The Joint Commission, one of the nation’s top accreditation organizations for health care providers, has published a variety of useful resources for health care organizations.  The resources provide some excellent coverage and are useful for all providers who are facing the Coronavirus pandemic.  The Joint Commission says that its goal in creating the resource page is to support health care professionals and organizations on the front lines of the COVID-19 pandemic.  Perhaps the biggest highlight of general application is the Joint Commissions “Real Voices. Real Stories.”  The Real Voices includes stories from a variety of front-line health care workers. 

You can download a PDF file of “Real Voices. Real Stories” at the following link: Real Voices PDF Download

Some of the stories in the “Real Voices” section include coverage of a Joint Commission Life Safety Coach Surveyor  and an emergency department nurse at one of the largest hospitals in Chicago, among others.

The Joint Commission website includes a variety of other resources.   The Joint Commission does not have the largest list of resources.  Instead, the Joint Commission’s goal is to attempt to cut through the deluge of information on the COVID-19 virus and provide “only the information that best meets the needs of health care workers and leaders.”

Wisconsin Prohibited Maneuvers and Techniques in Community Based Programs

The Wisconsin Department of Health Services (DHS) as released a memo that specifies maneuvers or techniques that may not be used at any time in community based programs and facilities. DHS deems the prohibited maneuvers or techniques to “present an inherently high risk of serious injury and even death.”  Providers are directed by DHS to immediately discontinue the use of any of the listed maneuvers.  Prohibited maneuvers, techniques, and procedures that may not be used under any circumstances include:

• Any maneuver or technique that does not give adequate attention and care to protection
  of the head.
• Any maneuver or technique that places pressure or weight on the chest, lungs, sternum,
  diaphragm, back, or abdomen.
• Any maneuver or technique that places pressure, weight, or leverage on the neck or throat, on any artery, or on the back of the head or neck, or that otherwise obstructs or restricts the circulation of blood or obstructs an airway, such as straddling or sitting on the torso, or any type of choke hold.
• Any maneuver or technique that involves pushing into a person’s mouth, nose, or eyes.
• Any maneuver or technique that utilizes pain to obtain compliance or control, including punching, hitting, hyperextension of joints, or extended use of pressure points.
• Any maneuver or technique that forcibly takes a person from a standing position to the floor or ground. This includes taking a person from a standing position to a horizontal (prone or supine) position or to a seated position on the floor.
• Any maneuver or technique that creates a motion causing forcible impact on the person’s head or body, or forcibly pushes an individual against a hard surface.
• The use of seclusion where the door to the room would remain locked without someone having to remain present to apply some type of constant pressure or control to the locking mechanism.

DHS explains in the memo that the ultimate goal is to replace such interventions with trauma-informed systems and settings, positive behavior supports, and non-coercive intervention strategies. DHS promotes recovery and healing that is consumer-driven, person-centered, trauma-informed, and recovery-based.

In addition to describing measures that are completely prohibited, DHS states that restrictive measures that are not prohibited may only be used in emergency situations in which there is an imminent risk of serious harm to self or others, or as part of an approved plan. Situations in which the person’s behavior was foreseeable based on his or her
history are not considered an emergency.   Even restrictive measures that are not directly prohibited must be avoided whenever possible and may only be used after all other feasible alternatives, including de-escalation techniques, have been exhausted. When necessary, restrictive measures may only be used with the minimum amount of force needed, and for the shortest duration possible, to restore safety.

Facilities should review their policies and practices to assure compliance with the guidelines set forth in the memo. Additional staff training should be conducted to assure compliance with these standards.   Additionally, providers should become familiar with the changing standards of care and best practices focused on building skills and techniques to de-escalate and redirect behaviors that present safety concerns, and work earnestly to promote a trauma-informed culture of care.

Health Care Blog Articles Published by John Fisher

Here is a list of some of the recent health law related blog articles that I have recently posted across several different blog sites:

HIPAA Breach Notification Settlement – First Case of Untimely Notice of Breach

OIG Annual Work Plan for 2017 – Topics Covered

Skilled Nursing Facility and Nursing Home Initiatives OIG 2017 Annual Work Plan

Don’t Overlook Special Status of Behavioral Health Records

Off-Campus Provider-Based Departments Site-Neutrality

21st Century Cures Act Signed by President Obama

US Attorney Manual Updated to Incorporate Yates Memorandum DOJ Directives Incorporating the Yates Principles

Certification of Investigation of Individual Wrongdoing Under the Yates Memorandum

How Should Compliance Process Integrate the Yates Memorandum?

