduct underlying the same arrangement.

The author of this update, attorney Cynthia Marcotte Stamer, has extensive experience advising and assisting health care providers and other health industry clients to respond to these and other health care industry enforcement and other compliance, public policy, regulatory, staffing, and other operations and risk management matters. Ms. Stamer also regularly speaks and conducts training on and other health industry compliance, management and operations matters. You can get more information about her health industry experience here. If you need assistance with these or other compliance concerns, wish to inquire about arranging for compliance audit or training, or need legal representation on other matters please contact Ms. Stamer at (469) 767-8872 or via e-mail here.

Meanwhile, Section 6409(b) of the ACA grants HHS authority to reduce the amount of sanctions owing for all violations of the physician self-referral statute. In establishing the amount by which an overpayment resulting from an actual or potential violation(s) may be reduced, the Secretary may consider: the nature and extent of the improper or illegal practice; the timeliness of such disclosure; the cooperation in providing additional information related to the disclosure; and such other factors as the Secretary considers appropriate.

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Posted by Cynthia Marcotte Stamer

HHS announces Rules Implementing Tools Added By Affordable Care Act to Prevent Federal Health Program Fraud

September 22, 2010

The U.S. Department of Health and Human Services (HHS) proposed new rules it hopes to strengthen its efforts to help identify and fight waste, fraud and abuse in Medicare, Medicaid and the Children’s Health Insurance Program (CHIP). The rules implementing a series of provisions designed to fight fraud in the health care system enacted as part of the Affordable Care Act follow on the heels of HHS’ announcement of the Center for Program Integrity within the Centers for Medicare & Medicaid Services (CMS) focused on identifying and stopping fraud and acting swiftly to protect beneficiaries. Given the expanded powers to suspend program eligibility and other risks providers will face under these new rules, all health care providers participating in any of these federal programs should both review and strengthen their compliance efforts and practices and share any concerns in response to the proposed rules.

Among other things, the proposed rule will:

Define requirements for suspending payments to providers and suppliers based on credible allegations of fraud in Medicare and Medicaid;
Establish CMS authority for imposing a temporary moratorium on Medicare, Medicaid, and CHIP enrollment on providers and suppliers when necessary to help prevent or fight fraud, waste, and abuse without impeding beneficiaries’ access to care.
Strengthen and build on current provider enrollment and screening procedures to more accurately assure that fraudulent providers are not gaming the system and that only qualified health care providers and suppliers are allowed to enroll in and bill Medicare, Medicaid and CHIP;
Outline requirements for states to terminate providers from Medicaid and CHIP when they have been terminated by Medicare or by another state Medicaid program or CHIP;
Solicit input on how to best structure and develop provider compliance programs, now required under the Affordable Care Act, that will ensure providers are aware of and comply with CMS program requirements.

Health care providers and others likely to be affected by these proposed rules should evaluate the proposals and act quickly to share input on any areas of concern as they prepare to strengthen their processes in response to the new rules and tools.

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Posted by Cynthia Marcotte Stamer

Monday 9/13 Deadline To Comment Proposed HITECH Act HIPAA Privacy Rules; 9/14 Meeting Studies Proposed Changes

September 10, 2010

9/14 NTHCPA Meeting on Strategies for Managing HIPAA Privacy Compliance After The HITECH Act

Health care providers, payers, healthcare clearinghouses and their businesses associates (Covered Entities) face a Monday, September 13, 2010 deadline to comment on proposed changes to the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy, Security, and Enforcement Rules proposed by the U.S. Department of Health & Human Services Office for Civil Rights (OCR) on July 8, 2010 in response to amendments enacted under the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009. If adopted as proposed, the more than 220 page Notice of Proposed Rulemaking (NPRM) will significantly tighten the requirements that existing Standards for Privacy of Individually Identifiable Health Information (Privacy Rule); the Security Standards for the Protection of Electronic Protected Health Information (Security Rule); and the rules pertaining to Compliance and Investigations, Imposition of Civil Money Penalties, and Procedures for Hearings (Enforcement Rule) applicable to Covered Entities under HIPAA. With the risks of HIPAA noncompliance highlighted by OCR’s August announcement that drugstore giant RiteAid would pay $1 million to settle OCR charges that it violated the existing HIPAA’s Privacy & Security Rules and considering , Covered Entities Learn more about Rite Aid Resolution Agreement here. Learn more about Breach Notification Rules here.

The North Texas Health Care Compliance Professionals Association invites health industry compliance professionals share and learn Strategies for Managing HIPAA Privacy Compliance After the HITECH Act by participating in its September 14, 2010 meeting from 11:30 a.m. – 1:30 p.m. hosted by Cynthia Marcotte Stamer, P.C., at One Hanover Park, 16633 North Dallas Parkway, 6^th Floor, Addison Room, Addison, Texas 75001.

The author of this update, attorney Cynthia Marcotte Stamer, has extensive experience advising and assisting health care providers and other health industry clients with HIPAA and other privacy and data security, reimbursement, compliance, public policy, regulatory, staffing, and other operations and risk management matters. Ms. Stamer also regularly conducts training on HIPAA and other health industry compliance, management and operations matters. You can get more information about her health industry experience here. If you need assistance with these or other compliance concerns, wish to inquire about arranging for compliance audit or training, or need legal representation on other matters please contact Ms. Stamer at (469) 767-8872 or via e-mail here.

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Posted by Cynthia Marcotte Stamer

OIG: Texas Overbilled Medicaid for Medical Transportation Costs

September 5, 2010

The Department of Health & Human Services Office of Inspector General (OIG) estimates that Capital Area Rural Transit System received overpayments of at least $583,000 ($292,000 Federal share) for nonemergency medical transportation claims that did not comply with Federal and State requirements in 2007. The audit also identified other questionable claims, which are targeted for added review. The reported findings provide critical insights about some of the practices of Medicaid transportation services providers that are likely to draw audit or enforcement attention by OIG or other federal or state officials.

According to the “Review Of Nonemergency Medical Transportation Costs In The State Of Texas (Transportation Provided By Capital Area Rural Transit System,” Report Number a-06-08-00096 (the “Audit Report”), the audit found concerns in 68% of 100 audited samples of Medicaid billings of Capital Area Rural Transportation System (CARTS).for non-emergency services provided to Medicaid beneficiaries during 2007 as a subcontractor to the State of Texas. Texas Health and Human Services Commission contracted with the Texas Department of Transportation (TxDOT) to administer the nonemergency medical transportation to and from covered health care service providers for Medicaid beneficiaries and other eligible recipients. TxDOT subcontracted with CARTS to provide these transportation services to 10 Texas counties. Read More Details.

For More Information or Assistance

If you need assistance reviewing and updating your existing practices in response to this or other OIG, CMS or other federal or state Medicaid, Medicare or other audit or enfocement activities or with other health industry regulatory, reimbursement or other operational or compliance concerns, please contact the author of this update, attorney Cynthia Marcotte Stamer. Ms. Stamer has extensive experience advising and assisting health care providers and other health industry clients with licensure, contracting, reimbursement, compliance, public policy, regulatory, staffing, public policy and other operations and risk management matters. Ms. Stamer also regularly publishes and conducts training on these and other compliance, management and operations matters. You can contact Ms. Stamer to inquire about engaging her services or for information about training or other resources that she provides at (469) 767-8872 or via e-mail here. To get more information about Ms. Stamer and her health industry experience, see here.

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Posted by Cynthia Marcotte Stamer

DMEPOS Suppliers Face 9/27 Deadline To Meet Tightened Medicare Standards

August 31, 2010

Suppliers of durable medical equipment, prosthetics, orthotics, and related supplies (DMEPOS) must act quickly to comply with a new Centers for Medicare & Medicaid Services final regulation governing their Medicare program participation scheduled to take effect on September 27, 2010. CMS has announced that it intends to require all DMEPOS suppliers to meet the new standards set forth in the final regulation published in the Federal Register on August 27, 2010. Read more here.

To minimize their potential risks for failing to meet these new standards, DMEPOS suppliers should evaluate and update their existing practices in response to the Final Regulations as well as the additional interpretive insights include in the preamble to the Final Regulations.

For More Information or Assistance

If you need assistance reviewing and updating your existing practices in response to the Final Regulation other health industry regulatory, reimbursement or other operational or compliance concerns, please contact the author of this update, attorney Cynthia Marcotte Stamer. Ms. Stamer has extensive experience advising and assisting health care providers and other health industry clients with licensure, contracting, reimbursement, compliance, public policy, regulatory, staffing, and other operations and risk management matters. Ms. Stamer also regularly publishes and conducts training on these and other compliance, management and operations matters. You can contact Ms. Stamer to inquire about engaging her services or for information about training or other resources that she provides at (469) 767-8872 or via e-mail here. To get more information about Ms. Stamer and her health industry experience, see here.

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Posted by Cynthia Marcotte Stamer

Initial EHR Certification Bodies Named

August 30, 2010

The Office of the National Coordinator for Health Information Technology (ONC) today (August 30, 2010) named Certification Commission for Health Information Technology (CCHIT), Chicago, Ill. and the Drummond Group Inc. (DGI), Austin, Texas as the first technology review bodies authorized to test and certify electronic health record (EHR) systems for compliance with the standards and certification criteria that were issued by the U.S. Department of Health and Human Services earlier this year. The announcement comes less than two months after issuance of final meaningful use rules. Read more here.

For More Information or Assistance

If you need assistance responding to the EHR meaningful use, HITECH and other privacy, or other health industry regulatory, reimbursement or other operational or compliance concerns, please contact the author of this update, attorney Cynthia Marcotte Stamer. Ms. Stamer has extensive experience advising and assisting health care providers and other health industry clients with licensure, contracting, reimbursement, compliance, public policy, regulatory, staffing, and other operations and risk management matters. Ms. Stamer also regularly publishes and conducts training on these and other compliance, management and operations matters. You can contact Ms. Stamer to inquire about engaging her services or for information about training or other resources that she provides at (469) 767-8872 or via e-mail here. To get more information about Ms. Stamer and her health industry experience, see here.

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Posted by Cynthia Marcotte Stamer

CMS Publishes Corrections To Proposed 2011 Physician Fee Schedule Rules

August 26, 2010

Physicians and others likely to be affected by the proposed payment and other Medicare policy changes set forth in the “Medicare Program; Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2011” (“2011 Physician Fee Schedule”) proposed by the Centers for Medicare & Medicaid Services (CMS) on July 13, 2010 Federal Register should review and consider the potential implications, if any, of a series of corrections to the proposed 2011 Physician Fee Schedule (“Corrections”) published by CMS today (August 26, 2010) when evaluating the implications of the 2011 Physician Fee Schedule on their reimbursement and other operations.

The 2011 Physician Fee Schedule previously published in the Federal Register here on July 13, 2010 outlines a detailed series of proposed changes to the physician fee schedule and other Medicare Part B payment policies that CMS is proposing to implement in 2011. Among other things, the proposed 2011 Physician Fee Schedule would:

Change Medicare reimbursement rules and amounts to reflect changes in medical practice and the relative value of services;
Interprets and implements certain provisions of both the Affordable Care Act and the Medicare Improvements for Patients and Providers Act of 2008;;
Discusses payments under the Ambulance Fee Schedule, Clinical Laboratory Fee Schedule, payments to ESRD facilities, and payments for Part B drugs; and
Discusses rules regarding the Chiropractic Services Demonstration program, the Competitive Bidding Program for Durable Medical Equipment and Provider and Supplier Enrollment Issues associated with Air Ambulances.

The Corrections published in the August 26, 2010 Federal Register here list a series of corrections to specific provisions of the 2011 Physician Fee Schedule that CMS has identified as necessary to address technical or typographical errors in the 2011 Physician Fee Schedule as originally published in July. Physicians and others evaluating the potential implications of the previously proposed 2011 Physician Fee Schedule should review and take into account these proposed edits as part of their analysis and response.

For More Information or Assistance

If you need assistance with these or other health industry regulatory, reimbursement or other operational or compliance concerns, please contact the author of this update, attorney Cynthia Marcotte Stamer. Ms. Stamer has extensive experience advising and assisting health care providers and other health industry clients with licensure, contracting, reimbursement, compliance, public policy, regulatory, staffing, and other operations and risk management matters. Ms. Stamer also regularly publishes and conducts training on these and other compliance, management and operations matters. You can contact Ms. Stamer to inquire about engaging her services or for information about training or other resources that she provides at (469) 767-8872 or via e-mail here. To get more information about Ms. Stamer and her health industry experience, see here.

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Posted by Cynthia Marcotte Stamer

Medicare Changing How It Pays For Outpatient Dialysis

August 13, 2010

How Medicare pays for outpatient dialysis services for Medicare beneficiaries who have end-stage renal disease (ESRD) is changing in January.

Final regulations published yesterday (August 12, 2010) by the Centers for Medicare & Medicaid Services here will implement a case-mix adjusted bundled prospective payment system (PPS) for Medicare outpatient ESRD facilities beginning January 1, 2011 (ESRD PPS). The new reimbursement rules implement changes required by the Medicare Improvements for Patients and Providers Act (MIPPA) enacted July 15, 2008. This ESRD PPS also replaces the current basic case-mix adjusted composite payment system and the methodologies for the reimbursement of separately billable outpatient ESRD services.

Concurrently, CMS also proposed new rules here that would establish a new quality incentive program (QIP) to promote high quality services in dialysis facilities by linking a facility’ s payments to performance standards. The QIP is the first pay-for-performance program in a Medicare fee-for-service payment system.

In anticipation of its administration of these new rules, CMS also followed up today (August 13, 2010) by inviting public comment on the Independent Renal Dialysis Facility Cost Report, through which CMS requires providers participating in the Medicare program to identify the specific items of cost and statistics of facility operation that independent renal dialysis facilities are required to report. See here.

