Patient and consumer advocates are looking to Kamala Harris to accelerate federal efforts to help people struggling with medical debt if she prevails in next month’s presidential election.

By STEPHANIE ARMOUR

Vice President Kamala Harris is seeing a surge of support from Black women voters, galvanized in part by her work on health care issues such as maternal mortality, reproductive rights, and gun control.

The enthusiasm may be key for Democratic turnout at the polls in critical battleground states.

Black women have always been among the most reliable voters in the Democratic base and were central to former President Barack Obama’s victories in 2008 and 2012. Enthusiasm was also robust for President Joe Biden in 2020. But this year, before he bowed out of the race and Harris became the Democratic nominee, his support among this critical demographic had been fading, which could have dampened turnout in swing states.

Black voters’ support for the top of the Democratic ticket has since increased. In July, before he left the race, 64% of Black voters supported Biden, according to the Pew Research Center. Seventy-seven percent of Black voters supported Harris in August.

Black voter turnout, especially in rural areas of Georgia, North Carolina, and Pennsylvania, could help propel Harris to victory. That support — especially among Black women — has swelled since Biden’s departure, polling shows.

“This is a renaissance,” said Holli Holliday, a lawyer in the Washington, D.C., area who [Read More]

KAITLYN DELBENE
Wachler & Associates, PC

The Office of Inspector General recently issued a report recommending increased oversight following a data analysis of Medicare fee-for-service claims for remote patient monitoring services. Providers should be aware of possible increased scrutiny by CMS, including audits and new proposed coverage criteria.

What Is Remote Patient Monitoring?

Remote patient monitoring (“RPM,” also at times referred to as remote physiologic monitoring) is the collection and transmission of health data in a patient’s home that providers use to remotely monitor a patient’s health status and manage a patient’s condition. To qualify as RPM, the monitoring device must automatically transmit data to the patient’s provider. The provider is then able to review the data, make decisions about the patient’s treatment, and communicate with the patient to discuss any recommendations, such as medication adjustments.

A common example of RPM is the use of a connected blood pressure cuff to regularly collect blood pressure readings in order for a provider to monitor a patient with hypertension. Medicare covers RPM for both chronic and acute conditions, but OIG found that the vast majority of patients are receiving RPM for chronic conditions. In the data reviewed by the OIG, more than half of the patients receiving RPM received it for hypertension. [Read More]

By NICOLETTE TABER
Dickinson Wright

On Sept. 9, 2024, the Departments of Health and Human Services, Labor, and the Treasury (collectively “the Departments”) released final rules strengthening and clarifying the rules previously set forth in the Mental Health Parity and Addiction Equity Act (MHPAEA). These new rules signify the Departments’ commitment to enforcing existing mental health parity laws by imposing additional requirements on insurers while also outlining guidelines for compliance.

The final rules reinforce the MHPAEA’s mandate of group health plans and health insurance issuers that offer group and individual health insurance coverage of mental health or substance use disorder benefits to do so in parity with medical and surgical benefits. The MHPEAEA prohibits imposing more significant restrictions on mental health or substance use disorder benefits as compared to medical and surgical benefits. Since the passing of the MHPAEA in 2008, however, the Departments have noted through their audits of group health plans and health insurance issuers that many beneficiaries still encountered barriers to accessing mental health and substance use disorder care compared to medical and surgical care. Therefore, the Departments issued these new final rules to address this discrepancy.

The new rules also reinforce the prohibition of group health plans’ and issuers’ use of more restrictive, nonquantitative [Read More]

Lansing Lines is presented in cooperation with MIRS, a Lansing-based news and information service.

New PPOs For Seniors And Disabled Passes Senate

Beginning at 60 years old, senior Michiganders can petition for restraining orders against relatives and caretakers who they fear are abusive or exploitative, under legislation the Senate approved.

The Senate passed SB 922 by Sen. Veronica Klinefelt (D-Eastpointe), creating a system for elderly Michiganders and vulnerable adults to seek a new type of personal protection order. Under the legislation, a vulnerable adult includes someone 18 or older who’s unable to live on their own because of a physical or developmental disability or a mental illness.

