New Michigan Law Related to Billing Sexual Assault Survivors for Costs of Forensic Exam

Billing Sexual Assault Survivors for Costs of Forensic ExamHealth care providers may no longer seek payment directly from sexual assault survivors for any portion of the costs of a sexual assault medical forensic examination, including any insurance deductible, co-pay, denial of claim or other out-of-pocket expenses, if the survivors do not have insurance, or if they refuse to have the claim submitted to their insurance carrier. Instead, effective December 29, 2008, health care providers are eligible to seek reimbursement for these costs directly from the state Crime Victims Services Commission (formerly the Crime Victims Compensation Board).

Prior to seeking reimbursement from the Crime Victims Services Commission, health care providers must advise the patient, either orally or in writing, that a claim will not be submitted to their insurance carrier without their express written consent and that they may decline to consent if they believe that submitting the claim would substantially interfere with their personal privacy or safety. If the patient declines to have the claim submitted to his or her insurance carrier or if the patient is uninsured, the provider may then seek reimbursement from the Crime Victims Services Commission. The provider may not bill the patient directly.

If the patient consents to have the claim submitted to his or her insurance carrier, the health care provider must submit the claim to the patient’s insurance carrier, including Medicare or Medicaid. If reimbursement cannot be obtained from the patient’s insurance carrier, the health care provider may then submit the claim for reimbursement to the Crime Victims Services Commission. If reimbursed by the patient’s insurance carrier for any portion of the claim, the health care provider may not also seek reimbursement from the Crime Victims Services Commission or the patient for the balance of the claim.

In order to be eligible for reimbursement, the examination must include all of the following: collection of a medical history, a general medical examination, a detailed oral, anal, or genital examination, and administration of a sexual assault evidence kit and related medical procedures and laboratory and pharmacological services.

The Crime Victims Services Commission will not pay more than $600 for the cost of performing a sexual assault medical forensic examination. This includes payments up to $400 for the use of an emergency room, clinic, or examination room and the sexual assault medical forensic examination, up to $125 for laboratory services, and up to $75 for dispensing pharmaceutical items related to the sexual assault.…

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OCR Contemplates Electronic Medical Record Networks

health law careIn case you missed it, on December 15, 2008, the Office of Civil Rights published information that suggests it is thinking about how HIPAA applies to the electronic exchange of health information in a networked environment. If you want to review the materials for yourself, they are located here.

In summary, so long as the primary purpose for and function of an electronic network is treatment oriented, HIPAA should not be a barrier to the development of an effective network. OCR’s focus in its comments was on setting up electronic exchange networks so as to create a level of trust between patients and the covered entities participating in these networks. OCR recommends that patients be advised, either in the Notice of Privacy Practices or in some other document, that their health information will be used and disclosed for treatment purposes through an electronic network.

Some of the other points made by OCR in this guidance includes the following:

While covered entities are not required to agree to allow patients to restrict otherwise permissible uses and disclosures of their information, a covered entity must have policies in place to deal with the issue and if a covered entity does agree to allow certain restrictions, the covered entity must abide by that agreement, except in an emergency situation;
OCR acknowledges that HIPAA does not require a covered entity to allow patients to “opt-in” or “opt-out” of an electronic network but suggests that the ability to afford patients that kind of choice will help build trust between patients and providers who use electronic networks;
Minimum necessary concepts apply to the electronic networks and the access of health information for payment and health care operations purposes through such networks;
Regardless of the scope or purpose of an electronic health information exchange network, any disclosures of health information by a covered entity through the network must comply with the Privacy Rule and, in addition must also be in compliance with any more stringent State law requirements;
Even in an electronic exchange environment, the HIPAA Privacy Rule requirements that patients consent to the disclosure of psychotherapy notes still applies;
Covered entities who set up electronic health information exchange networks must implement appropriate administrative, technical and physical safeguards to protect the privacy of the protected health information; and
Covered entities that participate in an electronic network need to be aware that whatever information they import into their electronic records via a network become a part of their legal medical record. However, network participation alone does not make all of the information about a patient that is accessible through the network a part of their legal medical record.

Overall, given the clients that I have worked with who are setting up, trying to set up, or thinking about setting up these kinds of electronic exchange networks, the OCR guidance is not overly enlightening but still helpful in that it confirms that there is a right way and a wrong way to set up such a network and that if you have the right goal — facilitating better access to information for treatment purposes — you should be able to get where you are trying to go.…

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EMTALA – Covering Emergency Call Through Community Plans

Centers for Medicare and Medicaid ServicesOn July 31, 2008, the Centers for Medicare and Medicaid Services (CMS) released its FY 2009 final rule for the Inpatient Prospective Payment System. Included with in the manyy regulatory changes contained in this final rule are new provisions regarding the requirements of the Emergency Medical Treatment and Active Labor Act (EMTALA). Among these are new rules for hospitals to develop “community on-call plans” as a means of meeting their on-call services obligations under EMTALA.

The new rules allow for two or more hospitals to collaberate to develop a community on-call coverage plan that applies within a specific geographic area and divides the coverage of certain types of services between the participating hospitals at designated times. Specifically, a formal community on-call plan among a group of hospitals needs to include:

A clear delineation of on-call responsibilities for each hospital participating in the plan;
A description of the geographic area covered by the plan;
the signature of an appropriate representative of each participating hospital;
Assurances that local and/or regional EMS protocols include information on any such community on-call arrangements;
A statement from each hospital participating in the plan affirming their respective obligations under EMTALA to perform medical screening and stabilizing treatment within its capacity, and to comply with EMTALA transfer and acceptance of transfer requirements; and
An annual assessment by the participating hospitals of the efficacy of the plan.

Hospitals subject to EMTALA who struggle to maintain adequate ER coverage of key specialty areas including orthopedic surgery, cardiology and neurology should review these new rules and evaluate the potential to work with neighboring health care institutions to take advantage of this new opportunity as a way to better serve their communities and ease the often unweilding burden on specialty staffing caused by the EMTALA requirements.…

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