Contact Us
Subscribe to this blog via RSS
Join us on LinkedInCategories
- Workplace Violence
- Assisted Living Facilities
- Department of Health and Human Services' Office of Civil Rights
- Medical Residents
- EMTALA
- FDA
- Reproductive Rights
- Roe v. Wade
- SCOTUS
- Medical Spas
- medical billing
- No Surprises Act
- Mandatory vaccination policies
- Workplace health
- Coronavirus Aid, Relief and Economic Security Act
- Code Enforcement
- Department of Labor ("DOL")
- Employment Law
- FFCRA
- CARES Act
- Nursing Home Reform Act
- COVID-19
- Families First Coronavirus Response Act
- Family and Medical Leave Act (“FMLA”)
- KBML
- medication assisted therapy
- SB 150
- Acute Care Beds
- Clinical Support
- Coronavirus
- Emergency Medical Services
- Emergency Preparedness
- Department of Health and Human Services
- Legislative Developments
- Corporate
- United States Department of Justice ("DOJ")
- Employee Contracts
- Non-Compete Agreement
- Opioid Epidemic
- Sexual Harassment
- Health Resource and Services Administration
- House Bill 333
- Litigation
- Medical Malpractice
- Senate Bill 79
- Locum Tenens
- Senate Bill 4
- Physician Prescribing Authority
- Chronic Pain Management
- HIPAA
- Prescription Drugs
- "Two Midnights Rule"
- 340B Program
- Drug Screening
- EHR Systems
- Electronic Health Records (“EHR")
- Hospice
- ICD-10
- Kentucky minimum wage
- Minimum wage
- Primary Care Physicians ("PCPs")
- Skilled Nursing Facilities (“SNFs”)
- Uncategorized
- Urinalysis
- Affordable Insurance Exchanges
- Compliance
- Department of Health and Human Services (HHS)
- Fraud
- Health Care Fraud
- HIPAA Risk Assessment
- HPSA
- KASPER
- Kentucky Board of Medical Licensure
- Kentucky’s Department for Medicaid Services
- Mental Health Care
- Office for Civil Rights ("OCR")
- Office of Inspector General of the United States Department of Health and Human Services (OIG)
- Pharmacists
- Physician Assistants
- Qui Tam
- Stark Laws
- Accountable Care Organizations (“ACO”)
- Affordable Care Act
- Alternative Payment Models
- Anti-Kickback Statute
- Centers for Medicare & Medicaid Services (“CMS”)
- Certificate of Need ("CON")
- Charitable Hospitals
- Data Breach
- Electronic Protected Health Information (ePHI)
- False Claims Act
- Federally Qualified Health Centers (“FQHCs”)
- Fee for Service
- Health Information Technology for Economic and Clinical Health Act (HITECH Act)
- Health Insurance Portability and Accountability Act of 1996 (HIPAA)
- Health Professional Shortage Area ("HPSA")
- Hospitals
- HRSA
- Kentucky Board of Nursing
- Limited Services Clinics
- Medicaid
- Medical Staff By-Laws
- Medically Underserved Area ("MUA")
- Medicare
- Mid-Level Practitioners
- Part D
- Patient Protection and Affordable Care Act (“ACA”)
- Rural Health Centers (“RHCs”)
- Rural Health Clinic
- Telehealth
- American Telemedicine Association (“ATA”)
- Criminal Division of the Department of Justice (“DOJ”)
- Health Care Fraud Prevention and Enforcement Action Team (“HEAT”)
- Hydrocodone
- Kentucky Pharmacists Association
- Qualified Health Care Centers (“FQHC”)
- Telemedicine
- United States ex. Rel. Kane v. Continuum Health Partners
- Webinar
- Agreed Order
- APRNs
- Chain and Organization System (“PECOS”)
- Douglas v. Independent Living Center of Southern California
- Drug Enforcement Agency ("DEA")
- Emergency Rooms
- Enrollment
- Hinchy v. Walgreen Co.
