Posts Tagged ‘Elizabeth Hogue’

Elizabeth Hogue on What the Recent Supreme Court Decision Means for Home Care Providers

July 27, 2012

The U.S. Supreme recently issued its opinion in National Federation of Independent Business, et al v. Sebelius, Secretary of Health and Human Services, et al, Case 11-393, decided June 28, 2012. There were two crucial issues decided:

  • Can Congress enact a requirement that individuals must purchase health insurance or pay a penalty, the so-called individual mandate?
  • Can the federal government force the states to expand eligibility for the Medicaid Program by threatening to withdraw all Medicaid funding from States that do not expand eligibility as directed? (more…)

Elizabeth Hogue on the Fundamental Difference Between Home Care and Institutional Care

June 28, 2012

Discharge planners/case managers who work in institution such as acute hospitals, skilled nursing facilities, etc; may not have thought of a fundamental difference between home care and care provided in the institutions in which they work. The difference is that discharge planners/case managers and other staff at institutions have at least fundamental control over the environment in which they provide services. Home care providers, including home health agencies, hospices, HME (home medical equipment) companies and private duty agencies, work in an environment that is completely controlled by patients and their families. They have little or no control over the environment in which they render care to patients. (more…)

Elizabeth Hogue on Identification of Patients in Need of Discharge Planning

June 13, 2012

Part I: Hospital Conditions of Participation for Discharge Planning: Identification of Patients in Need of Discharge Planning

Conditions of Participation (CoP’s) of the Medicare Program for hospitals include CoP’s for discharge planning. This is the first in a series of articles about these requirements. Hospitals that do not meet these requirements may lose their certification and ability to receive payments from the Medicare and Medicaid Programs.

CoP’s governing discharge planning first state that hospitals must have a discharge planning process that applies to all patients. The Centers for Medicare and Medicaid Services (CMS) says that the CoP’s it develops apply to all patients, not only to patients whose care is paid for by the Medicare and Medicaid Programs. (more…)

Elizabeth Hogue on the Proposed Changes to Exemptions for Minimum Wage and Overtime Pay

April 25, 2012

The U.S. Department of Labor (DOL) proposes to revise the current Fair Labor Standards Act (FLSA) regarding the exemption for companionship services and live-in domestic services. The FLSA currently exempts from its minimum wage and overtime provisions domestic service employees employed “to provide companionship services for individuals who because of age or infirmity are unable to care for themselves.” The FLSA also currently exempts workers employed in domestic service in a household and who reside in such households from requirements to provide overtime pay. (more…)

Health Care Reform Part II: Health Care Reform: Disclosure of Items Received by Physicians

March 20, 2012

Special by Elizabeth E. Hogue, Esq.

The Centers for Medicare and Medicaid Services (CMS) issued a proposed rule on December 27, 2011, that implements Section 6002 of the Affordable Care Act (ACA). This proposed rule requires manufacturers of drugs, devices, and biological and medical supplies covered by Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP) to report annually to the Secretary of the U.S. Department of Health and Human Services (HHS) payments or transfers of value provided to physicians and teaching hospitals. Information must be reported in an electronic format by March 3, 2013, and on the 90th day of each calendar year thereafter. The Secretary is required to publish information received from manufacturers on a public website. The goal of this requirement is to provide greater transparency regarding payments and items given to physicians. (more…)

Health Care Reform Part I: Physicians and Patients’ Right to Freedom of Choice of Providers

March 20, 2012

Special by Elizabeth E. Hogue, Esq.

To date, only hospitals are required to present lists of some types of providers to patients so that they can choose which providers they want to render services to them. Likewise, statutes in some, but not all states, require physicians and other types of providers to give notice to patients if they have financial/ownership interests in providers to which they make referrals. As a result of health care reform, the “picture,” with regard to physicians and patients’ right to freedom of choice, is about to change. (more…)

Elizabeth Hogue’s Series on ACOs: Patients’ Right to Freedom of Choice of Providers (Part VI)

February 14, 2012

Patients who are assigned or “aligned” with physicians who participate in ACOs are not required to receive services from such physicians or from any other participants in ACOs. Patients who are aligned with physicians in ACOs still have the right to freedom of choice of all types of providers. The Centers for Medicare and Medicaid Services (CMS) emphasizes this fact in commentary to the final regulations governing ACO’s as follows: (more…)

Elizabeth Hogue’s Series on ACOs: Can Post-Acute Providers Participate in ACOs? (Part V)

January 25, 2012

ACOs seem to be the next “big thing.”  Doctors and hospitals clearly have a role to play in ACOs.  Many post-acute providers, however; including home health agencies, hospices, and HME companies; would like to know if they can also be part of ACOs.  Section 1899(a)(1)(A) of the Affordable Care Act defines ACOs as “groups of providers of services and suppliers” that work together to manage and coordinate care for Medicare fee-for-services beneficiaries.  The statute lists the following groups of providers of services and suppliers that are eligible to participate as an ACO: (more…)

Elizabeth Hogue’s Series on ACOs: The Role of Post-Acute Providers (Part IV)

December 28, 2011

Section 302 of the Affordable Care Act includes provisions related to Medicare payments to providers of services and suppliers that participate in Accountable Care Organizations (ACOs). Providers of services and suppliers who participate in ACOs will continue to receive payments under Parts A and B of the Medicare Program, but will also be eligible for additional payments if they meet certain requirements related to quality of care and cost savings. The Secretary of the U.S. Department of Health and Human Services has published final regulations establishing ACOs as early as April, 2012. (more…)

Elizabeth Hogue’s Series on ACOs: Final Regulations Issued (Part III)

December 20, 2011

Section 302 of the Affordable Care Act includes provisions related to Medicare payments to providers of services and suppliers that participate in Accountable Care Organizations (ACOs). Providers of services and suppliers who participate in ACO’s will continue to receive payments under Parts A and B of the Medicare Program, but will also be eligible for additional payments if they meet certain requirements related to quality of care and cost savings. Proposed regulations to implement these provisions were published in the Federal Register on April 7, 2011.

(more…)