How CON Laws Influence Hospice Quality, Program Integrity [Featuring HHAC]

Hospice News / By Holly Vossel

Variations in hospice certificate of need (CON) state laws are raising program integrity concerns.

However, this coin has two sides. CONs have a big role to play when it comes to quality and utilization, according to Susan Ponder-Stansel, president and CEO of Florida-based Alivia Care.

“What ends up happening in states without CON is actually lower hospice utilization with way too many hospices in one service area, and often fragmented care without all four levels of hospice offered,” Ponder-Stansel told Hospice News. “In states with CON, we see much higher utilization rates and more scaling down on quality. You can’t create an unlimited demand or more demand without understanding consumer preferences and regulatory barriers. You have to walk in line with the [patient] demand and regulatory requirements.”…

If a state does not have a CON program in place, then local governing bodies are often unable to play a direct role in the hospice needs determination process, according to Matt Hansen, deputy director of the Home Care and Hospice Association of Colorado (HHAC). Hansen also serves as executive director of the Homecare & Hospice Association of Utah (HHAU).

“They may be aware of a need due to reports from referring parties that they aren’t able to find a provider. However, approving a new license is not based on how many providers are already in an area,” Hansen said.

Without having a role in the determination process, it can make it difficult to balance quality with supply and demand of hospice in a region, according to Hansen.

“Demand and supply of hospice resources is balanced by market conditions,” Hansen said. “If there are too many hospices in an area to meet current demand, those hospice agencies that do not have a large enough referral base and patient census will typically flounder until they sell to another provider or close.”

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Breaking Down Biden's $7.3T Proposed Budget for 2025: Here are his Top Health Priorities

Fierce Healthcare / By Noah Tong

President Joe Biden unveiled a proposed $7.3 trillion budget for fiscal year 2025 on Monday, which continued upon and expanded key health items from previous years.

The administration said his budget (PDF) will lower healthcare costs and drug prices, expand access to prescription drugs, build upon the Affordable Care Act (ACA) and fortify Medicare through a tax on the wealthy. Many of these priorities were previewed during Biden's State of the Union address last week.

Biden argues his plan will reduce the deficit by $3 trillion, whereas Republican-backed plans do the opposite over 10 years. The national debt would rise to $45.1 trillion by 2034.

"The national debt is on a steady march upwards, and it would take nearly $8 trillion of savings just to stabilize the debt over the next decade," said Maya MacGuineas, president of the Committee for a Responsible Federal Budget, in a statement. "It’s dangerous that we’ve let things get this bad, and we need to treat it like the priority that it is. The President’s call for over 3 trillion of deficit reduction is a welcome start, and he deserves credit for presenting a budget that pays for new initiatives and improves our fiscal situation, but the budget doesn’t go nearly far enough."

Department of Health and Human Services (HHS) Secretary Xavier Becerra said the fiscal year budget proposes $130 billion in discretionary spending and $1.7 trillion in mandatory funding.

While not necessarily a focus of the budget itself, much of the news briefing was dedicated toward the administration's stance on defending abortion rights.

"The department is fighting tooth and nail to protect and expand reproductive health care including making contraception, IVF, and basic pre- and postnatal healthcare not only available, but more affordable," said HHS Deputy Secretary Andrea Palm during a press briefing.

Becerra said federal agencies are focused on how they can help protect reproductive rights. He cited the FDA working to protect patient access to mifepristone along with the Office of Civil Rights allowing patients to receive the right care for them.. He also referenced the Braidwood case, where the federal government is trying to protect the ACA's preventive services clause in court, and the Centers for Medicare & Medicaid Services (CMS) working to provide adequate maternal health care.

Click here for three of the top health policies to be aware of in the budget.

 

That’s A Wrap! CDC Reduces Recommended COVID-19 Isolation Period

Littler / By Devjani Mishara and Alka Ramchandani-Raj

On March 1, 2024, the Centers for Disease Control and Prevention announced that it is updating its COVID-19 guidance and is no longer recommending that individuals who test positive for COVID-19 isolate for five days.  The agency is recommending a new, “unified approach” to respiratory viruses, including not only COVID-19 but also flu and respiratory syncytial virus (RSV). 

Under the new guidance, individuals should monitor themselves for various respiratory virus symptoms, including fever, chills, fatigue, cough, runny nose and headache.  Those who develop such symptoms are recommended to “stay home and away from others,” but also advised that they can return to normal activities “when, for at least 24 hours,” their symptoms are improving and they have not had a fever without the use of fever-reducing medication.  The CDC’s recommendations are now independent of whether an individual actually has tested positive for COVID-19 or any other respiratory virus, and do not include any minimum isolation period.