- Jimmo v. Sebelius
- Kentucky Senate Bill 7
- Maintenance Standard
- Medicare Part D
- Minors
- Overpayments
- Re-validation
- Texting
- Vitas Innovative Hospice Care
- 2014 Medicare Physician Fee Schedule (“PFS”)
- 501(c)(3)
- All-Payer Claims Database ("APCD")
- Appeal
- Cadillac tax
- Centers for Disease Control and Prevention
- Chiropractic services
- Chronic Care Management
- Clinical Laboratory Improvement Amendments of 1988 (“CLIA”)
- Compliance Officer
- Compounding
- CPR
- Dispenser
- Drug Quality and Security Act (“DQSA”)
- Essential Health Benefits
- Federation of State Medical Boards (“FSMB”)
- Food and Drug Administratio
- HealthCare.gov
- House Bill 3204
- ICD-9
- Individual mandate
- Kentucky Medical Practice Act
- Kindred v. Cherolis
- Kynect
- Long-term care communities
- Mobile medical applications ("apps")
- Model Policy for the Appropriate Use of Social Media and Social Networking in Medical Practice (“Model Policy”)
- National Drug Code ("NDC")
- National Institutes of Health
- New England Compounding Center ("NECC")
- Ophthalmological services
- Outsourcing facility
- Physician Compare website
- Ping v. Beverly Enterprises
- Power of Attorney ("POA")
- Prescriber
- Social Media
- Spousal coverage
- State Health Plan
- Sustainable Growth Rate (“SGR”)
- UPS
- "Plan of Correction"
- Advanced Practice Registered Nurses
- Affinity Health Plan
- Arbitration
- Audit
- Call Coverage
- Community health needs assessment (“CHNA”)
- Condition of Participation ("CoP")
- Daycare centers
- Decertification
- Denied Claims
- Department of Medicaid Services’ (“DMS”)
- Division of Regulated Child Care
- Doe v. Guthrie Clinic
- EHR vendor
- Employer Group Health Plans
- Employer Mandate
- ERISA
- Fair Labor Standards Act (FLSA)
- False Billings
- Form 4720
- Grace Period
- Group Purchasing Organizations ("GPO")
- Health Professional Shortage Areas (“HPSA”)
- Health Reform
- Home Health Prospective Payment System
- Home Medical Equipment Providers
- Hospitalists
- House Bill 104
- Inpatient Care
- Intermediate Sanctions Agreement
- Kentucky Health Benefit Exchange
- Kentucky House Bill 217
- Licensed practical nurses (LPN)
- Licensure Requirements
- List of Excluded Individuals and Entities
- LLC v. Sutter
- Long-Term Care Providers ("LTC")
- Low-utilization payment adjustment ("LUPA")
- Meaningful use incentives
- Medicare Administrative Coordinators
- Medicare Benefit Policy Manual
- Medicare Shared Saving Program (MSSP)
- Network provider agreement
- Nonprofit hospitals
- Nonroutine medical supplies conversion factor (“NRS”)
- Nurse practitioners (NP)
- Office of the National Coordinator for Health Information Technology (“ONC”)
- Part A
- Part B
- Patient Privacy
- Payors
- Personal Service Entities
- Physician Payments
- Physician Recruitment
- Physician shortages
- Provider Self Disclosure Protocol
- Qualified Health Plan ("QHP")
- Quality reporting
- Registered nurses (RN)
- Residency Programs
- Self-Disclosure Protocol
- Statement of Deficiency ("SOD")
- Trade Association Group Coverage
- Upcoding
- “Superuser”
- Autism/ASD
- Business Associate Agreements
- Business Associates
- Center for Disease Control
- Compliance Programs
- Critical Access Hospitals (“CAHs”)
- Essential Health Benefits (“EHBs”)
- Genetic Information Nondiscrimination Act ("GINA")
- Healthcare Information and Management Systems Society (HIMSS)
- Kentucky House Bill 159
- Kentucky Primary Care Centers (“PCCs”)
- Managed Care Organizations (“MCOs”)
- Medicare Audit Improvement Act of 2012
- Patient Autonomy
- Personal Health Information
- Recovery Audit Contractors (“RAC”)
- Senate Bill 39
- Senate Finance Committee Report
- Small Business Health Options Program (“SHOP”)
- State Medicaid Expansion
- Sunshine Act
- Abuse and Waste
- Consumer Operated and Oriented Plan programs (“CO-OPS”)
- Free Conference Committee Report
- Health Care Fraud and Abuse Control Program
- House Bill 1
- House Bill 4
- Kentucky Cabinet for Health and Family Services
- Kentucky Health Care Co-Op
- Kentucky Health Cooperative (“KYHC”)
- Kentucky “Pill Mill Bill”
- Occupational Safety and Health Administration (“OSHA”)
- Pain Management Facilities
- Employee Agreement
- Health Care Law
- Health Insurance
- Healthcare Regulation
McBrayer Blogs
Showing 65 posts tagged Health Care Law.
