Upcoming Deadlines a Medical Practice Should Keep In Mind

With the traditional summer behind us, here are some upcoming deadlines to keep in mind this Fall:  on Sept. 23, the HIPAA-HITECH omnibus final regs become enforceable by the government; Oct. 9 is the effective date of legislation enacted during the First Regular Session of the 126th Legislature; and on Oct. 25, the processing of Medicare claims in Maine moves from NHIC to NGS. 

See articles below for more details on both the HIPAA regulations and the processing of the Medicare claims.  The effective date of legislation enacted this past session is Oct. 9 (90 days following final adjournment) except for those bills in which a different effective date was specifically set forth in the legislation.  This latter exception would include all the bills that passed as emergencies and became effective upon the Governor's signature.

Each issue of the Weekly Update is featuring an explanation of an enacted bill that would be of particular interest to physicians or medical practices, prepared by Associate General Counsel Jessa Barnard, J.D.

State Sells Liquor Revenue Bond; Governor Signs Bond Package, Riverview Bill

The State of Maine's liquor revenue bond has been sold, according to a press release issued today from Governor Paul LePage. The revenue bond, part of Governor LePage's plan for a new wholesale liquor contract, will be used to repay $183.5 million in debt the state owes to Maine hospitals. This payment will trigger a federal match of $305 million.  The full payment is expected to be paid during the month of September.

The Governor also announced last week that he was signing a package of bond bills totaling $149.5 million for infrastructure projects, college and university improvements and rehabilitation of Maine's National Guard armories, as well as a bill to address safety concerns at the State's psychiatric hospital. The Legislature approved these measures in a special session held last Thursday. 

This past session, the Governor proposed LD 1515, "An Act To Increase the Availability of Mental Health Services", to establish an inpatient-level treatment facility within a correctional institution. The bill - intended in part to address long wait times to admit patients to Riverview - was passed by initial votes in the Legislature, but carried over to the 2014 session due to a $3 million price tag.  In the meantime, the Administration learned that certification of Riverview was in jeopardy for its Medicare deficiencies, which requires compliance with the Centers for Medicare and Medicaid Services.  LD 1515 gained attention in order to address some of the issues raised by the CMS audit, though Legislators and the Administration acknowledget that it does not resolve all of the concerns. 

The Legislature wants to be more involved in understanding the issues raised by the CMS audit and LD 1515 includes a legislative oversight committee that will monitor the changes at Riverview.

The Administration submitted a plan of correction in response to the CMS audit this summer and received a letter last week from the Centers for Medicare and Medicaid Services accepting the state's plan of correction for Riverview.

Room Block Expires Today for MMA Annual Meeting, Oct. 4-6, in Portland

Registration for the meeting and a full schedule of events is available on MMA's website. Registration materials were also mailed to each member in July.  Room reservations at the Holiday Inn by the Bay can be made by calling 1-800-345-5050.  Call soon, as the room block expires on Sept. 3rd.

Potential exhibitors and sponsors should contact Lisa Martin at MMA (lmartin@mainemed.com or call 622-3374 ext. 221) [return to top]

WINXNET Offers Free HIPAA Security Audits to 20 MMA Members

Compliance with the HIPAA Security Rule can be daunting. It can be even more difficult when you don’t have a firm grasp on the underlying technology. When you dig deep and try to understand the tasks and procedures you need to protect electronic data, you are likely to encounter technical terms and IT buzzwords that are confusing.

Winxnet, a HIPAA compliant IT consulting and outsourcing firm, has worked with hundreds of healthcare organizations to help them understand and cost-effectively address their technology needs.  The Winxnet Security & Compliance Health Check is designed to help healthcare organizations quickly cut through the confusion by providing answers to the question, “Do I have the correct administrative, physical and technical controls in place to pass an audit?”

How does it work? It’s simple and can be completed in one day.  

A team of Winxnet Certified HIPAA Security and Compliance Professionals will conduct a health check which includes the following steps:

1. Review a short list of questions with you.  
2. With your permission, run a secure software program to gather information about the state of your information security.
3. Conduct a vulnerability scan of your internal network (Internal test). 
4. Conduct a vulnerability scan of your firewall (External test). 
5. Review the documented findings with you.  

