Health Centers
May 9, 2011
Posted by Frank Ciesla
The Centers for Medicare and Medicaid Services, as you will see in the proposed regulations published Friday in the Federal Register, is attempting to establish criteria for assuring access to Medicaid services.
This proposed regulation has already drawn comments from various state officials as reported on Tuesday, May 3, 2011 in the New York Times. They are significantly concerned with the administration’s approach and are seeking to have the administration work with the States in implementing the Medicaid program. As we all are aware, under the Patient Protection and Affordable Care Act (PPACA) there will be a significant expansion of the Medicaid program and further, as set forth in a prior blog, PPACA mandates an increase in payments to primary care physicians. Neither the federal legislation nor the proposed regulations provide the States the funds necessary to upgrade the payments through the Medicaid program.
New Jersey is close to, if not the lowest state in Medicaid payments to physicians. As we are aware, many of the Medicaid patients are now seen in government funded health centers. Under Governor Chris Christie’s proposed budget, there will be a 10 percent cut in payments made by the State of New Jersey to the Federally Qualified Health Centers (FQHCs). As stated in the Star Ledger of Thursday, May 5, 2011, “With a 10 percent rate cut, the North Hudson Community Action Corp. Health Center would lose $933,000, Grant-Davis [President and CEO of the Primary Care Association] said, ‘A 10 percent cut cannot be absorbed.’. . .” As we are all aware, the payments made to private physicians by the Medicaid program are significantly below the payments being made by the State of New Jersey, to the FQHCs.
The simple question is — where is the money going to come from to pay for these Medicaid services, whether provided in the FQHC or doctors’ offices.
It will be critical to see, especially for the State’s primary care physicians, how the funding will be created to fund the provision of services by the primary care doctors, to the Medicaid population. At the current time, there is no answer other than unfunded statutory and regulatory obligations.
Hospitals Fire Employees Over Privacy Violation
May 9, 2011
Posted by Sharlene Hunt
The StarTribune in Minneapolis St. Paul has reported that two related hospitals in Minnesota fired 32 employees for violating patient privacy when they accessed medical records of patients hospitalized as the result of a massive drug overdose at a party in the area. According to the news story, because the drug overdose story was so high profile, the hospitals conducted an investigation to determine whether employees had wrongfully accessed the electronic hospital records of the patients involved in the case. Thirty-two employees were found to have accessed records without permission. Although the employees held positions in which they accessed electronic medical records as part of their job duties, they were not authorized to do so with respect to these particular patients. The hospitals fired all 32 employees under their “zero tolerance” policy.
We have previously commented on the importance of health care providers having in place safeguards to protect patient information under the Health Insurance Portability and Accountability Act (“HIPAA”). Health care providers have an obligation to enforce their policies, which may include taking disciplinary action, up to and including termination, against employees who access records inappropriately. Idle curiosity is not a legitimate reason to access a medical record. With electronic health records, it will be easier to determine who has accessed a record and whether that access was job related.
A violation of the HIPAA privacy laws can result in the filing of a complaint with the federal Office of Civil Rights (OCR). The OCR can then decide whether to investigate the complaint and if it finds that a violation occurred, the OCR has the authority to impose civil monetary penalties or refer the matter to the Department of Justice for criminal prosecution. Thus, this issue must be treated very seriously by health care providers, and appropriate action taken to protect patient privacy.
Medical Society of New Jersey Annual Meeting
May 5, 2011
Posted by Beth Christian
Frank Ciesla, Sharlene Hunt, and Beth Christian will speak at the Annual Meeting of the Medical Society of New Jersey on May 13, 2011 at 1:30 p.m. The topic that they will be discussing is “Interpreting the Language in your Payor Contracts”. Please feel free to stop by Salon CD on the second floor if you are attending the meeting.
The Confluence of the Sustainable Growth Rate and the Deficit
April 13, 2011
Posted by Frank Ciesla
Last Thursday, the Commissioners of the Medical Advisory Commission recommended that the Sustainable Growth Rate (“SGR”) formula be scrapped and that the 300 plus billion dollars (the cost of getting rid of the SGR) be written off. This suggestion appears to be based upon the fact that Congress has been unable or unwilling to come up with a methodology for off-setting the reductions in payments to physicians, as well as a recognition by Congress that cutting physician payments in a manner consistent with the SGR formula would result in the inability of seniors to be able to obtain physician care under Medicare.
