16 May · Thu 2013
Increased Spotlight on Emergency Department Facility Coding by CMS, HHS and DOJ
29 Jan · Tue 2013
Deadline Looming (March 23, 2013) for Nursing Facilities to Have "In Operation" an "Effective Compliance and Ethics Program"
04 May · Fri 2012
California Spotlights Mobile Applications and Privacy: The Impact on the App (Including the mHealth) Industry
The relationship between privacy and mobile applications is coming into focus. On February 27, 2012, the California Attorney General entered into a Joint Statement of Principles with the six largest mobile application companies – Apple, Google, H-P, Microsoft, Amazon and RIM – regarding consumer privacy and transparency issues when data is collected through an app. http://ag.ca.gov/cms_attachments/press/pdfs/n2647_agreement.pdf. The Five Principles set parameters for good practice. Although not legally binding, the AG promises to review compliance in the fall, and may use California laws on privacy, false advertising, unfair business practices and others as enforcement tools. Since California often leads the way in privacy enforcement it is likely that other states will follow suit.[Read More]
22 Mar · Thu 2012
Warning: If You Handle Protected Health Information (PHI) or Personally Identifiable Information (PII), Buy Data Breach and Security Incident Insurance!
30 Dec · Fri 2011
HHS OIG Notice Seeks Comments on Safe Harbors, Special Fraud Alerts
Once a year, as required by the Health Insurance Portability and Accountability Act of 1996, the Department of Health and Human Services Office of the Inspector General (“OIG”) solicits proposals to develop new or revised anti-kickback, fraud and abuse safe harbors. The OIG published its request for proposals for new or revised safe harbors in the December 29, 2011 Federal Register. The notice also seeks comments on developing special fraud alerts.
Comments are due February 27, 2012.[Read More]
22 Dec · Thu 2011
Essential Health Benefits: What Hospitals and Doctors Need To Know
As the holiday season continues to heat up, many hospital and medical group practice administrators may have missed an important change in the creation of the health insurance exchange under the Affordable Care Act. The issue concerns how the “essential health benefits” under the health insurance policies to be offered under the health insurance exchanges would be determined. Initially, this was to be determined by Health and Human Services. However, in a recently issued regulation, HHS determined that each state could determine what constitutes “essential health benefits” for the health insurance policies offered to individuals and to small groups. Many providers have not followed this debate because very few states have decided to participate in the health insurance exchanges. However, for those states that are participating, hospitals and physicians need to get into this debate.[Read More]
16 Dec · Fri 2011
HHS Issues Guidance on ‘Essential Health Benefits’ under ACA
30 Nov · Wed 2011
HHS Awards Planning Grants to States to Establish Insurance Exchanges
The Department of Health & Human Services (“HHS”) Secretary Kathleen Sebelius recently announced the distribution of $220 million to states for the creation of private health-insurance exchanges. Alabama, Arizona, Delaware, Hawaii, Idaho, Iowa, Maine, Michigan, Nebraska, New Mexico, Rhode Island, Tennessee and Vermont were the state recipients in this latest funding effort, and Rhode Island is the first state to receive a Level Two grant geared towards states in more advanced planning stages. State health insurance exchanges are expected to start operating in 2014. Currently only 13 states have enacted legislation to establish insurance exchanges; though 49 states have received planning grants so far.
Read HHS’ full press release here.
01 Aug · Mon 2011
New Guidelines Require New Insurance Plans to Provide Preventive Services to Women at No Additional Cost
On August 1, 2011, the U.S. Department of Health and Human Services (HHS) announced guidelines requiring new health insurance plans to provide certain preventive services to women without cost-sharing. The guidelines were developed by the Institute of Medicine. The preventive services that will no longer be subject to any co-payment, co-insurance or deductible include well-woman visits, screening for gestational diabetes, HPV testing for women 30 years of age and older, sexually-transmitted infection counseling, HIV screening and counseling, contraception and contraception counseling, breastfeeding support, and domestic violence screening and counseling. New health insurance plans must comply for plan years starting on or after August 1, 2012.
To read more about this announcement, please go to http://www.hhs.gov/news/press/2011pres/08/20110801b.html.
