Brown McCarroll | Resource Center | E-Alerts

Health Care - Previously-Proposed Rules Adopted by PT Board and DADS

2012-05-25T21:23:08+00:00

The Texas Board of Physical Therapy Examiners (TBPTE) Adopts a Rule Regarding Licensure Requirements and Procedures - On May 25, 2012, TBPTE published an adopted rule in the Texas Register (37 Tex. Reg. 3831) amending §329.1, regarding General Licensure Requirements and Procedures, and §329.5, regarding Licensing Procedures for Foreign-Trained Applicants. The amendments to §329.1 clarify and update the license application requirements, reflect changes to procedures, eliminate a copy of the diploma as proof of program completion and graduation, and reflect the addition of the mailing address as contact information. The amendments to §329.5 add H1-B visa holders to the list of applicants eligible for an exemption from English language proficiency requirements, if they meet the other requirements of the exemption, and reinsert language exempting graduates of foreign CAPTE-accredited programs from the educational evaluation. The adopted rule is effective May 27, 2012.

Health Care - CMS Reduces Some Regulatory Burdens

2012-05-18T21:46:41+00:00

On May 16, 2012, CMS published a final rule in the Federal Register (77 Fed. Reg. 29002) regarding regulatory provisions to promote program efficiency, transparency, and burden reduction. This adopted rule identifies reforms in Medicare and Medicaid regulations that CMS has identified as unnecessary, obsolete, or excessively burdensome on health care providers and beneficiaries. The rule impacts certain requirements including those applicable to end stage renal disease (ESRD) facilities, intermediate care facilities, ambulatory surgical centers (ASCs) and provider re-enrollment.

Health Care - TMB Adopts Rules Regarding PITs Office-based Anesthesia and Pain Clinics

2012-05-11T21:50:39+00:00

On May 7, 2012, CMS published a final rule in the Federal Register (77 Fed. Reg. 26,828) implementing section 2401 of the Affordable Care Act of 2010, which establishes a new state option to provide home and community-based attendant services and supports at a six percentage point increase in federal medical assistance percentage (FMAP). These services and supports are known as Community First Choice (CFC). While this final rule sets forth the requirements for implementation of CFC, they did not finalize the section concerning the CFC setting. The adopted rule is effective July 6, 2012. For further information, contact Kenya Cantwell at (410) 786-1025.

Health Care - HHSC Extends Adoption of an Emergency Rule Regarding Transition Payments Under the Medicaid 1115 Waiver

2012-05-04T21:50:14+00:00

On May 1, 2012, OIG released an opinion stating that a proposed rewards program (the Reward Program) that would allow customers to earn gasoline discounts based on the amount spent on purchases in retail stores and pharmacies -- including cost-sharing amounts paid for items covered by federal healthcare program -- would not be considered remuneration and would not trigger administrative sanctions. OIG explained that there is little risk that the proposed Reward Program would steer federal healthcare beneficiaries to certain stores to purchase federally reimbursable items or services.

Health Care - CMS Adopts Rule regarding Changes in Provider and Supplier Enrollment, Ordering and Referring, and Documentation Requirements

2012-04-27T21:51:29+00:00

On April 27, 2012, CMS published a final rule in the Federal Register (77 Fed. Reg. 25,283) that finalizes several provisions of the Affordable Care Act implemented in the May 5, 2010 interim final rule. The adopted rule requires all providers of medical or other items or services and suppliers that qualify for a National Provider Identifier (NPI) to include their NPI on all applications to enroll in the Medicare and Medicaid programs and on all claims for payment. The rule also requires physicians and eligible professionals that order and refer covered items and services for Medicare beneficiaries to be enrolled in Medicare. It further adds requirements for providers, physicians, and other suppliers participating in Medicare to provide documentation regarding referrals to programs at high risk of waste and abuse, to include durable medical equipment, prosthetics, orthotics and supplies, home health services, and other items or services specified by the Secretary.

Health Care - HHSC Proposes Medicaid RAC Rules; DSH Program Changes and §1115 Waiver Supplemental Payment Rules

2012-04-20T18:38:47+00:00

On April 20, 2012, HHSC published a proposed rule in the Texas Register (37 Tex. Reg. 2821) regarding the Medicaid RAC program. The proposed rule provides for the review of Medicaid claims submitted to HHSC by a RAC. The RAC will analyze Medicaid paid claims data to determine if services were provided in accordance with state and federal requirements and include review of medical documentation to determine if services were medically necessary. Suspected fraud or abuse may be referred to the HHSC office of inspector general. Providers may appeal RAC audit determinations through the Medicaid appeal process if the claim is paid by HHSC or through the appeal process of the agency that paid the claim if it was not HHSC.