New Federal Prosecution Standards Require Revisions to Investigation Policies

300 Pages of New Regulations Ruining Health Care Attorney Lives Across the Country

60 Day Repayment Rule Affordable Care Act

ACO Primary Care Exclusivity Requirement – Not As Broad As Some Believe

Ambulatory Surgery Center Advisory Opinions

Antitrust Law Application In Rural Areas- Hospital Mergers

Antitrust Market Analysis In Provider Integration

Antitrust Policies Avoiding Spillover – Clinically Integrated Networks

Auditing Physician Payments For Stark Law

Bundled Payment Arrangements for Clinically Integrated Networks

Certification of Investigation of Individual Wrongdoing Under the Yates Memorandum

Clinical Integration Readiness Analysis CINs

CMS Releases Final Rules Under Medicare Shared Savings Program

CMS Releases the First Comprehensive Overhaul of Nursing Home Conditions of Participation in Over 25 Years

False Claims Act Basics – Known Overpayment Becomes False Claim

False Claims Act Liability – Conditions of Participation and Conditions of Payment

Final Rule Under the Medicare Shared Savings Program Released

HHS Releases Inflation Adjusted Federal Civil Penalties

How Should Compliance Process Integrate the Yates Memorandum?

Incident To Billing Rules Changed In New CMS Regulations

Major Revamp of Nursing Home Regulations Proposed By CMS

Medicare Shared Savings Program Changes Under 2016 Physician Fee Schedule Regulations

Medigap PHO Discount Program Receives OIG Approval

New Federal Prosecution Standards Require Revisions to Investigation Policies

Off-Campus Provider-Based Departments Neutrality

OIG Fraud Alert – Medical Director Compensation Arrangements

Outpatient Surgery Article On Using A Safe Surgery Checklist

Population Health Management and Clinical Integration

President Signs the 21st Century Cures Act

Primary Care Integration Strategies – Divisional Group Practice Mergers

Provider Self-Disclosure Decisions – Voluntary Disclosure Process

Referral Requirements – Can Employed Doctors Be Required to Make Referrals?

Reimbursement for Telemedicine and Telehealth Services

Telemedicine Credentialing By Proxy

When Can Violation of a Condition of Participation Result in False Claims Act Liability? Update on Escobar’s Materiality Standard

Health Care Legislation Signed By Governor Walker 

Wisconsin Governor Scott Walker signed 63 new pieces of legislation into law on April 9, 2014, several of which relate to the health care industry.  The new health care legislation includes the following:

1.         HIPAA Harmonization.  The HIPAA Harmonization Act which changes laws relating to behavioral health records to better align Wisconsin laws to federal HIPAA requirements.  Assembly Bill 453.

2.         Hospital Conditions of Participation.  A new law requiring the Wisconsin Department of Health Services to use Medicare Conditions of Participation when surveying hospitals.  This legislation gives DHS the authority to enforce standards that are contained in federal regulations as the minimum standards for Wisconsin hospitals.  The DHS is required to interpret the conditions of participation using guidelines established by the Federal Center for Medicare and Medicaid Services (“CMS”).  The new standards will apply beginning July 1, 2016.  Senate Bill 560.

3.         Physician Residency Requirement.  Post medical school residency requirements for physicians are increased from one to two years.  New medical school graduates will now be required to complete two years of residency unless they receive an unconditional endorsement from the residency program director.  The new law also creates a new “resident educational license” to replace the current “temporary educational permit.”  A new “administrative physician license” is also created which authorizes physicians to hold a license limited to administrative services.  Senate Bill 579.

4.         Mental Health Pilot Program.  A new pilot program in Milwaukee County was created which allows emergency detention without the involvement of law enforcement in certain circumstances.  Under this bill, the authority to initiate emergency detention is expanded to a “treatment director” or their designee, including a licensed social worker, professional counselor, or psychiatric nurse.  The stated purpose of the pilot program is to reduce stigma in mental health by allowing a clinical approach rather than a law enforcement approach to emergency detentions.  Assembly Bill 500.

5.         Volunteer Health Care Programs.  A law to allow an out-of-state health care professional to partner with a non-profit provider to participate in Wisconsin’s volunteer health care provider program.  The health care provider must have a current license to practice in their home state or territory and must only volunteer within their scope of their practice.  Senate Bill 391.