After gathering the needed information the team will analyze the data, document findings and recommendations, and review them with you with a clear path forward. 

The results of the findings may include steps you need to take towards full compliance with the HIPAA Security Rule.  If you need outside support to address some or all of the recommendation towards full compliance, Winxnet has a team of Certified HIPAA Security and Compliance Professionals ready to assist.

Through the MMA and our strategic partnership, this Health Check valued at $949 is being offered at no cost for the first 20 MMA members.  If interested, send an email to HIT@winxnet.com or call 207.780.0497 and reference the MMA.  [return to top]

New Laws Impacting Your Practice: LD 534, Disclosure of Mental Health Information

Each week MMA is running weekly articles highlighting new laws passed by the 126th Legislature that impact the practice of medicine in Maine.  We are also happy to present an overview of new laws to your medical staff, practice or specialty society and have posted a summary of laws and explanatory slide presentation on the MMA website. 

LD 534 changes the way some mental health information can be shared with the goal of increasing coordination of care.  MMA supported the law change. 

Currently, Maine law requires a patient's authorization to disclosure their health information outside of the office or facility where the services were provided if it reflects mental health services provided by a clinical nurse specialist, psychologist, social worker, LCPC or psychiatrist.  

LD 597 allows disclosure of information reflecting mental health services provided by these clinicians without authorization to another health care practitioner, facility or payor for purposes of care management or coordination of care. Disclosure of psychotherapy notes remains governed by HIPAA.  The practice disclosing the information is still required to make a reasonable effort to notify the individual of the disclosure. 

The new law goes into effect on October 9th and the full text can be found here.

With questions or for more information contact the MMA at jbarnard@mainemed.com or gsmith@mainemed.com.  [return to top]

Compliance Deadline for New HIPAA Rules Approaching Sept 23

The Sept. 23 compliance deadline for the omnibus rule/HITECH amendments to the Health Insurance Portability and Accountability Act (HIPAA) is just around the corner.  

Your practice will need to ensure compliance with the changes in the Privacy Rule, Breach Notification and Security Rule.  MMA has tools and resources to assist you, incuding a sample Notice of Privacy Practices, Sample Business Associates Agreement and overview slide presentation.  See http://www.mainemed.com/education-info-cme/hipaa for more information.  

Here are some key steps you should be taking between now and September 23rd: 

1. Update your Notices of Privacy Practices to comply with the new HITECH requirements. The amended Notice of Privacy Practices should be posted in a prominent location, placed on your website (if you maintain a website), given to new patients, and made available upon request to existing patients who have already received and signed a Notice of Privacy Practices.

2. Update and revise existing business associate agreements to address the final rule provisions and obtain new business associate agreements as needed. (Note that covered entities that have business associate agreements that were effective before Jan.25, 2013 have until Sept. 23, 2014 to update them.)

3. Update your breach response policies. The Final Rule changed the definition of “breach” as well as the risk assessment that must be undertaken to determine if there has been a breach. It is more likely that an impermissible access, use or disclosure of PHI will be a “breach” necessitating notification to the individual, HHS, and possibly the media. Breach response policies should reflect the new standards.

4. Review and update your HIPAA Policies and Procedures Manual. Perform a "gap" analysis to determine what changes are needed to existing HIPAA policies and procedures and update them accordingly. It is important to ensure that the policies and procedures accurately reflect both the new rules and the operations of your practice. 

5. Notify business associates of their obligation to comply with the HIPAA Security Rule and certain parts of the HIPAA Privacy Rule. 

6. Train your employees on the new HIPAA requirements.  Document the training.  MMA attorneys are available to come to your practice to train you and your employees on the new requirements. 

Contact Jessa Barnard at jbarnard@mainemed.com for more information.   [return to top]

Employers Required to Notify Employees of Health Insurance Marketplace By Oct 1

Beginning January 1, 2014, individuals and employees of small businesses will have access to health insurance through a new competitive private health insurance market – the Health Insurance Marketplace. Section 18B of the Fair Labor Standards Act, as added by the Affordable Care Act, generally provides that an applicable employer must provide each employee at the time of hiring (or with respect to current employees, not later than October 1, 2013), a written notice about the heath insurance marketplace and health insurance options.  

