The AP reports, “State lawmakers have approved tightening health insurance standards for pre-existing conditions.” At present, “health insurers can refuse to cover a pre-existing condition for two years in individual policies. The state Assembly voted 61-38 to approve a bill that would reduce that to one year.” The legislation “also allows insurers to look back for pre-existing conditions in current policy holders for only one year. Right now, they can go through a person’s entire medical history.” Furthermore, the measure “calls for insurers to renew individual polices without additional underwriting.”
von Briesen Health Law Blog
April 29, 2009
April 27, 2009
IRS Publishes Form 990 Filing Tips
The IRS recently released the first in a series of filing tips for tax-exempt organizations as they prepare to file the resdesigned Form 990 for 2008. The first filing tip is a preparation checklist of important initial considerations and is available here.
For an introduction to the redesigned Form 990, a helpful online mini-course produced by the IRS Exempt Organizations office is available here.
A Group of Organizations Requests CMS to Reconsider Recent Guidance on Supervision Requirements for Hospital Outpatient Therapeutic Services
A group of 12 organizations has submitted a letter to CMS requesting that it withdraw its recent guidance on the supervision required for hospital outpatient therapeutic services provided incident to a physician’s services. The guidance, provided in the 2009 Outpatient Prospective Payment System (“OPPS”) Final Rule published on November 18, 2008, made several “clarifications” to the supervision requirement for such services. See 73 Fed. Reg. 68702-4.
First, CMS “clarified” that it requires “direct supervision” for therapeutic services provided incident to a physician’s services in a hospital and in provider-based departments of the hospital (both on and off campus). In the 2001 OPPS Final Rule, CMS had required direct supervision for off-campus provider-based departments, but stated that direct supervision did not apply to services furnished in an on-campus outpatient hospital department. Second, CMS stated in the 2009 OPPS Final Rule that for provider-based departments, the physician providing the supervision must be present in the provider-based department. CMS has since incorporated this concept into the Medicare Benefit Policy Manual, Chapter 6, §20.5.1.
In the letter, the group of organizations has requested that CMS withdraw this guidance or, at least, give providers more time to make any necessary changes to become compliant. The group asserts that “there was a clear lack of effective and adequate notice about the CMS policy change, which as a result, affected the opportunity to comment on the proposal.” The group asserts that the “new policy places a considerable burden on hospitals, requiring them to engage more physicians for direct supervisory coverage without a clear clinical need.” The group also urges CMS to schedule a meeting to allow providers to offer feedback to CMS about these requirements. You can view the letter here.
April 23, 2009
OIG: “How you pay determines how you will be cheated.”
In a formal statement before the U.S. Senate Committee on Finance’s April 21, 2009 Roundtable Discussion on Health Care Reform, Chief Counsel to the Inspector General, Lewis Morris, discussed why combating waste, fraud, and abuse must be an essential component of any strategy to reform the health care system. Morris emphasized OIG’s impressive return on investment when it comes to fraud and abuse enforcement. Morris noted that from FY 2006 through FY 2008, OIG’s investigative receivables averaged $2.04 billion and its audit disallowances resulting from Medicare and Medicaid oversight averaged $1.22 billion per year. The result was a Medicare and Medicaid specific return on investment for OIG oversight of $17:$1. In addition, in FY 2008, implemented OIG recommendations resulted in $16.72 billion in savings and funds put to better use. OIG opened 1,750 new health care fraud investigations and had over 2,500 health care investigations open at the end of FY 2008.
Morris detailed the following five principles for combating health care fraud, waste, and abuse:
1. Scrutinize individuals and entities that want to participate as providers and suppliers, prior to their enrollment in health care programs.
2. Establish payment methodologies that are reasonable and responsive to changes in the marketplace.
3. Assist health care providers and suppliers in adopting practices that promote compliance with program requirements, including quality and safety standards.
4. Vigilantly monitor the programs for evidence of fraud, waste, and abuse.
5. Respond swiftly to detected frauds, impose sufficient punishment to deter others, and promptly remedy program vulnerabilities.
To be sure, health care reform will include comprehensive fraud and abuse enforcement as a critical cost saving component. You can view the complete statement here.
April 22, 2009
Joint Commission Releases Revised Scoring Guidelines
The Joint Commission has released scoring guidelines for the current list of revisions that are expected to be implemented on July 1.
Intending to bring existing standards in line with the Medicare Conditions of Participation, The Joint Commission previously released an update in January, shortly after the 2009 standards went into effect.
