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Loosened Maximum Distance Requirements for APRNs in Missouri

Effective Thursday, April 26, the Missouri Board of Registration for the Healing Arts (MBHA) and the Missouri Board of Nursing (MBN) loosened the regulatory requirements which dictate the maximum distance between the location at which an Advance Practice Registered Nurse (APRN) practices and the location at which his/her collaborating physician practices.

Ramifications for Missouri Physicians of Enhanced Mo HealthNet OPI Program

Effective March 1, 2018, the Missouri Department of Social Services (“MDSS”) – Mo HealthNet Division (“Mo HealthNet”) began working collaboratively with the Missouri Department of Mental Health and the Missouri Department of Health and Senior Services to enhance the Mo HealthNet Opioid Prescription Intervention (“OPI”) Program. 

Pass Through Deduction in New Tax Bill Unlikely to Slow Trend Toward Industry Consolidation

The Tax Cuts and Jobs Act of 2017 signed into law on December 22, 2017 by President Trump added a new deduction for noncorporate taxpayers (i.e. S corporations, partnerships, sole proprietorships, and trusts) who have qualified business income.  This deduction, found in section 199A of the Internal Revenue Code, is also referred to as the “business pass-through income deduction.” 

CJR “To-Do-List”

With the effective date for the Comprehensive Care for Joint Replacement (“CJR”) program now upon us, we wanted to take a moment to highlight key steps that affected hospitals should be pursuing if they wish to realize the benefits of – or at a minimum, avoid potential adverse consequences of – this new payment model.

A Tidal Wave of Meaningful Use Audits Hits the Midwest – 5 Steps to Take Now

The Centers for Medicare and Medicaid Services (“CMS”) provided over $20 billion in Meaningful Use incentive payments to hospitals and eligible professionals who attested to compliance with the EHR Incentive Program (the “Program”).

Providers Need to Take the “Necessary Steps” for HIPAA Compliance

On February 3, 2016, the U.S. Department of Health and Human Services issued a statement and released the opinion of the Administrative Law Judge who found in favor of the Office of Civil Rights (“OCR”) determining that a home health agency, Lincare, Inc. (“Lincare”) violated the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) Privacy Rule requiring Lincare, to pay $239,800 in civil money penalties. All covered entities should review the opinion and the OCR’s comments and begin taking any and all “necessary steps” to ensure HIPAA compliance and to make certain protected health information is adequately protected.

Three Key Take-Aways from CMS’ Final Rule on Reporting and Returning Overpayments

In the Centers for Medicare & Medicaid Services’ (“CMS”) Reporting and Return of Overpayments Final Rule, published February 11, 2016 (“Final Rule”), CMS has clarified some outstanding questions faced by healthcare providers and suppliers who may have received overpayments from the Medicare program.

The Supreme Court Enters Decision in King v. Burwell

This morning, the U.S. Supreme Court entered the much anticipated decision in King v. Burwell.  In a 6-3 decision, the Supreme Court held that the subsidies “are available to individuals in States that have a Federal Exchange.”

“Practically Speaking” the OIG Releases Compliance Guidance for Health Care Boards

A little over a month ago the Office of Inspector General, U.S. Department of Health and Human Services (“OIG”), in collaboration with a number of other independent health care organizations, issued what it deemed to be “practical guidance for health care governing boards on compliance oversight.” This document is intended to assist governing boards in carrying out their compliance program oversight function under the applicable health care laws, rules and regulations.

Four weeks and counting for “grandfathered” HIPAA business associate agreements

The HIPAA Omnibus/Final Rule, published on January 25, 2013, changed the specifications for business associate agreements (BAAs). In general, covered entities were required to comply with the changes to the rule; however, rather than requiring covered entities to immediately enter into new BAAs with all business associates, the Final Rule grandfathered valid HIPAA business associate agreements entered into by the covered entity prior to that date through September 22, 2014. But now this grace period is quickly coming to an end. With the ultimate compliance deadline looming, covered entities that took advantage of this grace period will be required to ensure their grandfathered BAAs, and for that matter all their BAAs, are fully compliant with the Final Rule requirements.