Employers are required to provide the notice to each new employee at the time of hiring beginning October 1, 2013 or to all current employees no later than October 1, 2013.  The requirement applies to employers to which the FLSA applies.

The notice must include: 

• Informing the employee of the existence of the Marketplace (referred to in the statute as the Exchange) including a description of the services provided by the Marketplace, and the manner in which the employee may contact the Marketplace to request assistance;
• If the employer plan's share of the total allowed costs of benefits provided under an employer's health insurance plan is less than 60 percent of such costs, that the employee may be eligible for a premium tax credit if the employee purchases a qualified health plan through the Marketplace; and
• If the employee purchases a qualified health plan through the Marketplace, the employee may lose the employer contribution (if any) to any health benefits plan offered by the employer and that all or a portion of such contribution may be excludable from income for Federal income tax purposes.

For more information, and sample notices based on whether you currently offer health insurance to your employees, see: http://www.dol.gov/ebsa/healthreform/ [return to top]

MMA Webinars: The Affordable Care Act Marketplace Update, Sept 11 & 25

The Affordable Care Act: Marketplace Update (and more)

September 11th, 12-1:30 pm or 

September 25th, 12-1:30 pm 

Presented by CarePartners - MaineHealth, Consumers for Affordable Health Care, Maine Medical Association/Maine Medical Education Trust, and the Maine Primary Care Association.  

Topics will include: 

• The ACA Overview: What has happened so far
• Details on coverage, enrollment and subsidies for the new health insurance marketplace opening Oct 1 
• Where to send patients for assistance in enrollment and how practices and health systems can help with enrolling the uninsured
• Implications for practices and health care systems

Free and open to any hospital or medical practice staff, administrators or clinicians. To register, contact Jill Barkley at jbarkley@mainemed.com.   Log in information will be emailed after registration.   

Supported with funding from the Maine Health Access Foundation.  

Processing of Medicare Claims Transitioning to NGS on Oct. 25

On Feb. 22, 2013, CMS made a contract award to National Government Service (NGS) for Jurisdiction K (Maine, New Hampshire, Vermont, Massachusetts, Rhode Island, Connecticut and New York) for the processing of Medicare claims for both Part A and Part B.  In doing so, CMS consolidated the contracts for what was previously known as Jurisdiction 13 (Ct. and NY) and jurisdiction 14 (remaining New England states).  The effective date of the change from the current NHIC states for Part B claims is Oct. 25, 2013.  NGS will also be responsible for processing Medicare home health and hospice claims in all the New England states.  NGS is a subsidiary of Wellpoint and has extensive experience across the country in administering Medicare claims.  NHIC, which has been the part B carrier in Maine for several years will still have a role in the process, but will provide that service as a contractor to NGS.

This change represents implementation of the plans of CMS to contract with fewer carriers across the country. MMA staff recently met with NGS representatives and discussed this significant change and came away from the meeting believing that NGS is committed to a smooth transition.

National Government Services has been working with NHIC to identify differences between their business practices.

They have identified the following areas where providers may notice a difference in the JK MAC:

• Local coverage determinations (LCDs) are being standardized throughout the jurisdiction
• New electronic data interchange (EDI) connectivity front end (M2)
• New P.O. Box numbers for use with JK MAC
• New interactive voice response/recognition (IVR) format for use with JK MAC
• New toll-free customer care telephone numbers for use with JK MAC
• New business organization telephone numbers for use with JK MAC
• Fax on demand option (available through IVR)
• Telephone Reopening Unit (TRU) telephone numbers and process (available for Part B providers)
• Medical records are not accepted via fax
• New contractor ID numbers

First Friday's Educational Programming Resumes on Sept. 6 with the Annual Risk Management Seminar

On Friday morning, Sept. 6, three senior risk managers from Medical Mutual Insurance Company of Maine will present three current risk management topics at MMA's offices in Manchester (also offered via webex).  

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