Last Call: Today Deadline To Comment on Proposed Edits To CMS Nursing Home Civil Monetary Penalty Regs

August 11, 2010

Today (August 11, 2010) is the deadline to submit comments on proposed changes to Medicare and Medicaid regulations governing the imposition and collection of civil monetary penalties against nursing homes for failing to comply with Medicare & Medicaid regulations.

The Centers for Medicare & Medicaid Services proposed regulations that would expand and revise current Medicare and Medicaid regulations regarding the imposition and collection of civil money penalties by CMS when nursing homes are not in compliance with Federal participation requirements in accordance with the Patient Protection and Affordable Care Act of 2010 on July 12. A copy of the proposed regulations is available for review here. Comments must be submitted today by 5 P.M. Eastern Time.

If you need assistance evaluating, preparing comments, or responding to the proposed regulations or with other health industry matters, please consider contacting the author of this update. Attorney Cynthia Marcotte Stamer, has extensive experience advising and assisting health care providers and other health industry clients with reimbursement, compliance, public policy, regulatory, staffing, and other operations and risk management matters. Ms. Stamer also regularly publishes and conducts training on health industry compliance, management and operations matters. You can get more information about her health industry experience here. If you need assistance with these or other compliance concerns, wish to inquire about arranging for compliance audit or training, or need legal representation on other matters please contact Ms. Stamer at (469) 767-8872 or via e-mail here.

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Posted by Cynthia Marcotte Stamer

Rite Aid Agrees to Pay $1 Million to Settle HIPAA Privacy Case As OCR Moves To Tighten Privacy Rules

August 3, 2010

One of the nation’s largest drug store chains, Rite Aid Corporation and its 40 affiliated entities (Rite Aid) will pay $1 million to settle potential violations of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule. The U.S. Department of Health and Human Services (HHS) Office of Civil Rights announcement of the HIPAA resolution agreement with Rite Aid and the concurrent negotiation of a separate consent order of potential FTC Act violations between Rite Aid and the Federal Trade Commission (FTC) follows HHS’ announcement of proposed changes to its HIPAA Privacy Rules and associated penalties in response to changes enacted under the Health Information Technology for Economic and Clinical Health Act of 2009 (HITECH Act). The Rite Aid settlement and the proposed Privacy Rule changes illustrate the growing penalty risks that health care providers, health plans, healthcare clearinghouses and their business associates (Covered Entities) face for violating the Privacy Rules.

Rite Aid Resolution Agreement

The Rite Aid resolution agreements settle charges that Rite Aid failed to appropriately safeguard the privacy of its customers when disposing of identifying information on pill bottle labels and other health information. The settlements apply to all of Rite Aid’s nearly 4,800 retail pharmacies and follow an extensive joint investigation by the HHS Office for Civil Rights (OCR) and the FTC.

OCR opened its investigation of Rite Aid after television media videotaped incidents in which pharmacies were shown to have disposed of prescriptions and labeled pill bottles containing individuals’ identifiable information in industrial trash containers that were accessible to the public in a variety of Rite Aid locations in cities across the United States. OCR and FTC previously settled a similar case involving the national drug store chain CVS in February 2009.

The HIPAA Privacy Rule requires covered entities to safeguard the privacy of patient information and other “protected health information” including during its disposal. In addition to the detailed requirements for protection and safeguarding of protected health information and electronic protected health information under the Privacy Rules, breach notification rules added to HIPAA under the HITECH Act also generally require that Covered Entities investigate and provide timely notification of breach to patients, OCR and in some cases the media when “unsecured protected heath information” is breached. Meanwhile, the FTC Act and associated regulations require those retailers and certain other parties receiving personal financial information to comply with certain requirements for the protection and use of that information and to provide certain notifications of their privacy polices for protecting personal financial information.

The joint OCR and the FTC investigations raised concerns that:

Rite Aid failed to implement adequate policies and procedures to appropriately safeguard patient information during the disposal process;
Rite Aid failed to adequately train employees on how to dispose of such information properly; and
Rite Aid did not maintain a sanctions policy for members of its workforce who failed to properly dispose of patient information.

Under the HHS resolution agreement, Rite Aid agreed to pay a $1 million resolution amount to HHS and must implement a strong corrective action program under which Rite Aid agreed to:

Revise and distribute its policies and procedures regarding disposal of protected health information and sanctioning workers who do not follow them;
Train workforce members on these new requirements;
Conduct internal monitoring; and
Engage a qualified, independent third-party assessor to conduct compliance reviews and render reports to HHS.

In addition, under its FTC consent order, Rite Aid separately agreed to external, independent assessments of its pharmacy stores’ compliance with the FTC consent order.

The HHS corrective action plan will be in place for three years; the FTC order will be in place for 20 years.

Proposed Privacy Rule Changes

The Rite Aid resolution agreement and consent order follows the July 8, 2010 publication by OCR of proposed changes to its existing HIPAA Privacy, Security, and Enforcement Rules in response to amendments enacted under the HITECH Act. Because of the lead time required to implement needed changes in policies, technology and training, Covered Entities need to begin preparations to adjust their health information privacy and data security policies and practices in anticipation of the finalization and implementation of these rules as well as to act quickly to submit their comments about the proposed changes. .

The more than 220 page Notice of Proposed Rulemaking (NPRM) proposes to revise the existing Standards for Privacy of Individually Identifiable Health Information (Privacy Rule); the Security Standards for the Protection of Electronic Protected Health Information (Security Rule); and the rules pertaining to Compliance and Investigations, Imposition of Civil Money Penalties, and Procedures for Hearings (Enforcement Rule) issued under HIPAA.

The author of this update, attorney Cynthia Marcotte Stamer, has extensive experience advising and assisting health care providers and other health industry clients with HIPAA and other privacy and data security, reimbursement, compliance, public policy, regulatory, staffing, and other operations and risk management matters. Ms. Stamer also is regularly conducts training on HIPAA and other health industry compliance, management and operations matters. You can get more information about her health industry experience here. If you need assistance with these or other compliance concerns, wish to inquire about arranging for compliance audit or training, or need legal representation on other matters please contact Ms. Stamer at (469) 767-8872 or via e-mail here.

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Posted by Cynthia Marcotte Stamer

HHS Invites Input On Medicaid Changes To Promote Children’s Health Quality

August 2, 2010

August 30, 2010 is the deadline for interested persons to provide input to Health & Human Services about legislation to improve the quality of care provided to children under Medicaid and the Children’s Health Insurance Program, including recommendations for quality reporting by the States. The Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) requires the Secretary of Health and Human Services to provide to Congress recommendations for legislative changes to improve the quality of care provided to children under Medicaid and the Children’s Health Insurance Program. HHS invited public input for use in preparing these recommendations on July 30, 2010 here.

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Posted by Cynthia Marcotte Stamer

CMS Adopts ESRD Facility Prospective Payment System & Proposes New Quality Incentive Program

August 1, 2010

The Centers for Medicare & Medicaid Services (CMS) on July 26 issued a final rule that will change how Medicare pays for dialysis services for Medicare beneficiaries who have end-stage renal disease (ESRD). Concurrently, CMS also proposed new rules that would establish a new quality incentive program (QIP) to promote high quality services in dialysis facilities by linking a facility’ s payments to performance standards. The QIP is the first pay-for-performance program in a Medicare fee-for-service payment system. Read on here .

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Posted by Cynthia Marcotte Stamer

CMS Rule Clarifies When Outpatient Services Subject to 3-Day Rule & Finalizes FY 2011 Inpatient Payment Rates

August 1, 2010

Regulations published July 30^th by the Centers for Medicare & Medicaid Services (CMS) clarify when non-diagnostic services provided on an outpatient basis will be treated as inpatient services under the “3-Day Rule” in light of the clarifications made by the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010 (“Preservation of Access to Care Act”). The regulations also finalize Medicare payment rates for inpatient services furnished to people with Medicare by acute care hospitals, long-term care hospitals (LTCHs), and certain excluded hospitals. Get more details here.

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Posted by Cynthia Marcotte Stamer

New Affordable Care Act Mandated High Risk Pre-Existing Condition Insurance Pool Program Regulations Set Program Rules, Prohibit Plan Dumping of High Risk Members

July 31, 2010

nterim final rules (Regulations) implementing the implementation of the “Pre-Existing Condition Insurance Plan” (PCIP) program required by the Patient Protection and Affordable Care Act of 2010 (Affordable Care Act) became effective immediately upon their publication by the Department of Human Services on Friday, July 30, 2010. The Regulations published by HHS on July 30, 2010 define eligible individuals and detail the rules governing the establishment, implementation and administration of the PCIP program. The Regulations also send a clear message that insurers and group health plans risk stiff penalties for engaging in activities that HHS considers inappropriate dumping from coverage of individuals with pre-existing conditions. Read details

Leave a Comment » | Affordable Care Act, Health Care, Hospital, Laws, Preexisting Condition Insurance Plan, Reimbursement, Uncategorized | Tagged: Affordable Care Act, Health Plans, PCIP, Pre-Existing Condition Insurance Plan, Preexisting Condition | Permalink
Posted by Cynthia Marcotte Stamer

CMS & ONC To Co-Host 7/22 ONC Certification & Medicare/Medicaid EHR Incentive Program Audio Training

July 20, 2010

The Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) will co-host an Audio Training on the Final Rules for ONC Certification and Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs on July 22, 2010 from 2:00-3:30 pm EST.

During the training, the Agencies plan to discuss:

Benefits of HIT
Summary of the final rules
ONC temporary certification process
ONC initial set of standards and implementation specifications
Medicare and Medicaid EHR Incentives Programs including the initial definition of meaningful Use

To join the audio training, dial 1-877-251-0301 and enter the Conference ID pass code: 87841621

Materials will be made available prior to the training at the following web address here.

For more information about CMS EMR incentives, see here.

The author of this update, attorney Cynthia Marcotte Stamer, has extensive experience advising and assisting health care providers, health plans and insurers, and other health and insurance industry clients with HIPAA, EMR and other privacy and data security, reimbursement, compliance, public policy, regulatory, staffing, and other operations and risk management matters. Ms. Stamer also regularly conducts training on these and other health industry technology, compliance, management and operations matters. You can get more information about her health industry experience here. If you need assistance with these or other compliance concerns, wish to inquire about arranging for compliance audit or training, or need legal representation on other matters please contact Ms. Stamer at (469) 767-8872 or via e-mail here.

Other Recent Developments

If you found this information of interest, you also may be interested in reviewing some of the following recent Updates available online by clicking on the article title:

For More Information

Leave a Comment » | Affordable Care Act, ARRA, Doctor, E-Prescribing, Electronic Health Records, Genetic Information, GINA, Health Care, Health Care Provider, Health Care Reform, Health IT, Health Plan, Health Plans, HIPAA, HITECH Act, Hospital, Hospital, Meaningful Use, Medicaid, Medicare, Medicare Advantage, OCR, Privacy, Technology, Telemedicine | Tagged: Data Security, EHR, Electronic Health Records, EMR, Health Information Technology, Health IT, Hi-TECH Act, HIPAA, HITECH Act, IT, ONC, ONC Certification, Privacy | Permalink
Posted by Cynthia Marcotte Stamer

CMS Proposes Changes To Civil Monetary Penalty Rules For Nursing Homes

July 12, 2010

August 11, 2010 is the deadline to submit comments on proposed changes to Medicare and Medicaid regulations governing the imposition and collection of civil monetary penalties against nursing homes for failing to comply with Medicare & Medicaid regulations.

The Centers for Medicare & Medicaid Services today (July 12, 2010) proposed regulations that would expand and revise current Medicare and Medicaid regulations regarding the imposition and collection of civil money penalties by CMS when nursing homes are not in compliance with Federal participation requirements in accordance with the Patient Protection and Affordable Care Act of 2010. A copy of the proposed regulations is available for review here.

Other Recent Developments

If you found this information of interest, you also may be interested in reviewing some of the following recent Updates available online by clicking on the article title:

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Leave a Comment » | Anti-KickBack, ASC, Conditions of Participation, Corporate Compliance, Doctor, Health Care, Health Care Fraud, Health Care Provider, Health Care Quality, Medicaid, Medicare, Stark | Tagged: Civil Monetary Penalties, CMS, Health Care, Health Care Fraud, Hospitals, Medicaid, Medicare, Nursing Homes, Physicians, Reimbursement | Permalink
Posted by Cynthia Marcotte Stamer

Office of Civil Rights Proposes Changes To HIPAA Privacy, Security & Civil Sanctions Rules

July 9, 2010

Stay Tuned To Solutions Law Press For More Details

Get ready for even tighter privacy and security rules and more enforcement! The U.S. Department of Health & Human Services Office for Civil Rights (OCR) on July 8, 2010 proposed changes to its existing Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy, Security, and Enforcement Rules in response to amendments enacted under the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009. Because of the lead time required to implement needed changes in policies, technology and training, health care providers, health plans, healthcare clearinghouses and their business associates should evaluate and begin preparations to adjust their health information privacy and data security policies and practices in anticipation of the finalization and implementation of these rules.

Solutions Law Press is finalizing arrangements to host a briefing on the proposed changes in August and planning more detailed updates on these developments. Stay tuned to Solutions Law Press for additional updates and details about a future briefing on these proposed HIPAA changes and other developments affecting HIPAA and other health plan and human resources matters. In the meanwhile, you may want to check out other existing Solutions Law Press updates and resources about HITECH Act and other HIPAA developments such as HIPAA Heats Up: HITECH Act Changes Take Effect & OCR Begins Posting Names, Other Details Of Unsecured PHI Breach Reports On Website.

The author of this update, attorney Cynthia Marcotte Stamer, has extensive experience advising and assisting health care providers and other health industry clients with HIPAA and other privacy and data security, reimbursement, compliance, public policy, regulatory, staffing, and other operations and risk management matters. You can get more information about her health industry experience here. If you need assistance with these or other compliance concerns, wish to inquire about arranging for compliance audit or training, or need legal representation on other matters please contact Ms. Stamer at (469) 767-8872 or via e-mail here.

