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Effective January 1, 2011:

John S. Conniff and John C. Peick have separated and lead new law firms. Both partners will continue to work together through their new firms. Peick|Conniff, P.S. will become:

Peick Law Group, P.S. and John S Conniff PLLC

Washington Insurance Commissioner Interpretations of Health Care Reforms:

Does the restriction on lifetime limits apply to transplant benefits? Although PPACA leaves it to HHS to define essential benefits, transplants are not currently identified in the general list of these benefits contained in Section 1302. We continue to maintain that a lifetime limit for transplants is acceptable, provided that limit is exhausted only by transplant related services. Non-transplant related services falling within the scope of essential benefits should be covered without limitations.

May carriers continue to impose benefit-specific annual dollar limits on essential benefits? We believe that PPACA addresses only overall annual limits rather than benefit-specific annual dollar limits. Failure to permit carriers to continue to impose benefit-specific annual limits for essential benefits such as medical equipment, medical supplies, and preventive care may result in more harm to the health insurance market prior to the major market reforms in 2014. Requiring carries to discontinue this common practice may compel discontinuation of certain essential benefits prior to 2014 or the imposition of premium increases that make coverage cost prohibitive.

Is the Washington chemical dependency benefit minimum considered a permissible restricted annual limit on essential benefits?Although the current chemical dependency benefit minimum amount is not specifically payable on an annual basis, our interpretation of the benefit specific dollar limit for this coverage is the same as with other benefit-specific annual dollar limits on essential benefits. Prior to 2014, we will allow carriers to continue to include the benefit minimum established under Chapter 284-53 WAC in their contracts.

Read John Conniff's Health Care Reform Blog

Health Care Practitioners - National Provider Identification numbers booklet available. HIPAA mandated the adoption of a standard, unique health identifier for every health care provider. CMS (the Centers for Medicare and Medicaid Services) has just published an informational booklet on the NPI for providers wishing to learn more. NPI Booklet

HHS Issues new regulations increasing HIPAA violation penalties - On October 30 [Happy Halloween], the U.S. Department of Health and Human Services issued new interim final regulations substantially increasing penalties for HIPAA violations and removing some defenses against penalties. These changes follow Congressional action earlier in the year that beefed up HIPAA standards and enforcement. You will be punished for violations that occur after February 18, 2009, as follows:

• If you did not know of the violation and would not have known even with reasonable diligence, the civil fine is at least $100 for each violation up to $50,000 for each violation.
• If the violation was due to "reasonable cause" but not "willful neglect", the civil fine is at least $1,000 for each violation.
• If the violation was a result of "willful neglect" and the problem is fixed within 30 days of violation, the minimum fine is $10,000 for each violation.
• If the violation was a result of "willful neglect" and the problem is not fixed within 30 days of violation, the minimum fine is $50,000 for each violation.
• There is an annual limit of $1.5 million in fines for identical violations.

You may still avoid penalties if you correct the problems within 30 days and the violation is not due to "willful neglect." Willful neglect means in essence, that you just didn't care whether you met your obligations under HIPAA. Read the Regulation

Information:

Electronic Medical Records - A very useful guide to electronic medical records has been developed by the Texas Medical Association. With permission, we have included a link to the report here. The Electronic Medical Record Implementation Guide, The Link to a Better Future was developed by the Texas Medical Association Special Funds Foundation through a grant from The Physicians Foundation. The Physicians Foundation devotes its resources to helping practicing physicians improve the care they deliver to their patients. The Foundation provides grants to nonprofit organizations for practice-based, innovative projects that improve the quality of healthcare. For more information visit: www.physiciansfoundation.org.

OIG & CMS Gear up for HIPAA security audits - Lawyers for health care practitioners are getting ready to defend against federal audits of health care practitioners and hospitals for compliance with HIPAA security regulations.  While HIPAA compliance is scalable, if you have not done a self-audit of your clinic or facility, now is the time. Also, if you have not trained you staff as required by HIPAA, HCCS has  an interactive course to train staff in HIPAA Privacy and Security which has been updated within recent months. HIPAA Training