Health Care Today | Health Law Blog

The Office of Civil Rights (OCR) within the Department of Health and Human Services (HHS) has been able to hold “business associates” directly liable for certain HIPAA violations since 2009, with the passage of the Health Information Technology for Economic and Clinical Health (HITECH) Act. Under HIPAA, a “business associate” is an entity that receives protected health information (PHI) in order to provide services to a “covered entity” (such as a health care provider, a health plan, or a heath care clearinghouse).

There has been a lot of movement throughout the country on the state level to prevent patients from receiving surprise medical bills when they receive unanticipated care from out-of-network providers while seeking care from in-network providers. For example, in 2018, Missouri passed such legislation, which banned surprise medical bills for patients who are treated by an out-of-network physician at an in-network emergency room.

The expansion of telehealth is changing the landscape of health care. This is the final installment in a four-part series exploring what providers should know about this growing area.

There are many business models and provider arrangements for the provision of telehealth. Given the regulatory climate and increasing use of telehealth by health care providers and patients, these business models and provider arrangements are continuing to change.

On May 24, 2019, the U.S. Department of Health & Human Services (HHS) announced that it is issuing proposed revised regulations under Section 1557 of the Affordable Care Act that remove the redefinition of “sex” and certain regulatory burdens, including language taglines. The changes substantially roll back the original Obama-era regulations.

Health care transactions can be complex, given the regulatory maze of health care laws and regulations applicable to the entities involved. One way to help mitigate the risks inherent in such transactions is through representations and warranties insurance (“R&W insurance”), which can be purchased by a buyer or seller. R&W insurance is becoming more common in health care transactions as a means to provide buyer and seller more financial certainty in finalizing a deal.

The expansion of telehealth is changing the landscape of health care. This is the third in a four-part series exploring what providers should know about this growing area.

Medicaid programs pay for telemedicine, telehealth and telemonitoring services delivered through a range of interactive video, audio or data transmission (telecommunications). Various state Medicaid programs are experiencing a significant increase in claims for these services and expect this trend to continue.

Many hospitals share space with other health care entities. Despite this, the Centers for Medicare & Medicaid Services (CMS) has given mixed signals — and never issued formal guidance — concerning the permissibility of shared spaces under the Medicare Conditions of Participation (CoP). This has created great confusion and uncertainty for hospitals as they try to meet the challenges of a rapidly changing health care system.

That’s all about to change!

According to the Department of Justice (DOJ), the opioid crisis in the United States is now a national public health emergency. Unfortunately, such pervasive opioid use is presenting prime opportunities for drug manufacturers, health care providers and pharmacies to make money by engaging in various illegal kickback schemes.

On April 23, 2019, the U.S. Department of Health & Human Services (HHS) published a Notification of Enforcement Discretion Regarding HIPAA Civil Money Penalties (CMP) outlining interim annual limits for HIPAA violations. HHS believes the revised annual limits “reflect the most logical reading of the HITECH Act.” These amounts are subject to change pending further rulemaking.

In November 2018, Missouri became the 33^rd state to approve the use of medical marijuana, and rules and regulations for medical marijuana are being drafted by the Missouri Department of Health & Senior Services (DHHS). On March 15, 2019, DHSS released more draft rules. Of the published draft rules, there is only one set that relates to physician certifications. However, hospitals and other health care providers will encounter numerous challenges once medical marijuana becomes available in Missouri in 2020.