Join Vorys attorneys Lisa Pierce Reisz and Liam Gruzs for the third complimentary webinar in a series of three focused on discussing the release of the final omnibus HIPAA rule by the U.S. Department of Health and Human Services. The new rule includes sweeping changes to the HIPAA Privacy and Security Rules.
Tuesday, May 21, 2013 Noon – 12:30 p.m. (Eastern Time)
- Analysis of unauthorized access, use, or disclosure
- Meaning of “breach”
- Documentation requirements
- Notification requirements – affected individuals, media, and HHS
- Breach prevention
- Robust compliance efforts
- Insurance products
Click here to register or for more information.
Earlier this week, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule that cuts federal payments to hospitals for uncompensated care. What still remains unclear, however, is how these cuts will impact states that do not expand their Medicaid programs.
The Affordable Care Act (ACA) requires significant cuts to Disproportionate Share Hospital (DSH) payments beginning in federal fiscal year 2014. These payments compensate hospitals for the cost of providing uncompensated care to uninsured and underinsured individuals. Congress imposed the cuts on the theory that ACA reforms, such as expansion of Medicaid to additional low-income populations, would decrease the number of individuals without health insurance, thus decreasing the amount of uncompensated care provided by hospitals.
The Supreme Court decision on the constitutionality of the Medicaid expansion made it optional for states. The Court did not, however, address the DSH cuts. A number of states have announced that they will not expand Medicaid, and policymakers in other states, including Ohio, continue to vigorously debate the issue. States that choose not to expand Medicaid may not see the reduction in the number of uninsured that expansion states will. Since the ACA links the cuts in part to states’ relative levels of uninsured, one consequence is that states that choose to expand Medicaid could see a larger reduction in DSH funds than those that do not.
The ACA specified the aggregate amount of annual DSH cuts ($18.1 billion through 2020), but outlined only general principles for how the cuts would be implemented and required the Secretary of Health and Human Services to design a methodology for the cuts based on those principles. Currently, each states receives an annual allotment of DSH funds and has a great deal of discretion on how to allocate those funds to hospitals within the state. The ACA specified that the methodology designed by CMS must impose smaller reductions on low DSH states (as defined in statute) and larger reductions on states with the lowest percentages of uninsured individuals and those that do not target DSH payments to hospitals with high volumes of Medicaid inpatients or high levels of uncompensated care. Finally, CMS must take into account any DSH allotment amounts that a state included in a budget neutrality calculation for a coverage expansion approved under a Section 1115 waiver.
CMS has proposed a methodology that would allocate cuts to state DSH allotments in FY 2014 and 2015. The total required cuts ($500 million for 2014 and $600 million for 2015) would be allocated proportionately between high DSH and low DSH states. Then CMS would calculate a reduction for each state by applying a formula that gives equal weight to factors that represent the state’s insured numbers relative to other states and the extent to which it targets DSH funds to high Medicaid volume and high uncompensated care hospitals. Applying the proposed methodology, CMS estimates that Ohio’s DSH allotment would be reduced by $23.4 million in FY 2014, a reduction of 5.41 percent from what it otherwise would receive for that year.
In the preamble to the proposed rule, CMS addresses the dilemma regarding states that do not adopt the Medicaid expansion, noting that it needs additional information on the impact of state decisions to implement the expansion. Further, CMS asserts that the data necessary to address the issue may not be available until 2016. Therefore, CMS proposes to apply its methodology for FY 2014 and 2015 and to address FY 2016 and beyond in future rulemaking.
Do you ever think about how the Ohio Constitution impacts health care in Ohio? Consider the following:
- The constitution governs debt limits and bond ratings, both of which are important issues to Ohio businesses, including hospitals and other health care organizations.
- The constitution authorizes the use of state funds to assist with low-income housing from which disabled Ohioans and others may benefit.
- The constitution indicates that the state has an obligation to care for those who are seriously and persistently mentally ill or developmentally disabled.
Additionally, if you’ve been following the news recently, you may have read that advocates for Medicaid expansion in Ohio are preparing a ballot initiative – a potential proposal to amend the Ohio Constitution to provide access to affordable health care through the Medicaid expansion – in the event that legislative efforts fall short.
As Ohio undertakes a review of the state constitution, we will look to the experience, caliber, and integrity of those afforded the responsibility to lead the discussion.
