Category Archives: Consumers

CMS Issues 2012 Nursing Home Action Plan

The Centers for Medicare and Medicaid Services (CMS) recently announced the issuance of the 2012 Nursing Home Action Plan (S&C:12-39-NH).  The 39 page action plan focuses on goals of further improvement of nursing home quality.    The plan outlines three objectives:  1) better care for individuals; 2) better health for the populations; and 3) lower cost through improvement.  Continue reading

Veterans On Waiver Programs Get Larger Personal Allowance

On June 18, 2012, Judge Sandra Beck of the US District Court for the Southern District of Ohio sided with a group of  Veterans Affairs (VA) pension recipients in Ledford, et al., vs. Michael B. Colbert, director, Ohio Department of Job and Family Services, Case No. 1:10-cv-706.

Judge Beck  found that the Ohio Department of Job and Family Services (ODJFS) violated federal law by not providing recipients of the Medicaid assisted living waiver a $90 Personal Needs Allowance (PNA) in the patient liability calculation of their Medicaid budget when the individual is a recipient of VA Aid and Attendance benefits. Continue reading

The U.S. Supreme Court Rules on the ACA – The Individual Mandate is Constitutional

This morning, June 28, 2012, the United States Supreme Court released its decision upholding the constitutionality of the individual mandate – the centerpiece of President Obama’s health care law.

The individual mandate requires that all Americans maintain “minimum essential” health insurance coverage. Beginning in 2014, individuals that do not comply with the mandate must make a “shared responsibility payment” to the Federal Government. The amount of the payment varies with household income, subject to a floor and a ceiling based on the average annual premium that the individual would have to pay for private health insurance.

Interestingly, the Supreme Court rejected the Obama administration’s argument that the individual mandate was permissible under the Commerce Clause, instead concluding that the individual mandate was permissible under Congress’ taxing authority.

Another key provision of the Affordable Care Act is the expansion of the Medicaid program. The Affordable Care Act expands the scope of the Medicaid program and increases the number of individuals that states must cover. For example, the Act requires state programs to provide Medicaid coverage to adults that earn up to 133 percent of the federal poverty level. Many states only provide Medicaid to individuals whose incomes are significantly lower.

While the Act increases federal funding to cover the states’ costs in expanding coverage, it also threatened to withdraw all federal Medicaid funds for failure to comply. This morning, the Supreme Court ruled that while it was permissible to expand the Medicaid program, the Act could not withdraw existing Medicaid funds for states that opt out of the expansion.

A copy of the full opinion can be found here–> USCT ACA Opinion

For more information on the U.S. Supreme Court’s decision,  please feel free to contact any member of our health care practice group for a further discussion.

Please all check back here often for further posts on the decision.

HHS Announces $100,000 HIPAA Settlement with a Physician Practice

On April 17, 2012, the U.S. Department of Health and Human Services announced that Phoenix Cardiac Surgery, P.C. agreed to a $100,000 settlement for the continuing failure of the covered entity from complying with the HIPAA Privacy and Security Rules. (HHS Press Release) The settlement also included the requirement of the implementation of an extensive corrective action plan to bring the covered entity into compliance with the HIPAA Privacy and Security Rules. The settlement came about after an investigation by the HHS Office of Civil Rights in response to a report it received related to the covered entity’s practice of posting protected health information on an Internet-based calendar accessible by the public.  Continue reading

Benesch Health Care Attorney Published in AHLA’s HIT News

Frank Carsonie, Chair of our Health Care Practice Group, co-authored the article Reducing Risk in the Electronic Implementation of Electronic Records Systems: Practical Considerations and Benefits of a Risk Assessment in the March 2012 issue of HIT News published by the American Health Lawyer’s Association. Frank co-authorized the article with John DiMaggio, CEO of MCS2 Solutions, a veteran in the area of health care information technology solutions and privacy and security protections. The article provides a road map for organizations considering risk assessments for compliance with HIPAA and discusses some of the more common obstacles to completing a meaningful risk assessment and fully deploying a risk management plan.

The HIT Newsletter article* by Frank and John can be viewed here.

*Copyright 2012 American Health Lawyers Association, Washington, DC  Reprint permission granted.

HHS and Other Federal Departments Issue New Rule on Health Plans

The U.S. Departments of Health and Human Services, Labor and Treasury issued a final rule on February 9, 2012 requiring health insurers and group health plans to provide consumers with an easy-to-understand summary of benefits and coverage and a uniform glossary of commonly used health insurance terms. These disclosure requirements are intended to help those shopping for insurance, as well as those already enrolled in a plan, to make comparisons to better evaluate their health insurance coverage options. The Final Rule is slated for publication in the February 14, 2012 Federal Register. Continue reading

HHS Expands Initiative to Combat Fraud and Abuse

On November 22, 2011, the U.S. Department of Health and Human Services (“HHS”) announced the award of another $9 million in grants from CMS to assist 52 Senior Medicare Patrol (“SMP”) programs across the nation in their efforts to fight Medicare fraud. Continue reading