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& Medical Provider Attorneys

Free Introductory Home Health Visits Don’t Violate Anti-Kickback Law

Anti-Kickback StatuteInspector General: No Kickback violation for free home health introductory visits

The Office of the Inspector General issued an advisory opinion clearing the way for home health providers who provide “introductory” home visits to individuals who eventually become their clients. The OIG advised that home healthcare providers who contact  patients after being selected by that patient and provide information to those patients about their services, do not violate the federal Anti-Kickback statute.

The Federal Anti-Kickback law makes it a criminal offense to knowingly and willfully offer, pay, solicit or receive anything of value in exchange for inducing or rewarding referrals of items or services reimbursable by a Federal health program

The OIG’s office stated that the “primary purpose of the Introductory Visit is to facilitate the patient’s transition to home health services in an effort to increase compliance with the post-acute treatment plan.” In addition, the OIG”s noted that during the “Introductory” visit, the health care provider ‘”does not provide any type of  any federally reimbursable diagnostic or therapeutic services during the Introductory Visits,” which occur where a patient is receiving care whether it’s a physician’s office, hospital or personal home. Further, the home health provider is not involved in any way in the patient’s selection process and “Introductory Visits” do not provide any actual or economic benefit to the patients. .

It’s important to reiterate, that healthcare providers should not contact the patient prior to receiving notification from the  patient that they have been selected nor can the “Introductory Visits” be a covered service under Medicare or Medicaid, or reimbursed by third-party payors. These actions could violate the Anti-Kickback statute.

To read the full opinion, click here.

For more information, please contact Kimberly Sheridan at 678-708-4703.

DCH’s “Engagement Process” Now Official

DCH Policy As of July 2015, the Department of Community’s Health’s “Engagement Process” became an official part of its Policy and Manual, section 402.5(b).

The “Engagement Process” offers providers an opportunity to discuss findings of an audit or other proposed adverse action and to possibly resolve the matter prior to any request for an Administrative Review during an Engagement Conference.

However, we strongly advise you to contact an attorney prior to requesting an Engagement Conference to help ensure the best possible outcome. 

Here is what you need to know:

  • PURPOSE: The purpose of the Engagement Conference is to discuss a proposed adverse action “with the goal of informally resolving the matter.”
  • WHO INITIATES: You. A provider may request an Engagement Conference following receipt of Initial Findings of Notice of Proposed Adverse Action letter
  • PROVIDER TIME DEADLINE: This request must be in writing within seven (7) calendar days of receipt; and submitted to Engagement@dch.ga.gov.
  • DCH TIME DEADLINE: The Engagement Conference must be held with twenty-one (21) calendar days of the receipt of the Request.
  • WAIVER: If you do not participate in the Engagement Conference and fail to provide the Department prior written notice of your absence, you waive your right to an Engagement Conference. Notice should be submitted to Engagement@dch.ga.gov. This waiver does not preclude you from requesting an Administrative Review.
  • SETTLEMENT:“The Engagement Conference is considered settlement talks, and therefore, is not admissible in any pending or future proceeding, including Administrative Review or Administrative Hearing.” This includes conduct during conferences, notes, and correspondence.
  • ACCEPTANCE/REJECTION: You have seven (7) calendar days from the date of the Conference to accept or reject the offer in writing.
    • Acceptance must be in writing and waives your right to an administrative review.
    • If you reject the offer, you have the Right to Request an Administrative Review pursuant to Policy and Procedures Manual Sections 402.6 and 505.

Remember to print a copy of any communication you have with DCH and always ask for a “read receipt” when you send an email to DCH.

If you have received a Proposed Adverse Action from the Department, please contact Kimberly Sheridan at ksheridan@jeylaw.com or 678-708-4703 for assistance.

CMS Proposes 2 New Stark Exceptions

drIf adopted, the new exceptions will provide physicians with more options when setting up financial arrangements with hospitals.

On July 15, the Centers for Medicare & Medicaid Services (CMS) published several proposed changes to the Stark regulations as well as two new exceptions. The changes made pursuant to the proposed rule would clarify certain requirements which must be met for many of the Stark Law exceptions.

One notable change would impact several Stark exceptions (e.g., office space and equipment rental, personal service arrangements, physician recruitment arrangements, etc.) which require that an arrangement be either “in writing” or memorialized in a “written agreement.” If adopted, the proposal would make the writing requirement uniform throughout by replacing “written agreement” with “in writing.” CMS’s comments further clarify that a formal contract is not required. Rather, if under the circumstances it is appropriate, the writing requirement may be satisfied with a collection of “contemporaneous documents evidencing the course of conduct between the parties.”

CMS also provides clarification on how to satisfy Stark exception requirements that are conditioned on having an arrangement that lasts at least one year. According to CMS, a “formal contract or other document with an explicit ‘term’ provision is generally not necessary to satisfy the [one-year-term] element.” An arrangement that lasts at least one year satisfies the requirement.