Courts can issue one of these PPOs if there’s reasonable cause to believe the person to be restrained may refuse to leave the premises of the petitioner’s home.

The restraining orders could also be issued if there’s concern that the person could assault or wound the petitioner, remove a pet from the petitioner’s possession, withhold their access to medication and phone calls or could financially exploit them.

If the person resides with the petitioner, and there’s a belief they might use “a pattern of derogatory” names or sexual comments to emotionally distress them, the court could additionally issue one of these PPOs.

“I think the [Read More]

By KFF Health News and PolitiFact staffs

When Vice President Kamala Harris walked across the debate stage Sept. 11 to shake the hand of former President Donald Trump, it was the first time the two had met in person. But that was the rare collegial moment in a face-off otherwise marked by false and sometimes bizarre statements by the former president.

The debate was hosted by ABC with moderators David Muir and Linsey Davis, who occasionally fact-checked Trump. He complained on the Fox News show “Fox & Friends” on Wednesday morning that it was a “three-to-one” contest.

The two presidential candidates covered a wide range of issues — from job and inflation numbers to abortion and immigration — in exchanges marked by personal attacks. As our PolitiFact partners noted, Harris often directly addressed Trump while answering the moderators’ questions. Trump mostly stared straight ahead. In response to Trump’s claims about the Biden administration’s record on crime, Harris cited Trump’s criminal conviction in New York and other indictments.

The moderators questioned Trump about whether he would attempt to dismantle the Affordable Care Act, also known as Obamacare — the health insurance program he pledged and failed to repeal and replace during his previous administration.

He said, if president, he would “only [Read More]

By CHRISTINE SPOLAR

PITTSBURGH — A false alarm that a gunman was roaming one Catholic high school and then another in March 2023 touched off frightening evacuations and a robust police response in the city. It also prompted the diocese to rethink what constitutes a model learning environment.

Months after hundreds of students were met by SWAT teams, the Catholic Diocese of Pittsburgh began forming its own armed police force.

Wendell Hissrich, a former safety director for the city and career FBI unit chief, was hired that year to form a department to safeguard 39 Catholic schools as well as dozens of churches in the region. Hissrich has since added 15 officers and four supervisors, including many formerly retired officers and state troopers, who now oversee school campuses fitted with Stop the Bleed kits, cameras, and defibrillators.

When religious leaders first asked for advice after what are known as “swatting” incidents, the veteran lawman said he didn’t hesitate to deliver blunt advice: “You need to put armed officers in the schools.”

But he added that the officers had to view schools as a special assignment: “I want them to be role models. I want them to be good fits within the school. I’m looking for someone to know how to [Read More]

By MAYA MILLER & ANNIE WALDMAN

This story originally published by ProPublica, a nonprofit newsroom that investigates abuses of power.

The Biden administration announced on Monday that it has finalized new regulations to strengthen protections for mental health care coverage and hold insurance companies accountable for unlawfully denying it.

The rules update the Mental Health Parity and Addiction Equity Act, which was passed in 2008, requiring health insurance plans to provide the same access to mental health care as medical care. The new provisions will force health insurance plans to collect and report more robust data on how they limit and deny mental health claims. If disparities exist between mental and medical care, insurers will need to lay out how they are attempting to address these gaps.

“Mental health care is health care. But for far too many Americans, critical care and treatments are out of reach,” President Joe Biden said in a press release announcing the final rules. “There is no reason that breaking your arm should be treated differently than having a mental health condition.”

The updated rules seek to address a problem captured in numerous studies and reports and examined in a new level of detail in a recent ProPublica investigation.