Other Recent Developments

If you found this information of interest, you also may be interested in reviewing some of the following recent Updates available online by clicking on the article title:

For More Information

Leave a Comment » | Corporate Compliance, Doctor, Electronic Health Records, Electronic Medical Records, Employer, FACTA, Federal Sentencing Guidelines, Genetic Information, GINA, Health Care, Health IT, Health Plan, Health Plans, HIPAA, HITECH Act, Hospital, Hospital, Indian Health, OCR, Physician, Technology | Tagged: Data Breach, Data Securty, Health Care Provider, Health Plans, Healthcare Clearinghouse, HIPAA, OCR, Protected Health Information | Permalink
Posted by Cynthia Marcotte Stamer

NTHCPA July 13 Meeting On Annual Reporting under a Corporate Integrity Agreement

July 5, 2010

NORTH TEXAS HEALTHCARE COMPLIANCE PROFESSIONAL ASSOCIATION

Invites Members and Guests to

“Annual Reporting under a Corporate Integrity Agreement”

July 13, 2010
2:00 p.m..-4:00 p.m.
Tenet Healthcare Corporation

Fountain Place, 14th Floor Room 1454

1445 Ross Avenue

Dallas, Texas 75202

North Texas Healthcare Compliance Professional Association (NTHCPA) invites members and other interested health care compliance professionals to learn about “Annual Reporting Under a Corporate Integrity Agreement” by participating in the July 13, 2010 NTHCPA meeting from 2:00 p.m. to 4:00 p.m.

Listen to a panel discussion of Audrey Andrews, Sarah Campbell, Al Josephs and Ryan Whitehill from the compliance team of Tenet Healthcare Corporation as they discuss their insights on preparing for and managing annual reporting requirements when operating under a corporate integrity agreement.

The meeting will be held at the offices of Tenet Healthcare Corporation located at Fountain Place, 14th Floor Room 1454, 1445 Ross Avenue, Dallas, Texas 75202. NTHCPA thanks Tenet Healthcare Corporation for hosting and leading this meeting.

NTHCPA meetings are open to all NTHCPA members and other interested health care compliance professionals. Participation in the meeting is complimentary. Participants are responsible for any parking charges incurred.

To help us to notify you about upcoming meetings and to arrange for adequate space and refreshments, for this and other meetings, interested persons are encouraged to forward their current contact information including e-mail to Vice-President Cynthia Marcotte Stamer at (469) 767-8872 or by e-mail to cstamer@solutionslawyer.net.

If you are interested in hosting one of the upcoming meetings, wish to suggest topics or speakers, or wish to obtain or share other information, please contact NTHCPA President Erma Lee at (817) 927-1232 or by e-mail at ELee@jpshealth.org or Vice-President Cynthia Marcotte Stamer at (469) 767-8872 or by e-mail to cstamer@solutionslawyer.net.

About the NTHCPA

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Posted by Cynthia Marcotte Stamer

Stamer Speaks On “Sex, Drugs & Rock ‘N Role: Personal Misconduct In Health Care” July 21, 2010 In Dallas

July 5, 2010

From substance abuse to stress, medical staff and other health care workforce personal misconduct creates major liability and management challenges for health care organizations and their licensed providers. Cynthia Marcotte Stamer will speak about “Sex Drugs & Rock ‘N Role: Personal Misconduct in Health Care” at the Wednesday, July 21, 2010 monthly meeting of the Dallas Bar Association Health Law Section.

Former Chair of the ABA Health Law Section Managed Care & Insurance Interest Group, attorney and author Cynthia Marcotte Stamer is nationally and internationally recognized for her legal work, publications and programs, and advocacy on health industry performance management and other health industry matters. Ms. Stamer works extensively with health care organizations, managed care and health insurance organizations, governments and others to manage performance and legal risks. Board Certified in Labor & Employment Law by the Texas Board of Legal Specialization, Ms. Stamer combines her more than 23 years of health industry regulatory and risk management experience with an in-depth knowledge of workforce management and regulation to help clients manage performance and legal and operational risks. Her experience includes advising public and private health industry clients domestically and internationally on a wide range of matters. A widely published author and popular speaker, Ms. Stamer’s insights on health industry matters also are quoted in HealthLeaders, Managed Care Executive, the Wall Street Journal and many other national popular, business and industry publications. She also conducts continuing medical education and other health industry compliance and risk management training for many organizations on a wide range of topics.

The program will be held from Noon to 1:00 p.m. Central Time at the Dallas Bar Association Belo Mansion located at 2101 Ross Avenue, Dallas Texas. For additional information, visit www.dallasbar.org.

For additional information, call the Dallas Bar Association at 214-220-7400 or see http://www.dallasbar.org.

Other Recent Developments

If you are interested in this health industry development, you also may be interested in reviewing some of our other recent updates available at https://slphealthcareupdate.wordpress.com including:

For More Information

We hope that this information is useful to you. If you need assistance with medical staff credentialing or discipline, employment, benefits and compensation, reimbursement, health care fraud or other health care compliance, risk management, transaction or operations concerns, please contact Cynthia Marcotte Stamer at (469) 767-8872 or via e-mail to here.

You can review other recent health care and internal controls resources and get additional information about the health industry and other experience of Cynthia Marcotte Stamer, P.C. here. If you or someone else you know would like to receive future updates about developments on these and other concerns, register or update your profile – including your preferred e-mail – by creating or updating your profile at here or e-mailing this information to here.

Leave a Comment » | Employment, Health Care, Health Care Provider, Hospital, Hospital, Medical Malpractice, Peer Review, Physician, Physician Licensing, Substance Abuse | Tagged: Credentialing, Disruptive Physician, Drug Testing, Employment, Medical Staff, Peer Review | Permalink
Posted by Cynthia Marcotte Stamer

CMS PROPOSES RULES TO IMPLEMENT AFFORDABLE CARE ACT REQUIRED EXPANSION OF MEDICARE PREVENTIVE SERVICES AND OTHER 2011 REIMBURSEMENT CHANGES

July 3, 2010

August 24, 2010 is the deadline for concerned health care providers or others to submit comments on regulations that the Centers for Medicare & Medicaid Services (CMS) recently proposed to implement key provisions in the Affordable Care Act of 2010 concerning Medicare reimbursement preventive services, primary care services, certain rural health care services, imaging and certain other services. Health care providers providing Medicare-covered services should review the proposed regulation available here and an accompanying CMS Fact Sheet on the rule available here to assess its likely implications on their reimbursement and other operations act quickly to share any comments and concerns.

The proposed regulation published by CMS June 26, 2010 would apply to payments under the Medicare Physician Fee Schedule for services furnished on or after January 1, 2011. Among other things, it outlines the conditions under which CMS proposes that:

Medicare will cover an annual wellness visit
Eliminate out-of-pocket costs for Medicare beneficiaries for most preventive services
Add an incentive payment for primary care services furnished by primary care practitioners that can include physicians, nurse practitioners, clinical nurse specialists and physician assistants. Implement a payment incentive program for general surgeons performing major surgery in areas designated by the Secretary as Health Professional Shortage Areas (HPSAs)
Allow physician assistants to order post-hospital extended care services in skilled nursing facilities
Pay certified nurse midwives for their services under the Medicare Physician Fee Schedule (MPFS) at the same rates as physicians
Update its policies and payment rates for services by physicians, nonphysician practitioners (NPPs) and certain other suppliers that are paid under the MPFS during calendar year (CY) 2011.
Continue recent efforts by CMS to improve the accuracy of physicians’ payment rates by implementing Affordable Care Act mandates to identify services in categories that are at significant risk for inaccurate payment and by further reducing payments in CY 2011 for diagnostic imaging equipment used in diagnostic computed tomography (CT) and magnetic resonance imaging (MRI) services
Require physicians referring CT, MRI and positron emission tomography (PET) services under the in-office ancillary services exception to the physician self-referral prohibition, to notify patients that they may receive the same services from other suppliers in the area. The physician would also provide a list of alternate suppliers.

The author of this update, attorney Cynthia Marcotte Stamer, has extensive experience advising and assisting health care providers and other health industry clients with reimbursement, compliance, public policy, regulatory, staffing, and other operations and risk management matters. You can get more information about her health industry experience here. If you need assistance with these or other compliance concerns, wish to inquire about arranging for compliance audit or training, or need legal representation on other matters please contact Ms. Stamer at (469) 767-8872 or via e-mail here.

Other Recent Developments

If you found this information of interest, you also may be interested in reviewing some of the following recent Updates available online by clicking on the article title:

For More Information

Leave a Comment » | Health Care, Health Care Finance, Health Care Fraud, Health Care Provider, Health Care Reform, Hospital, Inpatient Rehabilitation Facility, Medicare, Medicare Advantage, Medicare Fee Schedule, Medicare Fee Schedule, Physician, Reimbursement, Rural Health Care | Tagged: Affordable Care Act, CMS, Health Care, Hospitals, Imaging, Medicare, Reimbursement | Permalink
Posted by Cynthia Marcotte Stamer

New Law Clarifies Medicare 3-Day Payment Window Rule

July 3, 2010

The “Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010” (Act) signed into law on June 25, 2010, clarifies Medicare’s policy for payment of services provided in hospital outpatient departments on either the day of or during the three days before an inpatient admission (“3-day payment window”). Read more about the clarifications made by the Act to the three-day rule here.

The author of this update, attorney Cynthia Marcotte Stamer, has extensive experience advising and assisting health care providers and other health industry clients with reimbursement, compliance, public policy, regulatory, staffing, and other operations and risk management matters. You can get more information about her health industry experience here. If you need help with these or other compliance concerns, wish to ask about arranging for compliance audit or training, or need legal representation on other matters please contact Ms. Stamer at (469) 767-8872 or via e-mail here.

Other Recent Developments

If you found this information of interest, you also may be interested in reviewing some of the following recent Updates available online by clicking on the article title:

For More Information

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Posted by Cynthia Marcotte Stamer

HHS Invites Comments On Health Center Program Federal Tort Claims Policy Manual

July 1, 2010

The Federal Tort Claims Act (FTCA) Policy Manual (Manual) posted here that the Department of Health & Human Services intends to serve as the primary policy source for information on FTCA for Health Center Program grantees funded under section 330 (Section 330) of the Public Health Service (PHS) Act. August 6, 2010 is the deadline to share feedback on the Manual in response to an invitation from HHS published in the July 1, 2010 Federal Register. See here.

The Manual is intended to consolidate, update and replace a variety of guidance previously issued by HHS about the FTCA Medical Malpractice program for participating Health Center Program grantees. HHS previously has issued numerous Program Information Notices (PINs) and Program Assistance Letters (PALs) related to the Health Center FTCA Medical Malpractice Program. HHS consolidated these PINs and PALs to create the Manual. HHS intends for the Manual to convey guidance about existing policy and current processes, and to serve as the principal policy resource on FTCA matters for Health Center Program grantees and related stakeholders. HHS going forward plans to update the Manual as it issues new policy and program guidance.

The Health Center Program supports more than 1,100 organizations operating almost 8,000 health care delivery sites, including community health centers, migrant health centers, health care for the homeless centers, and public housing primary care centers. Health centers serve medically underserved communities delivering preventive and primary care services to patients regardless of their ability to pay.

Health Center Program grantees funded under section 330 of the PHS Act, including Community Health Centers, Migrant Health Centers, Health Care for the Homeless Health Centers, and Public Housing Primary Care Health Centers, have access to medical malpractice coverage under the FTCA. FTCA is the legal mechanism for compensating people who have suffered personal injury due to the negligent or wrongful action of employees of the U.S. Government.

Under section 224 of the PHS Act, as amended by the Federally Supported Health Centers Assistance Act (FSHCAA) of 1992 and 1995, a section 330-funded health center, as well as its officers, directors, employees, and certain contractors, may be considered deemed to be Federal employees for the purpose of medical malpractice coverage under the FTCA. Accordingly, they are immune from personal liability for claims of medical malpractice arising from their deemed employment, contract for services, or duties as an officer or director of the deemed health center. FSHCAA requires health centers to apply for deemed status in order for FTCA coverage to be effective.

Other Recent Developments

If you found this information of interest, you also may be interested in reviewing some of the following recent Updates available online by clicking on the article title:

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Leave a Comment » | Federal Health Center, Health Care, Health Care Provider, Hospital, Hospital, Indian Health, Medical Malpractice, Physician | Tagged: Federal Health Center, FTCA, Health Care, health care access, HHS, Malpractice, Public Health Service, Section 330 | Permalink
Posted by Cynthia Marcotte Stamer

NCPDP SCRIPT 10.6 Approved As Medicare Part D/Advantage E-Prescribing Option

July 1, 2010

The Centers for Medicare & Medicaid Services (CMS) today (July 1, 2010) issued an interim final rule (Rule) that permits the voluntary use of the National Council for the Prescription Drug Programs (NCPDP) Prescriber/Pharmacist Interface SCRIPT standard, Implementation Guide, Version 10, Release 6 (Version 10.6) (NCPDP SCRIPT 10.6) for conducting certain e-prescribing transactions for the Medicare Part D electronic prescription drug program. Review the Rule here.

Prior to the adoption the Rule, only NCPDP SCRIPT 8.1 was authorized for use in communicating Medicare Part D medication history among sponsors, prescribers and dispensers. The Rule revises Regulation §423.160(b)(4) to specify that entities now may use either NCPDP SCRIPT 10.6 or 8.1 for the communication of Medicare Part D medication history among sponsors, prescribers, and dispensers.

Along with the rule, CMS issued a request for comments on the Rule. The deadline for interested parties to comment is 5 p.m. Eastern Daylight Time on August 30, 2010.

Section 101 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) (Pub. L. 108-173) requires that Prescription Drug Plan (PDP) sponsors, Medicare Advantage (MA) organizations offering Medicare Advantage-Prescription Drug Plans and other Medicare Part D sponsors (Plans) provide for electronic transmittal the prescribing provider, dispensing pharmacy and the dispenser of information about:

Eligibility,
Benefits (including drugs included in the applicable formulary, any tiered formulary structure and any requirements for prior authorization),
The drug being prescribed or dispensed and other drugs listed in the medication history,
The availability of lower cost, therapeutically appropriate alternatives (if any) for the drug prescribed, and
Certain other information.