THE PERILS OF PRESCRIBING CONTROLLED SUBSTANCES
As the Kentucky Board of Medical Licensure’s (“KBML”) implementing regulations for House Bill 1 are now effective on an emergency basis for the next six months, physicians, nurse practitioners, and other licensed prescribers have specific statutory and regulatory requirements establishing when and how they may prescribe controlled substances. These rules must be followed or physicians and others may face serious consequences that include criminal misdemeanor offenses, loss of prescribing privileges, and disciplinary actions against professional licenses. All practitioners must pay careful attention to these rules because even minor violations may create problems. Because the KBML’s regulations are more comprehensive than the requirements of House Bill 1, a great deal of confusion exists concerning what physicians and practitioners are required to do and when. Recognizing that compliance with its emergency regulations may mean major changes in the way physicians practice medicine, the KBML has announced that it expects full compliance by October 1, which creates a welcome grace period. While the ambiguities and details will be worked out over the course of the next six months, physicians should take heed and incorporate these things into their practices. More >
Federal Medicaid Opt-Out Effect on Hospitals
The mandatory expansion of Medicaid was an important element of the Affordable Care Act as providing health care benefits to uninsured was intended to achieve equity. The expansion of Medicaid rolls was also intended to reduce the cost of providing care for the uninsured and the need for disproportionate share hospital funding, which is an adjustment to account for the needs of hospitals serving a large number of low-income patients. With the ability to opt out of the Affordable Care Act’s expansion of Medicaid eligibility (read more: The Federal Medicaid Apple: Poison or the Cure?), the opt-out states may create financial problems for hospitals that depend on disproportionate share payments to cover part of their costs for providing non-reimbursed services to the indigent and uninsured. The Affordable Care Act’s decrease in disproportionate share payments to hospitals is not changed by the Supreme Court’s ruling. More >
The Federal Medicaid Apple: Poison or the Cure?
As the uncertainty about healthcare reform was extinguished by the Supreme Court in its 5-4 decision upholding the Affordable Care Act, with the provision that the Department of Health and Human Services may not withhold Medicaid funding from states that refuse to adopt the Medicaid expansion, all states, including Kentucky, now have important decisions to make about expansion of Medicaid to a projected 22.3 million uninsured eligible individuals. Under the Affordable Care Act, the federal government will pay the full cost of covering the newly eligible Medicaid participants for three years from 2014 to 2016. Thereafter the federal share will gradually decline until it reaches 90% in 2020. For traditional Medicaid, the federal government now pays, on average, about 57% of a state’s total Medicaid costs. With 826,941 Kentucky Medicaid beneficiaries in January 2012, and an additional 290,000 individuals that would be covered under the expansion, Governor Steve Beshear has announced that he is studying the issues and the costs. More >
House Bill 1
Kentucky’s General Assembly passed House Bill 1 during the 2012 Special Session. House Bill 1 will become effective July 20, 2012. More >
Supreme Court Ruling on the ACA
Writing for the majority, in the Supreme Court of the United States’ decision upholding the health care law, Chief Justice John Roberts wrote, “[t]he Affordable Care Act is constitutional in part and unconstitutional in part.” The Court held that even though “[t]he individual mandate cannot be upheld as an exercise of Congress’s power under the Commerce Clause,” that “it is reasonable to construe what Congress has done as increasing taxes on those who have a certain amount of income, but (who) choose to go without health insurance. Such legislation is within Congress’s power to tax.” Roberts made a point of noting that he and the other justices “possess neither the expertise nor the prerogative to make policy judgments. Those decisions are entrusted to our Nation’s elected leaders, who can be thrown out of office if the people disagree with them. It is not our job to protect the people from the consequences of their political choices.” So, in other words, the Court held that Congress cannot require individuals to enter into an activity so that it could regulate it but that the individual mandate passed muster under the taxing power. The Court also held that the States cannot be coerced into expanding their Medicaid programs and that States are free to opt of the expansion, which is projected to add nearly 30 million more people to the insurance program for our nation’s indigent, if they choose. More >
The New Business of Prescribing Controlled Substances
