The Texas Department of Health and Human Services Commission has adopted several amendments that will affect licensing standards for Home and Community Support Services Agencies, published September 8, 2006.

The rule changes “set for the criteria” used for determining whether a conviction will bar a person from obtaining licensure or participating in agency management. The amendments and new section also adds definitions, corrects, errors, and eliminates certain offenses that currently bar licensure and participation.

For more information, see the relevent section of the Texas Register, which includes the text of the Texas Administrative Code.

The Texas Department of Health and Human Services Commission will hold a hearing for public comment on proposed payment rates for the following operated by DADS: Residential Care program, assisted living/residential care services under the Community Based Alternatives program, and assisted living/residential care services under the Consolidated Waiver program.

Rates will be effective January 1, 2007.

The public hearing will be held on December 12, 2006, at 9:00 a.m. in the Lone Star Conference Room of the Braker Center, Building H, at 11209 Metric Boulevard, Austin, Texas 78758-4021. For more information, see the relevant section of the Texas Register.

I’ve blogged about the impending retirement of waves of baby boomers before. It’s a hot topic in the health care industry, which will need to adjust to the influx of Americans who’ll need long term, and sometimes specialized care.

A bipartisan committee called The National Commission for Quality Long-Term Care, co-chaired by former U.S. Sen. Bob Kerrey and former House Speaker Newt Gingrich, will release a report that will guide the industry and help it prepare for new patients and new technologies. (Source)

As soon as the report is available online, I will provide a blog update and post a link.

Open enrollment for Medicare Part D, the new prescription drug program, began last Wednesday and will end on December 31.

Current beneficiaries may switch plans and first-timers may sign up for new plans. For more information, visit the Medicare.gov web page.

Effective January 2007, the state of California will be authorized to seek drug discounts up of up to 60 percent for California residents receiving benefits from Medicare Part D. Drug companies are “alarmed,” of course.

From the Kaiser Network:

Although state officials say the measure is voluntary, the law also includes language that permits California in 2010 to remove from its Medicaid formulary treatments sold by companies that do not comply with the law. According to the Globe, the “law is intended to help California’s low-income and underinsured residents by leveraging their collective purchasing power.” It aims to lower the cash price of prescription brand-name drugs by 40% and generic drugs by 60%, according to Nicole Kasabian Evans, a spokesperson for the California Health and Human Services Agency.

Republican governor Arnold Schwarzenegger signed the bill into law in September.

The Texas Health and Human Services Commission (HHSC) has adopted new pay per day payment rates for state-owned veterans nursing facilities for state fiscal year 2007, which became effective September 1, 2006:

Big Spring, $133.00; Bonham, $133.00; Floresville, $133.00; Temple, $133.00: McAllen, $133.00 and El Paso, $133.00.

For more information, see the relevant section of the November 17 issue of the Texas Register.

While HIPAA protects the health information of individuals, it does not create a private cause of action for those aggrieved (65 Fed. Reg. 82566).  This is made abundantly clear from the commentary to the regulations and HIPAA’s legislative history. And while many federal district courts have dismissed individual plaintiffs’ lawsuits under this rule, the Fifth Circuit, in the case of Acara v. Banks (5th Cir. Nov.13, 2006), has become the first federal appellate court to affirm the ruling.  The Fifth Circuit supported its decision by noting that the U.S. Department of Health and Human Services was granted comprehensive enforcement powers under HIPAA through its Office of Civil Rights.

Enforcement by regulators, rather than through private actions, hopefully allows for a uniform national standard with which providers can comply and that consumers will understand. By contrast, private causes of action would result in the competing interpretations resulting less certainty and clarity.

What are the patient’s rights under HIPAA? Under HIPAA, patients have the right to:
·      Receive a privacy notice to inform them about how protected information will be used and disclosed;
·      Request that uses and disclosure of protected information be restricted (covered entities are not required to always agree to restrictions);
·      Inspect, copy and amend their medical records (providers are allowed to charge a reasonable fee for copying expenses);
·      Get an accounting of the disclosure of their protected information for the past six years; and
·      File a complaint.

But then…there’s always State law.  State law, however, may arguably provide other theories of liability, such as violations of other statutory confidentiality restrictions, slander, intentional infliction of emotional distress, casting in a false light, etc.  And remember that such HIPAA restrictions apply in employer use of workers’ protected health information in addition to that of consumers.  Rather than a straightforward “HIPAA lawsuit,” you are much more likely to see HIPAA’s privacy requirements to bolster claims for other breaches of confidentiality and privacy rights under Texas law.

The nursing shortage is so critical that someone graduating with only a two-year nursing degree has his/her choice of nursing jobs at relatively high salaries. The average starting salary for RNs is $56,000.

The New York Daily News featured a story on the nursing job market and cited statistics from the Bureau of Labor Statistics and the American Nurses Association. The average nurse is 50 years old, and nursing schools have had to turn away students because there weren’t enough faculty to teach. I wrote about this last month is Over 41,000 Qualified Nursing School Applicants Rejected in 2005.

The nursing profession is a goldmine. As baby boomers enter retirement and require long term care, nursing school graduates will be able to command a lot more than $56,000 a year.

In a letter dated November 2, the Texas Department of Aging and Disability Services (DADS) informed nursing facilities and community services providers that third-party billers are required to enter into a contract with the Texas Health and Human Services Commission before claims can be submitted to the Texas Medicaid HealthCare Partnership, effective June 30, 2007.

This is an effort to combat fraud. You may download the letter here.

DADS informed home and community support services agencies about the Centers for Disease Control and Prevention’s recommendations for preventing and immunizing against influenza and pneumococcal pneumonia in a letter dated November 6. According to current guidelines, the CDC recommends that people at increased risk receive vaccinations every year. People 65 and older are part of this group.

For more information, you may download the here.

In a letter dated November 9, DADS alerted certain long term care providers about a final rule issued by the Centers for Medicare and Medicaid Services and published in the September 22, 2006, Federal Register (Vol. 71, No. 184, Page 55326), titled, “Medicare and Medicaid Programs; Fire Safety Requirements for Certain Health Care Facilities; Amendment.”

The final rule adopts the substance of an amendment that allows “certain health care facilities to place alcohol-based hand rub dispensers in egress corridors under specified conditions,” and specific requirements. To find out more, download the letter here.

The new majority party in Congress didn’t wait long before it starting pulling rank.

Under the current Medicare law, passed in 2003, the federal government is prohibited from negotiating drug prices or establishing a list of preferred drugs. Soon-to-be House Speaker Nancy Pelosi says the Democrats will try to repeal the ban straight out of the starting gate. (Kaiser Network)

So much for Republicans’ efforts to partially privatize the system.

One of the concerns about the government negotiating prices is that it may favor its own drug plan over better private plans. The Kaiser Network entry has more details, including links to related editorials.

Some Democratic politicians have accused the former Republican majority of catering to pharmaceutical companies and other corporate interests at the expense of recipients. Democratic Congressman Pete Stark, who will become chair of the House Ways and Means Health Subcommittee, said he plans to pass a bill that will reduce reimbursement rates for private health insurers that offer Medicare Advantage plans. (Kaiser Network)

And the political games continue.