6.         Provider “Apology” Protection.  A new law which allows a health care provider to have full and frank conversations with patients or patients’ relatives that may include apology, benevolence, compassion, condolence, fault, liability, remorse, responsibility, or sympathy, without risk of admissibility in civil action, administrative hearing, disciplinary proceedings, mediation, or arbitration as evidence of liability.  Assembly Bill 120.

7.         Tribal Treatment Facilities.  A new law that permits an approved tribal treatment facility to assess and treat participants in the intoxicated driver program who are either tribal members or relatives of tribal members.  The bill requires a court to notify the person convicted of operating while intoxicated that the offender is eligible for treatment at the facility and the facility must notify the appropriate county assessment agency within 72 hours of assessing the individual.  Assembly Bill 32.

8.         Annual Mental Health Service Reports.  A new requirement that the Wisconsin Department of Health Services provide a report to the Legislature on January 1 of every odd numbered year that describes what mental health services are being provided by the counties.

9.         Fetal Alcohol Syndrome Reports.  A requirement that hospital employees refer infants to a physician if they suspect the infant has fetal alcohol syndrome.  The physician is then required to evaluate the infant for the syndrome if they determine there is a significant risk of fetal alcohol syndrome.  The physician must then report to the agency responsible for investigating cases of child abuse and neglect.  Assembly Bill 675.

If you require further information on any of these legislative enactments, please contact John H. Fisher, II, CHP, CCEP.  Further updates will also be found at http://www.healthlaw-blog.com.

By John Fisher, JD, CHC, CCEP

Personal Care Service Providers – Wisconsin Medical Assistance

Wisconsin Statute § 49.45(42)(d)3 describes the types of organizations that qualify to receive Medicaid reimbursement for “personal care services.”  Qualified entities include licensed home health agencies and other entities that are certified under section (2)(a)(11) to provide personal care services under section 49.46(2)(b)6j.  The DHS does not appear to have implemented regulations that specifically describe the criteria that “other entities” must meet in order to become qualified to receive reimbursement from Medicaid for the provision of personal care services.

The applicable provisions of section 49.45(2)(a)(11) do not contain specific criteria that “other entities” must meet but simply refers to the requirement that DHS promulgate rules establishing qualifications of providers.  The referenced statutory provision does not refer specifically to the requirements that “other entities” must meet in order to qualify to receive reimbursement for personal care services.

The requirements that must be met in order to become a licensed home health are more extensive than the personal care services entity.  However, becoming licensed as a home health agency will qualify you to provide and bill for personal care services directly.  It would also permit you to bill private pay patients for skilled nursing and other

Read more here: Health Law Blog

  

Nursing Facilities Are The First to Require Compliance Programs

The Patient Protection and Affordable Care Act of 2010 (PPACA) mandates compliance programs for most providers and requires the Secretary of Health and Human Services to publish regulations that establish the core elements for compliance programs.

Nursing facilities are the first providers to be mandated and must comply in 2013. However, CMS missed its statutory deadline of March 23, 2012 for issuing detailed regulations for nursing facility compliance programs. It is expected that these regulations and the requirements for other providers will be forthcoming now that the Supreme Court has opened the way for enforcement.  In the meantime, nursing facilities do not have precise guidance on compliance program requirements. 

Even though final detailed regulations have not been issued, providers should not wait to step up their compliance efforts.  There are many sources for guidance on how compliance should operate.  Providers will be required to certify that their compliance programs are effective in preventing and detecting criminal, civil, and administrative violations and in promoting quality of care.  Simply having a program in place is not enough.  The program must have sufficient operating history to demonstrate that it is “effective.”  Effectiveness reviews should be periodically performed to support the required certifications.

CMS Announces Skilled Nursing Facility PPS Rates for 2013

On July 27, 2012, the Centers for Medicare & Medicaid Services announced PPS increases for skilled nursing facilities for fiscal year 2013. Skilled nursing facilities will receive a 2.5% market basket update which will be reduced by a 0.7% productivity adjustment.
The rate incorporates adjustments for facility case mix. The RUG-IV case-mix classification system provides urban facilities with a 1.9% update and rural facilities with a 1.5% update.

A net Medicare prospective payment system increase of 1.8% ($670 million) will be provided to skilled nursing facilities in fiscal year 2013.

Access the announcement from CMS.