Out of the heated debate between the Attorney General representing law enforcement and the Kentucky Medical Association representing physicians, the Legislature enacted Kentucky’s “Pill Mill Bill,” which is sweeping legislation designed to combat prescription drug abuse through increased regulation of pain clinics and greater scrutiny of prescribing practices by various agencies of state government. The Pill Mill Bill becomes effective on July 20, 2012 and imposes requirements not just for doctors practicing pain medicine, but for all practitioners who prescribe controlled substances. In addition to placing significant limits on who can own a pain clinic and how a pain clinic is operated, the legislation requires Kentucky’s licensing boards, including the Kentucky Board of Medical Licensure and the Kentucky Board of Nursing, to enact new regulations that impose standards for physicians, nurses and other practitioners when a Schedule II or Schedule III controlled substance is prescribed. Because the Pill Mill Bill imposes sweeping changes for pain clinics and prescribing practices, all health care providers and their patients will face new challenges as procedures change. Regardless of whether the legislation stops the shifting pattern of drug abuse from illicit to prescription drugs, physicians are at the center of the Pill Mill Bill and are now required to reduce the risk of diversion and abuse of prescription drugs when treating a patient’s pain. Whether the collateral effect of the Pill Mill Bill is the serious under treatment of pain is yet to be seen. More >
PRESCRIBERS BEWARE: KENTUCKY ENACTS PAIN CLINIC AND CONTROLLED SUBSTANCES LEGISLATION
In a Special Session, the Kentucky General Assembly enacted House Bill 1, sweeping legislation designed to combat prescription drug abuse through increased regulation of pain clinics and greater scrutiny of prescribing practices by various agencies of state government. Governor Beshear signed the legislation into law, and it will become effective in July, 2012. In addition to placing significant limits on the ownership of pain clinics and imposing a host of requirements governing the operations of pain clinics, the legislation also strengthens licensing standards for physicians and other practitioners and requires practitioners to take specific steps prior to prescribing or dispensing a Schedule II or Schedule III controlled substance. More >
HOSPITAL PAYMENT FOR PERFORMANCE: DRIVEN BY PHYSICIAN’S QUALITY
As the fate of the Affordable Care Act is being determined by a divisive Supreme Court, the health care industry is being led or possibly dragged by the Department of Health and Human Services (“HHS”) and the Center for Medicare and Medicaid Services (“CMS”) into new payment systems that focus on quality of care, outcomes and individual provider performance rather than the traditional fee for service payment model. Even if the Supreme Court finds the Affordable Care Act to be unconstitutional, the change from a payment system focused upon individual services to payment focused upon the quality of the care and patient outcomes are being woven into the fabric of the Medicare reimbursement system. While change in the system is assured, whether the new models will actually bring about better and more efficient care or just reduce available reimbursement is unknown. Despite the unknown effect of paying for performance based upon quality, CMS is marching on with new programs and payment penalties. Physicians, whether employed by a hospital or in a private practice, should be aware of how quality is beginning to drive hospital reimbursement as well as the importance of the physician’s role in determining the quality of care provided by hospitals. By 2017, 6% of all DRG payments will be subject to quality measures through new CMS payment programs for hospital readmissions, value based purchasing and hospital acquired conditions. With these new programs determining a significant amount of payment, physicians must understand the programs and direct their services accordingly. Likewise, hospitals must develop ways to compensate physicians for providing high quality care in a manner that allows hospitals to earn performance payments. More >
PROPOSED PAIN CLINIC LEGISLATION WILL REQUIRE SIGNIFICANT CHANGES TO PROVIDER OPERATIONS AND INCREASE LEGAL SCRUTINY OF PRESCRIBING PRACTICES
The Kentucky General Assembly is currently considering sweeping legislation to combat prescription drug abuse through increased regulation of pain clinics and greater scrutiny of prescribing practices by various agencies of state government. House Bill 4 and the Free Conference Committee Report proposing to modify House Bill 4, if enacted and signed by Governor Beshear, will place significant limits on ownership of pain clinics and also impose a host of requirements governing the operation of pain clinics in the Commonwealth of Kentucky. More >
Federal Government Fight Against Health Care Fraud
FIFTEEN YEARS - $20.6 BILLION – NOT BAD!! More >