FTC PROSCRIPTION FOR ANTITRUST ENFORCEMENT IN HEALTH CARE

On June 19, 2014, Deborah Feinstein, the current Director of the Federal Trade Commission’s Bureau of Competition, addressed the Fifth National Accountable Care Organization Summit in Washington, D.C. Her speech, entitled “Antitrust Enforcement in Health Care: Proscription, Not Prescription, advised that “there is no tension between rigorous antitrust enforcement and bona fide efforts to coordinate care, so long as those efforts do not result in the accumulation of market power.”

FTC Proscription for Antitrust Enforcement in Health Care

On June 19, 2014, Deborah Feinstein, Director of the Federal Trade Commission’s Bureau of Competition, addressed the Fifth National Accountable Care Organization Summit in Washington, D.C.  Her full comments, entitled “Antitrust Enforcement in Health Care: Proscription, not Prescription,” are available on the FTC’s website: www.ftc.gov.

Outpatient Physical Therapy Supervison Requirement

As reported in the Kansas City and Wichita Business Journals, in January 2014, CMS will begin enforcing a law requiring the supervision of outpatient physical therapy services by physician or non-physician practitioners.  Outpatient physical therapy services that do not meet this supervision requirement will not be reimbursed by Medicaid.

Top Threat to Rural Health Care

Critical Access Hospitals are a critical to providing access to health care in rural America, yet they face devastating budget cuts and must take action to survive.

House Energy and Commerce Health Subcommittee Approves Repeal of SGR Formula

The Congressional Budget Office estimates the costs of maintaining physician Medicare reimbursement at current levels and preventing cuts to the sustainable growth rate (SGR) formula at $139 billion over the next 10 years.  Today, in an attempt to address that issue, the House Energy and Commerce Health Subcommittee approved legislation aimed at repealing the Medicare physician payment system that is presently in place.

Jury Finds Tuomey Health System False Claims Act – Facing up to $357 Million in Potential Liabilities

As previously posted in this Blog, the retrial in the case against Tuomey Healthcare System Inc. (Tuomey) alleging it violated the Stark Law and the False Claims Act (FCA) by illegally paying referring physicians started last month.  After a month long retrial, the jury found that Tuomey’s compensation arrangements with referring physicians violated the Stark Law. The result, nearly 22,000 false claims and more than $39 million in overpayments.  In total, with fines and penalties Toumey is facing $357 million in potential liabilities.  Tuomey officials have indicated that such a large penalty may cause the closure of its business.

OIG Publishes Updated Special Advisory Bulletin on the Effect of Exclusion from Federal Healthcare Programs

Last week, The U.S. Department of Health & Human Services, Office of Inspector General (OIG) published an “Updated Special Advisory Bulletin on the Effect of Exclusion from Participation in Federal Health Care Programs” (2013 Special Advisory Bulletin). As an update to the Bulletin also addressing the effect of exclusion issued in 1999, the 2013 Special Advisory Bulletin addresses frequently asked questions regarding the scope of exclusions and the Affordable Care Act’s (ACA) expansion of the OIG’s exclusion authority.

Corporate Compliance: A High Yield Investment Opportunity

The prevailing sentiment is that developing and maintaining a corporate compliance program in a health care organization is a costly burden.  Many health care organizations have compliance policies only because they are required and may lessen the penalties associated with regulatory enforcement.  In fact, the financial strain of maintaining regulatory compliance is a common issue raised by providers and those in health care administration.  In countless discussions, articles, and presentations, the cost of maintaining compliance with the current mountain and the seemingly always forthcoming tsunami of regulations is often listed as a key driver of the current physician employment boom.  However, these views are wrong, a corporate compliance program is an investment opportunity that when properly developed and executed provides opportunity for a significant return on investment.

