Washington Update

Office of National Coordinator Releases “Roadmap” for Interoperability

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A roadmap detailing the path to reach an “interoperable health IT ecosystem” by 2024 was released by the coordinator of the government’s health information technology effort.

Federal Health IT Strategic Plan Released

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draft version of the Federal Health IT Strategic Plan 2015-2020 released last month emphasizes, among other things, that new information about health care delivery be shared “quickly, securely, and efficiently.”

New CMS Rule Could Improve Accountable Care Organizations

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The Centers for Medicare and Medicaid Services (CMS) is seeking public comment on five adjustments the agency wants to make to the Shared Savings Program used by Accountable Care Organizations (ACOs).

HHS Issues Proposed Rule to Expand Anti-Kickback Safe Harbors

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The Department of Health and Human Services (HHS) issued a proposed rule on October 3, 2014, that would amend the safe harbors included in both the anti-kickback statute and the civil monetary penalty rule.

More Flexibility for Certification of Electronic Health Records

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The Department of Health and Human Services (HHS) has issued a final rule on Release 2 of the Electronic Health Record (EHR) certification criteria. The new rule will take effect on October 14, 2014.

HRSA Plans to Merge Health Workforce Bureaus

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The Health Resources and Services Administration (HRSA), the $8.4 billion agency charged with improving access to health care for the uninsured and medically vulnerable, plans to consolidate two of its bureaus into a newly created one.

Campaign Promotes Year-Round Enrollment in Medicaid and CHIP

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The Centers for Medicare and Medicaid Services initiated a new push in May to educate parents that they can enroll their children in Medicaid and the Children’s Health Insurance Program (CHIP) at any time during the year, and that parents themselves may also be eligible for Medicaid.

New Leadership at HHS

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Health and Human Services Secretary Kathleen Sebelius announced her resignation in April, shortly after the official close of the nation’s first enrollment period for health insurance under the Affordable Care Act. When the federally developed online insurance marketplace healthcare.gov first launched in October 2013, Sebelius was roundly criticized for what she herself called “a miserably frustrating experience” for many Americans who attempted to purchase coverage through the exchange. Nevertheless, she was able to testify that enrollment had hit 7.5 million, surpassing the administration’s target, when she appeared before the Senate Finance Committee earlier last month.

U.S. Department of Health and Human Services Releases Model HIPPA Privacy Notices

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On September 13, 2013, the U.S. Department of Health and Human Services (HHS) released several variations of a model Notice of Privacy Practices for use by health care providers and health plans to communicate with their patients and plan members. The new model notices facilitate compliance with a portion of the Omnibus Final Rule under the Health Insurance Portability and Accountability Act of 1996 (HIPPA). The Omnibus Rule was released in January of this year and its requirements went into effect on September 23, 2013.Under the Omnibus Rule, individuals have a fundamental right to be informed of the privacy practices of health plans and health care providers, as well as to be informed of their privacy rights with respect to their personal health information. Health plans and covered health care providers are required to develop and distribute a notice that provides a clear, user-friendly explanation of these rights and practices. According to HHS, many entities have asked for additional guidance on how to create a clear, accessible notice that their patients or plan members can understand. In response, the Office of Civil Rights and the Office of the National Coordinator for Health Information Technology have provided separate models for health plans and health care providers. The three options for the notice are: A layered notice that presents a summary of the information on the first page, followed by the full content on the following pages; A notice with the design elements found in the booklet, but formatted for full page presentation; and A text-only version of the notice. To obtain additional information on the Privacy Rule, please click here.

Senators Seek to Stop Medicaid Payments to Dental Clinics that Circumvent Oversight Regulations

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Senate Finance Committee Chairman Max Baucus (D-MT) and Sen. Chuck Grassley (R-IA), Ranking Member of Judiciary Committee, are calling on the U.S. Department of Health and Human Services (HHS) to ban dental clinics from participating in the Medicaid program if the dental clinics circumvent state laws designed to ensure only licensed dentists own dental practices. The request by the senators comes in the wake of a year-long investigation into allegations of abusive treatment of children in clinics controlled by corporate investors rather than dentists. The report, “Joint Staff Report on the Corporate Practice of Dentistry in the Medicaid Program” released by Sens. Baucus and Grassley focuses on dental management companies organized as a corporation or limited liability company that works with dentists in multiple states. The investigation found a failure to meet quality and compliance standards, including the unnecessary treatment on children, the improper administration of anesthesia, providing care without proper consent, and overcharging the Medicaid program. According to the report, while many clinics technically meet state-level rules requiring their owners to be licensed dentists, the clinics nonetheless have placed control of their operations in the hands of corporate investors and the result is a system that “places profits above patient care.” Twenty-two states and the District of Columbia ban corporate dentistry. Investigators looked at five dental chains that allegedly used deceptive business models which gave managers, rather than dentists, control over the clinics. They included the following: Church Street Health Management (Small Smiles) ReachOut HealthCare America NCDR (Kool Smiles) Heartland Dental Care Aspen Dental Management The report focused on CSHM (Small Smiles) and ReachOut HealthCare America (RHA), because both companies treat Medicaid children almost exclusively. Sens. Baucus and Grassley urged the Inspector General for the U.S. Department of Health and Human Services to take action to stop taxpayer reimbursement of dental management companies that operate in this manner. “When states can’t hold owners accountable to maintain a professional standard of care, then clinics are more likely to fail to meet basic quality and compliance standards, putting the children who should be helped at risk,” according to the report.

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