Although nearly all Americans have health insurance, millions still [Read More]

By SUSAN ADELMAN, MD
Doctors, do you know whether your patients actually are taking the medicines you have prescribed? Brick and mortar retail pharmacies are vanishing these days, or at least dwindling, and on-line pharmacies are proliferating. We need to understand what this means. Rite-Aid has gone bankrupt, closing 500 stores. CVS closed 244 stores between 2018 and 2020, and in 2021 it announced it would close 900. Walgreens announced in 2019 that it would close 200 stores, and in 2023 it announced it would close 150 more. Walmart is closing 11 stores in 2024, and it is divesting itself of 51 health clinics. The reason given is that these stores were unprofitable. But why? High on the list of reasons is retail theft, followed by lower fees for prescription (as a result of pharmaceutical managers) and reduced profits from household goods because of competition from Amazon and big box stores. Oh, and those on-line pharmacies.

According to Capsa, in 2010, 10% of all U.S. prescriptions were filled by mail order. Ten years later, it was close to 16%. This is unfortunate, because many of these online pharmacies lack important safeguards for the patient, and they are notoriously difficult to spot. In one study, fewer than 60% [Read More]

By ROLF LOWE
Wachler & Associates

The Department of Health and Humans Services (HHS) Office for the National Coordinator for Health Information Technology (NCHIT) and the Office of Civil Rights (OCR) will be releasing a new version of the Health Insurance Portability and Accountability Act (HIPAA) Security Risk Assessment Tool (SRA Tool) in the upcoming weeks. The SRA Tool is primarily designed to assist small to medium sized health care providers and the requirement to perform a risk analysis.

The requirement for covered entities to perform a risk analysis is part of the HIPAA security standards and can be found in the federal regulations delineating the administrative safeguards covered entities must comply with.  Administrative safeguards are defined as “Administrative actions, and policies and procedures, to manage the selection, development, implementation, and maintenance of security measures to protect electronic protected health information (PHI) and to manage the conduct of the covered entity’s workforce in relation to the protection of that information.”

A risk analysis, or risk assessment as it is often referred to, requires covered entities to conduct an accurate and thorough assessment of potential risks and vulnerabilities of the confidentiality, integrity, and availability of electronic PHI created and maintained by the covered entity, or any of its business associates. [Read More]

PEGGY KOZAL & KATHLEEN CAMPBELL WALKER
Dickinson Wright

The State of Texas filed a lawsuit against the Biden administration on August 16, 2024, seeking to vacate a rule requiring nursing homes that receive federal funding through Medicare and Medicaid to meet certain minimum staffing requirements. The lawsuit alleges that because 97% of all nursing homes participate in these programs, the Final Rule will impact nearly every U.S. nursing home. Texas is considered among those hardest hit by the Final Rule, with CMS estimating the state will have to hire more additional registered nurses (RNs) than any other state and spend half a billion dollars per year to comply with the requirement.

The Final Rule, issued in April 2024, revises 42 CFR § 483.35 to now require a registered nurse to be on-site at a nursing home 24 hours per day/seven days per week to provide direct resident care, with limited exceptions. The Final Rule also specifies that facilities must provide at least 3.48 nurse staffing hours per resident day (HPRD), including a minimum of .55 HPRD of registered nurse staffing and 2.45 HPRD of nurse aide staffing. “Hours per resident day” means the average hours of care that each nursing home resident receives per day.

Previously, [Read More]

By ALLAN DOBZYNIAK, MD
There was an article published recently (Healthcare Michigan August 2024) addressing the shortage of pediatricians. The article raises many additional questions regarding the physician workforce. Without question, continuing to decrease reimbursement, increasing maddening payment schemes and increasing regulatory requirements to pediatricians, and physicians in general, will have predictable results. There will be shortages. 

Hospitals do hire primary care physicians not because they are positive revenue streams but because these physicians use the profitable hospital services including lab, imaging, physical therapy, and surgical specialists. Hospitals view this as a way to protect market share. Hospital margins are tight. They must spread their RVU reimbursements to their employed physicians in a way to protect their balance sheets. As the regulatory onslaught and reimbursement contractions have made the private practice of medicine an increasing impossibility, in desperation increasing numbers of physicians have sought refuge as hospital employees. New physicians, largely ignorant of healthcare insurance, business principles, healthcare law and finance are unprepared for the realities of the marketplace. To even contemplate an adventure into entrepreneurialism [Read More]

Lansing Lines is presented in cooperation with MIRS, a Lansing-based news and information service.