Our colleague, Fred Mills, is one such leader. Fred, a partner in the Vorys Columbus office and head of the firm’s government relations group, has been selected to serve as the chair of the Ohio Constitutional Modernization Commission’s (OCMC) Legislative Branch and Executive Branch Subcommittee. The Commission is tasked with developing recommendations to the General Assembly for improving and modernizing Ohio’s Constitution, and the Subcommittee will be responsible for drafting recommendations on legislative and executive matters.
We look forward to these discussions, especially as they impact Ohio’s citizens and the health care services they need. We are confident that the fate of Ohio’s Constitution is in the capable hands of Fred and the rest of the Commission.
The Health Policy Institute of Ohio (HPIO) has recently added to its collection of Medicaid resources a brief focused on projected new employment and new local general sales tax revenues due to Medicaid expansion. Governor Kasich’s budget proposal includes language expanding Medicaid eligibility up to 138% of the federal poverty level, or $32,499 for a family of four. The fate of Medicaid expansion in Ohio now rests with the Ohio House of Representatives, where the budget is currently being considered.
In recent months, the partners in the Ohio Medicaid Expansion Study, which include HPIO, the Ohio State University, the Urban Institute, and Regional Economic Models, Inc., have released several publications highlighting the Study’s independent analysis of the likely impact of Medicaid expansion on Ohio. As reported by HPIO, the analysis indicates that:
- Expansion would create savings and new revenue that would exceed the cost to the state, resulting in an additional estimated $1.8 billion to $1.9 billion in net fiscal gain in the nine-year period between 2014 and 2022.
- An additional 450,000 Ohioans would gain health coverage because of the expansion.
- All 88 counties would realize a drop in the uninsured rate, an increase in tax revenue, and an increase in employment due to expansion.
HPIO’s website includes a variety of other helpful resources on Medicaid expansion and Medicaid more generally.
In a post on the Vorys HealtHITech Law Blog, Vorys attorney Robin Canowitz discusses EMR privacy issues unique to children, including parent access, patient portals, sharing among institutions, and role based access.
Join Vorys attorneys Lisa Reisz and J. Liam Gruzs on Tuesday, March 19th, noon-12:30 p.m. (Eastern Time) for a complimentary webinar to further discuss the release of the final omnibus HIPAA rule by the U.S. Department of Health and Human Services. The new rule includes sweeping changes to the HIPAA Privacy and Security Rules.
This presentation will discuss:
- Greater restrictions on provider use and disclosure of PHI
- Limitations on uses and disclosures for marketing and fundraising
- Prohibition on covered entity sale of PHI
- Increased individual rights to PHI
- What must be done by September?
- Revise Notice of Privacy Practices
- Update internal policies
- Associate training
RSVP or for more information: Contact Kayla Allen at email@example.com.
Follow developments at the HealtHITech Law blog.
Vorys, Sater, Seymour and Pease LLP recently announced that former Ohio Senate President Thomas E. Niehaus will join Vorys Advisors LLC.
Niehaus was a state senator from 2005 to 2012 and served as president of the Ohio Senate from 2011 to 2012. He also served in the Ohio House of Representatives from 2001 to 2004. Niehaus earned praise from 100 Capitol Square Insiders as the “best listener” and ranked as one of the top ten “most effective” state legislators.
Vorys Advisors is a wholly owned affiliate of the firm that provides business and strategic counsel to the law firm’s clients and other businesses and organizations. It is led by retired Congressman David L. Hobson (R-OH), and former Congressman Zack Space (D-OH) is a principal.
Niehaus will work in the firm’s Cincinnati office and maintain an office in Columbus.
Vorys Health Care Advisors professionals, Maureen Corcoran and Daphne Saneholtz, along with Vorys attorney Suzanne Scrutton, will present How the Governor’s Executive Budget Impacts Providers 12 pm – 1 pm (Eastern time) on February 21.
The presentation will discuss:
- Impact of the following on providers:
- Budget proposals affecting the behavioral health, developmental disability, child welfare, and juvenile justice systems
- Budget proposals affecting provider compliance requirements
- The proposed Medicaid expansion
- Update on key Ohio Medicaid-related projects, including health homes, the integrated care delivery system, managed care, and Ohio’s plan to streamline the Medicaid eligibility system.
