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December 28, 2010

EHR Incentive Signup Starts Monday January 3

Health care providers and hospitals planning on participating in Medicare’s EHR incentive programs in 2011 may begin to register online on Monday. The link will appear on at the following address: http://www.cms.gov/EHRIncentivePrograms/20_RegistrationandAttestation.asp.

Participation in the Medicare incentive payments for 2011 means implementing (or upgrading to) a certified EHR system, and using that system for a set of objectives and reporting of clinical quality measures over 90 consecutive days before the end of the 2011 program year (September 30th for providers and December 31st for hospitals).

Registration is just a first step in a pretty involved process. There is still time to aquire and implement the technology in order to qulaify for this year’s incentives. CMS has the details of how to participate set out at the following address: http://www.cms.gov/EHRIncentivePrograms/10_PathtoPayment.asp

Watch for updates as details get finalized and reporting starts to happen.

December 21, 2010

National Labor Relations Board Proposes Rule to Require Posting of NLRA Rights

Filed under: Labor & EmploymentDan Dennehy @ 2:52 pm

The Democratic-controlled NLRB has begun to take action to support the rights of employees to organize and collectively bargain.  The new poster the Board is likely to require all employers to post both physically and on intranets can be found here.  This is similar to the posting required of federal contractors.

December 17, 2010

Rule 146 Disclosure

The DQA published a memorandum today regarding its new rule regarding hospital disclosure of information regarding health care charges and quality.  To read this memorandum and the rule, go to: 

http://www.dhs.wisconsin.gov/rl_dsl/Publications/10-038.htm

December 14, 2010

PPACA Constitutional Challenges: Wins (2) – Losses (1) – Final Outcome (?)

Filed under: Legislation WatchLisa Gingerich @ 9:59 am

Virginia U.S. District Judge Henry E. Hudson declared that the mandate in the Patient Protection and Affordable Care Act (”PPACA”) requiring people to purchase health insurance exceeds Congress’ power to regulate economic activity under the commerce clause.  In his December 13, 2010 ruling in Commonwealth of Virginia v. Sebelius, Judge Hudson said that the government cannot require Americans to purchase insurance.  He also deemed that the mandate is not a tax.  Despite the ruling, the law will remain in tact while appeals continue.  There is no immediate impact of the coverage mandate which is not scheduled to begin until 2014.

Judge Hudson is the first federal judge to strike down material provisions of PPACA.   Federal judges in Virginia and Michigan have upheld the law, several challenges have been dismissed and still others are pending, including Florida.  Florida Federal District Judge Roger Vinson will hear arguments on Thursday, December 16 in a challenge to the mandate brought by 20 state attorneys general and a handful of governors.

Challenges to PPACA, including Virginia’s, are expected to continue and not be settled until decided by the Supreme Court.

December 8, 2010

von Briesen & Roper Health Law Update: Covenant v. Wauwatosa

Covenant v. Wauwatosa: Supreme Court Takes a Second Look

On Tuesday, December 7, the Wisconsin Supreme Court decided to review the extent to which outpatient hospital departments, including outpatient facilities that are located away from the main hospital campus, are eligible for property tax exemption under Wisconsin law. The case, Covenant Healthcare System, Inc. v. City of Wauwatosa, involved the St. Joseph Outpatient Center and the City of Wauwatosa (the “SJOC”).

In March 2009, a Milwaukee County trial court judge determined that the SJOC was exempt from property taxes under the non-profit hospital exemption found in § 70.11(4m) of the Wisconsin Statutes, but this decision was reversed by the Wisconsin Court of Appeals in August of this year. Covenant filed a petition for review by the Supreme Court. von Briesen & Roper filed an amicus curiae brief in support of this petition on behalf of the Wisconsin Hospital Association; the Rural Wisconsin Health Cooperative also filed an amicus brief in support of the petition for review.

The Covenant Decision
This promises to be a landmark case. The Wisconsin Supreme Court has the opportunity to provide clarity to nonprofit hospitals and municipal assessors alike regarding the circumstances under which hospital outpatient facilities qualify for a property tax exemption. Previous decisions of the Court of Appeals have muddied the waters somewhat due to language in § 70.11(4m) that excludes property used “as a doctor’s office” from the exemption. Prior to its decision in Covenant, the Court of Appeals issued two previous decisions that provided conflicting guidance on the line between traditional doctors’ offices and traditional outpatient hospital operations. See St. Elizabeth Hospital, Inc. v. City of Appleton (1987) and St. Clare Hosp. of Monroe, Wis., Inc. v. City of Monroe (1997).

In Covenant, the Court of Appeals distilled these previous cases into this simple distinction:

  • A doctor’s office is a place where doctors see patients, mostly by appointment, during scheduled business hours, and have their offices.
  • A hospital, on the other hand, is a place that offers inpatient, overnight care.