Before the Rule, CMS had approved NCPDP SCRIPT 8.1 for conducting these electronic transmittals.

As a consequence of the Rule, Plans, prescribers and dispensers now may use either NCPDP SCRIPT 10.6 or 8.1 when conducting e-Prescribing to conduct:

Get message transaction.
Status response transaction.
Error response transaction.
New prescription transaction.
Prescription change request transaction.
Prescription change response transaction.
Refill prescription request transaction.
Refill prescription response transaction.
Verification transaction.
Password change transaction.
Cancel prescription request transaction.
Cancel prescription response transaction.
Fill status notification transaction.
For the communication of Medicare Part D medication history among sponsors, prescribers, and dispensers.

The MMD does not require that prescribers or dispensers implement e-Prescribing, prescribers and dispensers who electronically transmit prescription and certain other prescription-related information for Medicare Part D covered drugs prescribed for Medicare Part D eligible individuals, directly or through an intermediary, must comply with any applicable final standards that are in effect. The Rule provides new choices on how to accomplish this.

The author of this update, attorney Cynthia Marcotte Stamer, has extensive experience advising and assisting health care providers and other health industry clients with reimbursement, compliance, public policy, regulatory, staffing, and other operations and risk management matters. You can get more information about her health industry experience here. If you need help with these or other compliance concerns, wish to ask about arranging for compliance audit or training, or need legal representation on other matters please contact Ms. Stamer at (469) 767-8872 or via e-mail here.

Other Recent Developments

If you found this information of interest, you also may be interested in reviewing some of the following recent Updates available online by clicking on the article title:

For More Information

Leave a Comment » | Controlled Substances, DEA, Doctor, Electronic Health Records, Electronic Medical Records, Health Care, Health Care Provider, Health IT, Health Plan, Health Plans, Hospital, Hospital, Meaningful Use, Medicare, Medicare Advantage, Pharmacy, Physician, Prescription Drugs, Privacy, Reimbursement, Telemedicine | Tagged: E-Prescribing, Health Care, Health Plans, Medicare Advantage, Medicare Part D NCPDP SCRIPTI, Payers, Physicians, Providers | Permalink
Posted by Cynthia Marcotte Stamer

Proposed Medicare Rules Will Require Hospitals Honor Patient Visitation Preferences

June 23, 2010

A new Condition of Participation rule proposed by the Centers for Medicare & Medicaid Services (CMS) would require hospitals to protect and honor patients’ rights to choose their own visitors during a hospital stay. The new proposed rule will implement an April 15, 2010, Presidential memorandum directing HHS to develop standards requiring Medicare- and Medicaid-participating hospitals (including critical access hospitals) to allow patients to choose who may visit them when they are inpatients of a facility.

The proposed rule would add the new requirement as an addition Condition of Participation for Medicare- and Medicaid-participating hospitals and critical access hospitals. To meet the Condition, the proposed rules would require every hospital to have written policies and procedures detailing patients’ visitation rights, as well as instances when the hospital may restrict patient access to visitors based on reasonable clinical needs. Among other things, the proposed rule specifically would require:

Visitors chosen by the patient (or his or her representative) be able to enjoy visitation privileges that are no more restrictive than those for immediate family members; and
Require hospitals and critical access hospitals to explain to all patients their right to choose who may visit them during their inpatient stay, regardless of whether the visitor is a family member, a spouse, or a domestic partner (including a same-sex domestic partner), as well as the right to withdraw such consent at any time.

The proposed rules expected to be published in the Federal Register this week will be available for public comment for 60 days. CMS plans to finalize the proposed rule after CMS has read and considered the comments. More information about the proposed rule see CMS’ website here and here.

The proposed new requirement would add to the already existing safety and other Conditions of Participation that hospitals must meet to participate in Medicare and would operate in addition to otherwise applicable patient’s visitation rights standards imposed by Joint Commission and other rules. The author of this update, attorney Cynthia Marcotte Stamer, has extensive experience advising and assisting hospitals and other health care providers to estalish and administer patient’s rights and other policies to comply with Conditions of Participation and other applicable laws, regulations and standards. You can get more information about her health industry experience here. If you need assistance with these or other compliance concerns, wish to inquire about arranging for compliance audit or training, or need legal representation on other matters please contact Ms. Stamer at (469) 767-8872 or via e-mail here.

Other Recent Developments

If you found this information of interest, you also may be interested in reviewing some of the following recent Updates available online by clicking on the article title:

For More Information

Leave a Comment » | Conditions of Participation, Consumer Driven Health Care, Health Care, Health Care Finance, Health Care Fraud, Health Care Provider, Health Care Quality, Hospital, Hospital, Medical Licensure, Medicare, Medicare Advantage | Permalink
Posted by Cynthia Marcotte Stamer

IRS Invites Input On Application of New Tax Exemption Requirements For Hospital Organizations Added By Affordable Care Act

May 28, 2010

July 22, 2010 is the deadline for non-profit hospital organizations and other concerned persons to share comments with the Internal Revenue Service (IRS) on the proper construction and application of additional requirements imposed under new Internal Revenue Code (Code) § 501(r)(1) requires that “hospital organizations” meet to qualify as tax-exempt charitable entities. The new Code § 501(r)(1) requirements were added to the Code by section 9007(a) of the Patient Protection and Affordable Care Act (Affordable Care Act) enacted March 23, 2010, Pub. L. No. 111-148 as part of its sweeping health care reforms. The Affordable Care Act also added new Code § 4959, which imposes an excise tax for failures to meet certain of the new Code § 501(r) requirements, and added reporting requirements under Code § 6033(b) related to sections 501(r) and 4959.

The added requirements of Code § 501(r) generally will apply on a facility-by-facility basis to: (1) an organization that operates a facility required by a State to be licensed, registered, or similarly recognized as a hospital; and (2) any other organization that the Secretary determines has the provision of hospital care as its principal function or purpose constituting the basis for its exemption under section 501(c)(3).

The IRS today (May 27, 2010) released an advanced copy of a request for comments on the application of certain of these requirements scheduled for publication as Notice 2010-39 in IRB 2010-24 on June 14, 2010.

For Assistance With Health Industry Concerns

If your organization needs advice or assistance analyzing or responding to the requirements of Code § 501 or other provisions of the Affordable Care Act, responding to the request for commences, or with other health care matters, contact Cynthia Marcotte Stamer at (469) 767-8872 or via e-mail here.

Vice President of the North Texas Health Care Compliance Professionals Association, Exempt Organization Vice-Coordinator of the Southern States IRS TEGE Council, a Council Member of the ABA Joint Committee On Employee Benefits Council, Past Chair of the ABA Health Law Section Managed Care & Insurance Section, the former Board Compliance Chair of the National Kidney Foundation of North Texas and former Board President of the Richardson Development Center for Children (now Warren Center), Ms. Stamer has more than 22 years experience advising health industry clients about health care operations, regulatory and compliance, reimbursement, staffing, risk management, public policy and other matters. A popular lecturer and widely published author on health industry matters, Ms. Stamer advises hospitals and other health industry clients about responding to and using these and other quality measures and other related concerns. Ms. Stamer also publishes and speaks extensively on health and managed care industry quality, regulatory, reimbursement, and other operations, risk management and public policy concerns. Her insights on these and other related matters appear in the Health Care Compliance Association, Atlantic Information Service, Bureau of National Affairs, World At Work, The Wall Street Journal, Business Insurance, the Dallas Morning News, Modern Health Care, Managed Healthcare, Health Leaders, and a many other national and local publications. For additional information about Ms. Stamer, her experience, involvements, programs or publications, see here.

Other Recent Developments

If you found this information of interest, you also may be interested in reviewing some of the following recent Updates available online by clicking on the article title:

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Leave a Comment » | Corporate Compliance, Health Care, Health Care Reform, Nonprofits, Tax, Tax-Exemption, Uncategorized | Tagged: Affordable Care Act | Permalink
Posted by Cynthia Marcotte Stamer

OIG Touts Expanding Health Care Fraud Enforcement Success & Launches New Health Care Fraud Hotline

May 20, 2010

Continuing expansion of health care fraud enforcement initiatives, the Office of Inspector General (OIG) recently released its Health Care Fraud and Abuse Control Program Report and launched a new online Fraud Hotline Website to allow individuals the option of reporting federal health care fraud suspicions to OIG online.

The May 12 launch of the Fraud Hotline Website means whistleblowers now can report suspected federal health care fraud to OIG over the Internet, by telephone or by mail. CMS hopes the addition of online fraud reporting capability will lead to more investigations, audits and/or monetary recoveries.

OIG followed up May 13, by releasing its latest Health Care Fraud and Abuse Control Program Report, In addition to detailing 2009 healthcare fraud enforcement activities and accomplishments, the Report also highlights the continuing success of its HEAT initiative as well as new enforcement tools created by the recent health care reform legislation, the “Fraud Enforcement and Recovery Act of 2009”(FERA) and other recent developments that facilitate the ability of OIG and the Justice Department to prosecute and secure larger fines and penalties from healthcare providers engaging in health care fraud. For more information, read the OIG Press Release here.

The heightened emphasis by federal officials on enforcement of federal health care fraud laws and the implementation of tools like the new Fraud Hotline Website increase the likelihood both that whistleblowers will turn in health care providers and other individuals and organizations that file false claims in violation of the FCA and the liability that violators may incur for that misconduct. These and other activities are part of a significant ramp up in federal emphasis on the detection and prosecution of violations of federal health care fraud laws by both the Administration and Congress. Many state agencies also are stepping up their health care fraud investigations and enforcement. In light of this new emphasis upon health care fraud detection and enforcement, health care providers now more than ever need to prepare to demonstrate the appropriateness and defensibility of their health care billing and other compliance efforts.

The author of this update, attorney Cynthia Marcotte Stamer, has extensive experience advising and assisting health care practitioners and other businesses and business leaders to establish, administer, investigate and defend health care fraud and other compliance and internal control policies and practices to reduce risk under federal and state health care and other laws. You can get more information about her health industry experience here. If you need assistance with these or other compliance concerns, wish to inquire about arranging for compliance audit or training, or need legal representation on other matters please contact Ms. Stamer at (469) 767-8872 or via e-mail here.

Other Recent Developments

If you found this information of interest, you also may be interested in reviewing some of the following recent Updates available online by clicking on the article title:

For More Information

Leave a Comment » | Affordable Care Act, America's Healthy Futures Act, American's Affordable Health Choices Act, Anti-KickBack, ASC, Centers For Disease Control, Corporate Compliance, Durable Medical Equipment, Federal Sentencing Guidelines, Health Care, Health Care Finance, Health Care Fraud, Health Care Provider, Health Care Quality, Health Care Reform, HITECH Act, Hospital, Medicaid, Medical Licensure, Medical Malpractice, Medicare, Medicare Advantage, Medicare Prescription Drug Program, Money Laundering, OCR, OIG, Patient Protection and Affordable Care Act, Pharmacy, Physician, Prescription Drugs, Public Policy, Reimbursement, Rural Health Care, Stark, Substance Abuse, Telemarketing, Uncategorized, Veterans Health, Veterans Health Care | Tagged: Health Care Fraud, Health Care Provider, Medicaid, Medicare, OIG | Permalink
Posted by Cynthia Marcotte Stamer

HHS Invites Input on Proposed Strategic Framework on Multiple Chronic Conditions

May 19, 2010

June 18, 2010 is the deadline for interested persons to submit comments to the Office of Public Health and Science of the Department of Health & Human Services (HHS) on the draft “HHS Strategic Framework on Multiple Chronic Conditions” in response to the request for information published here in the May 19, 2010 Federal Register. Interested parties can review the draft strategic framework here.

Approximately 75 million Americans have multiple (2 or more) concurrent chronic conditions, including problems such as hypertension, heart disease, arthritis, diabetes, mental health conditions, and chronic respiratory infections. As these combined morbidities drive significant health costs, HHS through the Office of Public Health and Science (OPHS) and its HHS Interagency Workgroup on Multiple Chronic Conditions has drafted a “Strategic Framework on Multiple Chronic Conditions” to address approaches to improving the health of individuals with concurrent multiple chronic conditions by providing options for HHS to strengthen coordination of its efforts internally and collaboration with stakeholders externally. The strategic framework seeks to improve the foundation for realizing optimum health and quality of life for individuals with multiple chronic conditions. In the request for information published May 19, 2010, HHS is seeking comments from stakeholders and the public on the draft strategic framework.

If you need assistance to submit comments in response to the request for information or with any other health industry regulatory or operational matter, please contact Cynthia Marcotte Stamer at (469) 767-8872 or e-mail her here.

Other Recent Developments

If you found this information of interest, you also may be interested in information about upcoming programs to be presented by Ms. Stamer, acquiring a copy of a recording or materials from previous programs she has presented, or arranging training for your organization. For more information about these opportunities, contact Ms. Stamer directly.

If you found this information of interest, you also may be interested in reviewing some of the following recent Updates available online by clicking on the article title:

For More Information

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Posted by Cynthia Marcotte Stamer

New CBO Analysis Hikes Projected Affordable Health Care Act Cost by $115 Billion

May 15, 2010

New analysis released Tuesday, May 11 by the non-partisan Congressional Budget Office (CBO) shows H.R. 3590, the Patient Protection and Affordable Care Act, Public Law 111-148 (Health Care Reform Law) passed in March will cost $115 Billion more than originally estimated in the CBO’s March 15, 2010 discretionary spending analysis.