Speakers: Maureen Corcoran, Daphne Saneholtz, and Suzanne Scrutton
To RSVP or for more information, contact Kayla Allen at firstname.lastname@example.org.
Log-in information will be provided before the session. The presentation will be followed by Q&A.
Vorys’ 2013 Health Care Webinar Series includes monthly programs focused on the changing legal, regulatory, and policy issues facing the health care industry.
The MetroHealth System announced on Tuesday that the federal government has approved its plan to provide a medical home and health coverage for up to 30,000 uninsured residents of Cuyahoga County.
The program, called MetroHealth Care Plus, is designed to provide the high-quality services people need to maintain their health, while also reducing health care spending.
The MetroHealth System will finance this care locally with the $36 million annual subsidy it receives from Cuyahoga County taxpayers, which allows the MetroHealth Care Plus program to leverage another $64 million in annual federal Medicaid matching funds. No state dollars are being used to pay for the demonstration project.
Primary care will be provided by The MetroHealth System’s 17 locations, Neighborhood Family Practice and Care Alliance, all of which carry the distinction of being designated as Level 3 Patient-Centered Medical Homes by the National Committee for Quality Assurance (NCQA).
MetroHealth will also partner with other community agencies to help deliver the care, including Recovery Resources, Murtis Taylor Human Services System, Catholic Charities Services, and Stella Maris, among others, as well as a network of ancillary service providers. MetroHealth Care Plus claims processing and related support functions are being provided in conjunction with a third party administrator vendor, Medical Mutual of Ohio Inc.
To be covered under MetroHealth Care Plus, Cuyahoga County residents must be:
- 19 to 64 years old
- Not eligible for regular Medicaid
- Income at or below 133% of the Federal Poverty Level ($14,856 a year for a family of one)
- U.S. citizen or legal resident of the United States for seven years
Enrollees of MetroHealth Care Plus will be assigned to a primary care provider who will coordinate all of their health care. These patients can obtain covered benefits from network providers for such health care services as:
- Preventive exams
- Doctor visits
- Prescription medications
- Hospital care
- Emergency services
- Dental care
- Physical and speech therapies
- Home health care
- Mental health services
- Nutrition counseling
- Alcohol and drug abuse services
- Durable medical equipment
- Transportation to MetroHealth medical appointments
The program is currently underway.
On Monday, February 4th, Governor John Kasich proposed that Ohio will expand Medicaid benefits to individuals earning up to 138% of the federal poverty level (FPL) (about $15,800 for an individual and $32,500 for a family of four). The Affordable Care Act (ACA) originally made such an expansion mandatory, but the Supreme Court’s ruling on the constitutionality of the ACA later made the expansion optional for states. States that choose to expand Medicaid will receive enhanced federal reimbursement—beginning at 100% and moving down to 90% in later years—for individuals newly eligible for Medicaid under the expansion. Governor Kasich also indicated that the Obama Administration is willing to engage in a conversation regarding affording flexibility to states in implementing a Medicaid expansion; specifically, allowing individuals earning between 100% and 138% of the FPL to receive subsidized coverage through the Health Insurance Exchange.
Expanding Medicaid will provide health coverage to many of the 1.5 million Ohioans with no way to pay for health care and no reliable access to medical treatments. According to the Ohio Alliance for Health Transformation, it is estimated that approximately 600,000 Ohioans will gain coverage under the expansion. Also, the expansion will result in more than $23.8 billion in additional federal funds flowing into Ohio’s economy through 2019. This money will support Ohio’s health care economy, including hospitals, health systems, and their employees. Importantly, the expansion will also mean that Ohio’s economy benefits from a healthier workforce.
According to the Governor’s Office of Health Transformation, the Governor is proposing new Medicaid cost sharing requirements for every adult earning more than 100% of the FPL. The state will require an $8 copayment for use of an emergency department for non-emergency conditions, $8 co-pays for nonpreferred drugs, and $3 co-pays for preferred drugs. Certain long-term maintenance drugs (such as insulin) will have no co-pay. Additionally, the Executive Budget includes an automatic opt out trigger so that if for any reason the federal government reduces its enhanced financial participation for expanded coverage, then the program for newly eligible groups shuts down.
Governor Kasich made this announcement as part of his 2014-2015 executive budget proposal. The matter, along with all other budget proposals, next moves to the General Assembly for debate.