As a result, the Court of Appeals in Covenant concluded that an outpatient clinic is the functional equivalent of a doctor’s office, and therefore taxable. The repercussions of that decision have already been felt by nonprofit hospitals across the state as assessors have begun to scrutinize hospital outpatient departments (particularly off-campus facilities) under the Covenant lens.

The Supreme Court has required that Covenant and the City file their briefs within the next two months, which may indicate that a decision could be forthcoming by late spring or early summer 2011. At a minimum, the Supreme Court is expected to provide greater definition to the myriad factors that previously were identified in St. Elizabeth and St. Clare, as well as Covenant. The Supreme Court will also have the opportunity to consider and clarify other aspects of the nonprofit hospital exemption, such as the question of when property is being used for a non-exempt “commercial purpose.”

Other Property Tax Considerations
As the year-end approaches, it is a good time for nonprofit hospitals and other exempt entities to plan ahead for the 2011 tax year. Applications for property tax exemption are due by March 1. Exempt entities should consider whether an application will be necessary to cover either newly acquired or developed property that was not previously subject to an exemption, or property that was previously taxable but whose use has changed in a manner that might now qualify for exemption.

The statutory assessment date is January 1. Potentially exempt property should be considered relative to its use on that date. For example, property that is being prepared for an exempt use through ongoing construction activities as of January 1 may qualify for exemption, while property that is lying fallow (in anticipation of future construction activities) may not qualify as an exempt use. Exempt entities should be prepared to document use of the property as of January 1 in order to support an exemption application on March 1.

December is also the month that property tax bills are issued by the assessing municipalities. In order to challenge a property tax bill on the basis of an exemption, the owner must pay the bill in full and request a refund by January 31 of 2011. An owner that elects to pay the tax bill in installments rather than in full by January 31 may lose the right to challenge the tax based on an exemption. Particularly as to outpatient facilities, hospitals should consider preserving their exemption claims through timely objections pending a final decision from the Wisconsin Supreme Court in the Covenant case.

Supreme Court accepts review in Covenant v. Wauwatosa

On Tuesday, December 7, the Wisconsin Supreme Court accepted review of a property tax case that should define the landscape for nonprofit hospitals for years to come. This case involves the property tax exemption under section 70.11(4m) for nonprofit hospitals as applied to outpatient hospital facilities. The circuit court found in favor of an exemption, while the court of appeals reversed based on a determination that the outpatient facility in question was tantamount to a non-exempt “doctor’s office.” von Briesen & Roper submitted a brief on behalf of the Wisconsin Hospital Association, as amicus curiae, in support of the petition for review.

December 3, 2010

Medicare Publishes New Roadmap for Avoiding Fraud and Abuse

Filed under: Fraud and Abuse, Medical StaffMichelle Frazier @ 10:44 am

The Department of Health and Human Services and Office of Inspector General just released a new publication geared toward avoiding fraud and abuse. This comprehensive roadmap for physicians can be found at www.oig.hhs.gov/fraud/PhysicianEducation/.

Health Care Providers Closer to Being Excluded from Red Flags Rule

The United States Senate’s “Red Flag Program Clarification Act of 2010” provides a definition of “creditor” that excludes health care providers and some other service providers.  The legislation specifically excludes from the definition of “creditor” persons who “advance funds” by providing services in advance of receiving payment.  However, the bill includes language that allows government agencies to designate an entity or person a “creditor” subject to the Red Flags Rule if the agency determines that the entity or person maintains accounts that may reasonably result in identity theft.  The House of Representatives Committee on Financial Services must now consider this bill and the House must pass the bill in order for the exemption to become law.  The House has already considered and passed similar legislation, but now the Senate version must be approved in the House’s lame duck session in order to be effective before the Red Flags Rule’s January 1, 2011 compliance date.

The Red Flags Rule requires businesses to implement safeguards intended to minimize identify theft.  The Federal Trade Commission, which will enforce the Red Flags Rule, has previously extended the enforcement date of the Rule several times.  Irrespective of the House’s passage of the Senate’s bill prior to the end of the year, pending litigation by the American Medical Association and other physician organizations may also require enforcement to be delayed until the litigation has been resolved.

More information regarding the Red Flags Rule is available at:  http://www.ftc.gov/redflagsrule

December 2, 2010

DHS Issues Memo On New Informed Consent Requirement

The Department of Health Services just issued a memorandum to inform nursing homes regulated by the DQA about new informed consent requirements for psychotropic medications. Effective December 1, 2010, informed consent is required before administration of psychotropic medication to a nursing home resident who has degenerative brain disorder. This new requirement comes from Wis. Stat. 50.08, which was signed into law this past May. A copy of the memorandum can be found at http://www.dhs.wisconsin.gov/rl_dsl/Publications/10-037.htm.