Health Care - HHSC Proposes a 72-Hour Rule for Medicaid Hospital Services

2012-04-13T20:19:57+00:00

On April 11, 2012, OIG issued a modification to a 2008 OIG opinion, which allowed a charitable foundation to provide financial assistance to financially needy patients diagnosed with cystic fibrosis and pulmonary complications with medical insurance, including those with Medicare and Medicaid, to help them afford the costs of medically necessary prescription drugs used to treat their condition. In 2010, OIG first modified the opinion to provide:

Health Care - OIG Issues Opinion Allowing Company to Operate a Website Advertising Healthcare Services

2012-03-30T21:26:44+00:00

On March 27, 2012, OIG issued an advisory opinion (OIG Advisory Opinion No. 12-02) regarding a company’s proposal to operate a website that would display coupons and advertising for healthcare services and supplies from healthcare providers, suppliers, and other entities (the Proposed Arrangement). The requesting parties of the OIG opinion (the Requesting Parties) set up the Proposed Arrangement so that healthcare providers and suppliers would enter into a contract with the Requesting Parties to pay a flat monthly fee to advertise and post coupons for healthcare services and supplies on the website.

Health Care - CMS Allows RACs to Increase Medical Record Requests

2012-03-23T14:12:12+00:00

CMS announced that it has significantly increased the number of medical records that RACs may request from hospitals and other institutional providers. Previously, RACs could request the medical records of up to one (1) percent of all claims submitted in the prior calendar year, divided by eight (8). Now RACs may request the medical records of up to two (2) percent of claims submitted in the prior calendar year. Additionally, the limit on how many medical records RACs may request in a 45-day period has increased from 300 to 400 medical records. CMS retains the right to allow RACs to exceed the stated limits. More information on the new limits can be accessed here.

Health Care - CMS Adopts New Standards for DMEPOS Suppliers

2012-03-16T17:52:01+00:00

On March 14, 2012, CMS published an adopted rule in the Federal Register (77 Fed. Reg. 50) regarding the Medicare standards for DMEPOS suppliers. The adopted rule deletes the existing prohibition on “direct solicitation” of beneficiaries. However, a beneficiary must still provide written permission before a DMEPOS supplier may contact the beneficiary via telephone. As such, under the adopted rule, the ordering physician must obtain the patient’s written permission to be contacted via telephone by the DMEPOS supplier or the DMEPOS supplier must initially contact the patient in a manner other than telephone. The adopted rule also allows DMEPOS suppliers to contract with an individual or entity to provide licensed services unless such a contractual arrangement is prohibited by state law. Previously, DMEPOS suppliers could not contract with third parties to provide licensed services. The adopted rule is effective April 13, 2012.

Health Care - HHSC Adopts a Rule Regarding the Medicaid Women’s Health Program

2012-03-09T15:08:40+00:00

On March 9, 2012, HHSC published an adopted rule in the Texas Register (37 Tex. Reg. 1696) regarding the Medicaid Women’s Health Program. Under the adopted rule, effective March 14, 2012, a provider who performs or promotes elective abortions or affiliates with an entity that performs or promotes elective abortions is unable to contract with HHSC to participate in the Medicaid Women’s Health Program. If a hospital enters into a transfer agreement with an entity that performs elective abortions under which the hospital agrees to accept patients of the elective abortion provider who require inpatient hospitalization, the hospital is not disqualified from participating in the Women’s Health Program if there is no other evidence of common control between the two organizations. However, if the hospital supplies physicians to perform services at the abortion facility and both organizations are managed or overseen by the same board of directors, then the hospital would be disqualified from participating in the Women’s Health Program.

Health Care - CMS Proposes Stage Two EHR Meaningful Use Requirements

2012-03-02T22:16:18+00:00

On February 23, 2012, CMS announced a proposed rule regarding the Stage Two requirements for providers to be eligible for incentive payments paid by the Medicaid and Medicare EHR Incentive Programs for meaningful use of EHR technology. In 2010, CMS announced that it would roll out three sets of requirements for providers to earn incentive payments for the meaningful use of EHR technology, each of which would require increasing use of EHR technology. The proposed Stage Two meaningful use includes standards such as online access for patients to their health information and electronic health information exchange between providers.