These latest revisions came about after discussions with CMS where certain new or revised standards were found to be covered elsewhere in the standards and thus unneeded.
A crosswalk between the first and second updates, including scoring information, can be found here.
April 21, 2009
HHS Releases Guidance for Securing Health Information and Preventing Harm from Breaches
The U.S. Department of Health and Human Services (HHS) published guidance regarding technologies and methodologies to secure health information and prevent harm by rendering health information unusable, unreadable, or indecipherable to unauthorized individuals. The American Recovery and Reinvestment Act required publication of the guidance by April 18. This builds on the existing requirements of the HIPAA Privacy and Security Rules, which are unchanged.
The guidance issued provides steps entities can take to secure personal health information and establishes the trigger for when entities must notify that patient data has been compromised. This guidance is related to “breach notification” regulations, which will be issued by HHS and the Federal Trade Commission (FTC) respectively. The HHS regulations will apply to entities covered by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the FTC regulation will apply to vendors of personal health records and certain others not covered by HIPAA. The Recovery Act requires that these regulations be published within 180 days of enactment.
The guidance must be updated annually but HHS may update and reissue it this year, after public comment is considered and at the same time HHS’ breach notification regulation is published.
Senators Baucus and Kennedy Aim For a Draft of Healthcare Reform Legislation by Early June
In a letter to President Barack Obama dated April 20, 2009, Senators Max Baucus (Senate Finance Committee Chairman) and Edward Kennedy (Senate Health, Education, Labor, and Pensions Committee Chairman) informed President Obama that they have set an “aggressive schedule” for healthcare reform. The Senators stated that their committees plan to mark-up legislation in early June, with the intention that the two committees can quickly merge their drafts into a single bill. The Senators did not discuss the legislation in detail, but asserted that “comprehensive healthcare reform legislation will responsibly contain costs, improve quality, enhance disease prevention, and provide coverage to all Americans.” You can view the letter here.
April 20, 2009
Healthy Workforce Act Is Introduced
A bill that would provide a tax credit to companies offering “effective and comprehensive wellness programs” was introduced in both the House and Senate on April 2. The Healthy Workforce Act (H.R. 1897, S. 803) would amend the Internal Revenue Code to provide a credit for 50 percent of the costs employers would incur in implementing such wellness programs for their employees. The bill was introduced by Senators Tom Harkin (D-IA) and John Cornyn (R-TX) and Representatives Earl Blumenauer (D-OR) and Mary Bono Mack (R-CA). Similar legislation was introduced and debated in 2007 but died in committee.
According to information provided by Sen. Harkin, to be eligible for this credit, businesses would need to provide programs that include, among other elements, “health risk assessments, health awareness and behavior change programs, meaningful incentives for program participation and an employee committee that tailors programs to meet workforce needs.” While the current bill has not yet been published, it is likely the same if not substantially similar to the bill introduced in 2007. The full version is available here. That bill capped the credit amount at $200 per employee for businesses with fewer than 200 employees, and $100 per employee for those with more than 200 employees.
The House bill has been referred to the House Committee on Ways and Means, and the Senate version to the Senate Committee on Finance.
April 16, 2009
FTC Publishes Proposed Breach Notification Rule for Electronic Health Information
The Federal Trade Commission announced today that it will publish a Federal Register notice of a proposed rule that requires that consumers be notified when the security of their electronic health information is breached (the “Proposed Rule”).
The Proposed Rule is a first step in the implementation of the American Recovery and Reinvestment Act of 2009’s (the “Act”) breach notification requirement. The Act requires that the Department of Health and Human Services and the FTC study and, in early 2010, publish a report on potential privacy, security, and breach notification requirements to be applicable to vendors of personal health records and any third-party entities from which those vendors purchase services.
In the interim, the Act requires that the FTC issue a temporary rule requiring these entities to notify consumers if the security of their health information is breached; that temporary rule is the Proposed Rule announced today. Most importantly, the Proposed Rule defines what actions trigger the notice, as well as the timing, method, and content of notice. The notice will be published in the Federal Register shortly, and is available now on the FTC’s web site.
April 13, 2009
IRS Solicits Comments on Redesigned Form 990
On April 6, 2009, the Internal Revenue Service posted a link requesting feedback from tax-exempt organizations on the revised Form 990, the information return filed by such organizations each year. The redesigned Form 990 is being used for the first time for the 2008 tax year. The IRS notes that comments will be considered as future revisions to the Form 990 are made and to identify areas where tax-exempt organizations may need further guidance and assistance. Comments should be sent by email to: Form990Revision@irs.gov.