According to CBO, additional information about the potential effects of the Health Care Reform Law on spending funded through the annual appropriation process (discretionary spending). By their nature all such potential effects on discretionary spending are subject to future appropriation actions, which could result in greater or smaller costs than the sums authorized by the legislation. While still limited in certain respects, the updated CBO analysis provides information on the major components of such costs in three general categories:

The costs that will be incurred by federal agencies to implement the new policies established by the Health Care Reform Law, such as administrative expenses for the Department of Health and Human Services and the Internal Revenue Service for carrying out key requirements of the legislation.

Explicit authorizations for future appropriations for a variety of grant and other program spending for which the act identifies the specific funding levels it envisions for one or more years. (Such cases include provisions where a specified funding level is authorized for an initial year along with the authorization of such sums as may be necessary for continued funding in subsequent years.)
Explicit authorizations for future appropriations for a variety of grant and other program spending for which no specific funding levels are identified in the legislation. That type of provision generally includes legislative language that authorizes the appropriation of “such sums as may be necessary,” often for a particular period of time.

According to the updated analysis, CBO estimates that total authorized costs in the first two categories probably exceed $115 billion over the 2010-2019 period. CBO still does not have an estimate of the potential costs of authorizations in the third category.

CBO previously issued an estimate of the Health Care Reform Law’s direct spending and revenue effects in combination with the Reconciliation Act of 2010 (Public Law 111-152), which amended it. (Direct spending effects are those that do not require subsequent appropriation action.) CBO estimated that those two laws, in combination, would produce a net reduction in federal deficits of $143 billion over the 2010-2019 period as a result of changes in direct spending and revenues.

Ultimately, the cost and other implications of the Health Care Reform Law will depend largely upon how its provisions are construed and implemented by federal and state regulators, along with any subsequent adjustments, if any that Congress may elect to enact. With federal officials hard at work preparing implementing regulations and other guidance and procedures, health industry leaders and other concerned Americans should stay informed and continue to share their input on these critical issues as these decisions are shaped. Join the discussion by participating in the Coalition For Responsible Health Care Policy linked in group and/or its subgroup, Project COPE: Coalition for Patient Empowerment .

Other Recent Developments

If you found this information of interest, you also may be interested in reviewing some of the following recent Updates available online by clicking on the article title:

For More Information

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Posted by Cynthia Marcotte Stamer

Pennsylvania Nurses Vote For Union In NLRB Election Highlights Rising Union Organizing Activity In Health Care Industry

May 7, 2010

A May 5, 2010 vote by registered nurses to join SEIU Healthcare Pennsylvania in an NLRB-supervised election at an acute care hospital in Natrona Heights, Pennsylvania highlights the rising exposures many hospital and other health industry employers face to union organizing and other activities. The May 5 a ballot count at Alle-Kiski Medical Center found 213 nurses in favor of the union, with 61 opposed and two challenged ballots. Management at the hospital now will be required to bargain with the union on terms and conditions of employment for nurses in the bargaining union and follow other NLRB procedures for dealing with employees represented by unions.

The union certification by the Alle-Kiski Medical Center nurses is one of a growing series of unionization campaigns targeting health industry employers around the nation this year. In March, for example, NLRB Regional Director Alan B. Reichard ordered elections at 31 California hospitals to decide which of two rival unions would represent employees. The Monday, March 2, 2010 order by Regional Director Reichard set the stage for elections between the Service Employees International /United Healthcare Workers-West (SEIU-UHW) and the National Union of Healthcare Workers (NUHW), which are competing to represent thousands of health care workers throughout California. Under the order, some elections may be preceded by hearings to clarify the voting group; others will proceed by agreement of the parties regarding such issues as voting dates and times and voter eligibility.

Health industry workers increasingly are viewed as attractive targets for union organization around the country. Many of these organizing efforts are helped by a series of NLRB decisions that ease the way for union organization of certain physician and other health care provider groups.

Many health care organizations and other employers are concerned about the potential financial and operational costs that organization of their workforce might produce. Whether concerned about the potential for future organization activities, confronting a union certification election or dealing with union representation in their workplace, health industry and other employers concerned about union organizing or representational activities must act carefully.

Federal labor law requires that employers tread carefully when dealing with union or other organizational activity. Existing federal law limits the actions that employers can take to deter or influence worker choices about whether to support or oppose a union certification campaign, to influence the certification of one union representative over another.

Legislation supported by the Obama Administration and the Democratic Leadership in Congress such as the Employee Free Choice Act of 2009 (H.R.1409 /S 560) would further expand these protections. If adopted as proposed, this legislation would further facilitate union organizing efforts and give union representatives new tools to pressure employers for contractual concessions to union negotiations.

Health industry and other employers concerned with these issues generally should carefully monitor and respond to proposed legislation and consult with qualified labor and employment counsel before discussing or taking other action in response to these activities to minimize risks of unintentionally running afoul of these requirements and to position their efforts for maximum effectiveness.

For Assistance With Compliance Or Other Concerns

If your organization needs advice or assistance in responding to labor and employment issues in your health care organization or other health care matters, consider contacting the author of this article, Cynthia Marcotte Stamer at (469) 767-8872 or via e-mail here.

Board Certified in Labor & Employment Law by the Texas Board of Legal Specialization, Ms. Stamer is nationally known for her more work, training and presentations, and publications on health and managed care staffing and employment, compensation, regulatory, and other operations, risk management and compliance matters.

Other Recent Developments

If you found this information of interest, you also may be interested in reviewing some of the following recent Updates available online by clicking on the article title:

For More Information

We hope that this information is useful to you. If you need assistance with auditing or defending these or other health care compliance, risk management, transaction or operation concerns, please contact the author of this update, Cynthia Marcotte Stamer, at (469) 767-8872, cstamer@Solutionslawyer.net. Ms. Stamer has extensive experience advising health industry clients on labor and employment, medical staff and other compliance and operations issues. She writes and speaks extensively on these and other health industry and other internal controls and risk management matters.

If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information – including your preferred e-mail – by creating or updating your profile at here or e-mailing this information here. To unsubscribe, e-mail here.

Leave a Comment » | Employment, Health Care, Uncategorized | Tagged: Employment, Health Care Staffing, Labor, Union, Union Organizing | Permalink
Posted by Cynthia Marcotte Stamer

NTHCPA Hosts May 11 Compliance Program on “Diversity & Nondiscrimination In Patient Care”

May 5, 2010

Register here!

“Diversity & Nondiscrimination In Patient Care: Meeting Expanding Health Care Provider Obligations”

May 11, 2010

2:00 – 4:00 P.M.

Texas Health Resources Tower

Pavilion, Classroom B

(New Meeting Room Location)

612 E. Lamar Blvd., Arlington, TX

The North Texas Healthcare Compliance Professional Association (NTHCPA) invites members and other interested health industry compliance professionals to mark your calendar and plan to attend the next NTHCPA meeting scheduled on Tuesday, May 11, 2010 from 2:00 to 4:00 PM. The program will feature a presentation on “Diversity & Nondiscrimination In Patient Care: Meeting Expanding Health Care Provider Obligations” by Texas Health Resources Director of Diversity and Inclusion, Mina Kini and Silver Communications President Kerry Silver. Register here!

About The Program

Health care providers face expanding legal and operational demands to deal effectively with diversity and nondiscrimination in dealing with patients and others. Communication is essential to assess, diagnose, and treat patients. Today, U.S. healthcare providers struggle to meet the healthcare needs of an increasingly diverse patient population.

Beyond expanding legal exposures, culture, ethnicity, religion, and language, as well as many other characteristics, play important roles in the patient’s attitudes and beliefs about healthcare, as well as the patient’s willingness and ability to report symptoms, understand a diagnosis, make healthcare decisions, and comply with medical recommendations. To deliver safe and effective care, the culturally competent healthcare professional must be aware of and sensitive to the culture-specific needs of the patient and his/her family. And, above all, patients and providers must be able to communicate clearly and effectively.

In this presentation, Mina Kini and Kerry Silver will discuss the strategies and resources used by Texas Health Resources to increase cultural competence and comply with legal requirements of Title 6 of the Civil Rights Act of 1964 and well as the Americans with Disabilities Act.

Mina Kini, as the Director of Texas Health Resources, leads the area of Diversity and Inclusion focused on building workforce diversity as well as providing culturally appropriate care to our multicultural and multilingual communities at all Texas Health Hospitals. Mina as a change agent has experience in non-profit organizations in various roles in education, community building and social science research. With 20 years of professional experience in international and US settings, Mina has Masters degrees in Social Work and in Human Resource Development.

About The Presenters

Kerry Silver is President of Silver Communications and communications consultant to Texas Health Resources. Kerry has more than 20 years of experience in helping large organizations communicate with their employees. She has significant experience in working with healthcare organizations. In 1994, Kerry was certified as a diversity trainer by the American Institute for Managing Diversity. She earned a Bachelor of Arts degree in marketing from the University of Texas at Austin.

About the NTHCPA

NTHCPA exists to champion ethical practice and compliance standards and to provide the necessary resources for ethics and compliance Professionals and others in North Texas who share these principles. The vision of NTHCPA is to be a pre-eminent compliance and ethics group promoting lasting success and integrity of organizations within North Texas. NTHCPA meetings are open to all NTHCPA members and other interested health care compliance professionals. Participation in the meeting is complimentary. Participants are responsible for any parking charges incurred. To register for a meeting or update your registration to receive notice of future meetings, e-mail your current contact information including e-mail here.

If you need more information, would like to host an upcoming meeting, wish to suggest topics or speakers, or wish to obtain or share other information, please contact NTHCPA President Erma Lee at (817) 927-1232 or by e-mail here or Vice-President Cynthia Marcotte Stamer at (469) 767-8872 or by e-mail here.

This communication may be considered a marketing communication for certain purposes. If you wish to update your e-mail for purposes of or would prefer not to receive future e-mail concerning meetings or other activities of the North Texas Healthcare Compliance Professionals Association or other marketing and promotional mailings from it, please send an email with the word “unsubscribe” in its subject heading to here.

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Posted by Cynthia Marcotte Stamer

WellPoint To Ban Coverage Rescissions Before Affordable Care Act Fall 2010 Deadline

April 28, 2010

WellPoint, Inc. will suspend the practice of rescinding patients’ coverage May 1, 2010, months in advance of this Fall’s deadline for insurers stop this practice established by the Affordable Care Act. The nation’s largest health insurer announced here its plans to implement the change in its practices regarding individual market rescissions on April 27, 2010.

Beginning this Fall, the Affordable Care Act will prohibit insurance companies from rescinding policies, except in cases of fraud or intentional misrepresentation of material fact. Wellpoint’s termination of individual policy rescissions announced this week comes months ahead of the effective deadline for terminating rescissions contained in the legislation. The ban against rescissions is one of a number of new federal restrictions on health insurers and group health plans enacted as part of the Affordable Care Act scheduled to take effect this Fall. Wellpoint previously announced it also would change its dependent coverage policies to extend the period that a dependent child can remain on his parent’s coverage to age 26 before the deadline required by the Affordable Care Act.

WellPoint’s announcement comes after Health & Human Services Secretary Kathleen Sebelius sent a letter on April 22 urging the company to immediately stop the practice of rescinding coverage for patients who become ill. Wellpoint recently drew criticism from Secretary Sebelius and others for targeting breast cancer victims for rescission of their policies. Secretary Sebelius’ initial letter to WellPoint can be found here or at here.

For Assistance With Health Industry Concerns

If your organization needs advice or assistance with the proposed regulation, preparing or submitting comments on the regulation or with other health care matters, contact Cynthia Marcotte Stamer at (469) 767-8872 or via e-mail here.

Other Recent Developments & Resources

If you found this information of interest, you also may be interested in reviewing some of the following recent Updates available online by clicking on the article title:

For More Information

We hope that this information is useful to you. If you need assistance with auditing or defending these or other health care compliance, risk management, transaction or operation concerns, please contact Cynthia Marcotte Stamer, at (469) 767-8872 or to cstamer@solutionslawyer.net. Ms. Stamer has extensive experience advising clients and writes and speaks extensively on these and other health industry and other internal controls and risk management matters.

Leave a Comment » | Health Care, Health Care Finance, Health Care Reform, Health Plan, Health Plans, Patient Protection and Affordable Care Act, Public Policy, Uncategorized | Tagged: Affordable Care Act, Health Care, Health Insurance, Health Plans, Patient Protection and Affordable Care Act | Permalink
Posted by Cynthia Marcotte Stamer

CMS Proposes FY 2011 Acute Care & Long-Term Care Inpatient Policy & Payment Rate Changes

April 20, 2010

June 18, 2010 is the deadline for health care providers and other concerned parties to comment on proposed Medicare inpatient acute care and long-term are hospital stay policy and payment rate changes announced by the Centers for Medicare & Medicaid Services (CMS) on Monday, April 19 2010. CMS intends to publish a final rule by August 1, 2010.

CMS issued the proposed fiscal year (FY) 2011 policies and payment rates for inpatient services furnished to people with Medicare by both acute care hospitals and long-term care hospitals on Monday. The proposed rule does not address inpatient hospital related provisions of the recently enacted Patient Protection and Affordable Care Act, as amended by the Health Care and Education Affordability Reconciliation Act (collectively the “Affordable Care Act”).

In the proposed Medicare payment rates announced April 19, CMS proposes update acute care hospital rates by a slight 2.4 percent for inflation and to apply an adjustment of -2.9 percentage points to recoup one-half of the estimated excess spending in FY 2008 and 2009 aggregate payments, due to changes in hospital coding practices that CMS says did not reflect increases in patients severity of illness. Legislation passed in 2007 requires CMS to recoup the entire amount of FY 2008 and 2009 excess spending from changes in hospital coding practices by FY 2012. CMS estimates that payments to general acute care hospitals under the proposed rule for operating expenses in FY 2011 will decline by 0.1 percent, or $142 million, compared with FY 2010, and taking into account all factors that would affect spending.

CMS concurrently is similarly proposing to update long-term care hospital (LTCH) rates by 2.4 percent for inflation and apply an adjustment of -2.5 percentage points for the estimated increase in spending in FYs 2008 and 2009 due to documentation and coding that did not reflect increases in patients’ severity of illness. Based on these two proposed provisions and other proposed changes, CMS estimates that payments to LTCHs would increase by 0.8 percent or $41 million.