Local Pro-Marijuana Initiatives Kicked Off Ballot

An attempt to put a new local regulatory and licensing scheme for adult-use recreational marijuana shops will not be allowed to appear on the ballots in Farmington, South Lyon, Sylvan Lake and Wixom.

Why is State government—instead of local governments—charged with setting the rules for marijuana regulations? Because local governments oversee the sale of marijuana, but must follow the state’s guidelines.

The Michigan Court of Appeals’ published opinion  held that voter-initiated charter amendments are not a permissible method of implementing local regulations authorized by the state’s Michigan Regulation and Taxation Marihuana Act (MRTMA).

The statute, MCL 333.27956, is a delegation of authority to the municipality—not individuals of the electorate, who can only “petition for an ordinance to completely prohibit or set the number of marijuana retail establishments,” the opinion from Judges Michelle M. Rick, Michael J. Kelly and Philip P. Mariani reads.

“… Aside from petitions to prohibit or set the number of establishments via ordinance, a voter-initiated petition cannot be used to abrogate the authority vested in the municipality to regulate marijuana establishments through legislative enactment of ordinances, and voter-initiated petitions cannot be used to enact regulations regarding marijuana establishments,” the opinion noted.

Survey [Read More]

By BERNARD J. WOLFSON & PHIL GALEWITZ

When Kamala Harris was California’s top prosecutor, she was concerned that mergers among hospitals, physician groups, and health insurers could thwart competition and lead to higher prices for patients. If she wins the presidency in November, she’ll have a wide range of options to blunt monopolistic behavior nationwide.

The Democratic vice president could influence the Federal Trade Commission and instruct the departments of Justice and Health and Human Services to prioritize enforcement of antitrust laws and channel resources accordingly. Already, the Biden administration has taken an aggressive stance against mergers and acquisitions. In his first year in office, President Joe Biden issued an executive order intended to intensify antitrust enforcement across multiple industries, including health care.

Under Biden, the FTC and DOJ have fought more mergers than they have in decades, often targeting health care deals.

“What Harris could do is set the tone that she is going to continue this laser focus on competition and health care prices,” said Katie Gudiksen, a senior health policy researcher at University of California College of the Law, San Francisco.

The Harris campaign didn’t respond to a request for comment.

For decades, the health industry has undergone consolidation despite government efforts to maintain competition. When health systems expand, adding hospitals [Read More]

By DANIEL CHANG

Illustration by Oona Tempest

Social media’s effects on the mental health of young people are not well understood. That hasn’t stopped Congress, state legislatures, and the U.S. surgeon general from moving ahead with age bans and warning labels for YouTube, TikTok, and Instagram.

But the emphasis on fears about social media may cause policymakers to miss the mental health benefits it provides teenagers, say researchers, pediatricians, and the National Academies of Sciences, Engineering, and Medicine.

In June, Surgeon General Vivek Murthy, the nation’s top doctor, called for warning labels on social media platforms. The Senate approved the bipartisan Kids Online Safety Act and a companion bill, the Children and Teens’ Online Privacy Protection Act, on July 30. And at least 30 states have pending legislation relating to children and social media — from age bans and parental consent requirements to new digital and media literacy courses for K-12 students.

Most research suggests that some features of social media can be harmful: Algorithmically driven content can distort reality and spread misinformation; incessant notifications distract attention and disrupt sleep; and the anonymity that sites offer can embolden cyberbullies.

But social media can also be helpful for some young people, said Linda Charmaraman, a research scientist and director of the Youth, Media & Wellbeing [Read More]

By STEPHANIE ARMOUR

From his perch in the Trump administration’s Department of Health and Human Services, Roger Severino made a controversial name for himself, working to shield health workers who declined to perform medical procedures including abortion on religious grounds.