What does this mean for employers?

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DOJ Says “Knock on Our Door Before We Knock on Yours”

By Elizabeth E. Hogue

On March 7, 2024, the U.S. Department of Justice (DOJ) announced a new pilot program that includes financial incentives for whistleblowers to report violations. The new pilot program will be launched later this year following a process to develop and implement the pilot, which is expected to take ninety days.

The DOJ likens this new program to “the days of ‘Wanted’ posters across the Old West” in the sense that law enforcement has historically benefited by offering rewards for tips and information. When whistleblowers help the DOJ discover significant misconduct, they may benefit financially from monies recovered.

The goals of the pilot program are to:

  • Produce more evidence for successful white-collar criminal prosecutions
  • Impose more significant penalties on wrongdoers
  • Aid in prosecution of large-scale misconduct

Here are some details:

  • The core principle is that when individuals help DOJ identify significant misconduct that is otherwise unknown to DOJ, they may qualify to receive a portion of any resulting recoupments.
  • Payments to whistleblowers will be available only when:
    • All victims are properly compensated before whistleblowers
    • Whistleblowers provide truthful information
    • Information provided by whistleblowers is not already known to the DOJ
    • Whistleblowers are not involved in criminal activity
    • No other relevant financial disclosure incentive exists

The DOJ says that it expects the pilot program to increase the likelihood that employees will decide to report misconduct to the DOJ without first notifying companies that employ them. This result will significantly decrease benefits to companies that decide to self-report because the benefits of self-reporting are available only then the government does not already know about the misconduct. This incentive may produce a race to the DOJ by employers and their employees reminiscent of races to the courthouse. 

These incentives also underscore the importance of making it clear in Compliance Programs that employees and contractors are required to report alleged misconduct to their employers/partners first before they tell outside third-parties. Certain woe will come to companies that ignore these allegations or, God forbid, retaliate against potential whistleblowers. 

The DOJ and other fraud enforcers are generally enamored with whistleblowers and the information they provide. They are perhaps even more enamored with encouraging companies to self-report.

©2024 Elizabeth E. Hogue, Esq. All rights reserved.

No portion of this material may be reproduced in any form without the advance written permission of the author

 

Implementing HIPAA Security Rule: A Cybersecurity Resource Guide

NAHC

The Department of Health & Human Services (HHS) Office for Civil Rights (OCR) and the National Institute of Standards and Technology (NIST) announced the publication of the final version of Special Publication (SP) 800-66 Revision 2, Implementing the Health Insurance Portability and Accountability Act (HIPAA) Security Rule: A Cybersecurity Resource GuideThis revised publication, a collaborative effort between NIST and OCR, includes resources for HIPAA covered entities (most health care providers, health plans and health care clearinghouses) and their business associates to help their understanding of the HIPAA Security Rule, drive compliance with the law and bolster security. This is the latest action in this work for HHS, who released a Department-wide Cybersecurity strategy for the health care sector in December of 2023, and voluntary performance goals to enhance cybersecurity across the health sector in January 2024.

The publication provides an overview of the HIPAA Security Rule, strategies for assessing and managing risks to electronic protected health information (ePHI), suggestions for cybersecurity measures and solutions that HIPAA covered entities and business associates might consider as part of an information security program, and resources for implementing the Security Rule. Specific topic areas include:

  • Explanations of the HIPAA Security Rule’s Risk Analysis and Risk Management requirements.
  • Key Activities to consider when implementing Security Rule requirements.
  • Actionable steps for implementing security measures.
  • Sample questions to determine adequacy of cybersecurity measures to protect ePHI.

In addition to the publication itself, NIST has also provided supplementary content on its website to further assist HIPAA covered entities and business associates with strategies to improve their cybersecurity in specific areas including:

  • Telehealth/Telemedicine
  • Mobile Device Security
  • Ransomware & Phishing
  • Medical Device Security
  • Cloud Services
  • Internet of Things Used in Healthcare
  • Application Security
  • Supply Chain

NIST also updated its Cybersecurity and Privacy Reference Tool (CPRT). The CPRT shows HIPAA Security Rule regulations with links to additional NIST tools

OCR also maintains information on its website to assist regulated entities with their obligations to protect ePHI including HIPAA Security Rule Guidance Material and Cybersecurity Guidance Material.

 
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