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Showing 7 posts from July 2014.

Update: CMS Issues Revised Guidance on Hospice & Part D Prior Authorization Process

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A few weeks ago, we discussed CMS’ newly-issued guidance establishing a prior authorization process for Hospice and Part D providers (read more here). As our previous blog post emphasized, soon after its March 10 implementation, advocacy groups, Hospice associations, and Members of Congress began urging CMS to suspend the process. According to opponents, the prior authorization requirement creates a barrier for beneficiaries to access necessary medications and leaves them to navigate complicated payor disputes in the midst of their terminal illnesses. More >

Labs & Referring Physicians Take Note of OIG’s Special Fraud Alert

Recently, the U.S. Department of Health & Human Services, Office of Inspector General (“OIG”) issued a Special Fraud Alert (“Alert”) entitled, “Laboratory Payments to Referring Physicians.” The Alert focuses on (1) Specimen Processing Arrangements and, (2) Registry Arrangements. These arrangements, according to the OIG, pose substantial risks for fraud and abuse under the federal Anti-Kickback Statute. More >

New Part D Regulations Face Increased Scrutiny from Advocacy Groups & Congress

On March 10, 2014, the Centers for Medicare & Medicaid Services (“CMS”) issued a memorandum to Part D Plan Sponsors and Medicare Hospice Providers entitled, "Part D Payment for Drugs for Beneficiaries Enrolled in Hospice – Final 2014 Guidance" (“Guidance”).   The Guidance, effective since May 1, 2014, requires a prior authorization process for Hospice and Part D providers to determine their respective responsibility for drug coverage. The Guidance followed a 2012 OIG report entitled "Medicare Could Be Paying Twice for Prescription Drugs for Beneficiaries in Hospice,” which found that Medicare Hospice patients’ medications were sometimes paid for by Part D rather than by the patient’s Hospice program. More >

New Law Affecting APRNs Takes Effect Today

Today, Senate Bill 7, signed by Governor Beshear on February 26, 2014, becomes effective. The new law allows for an Advanced Practice Registered Nurse (“APRN”) to request to discontinue a Collaborative Agreement for Prescribing Authority for Non-Scheduled drugs (“CAPA-NS”) after having a CAPA-NS in place for four years. Specifically, the new law states: More >

Have You Reviewed Your Existing Business Associate Agreements?

Pursuant to the HIPAA Final Omnibus Rule (“Final Rule”), covered entities and their business associates were required to enter into new business associate agreements (“BAAs”) or modify existing BAAs by Sept. 23, 2013. However, existing BAAs that (i) were entered into on or before Jan. 25, 2013; (ii) met the requirements that were applicable prior to the promulgation of the Final Rule; and (iii) were not modified after March 26, 2013, have until Sept. 23, 2014 to be updated. That deadline is quickly approaching. More >

OCR Offers “Lessons Learned” Regarding HIPAA Compliance, Part II

On Tuesday, some of the details of OCR’s recently released Breach and Compliance Reports were discussed. In addition to detailing facts and figures from cases involving breaches in 2011 and 2012, the Breach Report includes an important “Lessons Learned” section that all covered entities and their business associates should review. Based upon reported breaches, the OCR has outlined some specific areas of concern, which include the following: More >

OCR Offers “Lessons Learned” Regarding HIPAA Compliance

Two recent reports issued by the HHS Office for Civil Rights (“OCR”), pursuant to the HITECH Act, reveal some interesting information about HIPAA data breaches. The Annual Report to Congress on Breaches of Unsecured Protection Information (“Breach Report”) and the Annual Report to Congress on HIPAA Privacy, Security, and Breach Notification Rule Compliance (“Compliance Report”) should remind covered entities and their business associates about the many risks associated with HIPAA and the importance of compliance. More >

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