On May 8, ODMH released a communication inviting community behavioral health centers to submit nonbinding letters of intent expressing their readiness to implement health home services for persons with serious and persistent mental illness. Letters of intent should be submitted no later than June 1 in order to be considered for implementation during FY 2013.
A description of information to be included in the letter of intent can be found in the ODMH communication.
Historically, large hospitals have been the primary targets of HIPAA enforcement. The recent settlement involving a 5-physician practice in Phoenix which agreed to pay the U.S. Department of Health and Human Services (“HHS”) $100,000 and take corrective action is significant to all HIPAA covered entities because the target of the investigation was a fairly small practice — not a large hospital — and there was no major breach which prompted the action. This signals a potential sea-change in HIPAA enforcement, and all providers should be prepared to heed the lessons to be learned.
What Happened (or More Importantly, What Didn’t Happen)
A report to the HHS Office of Civil Rights (“OCR”) that the practice was posting clinical and surgical appointments for its patients on an Internet-based calendar that was publicly accessible triggered the enforcement. OCR followed up with an extensive investigation and, according to Leon Rodriguez, director of OCR, it uncovered a “multi-year, continuing failure on the part of this provider to comply with the requirements of the Privacy and Security Rules.”
Specifically, the practice failed to:
Indeed, the investigation uncovered staggering non-compliance for significant periods of time.
Why This Matters
Unlike the highly publicized incidents of HIPAA violations involving hospitals and stolen hard drives, unauthorized employee access, or patient information left on a subway, OCR decided to pursue (and thereby make an example of) a small physician practice for violations of HIPAA. This means that no provider, large or small, can put its head in the sand and ignore its legal obligations to protect both the privacy and security of patient information. In addition, no longer can providers cross their fingers and hope to avoid OCR by simply avoiding the headline-grabbing breaches of sensitive patient information. OCR has made clear that it intends to aggressively enforce all aspects of the HIPAA Privacy and Security Rules, and no provider is immune from enforcement.
Takeaways
It goes without saying that securing patient information and avoiding large-scale breaches is a must for every provider. What is now more clear than ever is that all providers must also proactively assess their compliance with all other aspects of the HIPAA Privacy and Security Rules. Providers should learn from this most recent enforcement, and promptly develop a strategy and assemble a team to do the following:
And if providers do decide to post patient appointments on-line, please note that OCR has made very clear that they are not to be publicly accessible.
The Kasich administration announced on Friday that it will merge the Ohio Departments of Mental Health (ODMH) and Alcohol and Drug Addiction Services (ODADAS). ODMH Director Tracy Plouck will lead the new agency, and ODADAS Director Orman Hall will maintain a cabinet-level position. Additional information can be found here:
Joint letter from ODMH and ODADAS
Columbus Dispatch article
Vorys Health Care Advisors’ president, Maureen Corcoran, was recently quoted in the Cincinnati Enquirer’s article “Big changes coming at Ohio Medicaid.” Read the article to learn more about important Medicaid initiatives and how they will impact Ohio Medicaid consumers, providers, and stakeholders.
The Ohio Office of Health Transformation is working with the Ohio Department of Job and Family Services’ Office of Ohio Health Plans and the Ohio Department of Mental Health to implement several new Medicaid behavioral health policy initiatives. To help psychiatric hospitals and other residential providers of behavioral health services understand and respond to these initiatives, our webinar will address the following:
To RSVP or for more information, contact Kayla Allen at ksallen@vorys.com.
Login information and materials will be provided before the webinar.
The presentation will be followed by a question-and-answer session.
About Vorys Health Care Advisors
Ideas. Strategies. Solutions. Action.
With a unique combination of Medicaid, public policy, financial and clinical experience, VHCA helps stakeholders meet the challenges of a complex, rapidly changing state and federal health care environment. We offer clients innovative strategies and the kind of counsel that leads to well-informed decisions — and action that gets results. Learn more at vorysHCAdvisors.com.
In fiscal year 2009, Ohio hospitals received nearly $408 million in Federal disproportionate share hospital (DSH) payments. One provision of the Patient Protection and Affordable Care Act (ACA)—coupled with Ohio’s methodology for determining how DSH payments are allocated—will reduce important funding for Ohio’s safety net hospitals.