Interested parties may review the proposed regulation here. More information about the proposed rule, including the documentation and coding adjustment and the RHQDAPU changes and HACs discussion, can be found in Fact Sheets on the CMS Website here. CMS warns that the projected inflation updates for both types of hospitals may be revised in the final rule based on more recent data.

The proposed rule would apply to approximately 3,500 acute care hospitals paid under the Inpatient Prospective Payment System (IPPS), and approximately 420 long-term care hospitals paid under the Long-Term Care Hospital Prospective Payment System (LTCH PPS), beginning with discharges occurring on or after October 1, 2010. Proposed payment rates are based on the most recently available data and may be revised in the final rule to reflect more current data.

Under current law, hospitals that successfully report quality measures included in the Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU) program will receive the full update for 2011. Hospitals that do not participate in the quality reporting program will get the update less two percentage points. Based on the required reporting in 2009, 96 percent of participating hospitals are receiving the full update this year.

CMS is proposing to add 45 measures to the RHQDAPU set for reporting in 2011. However, only 10 of the proposed measures, including rates of occurrence for eight of 10 categories of conditions that are subject to the hospital-acquired conditions (HACs) policy, will be considered in determining a hospital’s FY 2012 update. The remaining 35 measures would be considered in determining the hospital’s FY 2013 update, and hospitals would not be required to report all of the proposed registry-based measures. The proposed use of registries would prevent hospitals from having to report the same data twice. In addition, CMS is proposing to retire one existing measure for reporting mortality for selected surgical procedures.

For Assistance With Health Industry Concerns

If your organization needs advice or help with the proposed regulation, preparing or submitting comments on the regulation or with other health care matters, contact Cynthia Marcotte Stamer at (469) 767-8872 or via e-mail here.

Vice President of the North Texas Health Care Compliance Professionals Association, Exempt Organization Vice-Coordinator of the Southern States IRS TEGE Council, Chair of the American Bar Association (ABA) Real Property, Probate & Trust Section Employee Benefits & Other Compensation Arrangements Group, a Council Member of the ABA Joint Committee On Employee Benefits Council, Past Chair of the ABA Health Law Section Managed Care & Insurance Section and the former Board Compliance Chair of the National Kidney Foundation of North Texas, Ms. Stamer has more than 22 years experience advising health industry clients about these and other matters. A popular lecturer and widely published author on health industry matters, Ms. Stamer advises hospitals and other health industry clients about responding to and using these and other quality measures and other related concerns. Ms. Stamer also publishes and speaks extensively on health and managed care industry quality, regulatory, reimbursement, and other operations, risk management and public policy concerns. Her insights on these and other related matters appear in the Health Care Compliance Association, Atlantic Information Service, Bureau of National Affairs, World At Work, The Wall Street Journal, Business Insurance, the Dallas Morning News, Modern Health Care, Managed Healthcare, Health Leaders, and a many other national and local publications. For additional information about Ms. Stamer, her experience, involvements, programs or publications, see here.

Other Recent Developments & Resources

If you found this information of interest, you also may be interested in reviewing some of the following recent Updates available online by clicking on the article title:

For More Information

We hope that this information is useful to you. If you need assistance with auditing or defending these or other health care compliance, risk management, transaction or operation concerns, please contact Cynthia Marcotte Stamer, at (469) 767-8872 or to cstamer@solutionslawyer.net.. Ms. Stamer has extensive experience advising clients and writes and speaks extensively on these and other health industry and other internal controls and risk management matters.

Leave a Comment » | Health Care, Health Care Reform, Reimbursement | Tagged: Health Care, Health Care Policy, Health Care Provider, health care quality, Health Care Reform, Health Care Reimbursement, HHS, Hospital, Long Term Care Hospital, Medicare, Reimbursement | Permalink
Posted by Cynthia Marcotte Stamer

Agencies Seek Public Input On New Insurer Premium Revenue Reporting Obligations Added By Patient Protection and Affordable Care Act

April 15, 2010

By Cynthia Marcotte Stamer

The Departments of Treasury (IRS), Labor (DOL) and Health & Human Services (HHS) are inviting public comments on impending new federal requirements that will compel health insurance issuers offering individual or group medical coverage to send annual reports to HHS on the percentages of premiums that the coverage spends on reimbursement for clinical services and activities that improve health care quality, and to provide rebates to enrollees if this spending does not meet minimum standards for a given plan year added as Section 2718 of the Public Health Service Act (PHS Act), by the Patient Protection and Affordable Care Act (PPACA), Public Law 111-148, enacted on March 23, 2010.

Among other things, Section 2718 of the PHS Act, Section 715 of the Employee Retirement Income Security Act of 1974 (ERISA) and Section 9815 of the Internal Revenue Code of 1986 (the Code) will require health insurance issuers offering group or individual coverage to report to HHS annually:

The ratio of the incurred loss (or incurred claims) plus the loss adjustment expense (or change in contract reserves) to earned premiums (also known as the medical loss ratio (MLR)); and
The percentage of total premium revenue–after accounting for collections or receipts for risk adjustment and risk corridors and payments of reinsurance–that the coverage spends: (1) on reimbursement for clinical services provided to enrollees; (2) for activities that improve health care quality; and (3) on all other non-claims costs, including an explanation of the nature of these costs, and excluding Federal and State taxes and licensing or regulatory fees.

PPACA also requires that HHS make these reports available to the public on the Internet Web site of HHS. To review the request for comments and its instructions for commenting on the new requirements, see here.

For Assistance With This Opportunity Or Other Health Industry Concerns

If your organization needs advice or help with commenting on the request for comments or to evaluate or respond to other health care reform regulations or other health care matters, contact Cynthia Marcotte Stamer at (469) 767-8872 or via e-mail here.

Other Recent Developments & Resources

If you found this information of interest, you also may be interested in reviewing some of the following recent Updates available online by clicking on the article title:

For More Information

We hope that this information is useful to you. If you need assistance with auditing or defending these or other health care compliance, risk management, transaction or operation concerns, please contact Cynthia Marcotte Stamer, at (469) 767-8872 or to cstamer@solutionslawyer.net.. Ms. Stamer has extensive experience advising clients and writes and speaks extensively on these and other health industry and other internal controls and risk management matters.

Leave a Comment » | Health Care, Health Care Finance, Health Care Quality, Health Care Reform, Health Insurance Exchange, Health Plan, Health Plans, Medicare Advantage | Tagged: Health Care, Health Care Reform, Health Plans, Patient Protection and Affordable Care Act, PPACA | Permalink
Posted by Cynthia Marcotte Stamer

DEA/DOJ Release Interim Final E-Prescribing Rules

March 25, 2010

Health care providers wishing to electronically prescribe controlled substance should begin reviewing and updating their practices and technology to comply with requirements of the Interim Final Regulations scheduled for publication in the Federal Register on March 31, 2010. Read details at http://wp.me/ptOGJ-94

An advance copy of the new Interim Final Regulation with Request for Comments released March 24, 2010 by the Drug Enforcement Administration (DEA) and Department of Justice on Electronic Prescribing of Controlled Substance on is posted for review here.

Concurrent with publication of the Interim Final Rule, the DEA is inviting comment on DEA is seeking additional comments on the following issues: identity proofing, access control, authentication, biometric subsystems and testing of those subsystems, internal audit trails for electronic prescription applications, and third-party auditors and certification organizations.

About The Author

If you need assistance with health industry human resources or other management, concerns, wish to inquire about compliance, risk management or training, or need legal representation on other matters please contact Cynthia Marcotte Stamer at cstamer@solutionslawyer.net or (469) 767-8872.

Nationally and internationally recognized for more than 22 years of work with health industry technology, privacy and data security, regulatory compliance, reimbursement, workforce and staffing, licensure and accreditation, and other quality, risk management, operations and public policy matters organizations, publications, workshops and presentations and leadership Cynthia Marcotte Stamer has worked extensively with physicians, health systems, specialty and other pharmacy, telemedicine and other health technology, and other health industry clients on a diverse range of operational, product and process development, regulatory, licensure, public policy and risk management protections relating to e-prescribing, telemedicine, interoperable and other electronic health and medicine arrangements and other health care internal controls, process and privacy and technology matters. The publisher of the Solutions Law Press Health Care Update, and Solutions Law Press Health Care Privacy & Technology Update, Ms. Stamer also is a popular speaker and author of these and other health industry topics. She regularly publishes, speaks and conducts training for health industry and other organizations, the ABA, American Health Lawyers Association (AHLA), Health Care Compliance Association, Institute of Internal Auditors, various medical society and other professional organizations, the Medical Group Management Association, and many other organizations. Her many publications and programs include“Changing Regulations Will Ease Way for E-Prescribing, But Physicians Shouldn’t Jump the Gun,” “Telemedicine, E-Prescribing & Electronic Health Records: Opportunities & Exposures,” “Telemedicine & E-Prescribing: Evolving Ethical, Licensing & Reimbursement Rules & Realities,” the “Tort & Other Liability” Chapter of the ABA Health Law Section/BNA E-Health & Technology Treatise, “Protecting & Using Patient Data in Disease Management Opportunities, Liabilities and Prescriptions,” Chapter 1: Privacy.” The Quest for Interoperable Electronic Health Records: A Guide to Legal Issues in Establishing Health Information Networks (AHLA 2005) (Contributing Author), “Cybercrime and Identity Theft: Health Information Security beyond HIPAA,” “Privacy & Securities Standards-A Brief Nutshell” and numerous other programs and publications on telemedicine and e-prescribing, HIPAA and other privacy and data security, and other related internal controls and operational matters. Publishers of her many highly regarded writings on health industry and human resources matters include the Bureau of National Affairs, Aspen Publishers, ABA, AHLA, Spencer Publications, World At Work, SHRM, Business Insurance, James Publishing and many others. You can review other highlights of Ms. Stamer’s health care experience here, and employment experience here. Her insights on these and other matters appear in Managed Care Executive, Modern Health Care, the Wall Street Journal, the Dallas Business Journal, the Houston Business Journal, MDNews, Kentucky Physician, and many other national and local publications.

Other Resources

If you found this information of interest, you also may be interested in reviewing other updates and publications by Ms. Stamer including:

For More Information

We hope that this information is useful to you. If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information – including your preferred e-mail – by creating or updating your profile at here or e-mailing this information here. To unsubscribe, e-mail here.

Leave a Comment » | Centers For Disease Control, Controlled Substances, Corporate Compliance, DEA, Doctor, E-Prescribing, Electronic Health Records, Electronic Medical Records, false claims act, FDA, Federal Sentencing Guidelines, Health Care, Health Care Finance, Health Care Fraud, Health Care Provider, Health Care Quality, Health Care Reform, Health IT, HIPAA, HITECH Act, Hospital, Licensing, Meaningful Use, Medicaid, Medical Licensure, Medicare, Medicare Advantage, Medicare Prescription Drug Program, Pharmacy, Physician, Physician Licensing, Prescription Drugs, Privacy, Reimbursement, Telemedicine | Tagged: Controlled Substances, DEA, E-Prescribing, Health IT, Health Technology, HIPAA, HITECH Act, Meaningful Use, Telemedicine | Permalink
Posted by Cynthia Marcotte Stamer

Joint Commission Revises Medical Staff Bylaw Standard

March 25, 2010

On Monday, March 15, 2010, the Joint Commission announced revisions to Medical Staff Standard MS.01.01.01 relating to medical staff governance and accountability to the governing body for patient care quality and safety. Hospitals and their medical staff have until March 31, 2010 to comply with the revised standard. The revised standard is available for review here.

Standard MS.01.01.01 addresses the medical staff’s self-governance and its accountability to the governing body for the quality and safety of patient care. Intended by the Joint Commission to promote patient safety and quality of care through the support of a well-functioning, positive relationship between a hospital’s medical staff and governing body, the Standard recognizes that a hospital’s governing body is ultimately responsible for the quality and safety of care, but that collaboration among a hospital’s governing body, medical staff and administration.

Focusing on the key role that the definition of the medical staff’s organizational responsibilities and how the medical staff and governing body will work together in the medical staff bylaws, that Standard MS.01.01.01 outlines a detailed framework for constructing, writing and implementing bylaws that the Joint Commission believes best supports appropriate collaboration between the medical staff, the governing body and the administration to promote the safety and quality of care. These Standard address the allocation of responsibilities between the medical staff and the governing body for the development and adoption of medical staff bylaws, processes to be utilized to develop and implement bylaws and a detailed list of elements that medical staff bylaws are required to address to meet the Standard.

The new Medical Staff standard is only one of an expanding series of Joint Commission Standards focusing on medical staff regulation and performance to help promote quality that facilities and their medical staff must address to maintain accreditation. In addition to the revised Medical Staff Standard, for instance, health care facilities and their medical staffs also generally are working to address the Joint Commission’s Standards to Ongoing Professional Practice Evaluation, credentialing, peer review and disruptive conduct standards.

