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CMS Issues Final Rule on Price Transparency by Healthcare Facilities
/in Hospitals & Health Systems, LegislationBy Little V. West, Kaitlyn Luck, and Lisa Carlson
On November 15, 2019, CMS issued a final rule pursuant to President Trump’s June 24, 2019, Executive Order to ensure price transparency by healthcare facilities. This price transparency rule will go into effect January 1, 2021, and will require hospitals operating within the United States to establish, update, and publicize all standard charges for all items and services provided by the hospital. Hospitals will also be required to display, in a consumer-friendly manner, standard charges for at least 300 shoppable services provided by the hospital. The stated purpose of this rule is to “increase market competition, and ultimately drive down the cost of healthcare services, making them more affordable for all patients.”
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Encrypt Your Devices or Face HIPAA Penalties
/in Uncategorizedby Kim Stanger
This week, the Office for Civil Rights (“OCR”) announced a $3,000,000 HIPAA settlement arising from a medical center’s loss of an unencrypted laptop and flash drive. (https://www.hhs.gov/hipaa/for-professionals/compliance-enforcement/agreements/urmc/index.html). This is simply the latest of many HIPAA settlements based on the failure to encrypt mobile devices. Similar settlements have arisen from lost or stolen smartphones, computers, hard drives, or other electronic media that were not properly encrypted.
Encryption is an addressable standard under the HIPAA Security Rule, which generally requires covered entities and business associates to “[i]mplement a mechanism to encrypt and decrypt electronic protected health information” and, for such data transmitted over a network, to “[i]mplement a mechanism to encrypt electronic protected health information whenever deemed appropriate.” (45 CFR § 164.312(a)(2)(iv) and (e)(2)(ii)). The OCR explained the standard in a FAQ:
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Contacting Parents, Spouses or Others to Obtain Payment
/in UncategorizedBy Kim Stanger
Healthcare providers sometimes mistakenly assume that they cannot contact a patient’s spouse, parents, or other third parties to obtain payment without the patient’s consent. However, HIPAA generally allows healthcare providers to use or disclose protected health information for purposes of obtaining payment without the patient’s consent or authorization unless the provider has agreed otherwise with the patient. (45 CFR §§164.506(a), (c) and 164.524(a)). The Office for Civil Rights (“OCR”) published the following FAQ discussing this rule:
Does the HIPAA Privacy Rule permit a covered entity or its collection agency to communicate with parties other than the patient (e.g., spouses or guardians) regarding payment of a bill?
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CMS Issues Final Rule for Hospitals & Home Health Agencies for Patient Discharge Planning
/in MedicareBy J. Malcolm (Jay) DeVoy and Lisa Carlson
On September 26, 2019, the Centers for Medicare and Medicaid Services and Department of Health and Human Services published commentary and its final rule affecting how hospitals, including critical access hospitals (“CAHs”), and home health agencies (“HHAs”) must plan and document the discharge of patients in order to avoid re-admissions.1 CMS published this new rule with commentary in the Federal Register on September 30, 2019.2
In order to “empower patients to make informed decisions about their care as they are discharged”3 from hospitals or transferred from HHAs to the post-acute care (“PAC”) setting, CMS adopted this final rule under the Improving Medicare Post-Acute Care Transformation Act (“IMPACT Act”) of 2014. CMS’s final rule is predicated on hospitals, CAHs and HHAs using the quality and resource use information CMS gathers from HHAs, skilled nursing facilities (“SNFs”), inpatient rehabilitation facilities (“IRFs”), and long-term care hospitals (“LTCHs”) under the IMPACT Act. Hospitals, CAHs, and HHAs must now provide this information to patients and their caregivers so that they may consider it when selecting the PAC provider or services they will utilize to continue their treatment. Read more
Federal and New Mexico Surprise Billing Protections
/in Healthcare Law, State Law UpdatesBy Little V. West and Kaitlyn Luck
Surprise billing protections are part of both state and national policy agendas this year in an effort to provide health-care transparency and consumer transparency. New Mexico’s new law now protects consumers by specifically prohibiting health care providers from balance billing, and President Trump also signed an Executive Order with the same goals. New Mexico health care providers need to be aware of federal and state level developments regarding surprise billing because of the significant changes that could result in civil penalties for noncompliance if the proposed federal regulations are adopted.
On the state level, effective January 1, 2020, New Mexico’s Surprise Billing Protection Act (SB 337) (the Act) will generally prohibit providers from submitting a surprise bill to an insured person, or a collection agency, and provides for rights for insureds to appeal a health insurance carrier’s decision regarding a surprise bill. Among other things, the Act aims to prevent insured’s receipt of “surprise bills” by: (1) requiring a health insurance carrier to pay nonparticipating providers for emergency care necessary to evaluate and stabilize a covered person if a prudent layperson would believe such treatment is necessary, without requiring a prior authorization for such services; (2) requiring health insurance carriers to pay, and relieving an insured from liability for payment for, non-emergency care by an out-of-network provider when (a) the insured received care at an in-network facility, but did not have the ability or opportunity to choose an in-network provider who is available to provide covered services, or (b) medically necessary care is unavailable within the health benefit plan’s network; and (3) in nonemergency circumstances, requiring an out-of-network provider, with advance knowledge that the out-of-network provider is out of network, to inform the insured of that fact and to advise the insured person to contact their health insurance carrier to discuss the insured’s options. Balance billing is permitted by out-of-network providers to an individual who knowingly choses to receive services from the out-of-network provider. By July 1, 2020, the Act will require licensed health care facilities to post information about consumers’ rights.
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