In the early 1980s, Federal legislation established a requirement that States consider special payment needs of hospitals that serve a large portion of Medicaid and uninsured patients. The rationale for the DSH program was that hospitals that provide high volumes of care to low-income patients often lose money as a result of low Medicaid reimbursement and high levels of uncompensated care. Moreover, unlike other hospitals, they have fewer privately insured individuals onto which the costs of uncompensated care can be shifted.
In large part, high-DSH hospitals are either public hospitals, children’s hospitals, hospitals located in areas of greater economic distress, or private non-profit hospitals with a mission of providing access to care regardless of ability to pay.
Full implementation of the ACA in 2014 will add approximately 15 million Americans—nearly 1 million of them Ohioans—to the Medicaid program, thanks to expansion of the program to anyone younger than 65 with an annual income of up to 138% of the Federal poverty level—$31,809 a year for a family of four in 2012. In order to generate proposed savings to the health care system, and because the ACA will expand coverage to millions of currently uninsured Americans, Congress targeted Medicaid DSH payments for a reduction, reasoning that the program won’t need to be funded at its current level because hospitals currently receiving DSH payments to cushion the blow of providing uncompensated care will instead receive reimbursement from Medicaid or other insurance plans.
DSH payments will decrease by $14.1 billion between 2014 and 2020, with the reduction per year more heavily weighted towards the end of the decade. DSH cuts will be split among States based on the overall size of DSH participation per State. When making DSH allocation decisions, the HHS Secretary is instructed to make the biggest reductions to States with the lowest percentage of uninsured individuals or to States that do not target their DSH payments to hospitals with high Medicaid caseloads and high levels of uncompensated care.
In the aggregate, the reduction of DSH payments is a means of equalizing the benefit to providers of the increase in payments resulting from patients with newly issued insurance coverage. However, the disturbing reality is that these cuts to DSH payments will occur, while the projected decrease in uninsured or underinsured patients is not assured—it may vary drastically from one provider to another, creating unintended winners and losers. The ACA does not require that Medicaid DSH reductions be tied directly to increases in insurance coverage. Rather, they will be based on a State’s population of uninsured individuals and its methodology for distributing DSH payments.
Maureen Corcoran is quoted in a March 13th Cincinnati Enquirer story entitled “Ohio getting older.” The story highlights statistics on the growing number of Ohioans who are reaching the age of 65 and outlines the impact this increasing population will have on both the Ohio Medicaid program and local government services.
The story states:
“Ohio’s Medicaid costs of about $4.8 billion this year are nearly one-fifth of the state budget and growing.
‘We know that our current system cannot handle what’s coming,’ said Maureen Corcoran, former assistant deputy director of Ohio Medicaid and now president of consultant Vorys Health Care Advisers in Columbus.”
To read the entire article, please visit the Cincinnati Enquirer website.
Thanks to the many health care professionals and children’s advocates from around Ohio and beyond who participated in our Medicaid teleseminar last week! Participants from at least five states, including all regions of Ohio, took part in the learning opportunity. Our focus on Ohio’s Office of Health Transformation initiatives and other states’ coordinated care delivery systems proved to be of interest to approximately 60 listeners. We especially appreciate the participation of our friends at the Centers for Medicare and Medicaid Services.
We understand that others of you were not able to listen, so we’ve posted a recording of the call, in addition to the PowerPoint presentation and supplemental materials we shared last week (one on Medicaid managed care authorities and state examples and another on ACOs).
Thanks, too, to our partners at Vorys, Sater, Seymour and Pease for sharing space in their teleseminar series!
Please join Vorys and Vorys Health Care Advisors for a complimentary teleseminar, Thursday, February 16 from 12:00 – 1:00 p.m. (Eastern Time).
Teleseminar PowerPoint presentation
Teleseminar Supplemental Materials
The Deloitte Center for Health Solutions recently published a piece highlighting the GOP presidential candidates’ positions on health care.
This helpful chart (located a third of the way down the page) illustrates their plans for the Affordable Care Act, Medicare and Medicaid, public health and wellness, and other insurance industry issues.
Check it out to stay informed on an issue that matters.