About The Author

Nationally and internationally recognized for more than 22 years of work with health industry and other organizations, publications, workshops and presentations and leadership Cynthia Marcotte Stamer has worked extensively with medical staffs, hospitals and other health care facilities, physician organizations and others on these and other medical staff bylaws and management, physician and other health industry staffing and credentialing, performance management and discipline, peer review; regulatory compliance and internal controls; risk management; quality assurance; operations; tax; reimbursement; public policy and other matters. The publisher of the Solutions Law Press Health Care Update, and Solutions Law Press Health Care Privacy & Technology Update and a former legal columnist for MD News, and Board Certified in Labor and Employment Law, Ms. Stamer also is a popular speaker and author of these and other health industry topics. She regularly speaks and conducts training for the ABA, American Health Lawyers Association (AHLA), Health Care Compliance Association, Institute of Internal Auditors, Harris County Medical Society, the Medical Group Management Association, SHRM, Southwest Benefits Association and many other organizations. Her many publications and programs regularly include “Monitoring & Managing Physician Performance, Standards For Ongoing Professional Practice Evaluation and Beyond,” “Sex, Drugs & Rock ‘n Role in Medicine,” “Medical Staff Bylaws That Help Medical Staff’s Work,” “Payment or Not For Never Events” “Physician Survival Training,” and a host of other continuing medical education and other health industry compliance, operations and risk management topics. Publishers of her many highly regarded writings on health industry and human resources matters include the Bureau of National Affairs, Aspen Publishers, ABA, AHLA, Spencer Publications, World At Work, SHRM, Business Insurance, James Publishing and many others. You can review other highlights of Ms. Stamer’s health care experience here, and employment experience here. Her insights on these and other matters appear in Managed Care Executive, Modern Health Care, the Wall Street Journal, the Dallas Business Journal, the Houston Business Journal, MDNews, Kentucky Physician, and many other national and local publications.

Other Resources

If you found this information of interest, you also may be interested in reviewing other updates and publications by Ms. Stamer including:

For More Information

Leave a Comment » | Employer, Health Care, Health Care Qulity, Peer Review, Physician | Tagged: Credentialing, Joint Commission, Medical Staff Bylaws, Peer Review | Permalink
Posted by Cynthia Marcotte Stamer

TSHHRAE Provides Health Industry Managers Employment Law Update & Other Timely Management Training At April Barnstorm 2010: Creating Effective Leaders Programs

March 23, 2010

Get Details & Registration Information here!

A Legal Update on Employment Law presentation by Attorney Cynthia Marcotte Stamer is among 5 hours of “Barnstorm 2010: Creating an Effective Leaders-Tools of the Trade” management training that the Texas Society for Healthcare Human Resources Administration and Education (TSHHRAE) will be hosting for health industry human resources and other managers in five Texas cities between April 26 and April 30, 2010.

Interested health industry human resources and other managers can elect to participate in TSHHRAE’s Barnstorm 2010 management training at the following dates and locations:

April 26 – Weslaco, Knapp Medical Center
April 28 – Sweetwater, Rolling Plains Memorial Hospital
April 28 – Brenham, Trinity Medical Center
April 29 – Lubbock, University Medical Center
April 30 – Odessa, Medical Center Hospital

Update on Employment Law Program Highlights

Ms. Stamer’s Legal Update on Employment Law Program will address:

Recent changes in FMLA, Military Leave, wage and hour, ADA & other disability, COBRA, GINA, HIPAA and other selected federal & Texas employment laws and regulations;
Rising government enforcement of EEOC, HIPAA, wage & hour, worker classification, and other laws and regulations;
Recent developments and increases in retaliation claims;
Recent cases related to supervision; and
Other selected developments impacting health industry human resources management.

Other Barnstorm 2010 Program Highlights and Details

In addition to the Legal Update on Employment Law that Ms. Stamer is scheduled to present, the Barnstorm Program also will feature presentations on:

Leadership in 2010
Dealing with Poor Performers; and
Cultivating a Superstar

For registration and other information about the Barnstorm Program, see here.

About Ms. Stamer

Nationally and internationally recognized for more than 22 years of work with health industry and other organizations, publications, workshops and presentations and leadership on health industry and other labor and employment, staffing and credentialing, employee benefits, performance management and discipline, regulatory compliance and internal controls, risk management, and public policy matters, Ms. Stamer is Chair of the Curran Tomko Tarski Labor & Employment & Health Care Practice Groups, Vice President of the North Texas Health Care Compliance Professionals Association, Government Affairs Committee Legislative Chair for the Dallas Human Resources Management Association, Chair of the American Bar Association (ABA) RPTE Employee Benefits & Other Compensation Committee, a Council Representative on the ABA Joint Committee on Employee Benefits and past Chair of the ABA Health Law Section Managed Care & Insurance Interest Group, Ms. Stamer is. The publisher of Solutions Law Press HR & Benefits Update, the Solutions Law Press Health Care Update, and Solutions Law Press Health Care Privacy & Technology Update and a former legal columnist for MD News, Ms. Stamer also is a popular speaker and author of these topics. She regularly speaks and conducts training for the ABA, American Health Lawyers Association (AHLA), Health Care Compliance Association, Institute of Internal Auditors, Harris County Medical Society, the Medical Group Management Association, SHRM, Southwest Benefits Association and many other organizations. Publishers of her many highly regarded writings on health industry and human resources matters include the Bureau of National Affairs, Aspen Publishers, ABA, AHLA, Spencer Publications, World At Work, SHRM, Business Insurance, James Publishing and many others. You can review other highlights of Ms. Stamer’s health care experience here, and employment experience here. Her insights on these and other matters appear in Managed Care Executive, Modern Health Care, the Wall Street Journal, the Dallas Business Journal, the Houston Business Journal, MDNews, Kentucky Physician, and many other national and local publications.

Other Resources

If you found this information of interest, you also may be interested in reviewing other updates and publications by Ms. Stamer including:

For More Information

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Posted by Cynthia Marcotte Stamer

House Could Vote On Health Care Reform As Early As Sunday

March 19, 2010

By Cynthia Marcotte Stamer

The stage now appears to be set for the House of Representatives to vote as early as Sunday on the latest version of health care reform backed by President Obama, Speaker Nancy Pelosi and other key Congressional Democrats, the Reconciliation Act of 2010 (H.R. 4872). The impending deadline means that health industry providers and other Americans concerned about the potential outcome of the impending vote need to act quickly if they wish to attempt to influence the decision. For tips about sharing your input with Congress effectively, see Getting Your Health Care Reform Message Heard By Key Congressional Leaders.

Developments Today Start Clock Running For Vote

On Thursday, March 18, 2010, two key developments set the stage for a vote on H.R. 4871 as early as Sunday:

The House Rules Committee posted the text of H.R. 4872 on its website; and
The Congressional Budget Office (CBO) delivered its scoring of H.R 4872 to House Speaker Nancy Pelosi.

The delivery of CBO scoring started the clock running on the 72 hour mandatory period between the release of the CBO scoring and any final vote on the bill. This means the House could vote on H.R. 4872 as early as Sunday, March 21.

If passed by the House, H.R. 4872 would make sweeping changes to the U.S. health care system impacting virtually every American patient, health care provider, employer and taxpayer. To learn the facts about these proposed changes, read the full text of H.R. 4872 here.

According to the CBO, H.R. 4872 will cost $940 billion over 10 years to extend coverage to 32 million uninsured people. To learn more specifics about these cost and other determinations, review the CBO scoring here.

This Is Only The Beginning: Stay Involved

The outcome of this latest health care reform push is only a small part of a continuing process. Whether or not the President’s proposal or some other version of health care reform passes this week, Congress already has and will continue to consider other legislation impacting health care reform. This reality is demonstrated by Congressional actions recently taken on the COBRA premium subsidy extension, Medical reimbursement for physicians, continuing federal efforts to develop and implement federal health care quality and technology standards, and other legislative, regulatory and enforcement actions taken while public attention has been focused largely only on the broader health care reform debate.

Upcoming mid-term elections will significantly impact the nature and scope of these upcoming efforts. Perhaps even more significantly, the enactment of legislation is only a beginning point. The real meaning of these or other health care reforms will be determined largely by the shaping and implementation of regulations and enforcement actions which generally are conducted outside the public eye. Monitoring and staying active in these ongoing processes provides a critical opportunity to continue to monitor your issues and provide input to shape how they are addressed.

Individuals concerned about these and other health care reform proposals and concerns are invited to stay involved in the discussion by sharing their input with Congress, regulators. Concerned individuals also are invited to stay involved in the discussion by joining the Coalition for Responsible Health Care Reform Group on Linkedin and registering to receive these updates here. The author of this article, Curran Tomko and Tarski LLP Health Care Practice Chair Cynthia Marcotte Stamer has extensive experience advising and assisting health industry clients and others about a diverse range of health care policy, regulatory, compliance, risk management and operational concerns. You can get more information about her health industry experience here.

Help Monitoring & Responding To Developments

If you need assistance evaluating or formulating comments on the proposed reforms contained in the House Bill or on other health industry matters please contact Cynthia Marcotte Stamer, CTT Health Care Practice Group Chair, at cstamer@cttlegal.com or 214.270.2402.

From her extensive involvement with federal and state legislative and regulatory licensing, telemedicine, managed care, privacy and other health, pension and other reforms in the U.S. to her involvement as a lead advisor to the Government of Bolivia on its pension privatization legislation, Ms. Stamer’s experience includes significant experience working with clients domestically on key health care and other public policy matters. Vice President of the North Texas Health Care Compliance Professionals Association, Past Chair of the ABA Health Law Section Managed Care & Insurance Section and the former Chairman of the Board of Richardson Development Center for Children and past Board Compliance Chair of the National Kidney Foundation of North Texas, Ms. Stamer couples her policy experience with her extensive experience working with health industry clients on regulatory, staffing, reimbursement, risk management and compliance and other operational matters. She has more than 22 years experience advising health industry clients about these and other matters. A popular lecturer and widely published author on health industry matters, Ms. Stamer advises hospitals and other health industry clients about responding to and using these and other quality measures and other related concerns. Ms. Stamer also publishes and speaks extensively on health and managed care industry quality, regulatory, reimbursement, and other operations, risk management and public policy concerns. Her insights on these and other related matters appear in the Health Care Compliance Association, Atlantic Information Service, Bureau of National Affairs, World At Work, The Wall Street Journal, Business Insurance, the Dallas Morning News, Modern Health Care, Managed Healthcare, Health Leaders, and a many other national and local publications. For additional information about Ms. Stamer, her experience, involvements, programs or publications, see here.

Other Recent Developments & Resources

If you found this information of interest, you also may be interested in reviewing some of the following recent Updates available online by clicking on the article title:

For More Information

We hope that this information is useful to you. If you need assistance with auditing or defending these or other health care compliance, risk management, transaction or operation concerns, please contact the author of this update, Curran Tomko Tarski LLP Health Practice Group Chair, Cynthia Marcotte Stamer, at (214) 270‑2402, cstamer@cttlegal.com, Edwin J. Tomko at (214) 270-1405 or another Curran Tomko Tarski LLP Partner of your choice. Ms. Stamer has extensive experience advising clients and writes and speaks extensively on these and other health industry and other internal controls and risk management matters.

Leave a Comment » | Anti-KickBack, ASC, Childrens Health Insurance Program, Consumer Driven Health Care, Durable Medical Equipment, Electronic Health Records, Employment, Evidence Based Medicine, Health Care, Health Care Finance, Health Care Fraud, Health Care Provider, Health Care Quality, Health Care Reform, Health Insurance Exchange, Health IT, Health Plan, Health Plans, Hospital, Indian Health, Medical Malpractice, Medicare, Physician, Prescription Drugs, Public Policy, Reimbursement, Stark, Tax, Veterans Health, Veterans Health Care | Tagged: H.R. 4872, Health Care Fraud, Health Care Provider, Health Care Reform, Health insurer, Health IT, Health Plans, Payer, Physician, Provider, Reconciliation Act of 2010 | Permalink
Posted by Cynthia Marcotte Stamer

Medicare Ends Fox Insurance Company Drug Plan Contract As CMS Turns Up Heat on Medicare Advantage & Part D Plan Enforcement & Oversight

March 16, 2010

By Cynthia Marcotte Stamer

The Centers for Medicare & Medicaid Services (CMS) terminated its Medicare Part D prescription drug coverage contract with Fox Insurance Company (Fox) on March 9, 2010. The action highlights CMS’s growing scrutiny and enforcement of Medicare requirements against Medicare Part D, Medicare Advantage Plans and other federal health care program contractors.

CMS terminated the Fox contract after CMS found the failure by Fox’s plan and services to meet Medicare’s requirements to provide enrollees with prescription drugs according to recognized standards of care jeopardized the health and safety of Fox enrollees. When announcing the contract termination, CMS reported that an on-sight review by CMS showed that Fox committed a series of violations, including improperly denying its enrollees coverage of critical HIV, cancer, and seizure medications. CMS issued an enrollment and marketing sanction to Fox on Feb. 26, 2010, because the organization was not following Medicare’s rules for providing prescription drug coverage to its enrollees. According to CMS, an onsite audit conducted between March 2 and March 4 showed that Fox’s problems persisted and that Fox continued to subject its enrollees to obstacles in getting sustaining medicines or other needed medications. Among other things, CMS found Fox:

Failed to provide access to Medicare prescription drugs benefits by imposing unapproved prior authorization and step therapy criteria that made it more difficult for beneficiaries to get drugs that are protected by law;
Failed to meet the plan’s appeals deadlines; and
Did not comply with Medicare regulations requiring enrollees to be transitioned to new drugs at the beginning of the new plan year.
Failed to notify enrollees about prior authorization and step therapy determinations as required by Medicare.

CMS also found that many of the obstacles were in place to limit access to high-cost drugs, which could have led to enrollees’ clinical needs not being met.

In many cases, CMS reported that Fox required enrollees to have unnecessary and invasive medical procedures before they were able to obtain drugs. Finding that Fox was unable to satisfactorily address these compliance concerns and furnish medicines to its Medicare enrollees, CMS immediately terminated the Fox contract.

At the time of the termination, more than 123,000 Medicare beneficiaries were enrolled in Fox plans. Beginning March 10, 2010, CMS indicated that LI-NET, a Medicare run program administered by Humana, would replace the Medicare Part D coverage of enrollees affected by the Fox contract termination on an interim basis. Fox enrollees will be able to choose a new Medicare prescription drug plan through May 1, 2010. Current enrollees who do not choose a plan will be enrolled into a new plan by Medicare. CMS is sending letters explaining the actions taken by CMS to enrollees and has established a 1-800 number to receive questions.