The two new Stark Law exceptions involve payments related to employment of non-physician practitioners and timeshare arrangements for the use of office space, equipment, supplies, etc. The first exception would allow hospitals, Federally Qualified Health Centers and Rural Health Centers to subsidize physicians for the cost to employ physician assistants, nurse practitioners, clinical nurse specialists and certified nurse midwives up to a certain amount. The goal of the proposed exception is to promote the expansion of access to primary care services.

The other proposed exception would protect timeshare arrangements if certain requirements are met. Such arrangements would need to be between a hospital or physician organization (licensor) and a physician (licensee) for the use of the licensor’s premises, equipment, personnel, items, supplies, or services. Additionally, the licensed premises, equipment, personnel, items, supplies, and services would need to be used predominantly for evaluation and management services to patients of the physician.

If adopted, the new exceptions will provide physicians with more options when setting up financial arrangements with hospitals. However, CMS also clarifies and broadens certain limitations — the percentage of a hospital that may be owned by physicians will now encompass all physician owners, regardless of whether a physician owner refers patients to the hospital.

The CMS publication can be read here.

If you have any questions about the CMS guidance and proposed changes, our attorneys can help. Please contact Danielle Hildebrand at dhildebrand@jeylaw.com at 678-325-3872

 

What To Do When Your Special Needs Child Completes High School

ClassroomPictPart I: The Path To Employment

As our children begin to enter into early adolescence, many of us begin to realize that many – if not all – of the services and programs that our child relies on for care will soon disappear and be replaced by radically different benefits.

Most of these new benefits abruptly come into play once our children leave the public education system. This may happen at any time between the ages of 18 and 23, depending on the state you live in and your child’s particular needs.

One of the most important aspects of this transition is securing employment services for our children. According to the National Collaborative on Workforce and Disability, one-quarter of all adults with disabilities work at either a full- or part-time job.

Some of the remaining three-quarters are unable to work at all due to their disability; but a large number of disabled adults who aren’t employed don’t have a job because they lack the skills necessary for gainful employment. Several federal laws address this situation with the goal of providing vocational education to a wider segment of the population with disabilities.

The Individuals with Disabilities Education Act (IDEA) mandates that special education plans begin transition planning when a child turns 14. At this point, a written transition plan must be incorporated into a child’s Individual Education Plan (IEP), outlining the steps a school will take to help a child with special needs acquire skills necessary for an eventual move into the workforce.

By the time the child turns 16, the special education team must steer the child towards development programs keyed towards the child’s individual vocational preferences. The law also mandates periodic measurement of the child’s progress to ensure that he receives attention from the proper vocational advocates.

Once your child reaches 18 and receives either Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) payments, the Social Security Administration (SSA) offers several programs to encourage your child to work. The best-known program, Ticket to Work, is a somewhat complicated program designed to offer beneficiaries a way to begin a career without having to worry about losing their SSI or SSDI benefits.

SSI beneficiaries, on the other hand, must conform to very strict income and asset limits. Often, beneficiaries who could hold a job do not pursue one because they are worried that they will lose their SSI benefits once they earn too much. While this is certainly a concern, the benefits of employment may outweigh the loss of SSI. Furthermore, the government provides specific incentives for SSI beneficiaries to work. For instance, if a person with disabilities is under 22 and at school or in a vocational training program, $1,780 of his monthly income does not count against his SSI benefit, up to a yearly limit of $7,180.

The Social Security Administration also offers the PASS (Plan for Achieving Self Support) program for SSI beneficiaries who would like to work. Under this program, a beneficiary presents the SSA with a detailed plan for obtaining a specific type of employment. Once the SSA approves the plan, a beneficiary sets aside income and assets towards achieving her goal without having those funds count against her benefit. Funds can be used for things like childcare, transportation, books and supplies, and additional education and training.

Many programs are available for people with special needs to seek employment if they would like to do so. Unfortunately, the rules for most of these programs are complicated and the SSA is often not very good at explaining them.

Beginning to plan well before your child completes high school – with the assistance of local vocational agencies and qualified special needs planners – is your best chance for successfully navigating the maze of educational opportunities for your child.

 

 

Georgia to Hire Private For Profit Company to Oversee Medical Care of Foster Children

Streamlined Managed CareThe state is planning to streamline the medical care of children in foster care, adoption assistance or the juvenile justice system by transitioning to a managed care model.

Currently, the change in the living situation of these children may result in a change in doctors and incomplete medical records, which can ultimately result in complications when doctors are not aware of medical history or allergies.

Under the managed care model, the children will have one primary care physician and their records will be stored electronically, allowing for continuity of care and access to information regardless of where the child is living.

In addition to potentially saving the state $27.5 million over five years, the move to managed care may result in healthier children. Other states using the managed care model for foster children have reported decreases in the use of psychotropic medication and increases in health risk screenings.

Georgia plans to hire one of the three for-profit care management organizations in the state that currently oversee the provision of care to children and pregnant women who receive Medicaid.

Further, a quarterly oversight committee will be established that is comprised of representatives from several agencies to monitor the progress under the managed care model.

The managed care model for children in foster care, adoption assistance or the juvenile justice system may potentially provide less confusion for physicians and a greater continuity of care for children.