Second Tuomey Trial Starts Today

Opening arguments begin today in the second trial in a lawsuit filed by a whistleblower-physician against Tuomey Healthcare System, Inc. (Tuomey). The United States intervened in the matter which alleges that Tuomey entered into part-time employment agreements with 19 physicians that violated the Stark law resulting in False Claims Act (FCA) liability for Tuomey because as the government alleges, that Tuomey took into takes into account the revenue it expected to receive from physicians’ referrals to value the physicians’ base compensation.

Proposed Rules Would Extend and Modify EHR Donation Stark Exception and Anti-kickback Safe Harbor

The Stark exception and the Anti-kickback safe harbor that protect electronic health record (EHR) donation to physicians are both set to expire on December 31, 2013. This week, in response to this looming deadline, the Centers for Medicare & Medicaid Services (CMS) introduced a rule that would extend the Stark exception to December 31, 2016. Also this week, the Department of Health and Human Services Office of Inspector General (OIG) introduced a proposed rule extending the Anti-kickback safe harbor to December 31, 2016.

CMS Rule Change Affects Incorrect Medicare Part A Payments

CMS issued a new rule on March 13, 2013, allowing providers to be paid for services billed under Medicare Part A, which should have been billed under Part B. However, a notice of proposed rulemaking issued the same day states that those claims must still be submitted within a strict one-year window that renders the new rule ineffective.

Health Care Information Alliance Formed

McKesson Corp., Allscripts, athenahealth Inc., Greenway Medical Technologies Inc., RelayHealth, and Cerner announced at the 2013 Healthcare Information and Management Systems Society annual meeting in New Orleans that they have banded together to form an independent trade association.

Universities, Hospitals, and Related Institutions Subject to Revised Final EPA “Area Source” Boiler Air Rules

On December 20, 2012, EPA finalized its “area source” boiler regulations designed to limit air emissions from small- to medium-sized boilers that burn coal, oil, or biomass which serve as the source of heat and sometimes power at a variety of commercial businesses, such as hotels and office buildings, as well as institutional entities, including universities, schools, education centers, medical centers, hospitals, municipal buildings, and prisons. According to EPA, 183,000 boilers at 92,000 area source facilities nationwide will be impacted by the final rule, 85 percent of which EPA considers to be small businesses or entities.

Long-Awaited HIPAA Rule Finally Arrives

On January 17, 2013, the Department of Health and Human Services released the long-awaited final rule modifying the Health Insurance Portability and Accountability Act (HIPAA) regulations. The final rule, at 563 pages, is sure to cause a spike in sales of printer toner.

Court Grants Summary Judgment to Hospital on Patient’s Emergency Medical Treatment and Active Labor Act (“EMTALA”) Claims

William Romine went to the emergency room at St. Joseph-Mount Sterling hospital in Mount Sterling, Kentucky, after cutting his hand with a pair of scissors while trying to unclog a bottle of Gorilla Glue. . Romine was not immediately seen at St. Joseph-Mount Sterling because no beds were available. Unsatisfied with having to wait, he left to go to another hospital in Winchester, Kentucky. During the trip to the second hospital, Romine decided to return back to St. Joseph-Mount Sterling, where he was again told there were no available beds. A short while later Romine received treatment to temporarily stop the bleeding. St. Joseph-Mount Sterling determined that it was unable to treat the injury and Romine was airlifted to another hospital where his bleeding was stopped by the placement of sutures.

OCR De-Identificiation Guidance

The Department of Health and Human Services Office for Civil Rights (“OCR”) recently released guidance on de-identification of protected health information pursuant to the Health Insurance Portability and Accountability Act (“HIPAA”) Privacy Rule. The guidance discusses in detail the two methods that satisfy the de-identification standard of the Privacy Rule—the Expert Determination and Safe Harbor methods. While these methods are not new, the guidance provides a clearer picture of OCR’s expectations.

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