29 Jul · Fri 2011
$71.3 Million in Federal Funding to Expand Nursing Workforce
On July 29, 2011, the U.S. Department of Health and Human Services (HHS) announced that it would provide a total of $71.3 million in grant funding to expand the education and training of nurses and nursing diversity. The monies will be distributed among six types of awards: Nurse Education, Practice, Quality and Retention; Nursing Workforce Diversity; Nurse Faculty Loan Program; Advanced Nursing Education Program; Advanced Education Nursing Traineeships; Nurse Anesthetist Traineeships. Monies from these awards will support all levels of education from entry-level nursing to advanced traineeships, increase opportunities for individuals from disadvantaged backgrounds, and provide partial loan-forgiveness for nursing faculty.
To read more about this announcement and see details of each of the awards, please go to http://www.hhs.gov/news/press/2011pres/07/20110729a.html.
01 Apr · Fri 2011
FTC and DOJ Propose Enforcement Policy for Healthcare Antitrust Laws
The Federal Trade Commission and the U.S. Department of Justice have jointly issued a proposed enforcement policy for the application of the antitrust laws to healthcare collaborations among otherwise independent providers and provider groups that seek to participate as accountable care organizations (ACOs) under the Medicare Shared Savings Program. The agencies seek public comments until May 31, 2011, on the proposed enforcement policy and the new antitrust "safety zone" it would create.
For more information and the proposed antitrust policy, please visit the FTC and DOJ’s Proposed Statement.
31 Mar · Thu 2011
CMS Releases Long-Awaited Proposed Rule on Accountable Care Organizations
On March 31, 2011, the Centers for Medicare & Medicaid Services (CMS) and Health and Human Services (HHS) unveiled the long-awaited federal rule on accountable care organizations. This proposed rule would implement section 3022 of the Affordable Care Act, which allows service providers and suppliers to continue receiving traditional Medicare fee-for-service payments under Parts A and B, and to be eligible for additional payments based on meeting specified quality and savings requirements.
To view the proposed rule, please visit the Office of the Federal Register website.
18 Mar · Fri 2011
Civil Money Penalties for Nursing Homes
On March 18, 2011, the U.S. Centers for Medicare and Medicaid Services (CMS) and the Department of Health and Human Services (HHS) issued this regulation, implementing section 6111 of the Affordable Care Act. Section 6111 gives CMS authority to impose and collect civil monetary penalties (CMPs) against nursing homes. The penalties are reserved for nursing homes that fail to comply with federal participation requirements outlined in section 6111. Although penalties for noncompliance existed before the Affordable Care Act was promulgated, this regulation revises and expands CMS's authority to impose and collect CMPs. The final rule is effective January 1, 2012.
For additional information about this new regulation, please visit the Office of the Federal Register website.
24 Feb · Thu 2011
New Grant Funding Opportunity to Help States Monitor and Challenge Rising Health Insurance Premiums
On February 24, 2011, the U.S. Department of Health and Human Services (HHS) announced that states can begin to apply for a second round of grants, which they can use to create or improve existing health insurance premium review programs. Approximately $200 million is available to states to better track and review premium rate increases, and make the rate process more transparent to consumers. HHS anticipates that the state review programs will also enable states to challenge or even prevent unreasonable premium increases from being implemented. This round of grants marks the federal government’s continued effort to combat rising health insurance premiums.
To read more about this announcement and to see how to access grant funding, please go to http://www.healthcare.gov/news/factsheets/ratereview02242011a.html.
18 Feb · Fri 2011
Medicare and Medicaid Programs; Requirements for Long-Term Care Facilities; Notice of Facility Closure
Issued by the U.S. Department of Health and Human Services (HHS)on February 18, 2011, this regulation implements section 6113 of the Patient Protection and Affordable Care Act (PPACA). The interim final rule amends existing legislation by introducing new notice requirements associated with long-term care (LTC) facility and skilled nursing facility (SNF) closures. Its purpose is twofold: to protect resident health and safety, and to facilitate a “smooth transition” in the event of a facility’s closure.
New requirements under this regulation include:
- who the administrator of a facility must notify about a closure;
- what minimum content is required in the written notice of closure, such as a detailed closure plan outlining how the facility will transfer residents; and
- when an administrator must provide written notification, which depends on whether the secretary of HHS terminates the facility’s participation in the Medicare or Medicaid program, or whether the facility is closing for another reason.
The regulation also extends liability to facility administrators. For example, an administrator may be subject to a civil monetary penalty of up to $100,000 if he or she fails to comply with its requirements. This regulation is effective on March 23, 2011.