Duane Morris Health Law

March 18, 2011September 10, 2014 by Duane Morris

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.

March 11, 2011September 10, 2014 by Duane Morris

Changes to Hospital Outpatient Prospective Payment System (OPPS), the Ambulatory Surgical Center Payment System, and Hospital Reimbursements for Graduate Medical Education (GME)

This regulation was adopted to correct technical and typographic errors identified in a final rule published November 24, 2010, titled “Medicare Program: Hospital Outpatient Prospective Payment System and CY 2011 Payment Rates; Ambulatory Surgical Center Payment System and CY 2011 Payment Rates; Payments to Hospitals for Graduate Medical Education Costs; Physician Self-Referral Rules and Related Changes to Provider Agreement Regulations; Payment for Certified Registered Nurse Anesthetist Services Furnished in Rural Hospitals and Critical Access Hospitals.” The errors were found in the preamble and addenda B, AA and BB of the November 2010 final rule. The new regulation also incorporates changes to the Medicare Physician Fee Schedule (MPFS) for CY 2011, which appeared in a January 11, 2011, CY 2011 MPFS correction notice. The corrections are effective January 1, 2011, as if they were initially included in the November final rule.

More information about the November final rule can be found here. A detailed summary of the corrected errors can be found on the Office of the Federal Register website.

March 8, 2011September 10, 2014 by Duane Morris

12 Proposed Recommendations for Accreditation of Patient-Centered Medical Homes

On March 8, 2011, a coalition comprised of physicians representing the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Physicians, and the American Osteopathic Association, announced its completion of 12 new recommendations for accreditation organizations to use when developing and implementing standards for the patient-centered medical homes (PCMHs). The PCMHs are a central component of the Patient Protection and Affordable Care Act (ACA). The coalition developed the guidelines in anticipation of accreditation organizations, such as the Joint Commission, building upon its recommendations to establish updated standards for the PCMHs.

For additional information, please refer to the coalition’s guidelines.

February 24, 2011September 10, 2014 by Duane Morris

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.

February 22, 2011September 10, 2014 by Duane Morris

$45 Million More in Federal Funding to Assist Medicaid Beneficiaries

On February 22, 2011, the U.S. Department of Health and Human Services (HHS) announced that it would provide $45 million in grant funding to 13 states for the startup and operation of Money Follows the Person (MFP) demonstration projects. States operate MFP programs to provide financial support and assist Medicaid beneficiaries with moving from institutions (i.e., hospitals and nursing facilities) and transitioning back into their communities to live in their own homes or other facilities. HHS anticipates that this federal funding will help 13,000 more Medicaid beneficiaries, and it will continue to provide grant funding through 2016 by committing at least $621 million to the state projects.

To read more about this announcement and see the list of 13 states scheduled to receive grant funding, please go to http://www.hhs.gov/news/press/2011pres/02/20110222b.html.

February 18, 2011September 10, 2014 by Duane Morris

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.

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February 16, 2011September 10, 2014 by Duane Morris

HHS Awards $241 Million to Seven States for IT Infrastructure for Health Insurance Exchanges

On February 16, 2011, the U.S. Department of Health and Human Services (HHS) announced the states that will receive a total of $241 million to design and implement the IT infrastructure used to operate health insurance exchanges. The seven states selected by HHS are known as “early innovator” states because the infrastructure that they establish may be adopted by other states to set up their own exchanges. This announcement demonstrates HHS’s commitment to funding the development of user-friendly systems that will enable consumers to easily navigate the exchanges.

To read more about the IT grants and see the list of states scheduled to receive grant funding, please go to http://www.healthcare.gov/news/factsheets/exchanges02162011a.html.

February 9, 2011September 10, 2014 by Duane Morris

$750 Million More in Prevention Funding

On February 9, 2011, the Department of Health and Human Services (HHS) announced that the Prevention and Public Health Fund would make an additional $750 million available to fund prevention initiatives throughout the United States for FY2011. Last fiscal year, the Prevention and Public Health Fund made $500 million available to states. This year, the $750 million will be distributed to states and local communities to address community prevention, clinical prevention, public health infrastructure, and research and tracking. This investment demonstrates the importance of prevention initiatives in improving the nation’s health. For additional information regarding this announcement, please go to http://www.hhs.gov/news/press/2011pres/02/20110209b.html.

February 8, 2011September 10, 2014 by Duane Morris

$12 Million More in Electronic Health Record Funding

On February 8, 2011, the Office of the National Coordinator for Health Information Technology announced the availability of an additional $12 million in grant funding for the adoption and implementation of electronic health records (EHRs) by critical access and rural hospitals throughout the United States. The purpose of the additional grant funding is to help hospitals implement and adopt EHRs such that they meet “meaningful use” requirements. For additional information regarding this announcement, please go to http://www.govhealthit.com/newsitem.aspx?nid=76202.

January 31, 2011September 10, 2014 by Duane Morris

Federal Judge in Florida Strikes Down the Health Reform Law

On January 31, 2011, a United States District Court in Florida held that the individual mandate provision in the Patient Protection and Affordable Care Act (“Act”) is an unconstitutional exercise of Congress’ power under the Commerce Clause of the United States Constitution. The court also held that “[b]ecause the individual mandate is unconstitutional and not severable, the entire Act must be declared void.” The court reasoned that “[i]f [Congress] has the power to compel an otherwise passive individual into a commercial transaction with a third party merely by asserting—as was done in the Act—that compelling the actual transaction is itself ‘commercial and economic in nature, and substantially affects interstate commerce’ . . . it is not hyperbolizing to suggest that Congress could do almost anything it wanted.” In concluding its decision, the court emphasized that the ruling only addressed a constitutional issue and that it was not about whether the Act was good or bad legislation.

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