While the recommended write-off of the 300 billion dollar amount may be a recognition that Congress cannot keep putting off a resolution of the SGR issue, this is a simplistic proposal in light of the focus today in Washington on deficit reduction. Adding $300 billion to the national debt while simultaneously developing a debt reduction proposal appears to be unrealistic. However, the SGR will continue to be an issue that physicians and the government need to face until it is resolved. Therefore, this is an issue which will keep rearing its ugly head until it is resolved.
IRS Issues Notice Regarding ACOs
April 1, 2011
Posted by Sharlene Hunt
As mentioned in our blog post yesterday, the IRS has published notice 2011-20 soliciting public input on whether existing guidance issued by the IRS is adequate for tax-exempt organizations planning to participate in the Medicare shared savings program through an accountable care organization (ACO). If existing guidance is not sufficient, the IRS is seeking comments on what additional guidance is needed. The IRS is also soliciting comments regarding the tax implications for tax-exempt organizations using ACOs in arrangements with commercial health insurance plans that are unrelated to the Medicare shared savings program. Public comments are to be submitted by May 31, 2011. Read more
Federal Agencies Issue Guidance on ACOs
March 31, 2011
Posted by Sharlene Hunt
Today, the Centers for Medicare and Medicaid Services (“CMS”), the U.S. Department of Health and Human Services Office of Inspector General (“OIG”), the Federal Trade Commission and the Department of Justice, and the Internal Revenue Service issued guidance under the Patient Protection and Affordable Care Act (Affordable Care Act) regarding accountable care organizations participating in the Medicare shared savings program. Read more
CMS Proposed Regulations
March 31, 2011
Posted by Beth Christian
This morning, the Centers for Medicare and Medicaid Services (“CMS”) issued a long-awaited proposed rule governing accountable care organizations (“ACO’s”). The proposed rule outlines the requirements for both establishing an ACO and for participation in the shared savings program authorized by the Accountable Care Act. The regulations set forth requirements for (among other things) eligibility; beneficiary participation and protection; leadership, management and governance; processes; marketing; program integrity and compliance; data sharing; quality and other reporting requirements; shared savings determinations; payment models; and monitoring. The proposed regulations also include a discussion of waivers of civil monetary penalty, antikickback and physician self-referral laws; IRS guidance regarding tax-exempt organizations; and an antitrust policy statement, which have been addressed in notices published by the applicable federal agencies and discussed in a companion blog post which we are also publishing today. Read more
NJ Hospital Licensure Regulations Updated
March 24, 2011
Posted by Beth Christian
The New Jersey Department of Health and Senior Services recently adopted amendments to the existing hospital licensure regulations. One of the more controversial amendments deals with the expansion of the scope of practice for advanced practice nurses specializing in anesthesia. Under the original regulatory proposal, advanced practice nurses specializing in anesthesia were included within the list of professionals authorized to administer general anesthesia, major regional anesthesia, conscious sedation or minor regional blocks so long as the administration of anesthesia was performed in accordance with a joint protocol between the advanced practice nurse and a collaborating physician. Read more
Final Medicare/Medicaid Enrollment and Screening Requirement Regulations Adopted
March 22, 2011
Posted by Beth Christian
In a November 29, 2010 blog post, we reported that the Centers for Medicare and Medicaid services had published proposed regulations which would modify Medicare/Medicaid provider screening and enrollment requirements. The regulations have now been adopted as final, and will go into effect March 25, 2011. Read more
Additional Federal Contractor Obligations
February 17, 2011
Posted by Frank Ciesla
The Office of Federal Contract Compliance Programs on December 16, 2010 issued Transmittal Number 293, which is attached to this blog. The purpose of that transmittal is to alert healthcare providers that they may be considered subcontractors subject to the requirements of the Office of Federal Contract Compliance Programs. While it has been clear (and continues to be clear) that participation in Part A and Part B of the Medicare Program, does not subject a provider to the contractual obligations of a government contract (as set forth in bullet number 3 on page 5 of Transmittal 293), the transmittal further provides on page 11: Read more
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