The action against Fox is part of an ongoing series of oversight, disciplinary and enforcement actions by CMS against Medicare Advantage and other federal health care program participants. These programs and CMS’ oversight and enforcement of federal programs are drawing increasing Congressional scrutiny in connection with Congressional health care reform efforts. Amid this heightened scrutiny, Medicare Part D and Medicare Advantage Plans; health care providers, administrative services providers and others contracting with these plans and others involved with this programs should take appropriate action to maintain compliance, tighten their contracts with and oversight of actions of partners and vendors performing critical functions; review complaint reporting, investigation and response processes and procedures; and strengthen other practices to minimize exposures to audit or other enforcement actions.

For Assistance With Medicare Managed Care or Other Matters

If your organization needs advice or assistance about Medicare Part D or other Medicare Advantage contracting or other requirements or about other health plan or health care matters, consider contacting the author of this article, Curran Tomko Tarski LLP Partner Cynthia Marcotte Stamer at (214) 270-2402 or via e-mail here.

Past Chair of the ABA Health Law Section Managed Care & Insurance Section, Chair of the American Bar Association RPTE Employee Benefits & Compensation Committee and an ABA Joint Committee on Employee Benefits Council member, Ms. Stamer has more than 22 years experience advising health plans, health care providers, and other health industry and insurance clients. Her experience includes specific experience assisting Medicare, Medicaid and other health plan sponsors, administrators, or administrative services providers about contracting, compliance, coverage and other matters. A popular lecturer and widely published author on health industry matters, Ms. Stamer also conducts compliance and other training on Medicare Advantage and other contract and compliance matters, as well as a broad range of other health industry related concerns. Ms. Stamer also publishes and speaks extensively on health and managed care industry quality, regulatory, reimbursement, and other operations, risk management and public policy concerns. Her insights on health industry matters appear in the Health Care Compliance Association, Atlantic Information Service, Bureau of National Affairs, World At Work, The Wall Street Journal, Business Insurance, the Dallas Morning News, Modern Health Care, Managed Healthcare, Health Leaders, and a many other national and local publications. For additional information about Ms. Stamer, her experience, involvements, programs or publications, see here.

Other Recent Developments & Resources

If you found this information of interest, you also may be interested in reviewing some of the following recent updates available online by clicking on the article title:

You can review other recent health plan, health care and internal controls resources and additional information about the health industry and other experience of Ms. Stamer here. If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information – including your preferred e-mail – by creating or updating your profile at here; e-mailing this information to cstamer@cttlegal.com; or registering to participate in the distribution of these and other Solutions Law Press updates here. For important information concerning this communication click here.

To unsubscribe, e-mail here.

Leave a Comment » | Consumer Driven Health Care, Doctor, false claims act, Health Care, Health Care Finance, Health Care Fraud, Health Care Provider, Health Care Quality, Health Care Reform, Health Plan, Health Plans, Medicaid, Medicare, Medicare Advantage, Medicare Prescription Drug Program, OIG, Physician, Prescription Drugs | Tagged: Doctor, Health Care, Health Care Fraud, Health Care Provider, health care quality, Health Care Reform, Health Care Reimbursement, Health Insurance, Health Plans, Health Policy, HHS, Hospital, Medicare, Medicare Advantage, Medicare Part D, Physician, Physicians, Prescription Drugs, Reimbursement | Permalink
Posted by Cynthia Marcotte Stamer

Southern States Collect Largest Share of $162 Million AARA Fund Meaningful Use Development Grants

March 16, 2010

By Cynthia Marcotte Stamer

Southern states are the big winners among the 16 states and qualified state designated entities (SDEs) to share in the approximately $162 Million in American Recovery and Reinvestment Act of 2009 (ARRA) fund grants to facilitate the development of health information exchange and advance health information technology (health IT) announced by the U.S. Department of Health and Human Services HHS today (March 15, 2010).

Drawn from the $2 billion in funding set aside in ARRA to promote widespread meaningful use of health IT and use of an electronic health record, the following health information exchange awards seek to facilitate to facilitate non-proprietary health information exchange that adheres to national standards widely perceived as critical to enabling care coordination and improving the quality and efficiency of health care.

The recipients and award amounts of the grants announced today are:

Texas Health and Human Services Commission, $28,810,208
Florida Agency of Health Care Administration, $20,738,582
New Jersey Health Care Facilities Financing Authority, $11,408,594
Louisiana Health Care Quality Forum, $10,583,000
State of Mississippi, $10,387,000
Indiana Health Information Technology, Inc., $10,300,000
The Maryland Department of Health and Mental Hygiene, $9,313,924
South Carolina Department of Health & Human Services, $9,576,408
Iowa Department of Public Health, $8,375,000
State of Connecticut Department of Public Health, $7,297,930
Nebraska Department of Administrative Services, $6,837,180
South Dakota Department of Health, $6,081,750
Idaho Health Data Exchange, $5,940,500
State of North Dakota, Information Technology Department, $5,343,733
State of Alaska, $4,963,063

Additional information about the state HIE program may be found here. Other information about other health IT programs funded through ARRA generally can be found at here.

For Assistance With This Opportunity Or Other Health Industry Concerns

If your organization needs advice or assistance with commenting on the AHRO proposal or to respond to other health care quality or other health care matters, consider contacting the author of this article, Curran Tomko Tarski LLP Partner Cynthia Marcotte Stamer at (214) 270-2402 or via e-mail here.

Other Recent Developments & Resources

If you found this information of interest, you also may be interested in reviewing some of the following recent Updates available online by clicking on the article title:

We hope that this information is useful to you. If you need assistance with auditing or defending these or other health care compliance, risk management, transaction or operation concerns, please contact the author of this update, Curran Tomko Tarski LLP Health Practice Group Chair, Cynthia Marcotte Stamer, at (214) 270‑2402, cstamer@cttlegal.com, Edwin J. Tomko at (214) 270-1405 or another Curran Tomko Tarski LLP Partner of your choice. Ms. Stamer has extensive experience advising clients and writes and speaks extensively on these and other health industry and other internal controls and risk management matters.

Leave a Comment » | ARRA, ARRA Funding, Consumer Driven Health Care, Doctor, Electronic Health Records, Electronic Medical Records, Health Care, Health Care Reform, Health IT, Health Policy, HIPAA, HITECH Act, Hospital, Meaningful Use, Physician, Public Policy, Reimbursement, Technology, Telemedicine | Tagged: ARRA, Doctor, Health Care, Health Care Policy, Health Care Provider, Health Care Reform, Health Care Reimbursement, Health Policy, HHS, Hospital, Physician, Physicians, Reimbursement | Permalink
Posted by Cynthia Marcotte Stamer

AHRO Invites Comments On Project To Develop & Test Hospital Toolkit Intended To Guide Hospitals In Using AHRQ Quality Indicators

March 15, 2010

By Cynthia Marcotte Stamer

April 12, 2010 is the deadline for interested person to comment on the request by the Agency for Healthcare Research and Quality (AHRQ) for approval of its proposed “Development and Evaluation of AIIRQ’s Quality Indicators Improvement Toolkit” information collection project.

AHRO’s mission under 42 U.S.C. 299(b)(1)(F); 299a(a)(1) and (2) is to disseminate information and tools that can support improvement in quality and safety in the U.S. health care community. In furtherance of this mission, AHRQ has developed sets of Quality Indicators (QIs) for use by AHRO and others to document quality and safety conditions at U.S. hospitals. These and other federally established quality standards are a key part of ongoing government efforts to promote quality and cost effectiveness in the U.S. medical system, as well as to tie reimbursement to the satisfaction of these or other government-adopted quality standards.

To encourage broader use and adoption of its QIs by hospitals and others, AHRO now is working on developing and evaluating a toolkit to help hospitals to effectively use AHRQ’s QIs. The proposed AHRO toolkit would use two sets of QIs already developed and evaluated by AHRO:

The Inpatient Quality Indicators (IQIs), which contain measures of volume, mortality, and utilization for common medical conditions and major surgical procedures; and
The Patient Safety Indicators (PSIs), which are a set of measures to screen for potentially preventable adverse events that patients may experience during hospitalization.

The QIs and supportive documentation on how to work with them are posted on AHRQ’s Web site here. Many of the QIs have been endorsed by the National Quality Forum through its consensus review process.

To promote the appropriate use of these tools, AHRO plans to develop and then field test an alpha version of the Quality Indicators Improvement Toolkit with six hospitals. The currently open invitation to comment invites public comment on the proposed information collection efforts to be conducted as part of this phase of the project.

To review the pending request for comment for additional details or instructions on submitting comments, see here.

For Assistance With These Or Other Health Industry Concerns

Other Recent Developments & Resources

If you found this information of interest, you also may be interested in reviewing some of the following recent Updates available online by clicking on the article title:

For More Information

We hope that this information is useful to you. If you need assistance with auditing or defending these or other health care compliance, risk management, transaction or operation concerns, please contact the author of this update, Curran Tomko Tarski LLP Health Practice Group Chair, Cynthia Marcotte Stamer, at (214) 270‑2402, cstamer@cttlegal.com, Edwin J. Tomko at (214) 270-1405 or another Curran Tomko Tarski LLP Partner of your choice. Ms. Stamer has extensive experience advising clients and writes and speaks extensively on these and other health industry and other internal controls and risk management matters.

Leave a Comment » | Evidence Based Medicine, Health Care, Health Care Finance, Health Care Fraud, Health Care Provider, Health Care Quality, Health Care Reform, Health IT, Health Plan, Health Plans, Hospital, Medicaid, Medical Malpractice, Medicare, Medicare Advantage, Outcomes Data, Physician, Public Policy, Reimbursement | Tagged: AHRO, health care quality, Health Care Reform, Health Carfe, Managed Care, Medicaid, Medicare, Quality Indicators | Permalink
Posted by Cynthia Marcotte Stamer

NLRB Orders Union Elections In 31 California Health Care Facilities To Proceed

March 2, 2010

By Cynthia Marcotte Stamer

National Labor Relations Board (NLRB) Regional Director Alan B. Reichard has ordered elections to proceed between rival unions in about 31 health care facilities in northern California. The Monday, March 2, 2010 order by Regional Director Reichard sets the stage for elections between the Service Employees International /United Healthcare Workers-West (SEIU-UHW) and the National Union of Healthcare Workers (NUHW), which are competing to represent thousands of health care workers throughout California. Under the order, some elections may be preceded by hearings to clarify the voting group; others will proceed by agreement of the parties regarding such issues as voting dates and times and voter eligibility.

While the order allows elections in many facilities to proceed, approximately 32 elections are still blocked by allegations brought by SEIU-UHW against NUHW and its principals. These allegations remain under active consideration by the NLRB’s Office of the General Counsel.

To review the March 2, 2010, see here.

For Assistance With Compliance Or Other Concerns

If your organization needs advice or assistance in responding to labor and employment issues in your health care organization or other health care matters, consider contacting the author of this article, Curran Tomko Tarski LLP Partner Cynthia Marcotte Stamer at (214) 270-2402 or via e-mail here.

Other Recent Developments

If you found this information of interest, you also may be interested in reviewing some of the following recent Updates available online by clicking on the article title:

For More Information

We hope that this information is useful to you. If you need assistance with auditing or defending these or other health care compliance, risk management, transaction or operation concerns, please contact the author of this update, Curran Tomko Tarski LLP Health Practice Group Chair, Cynthia Marcotte Stamer, at (214) 270‑2402, cstamer@cttlegal.com, Edwin J. Tomko at (214) 270-1405 or another Curran Tomko Tarski LLP Partner of your choice. Ms. Stamer has extensive experience advising clients and writes and speaks extensively on these and other health industry and other internal controls and risk management matters.

Leave a Comment » | Employment, Health Care, Union | Tagged: Employer, Health Care, NLRB, Union, Union Organizing | Permalink
Posted by Cynthia Marcotte Stamer

IRS To Allow Medical Resident FICA Refund Claims

March 2, 2010

By Cynthia Marcotte Stamer

The Internal Revenue Service (IRS) announced today (March 2, 2010) that it has made an administrative determination to accept the position that medical residents are excepted from FICA taxes based on the student exception for tax periods ending before April 1, 2005, when new IRS regulations went into effect. The announcement paves the way for health care organizations that have paid and withheld covered FICA contributions with respect to medical residents and the affected medical residents who had those amounts deducted from wages before the change in the student exemption to seek a refund.

According to the March 2, 2010 IRS Newswire, the IRS will, within 90 days, begin contacting hospitals, universities and medical residents who filed FICA (Social Security and Medicare tax) refund claims for these periods with more information and procedures. Employers and individuals with pending claims do not need to take any action although not yet posted as of the release of this update, an official copy of IR-2010-025 is expected to be posted here soon.

For Assistance With Compliance Or Other Concerns

If your organization needs advice or assistance in responding to this guidance or with other health care matters, consider contacting the author of this article, Curran Tomko Tarski LLP Partner Cynthia Marcotte Stamer at (214) 270-2402 or via e-mail here.

Ms. Stamer is nationally known for her work, training and presentations, and publications on health and managed care staffing, employment, regulatory, tax and other operations, risk management and compliance matters.

Other Recent Developments

If you found this information of interest, you also may be interested in reviewing some of the following recent Updates available online by clicking on the article title:

For More Information

We hope that this information is useful to you. If you need assistance with auditing or defending these or other health care compliance, risk management, transaction or operation concerns, please contact the author of this update, Curran Tomko Tarski LLP Health Practice Group Chair, Cynthia Marcotte Stamer, at (214) 270‑2402, cstamer@cttlegal.com, Edwin J. Tomko at (214) 270-1405 or another Curran Tomko Tarski LLP Partner of your choice. Ms. Stamer has extensive experience advising clients and writes and speaks extensively on these and other health industry and other internal controls and risk management matters.

Leave a Comment » | Doctor, Employer, Health Care, Health Care Finance, Health Care Provider, Hospital, Tax | Tagged: academic medicine, fica, Health Care, Hospitals, medical residents, student exemption | Permalink
Posted by Cynthia Marcotte Stamer

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