Health Care - CMS Changes Interpretative Guidelines for Ordering Rehabilitation Services

2012-02-24T22:41:25+00:00

On February 17, 2012, CMS changed its interpretive guidelines for ordering rehabilitation services. Under the revised guidelines, outpatient services in hospitals may be ordered, and patients may be referred for hospital outpatient services, by a practitioner who is: (1) responsible for the patient’s care; (2) licensed in, or holds a license recognized in the jurisdiction where the practitioner sees the patient; (3) acting within the scope of the practitioner’s practice under state law; and (4) authorized by the hospital’s medical staff to order the outpatient services, including practitioners who are on the hospital medical staff and hold medical staff privileges and practitioners who are not on the hospital’s medical staff, but satisfy the hospital’s policies for ordering applicable outpatient services and referring patients for outpatient hospital services.

Health Care - CMS Proposes a Rule Regarding Reporting and Returning Overpayments

2012-02-17T18:56:02+00:00

On February 16, 2012, CMS published a proposed rule in the Federal Register (77 Fed. Reg. 9179) that, in accordance with Patient Protection and Affordable Care Act provisions, would require Medicare providers and suppliers to identify, report, and return Medicare overpayments by the later of sixty days after (i) the date on which the overpayment was identified or (ii) the date that any corresponding cost report is due. The proposed rule defines an overpayment to be “identified” when a provider has actual knowledge of the overpayment or acts in reckless disregard or deliberate ignorance of the overpayment. Under the proposed rule, if a Medicare provider fails to identify, report, and return the overpayment within the sixty day period, the provider will be deemed to have made a false claim under the False Claims Act, which could subject the provider to penalties, including exclusion from participating in federal healthcare programs.

Health Care - HHSC to Submit Amendments Regarding DSH Payments for Hospitals

2012-02-10T23:12:52+00:00

On February 10, 2012, HHSC announced its intent in the Texas Register (37 Tex. Reg. 802) to submit four amendments to the Texas State Plan for Medical Assistance.

Health Care - CMS Solicits Comments Regarding Whether Certain Hospitals Should Be Required To Accept Inpatient Transfers Under EMTALA

2012-02-03T22:53:01+00:00

On February 2, 2012, CMS published a notice in the Federal Register (77 Fed. Reg. 22) soliciting comments regarding the applicability of EMTALA to hospital inpatients and the responsibilities of hospitals with specialized capabilities. A hospital with specialized capabilities currently does not have an EMTALA obligation to accept a transfer of a patient from a hospital that admitted the patient as an inpatient even if the patient continues to have an unstabilized emergency medical condition after admission. In response to previous proposals to change this policy, most comments CMS received opposed changes. As a result CMS is not currently proposing changes, but seeking further comments, data and real-world examples regarding the impact of a change that would require hospitals with specialized capabilities to accept transfers of inpatients with unstabilized emergency medical conditions from other hospitals.

Health Care - HHSC Proposes Policies that Managed Care Organizations Must Adopt for Specialty Drugs

2012-01-27T21:38:02+00:00

On January 12, 2012, CMS announced a new Medicare appeals process for the EHR Incentive Program. Appeals can be filed for one of three reasons: (1) Eligibility Appeal: a provider meets all EHR Incentive Program requirements, but for circumstances out of its control, did not receive an incentive payment; (2) Meaningful Use Appeal: a provider is using certified EHR technology and meets the meaningful use objectives and associated measures; or (3) Incentive Payment Calculation Appeal: a provider provided claims inclusion data that was not used in determining the amount of its incentive payment.

Health Care - HHSC Adopts Emergency Rule Regarding Transition Payments Under the Medicaid 1115 Waiver

2012-01-21T00:01:17+00:00

Texas Health and Human Services Commission (HHSC) Adopts an Emergency Rule Regarding Transition Payments Under the Medicaid 1115 Waiver

Health Care - CMS Issues a Rule Regarding Medicare Advantage Prescription Drug Costs

2012-01-16T20:06:25+00:00

The Centers for Medicare and Medicaid (CMS) Issues a Rule Regarding Medicare Advantage Prescription Drug Costs

Health Care - HHS Adopts New Standards for Electronic Fund Transfers

2012-01-06T20:11:30+00:00

The Department of Health and Human Services (HHS) Issues Final Notice Regarding the Initial Core Set of Health Care Quality Measures for Medicaid-Eligible Adults