After President Donald Trump left office, Severino helped the conservative Heritage Foundation develop a plan to expand that conservative stamp to the broader department, recasting HHS with a focus on traditional marriage and family.

The vision is outlined in the Project 2025 “Mandate for Leadership,” a blueprint by the foundation and allied groups intended to guide the next presidential administration. It has emerged as a political flash point, as Democrats portray the 900-page document as promoting an authoritarian power grab by extreme conservatives.

Severino, the lead architect of the project’s section on HHS, has won praise from conservatives and criticism from LGBTQ+ and other liberal advocacy groups who say he poses a threat to reproductive rights and gender-affirming care.

His proposals smack of some of the most heated culture war conflicts shaping the election, from gay rights to gender identity to contraception. They would likely find support under a conservative administration.

Under Severino’s vision for HHS, federal approval of one commonly used abortion drug, mifepristone, could be revisited and potentially [Read More]

By SUSAN ADELMAN, MD
This summer, the New York Times discovered pediatrics. The latest article, on July 7, was headlined “Why Students are Shunning Pediatrics.”  In it, we read that in the latest match (when medical students are paired with residencies), there was a 6% drop in students applying for pediatric residencies, and almost a third of the pediatric residency slots in the country went unfilled. That meant 252 positions vacant. The writer, a pediatrician, correctly blamed the relatively low payments for pediatric services, since so many of the children are covered by Medicaid.

I have been there. I can confirm that it is true. Now retired from pediatric surgery, I found that the plastic surgeon who removed a tiny cyst from my face charged more than I ever received for a pediatric hernia, even for a delicate operation on a frail preemie at risk of a lethal bowel strangulation. In fact, I can recite a litany of tiny, dangerous operations for which I received just enough money to pay for dinner at a reasonably nice restaurant.

People who used to ask what my specialty was often would smile knowingly and nod when I said I was a surgical specialist. Little did they know. As a life-long do-gooder, [Read More]

Navigating the Post-Chevron Landscape: What Healthcare Providers Need to Know

 By DANIEL AYYASH & JOE VAN HORN
Wachler & Associates, P.C.

Overview

The United States Supreme Court’s June 28, 2024 decision in Loper Bright Enterprises v. Raimondo and Relentless v. Department of Commerce to end Chevron deference marks a pivotal shift in administrative law, with potentially significant implications for healthcare providers. Chevron deference, a doctrine that compels courts to defer to a federal agency’s interpretation of ambiguous laws, has been a cornerstone of administrative law since the Reagan administration. The end of Chevron deference means that healthcare providers must prepare for a new regulatory landscape where judicial interpretations of agency rules may assume a more prominent role. Increased legal challenges to agency actions will likely lead to uncertainty surrounding regulatory compliance, and create heightened risks for providers that depend on Medicare, Medicaid, and other federal healthcare benefit program payments to support their practice.

Chevron deference was initially established by the Supreme Court in Chevron, U.S.A., Inc. v. Natural Resources Defense Council, Inc. 467 U.S. 837 (1984), and has served as a foundation of administrative law for over three decades. The doctrine holds that courts should defer to a federal agency’s reasonable interpretation of an ambiguous statute, providing agencies with [Read More]

2024 Revisions to Part 2: Key Changes, Impact, and Compliance Tips

By ERICA ERMAN
Dickinson Wright

On February 8, 2024, the Department of Health and Human Services (HHS) finalized revisions to 42 CFR Part 2. Read on to learn more about Part 2, the changes, and helpful practice pointers.

Quick Refresher: What Is Part 2?

 42 CFR Part 2 is a set of Federal laws that house the Confidentiality of Alcohol and Drug Abuse Patient Records regulations. Part 2 stringently limits the use and disclosure of patients’ substance use and alcohol use disorder records.

Who Needs to Pay Attention to Part 2?

 Part 2 applies not only to “Part 2 Programs” but also to any lawful holder of Part 2 data, which can include, as examples, third-party payors and contractors, anyone who receives Part 2 data with the patient’s written consent and the required prohibition on redisclosure notice, administrative entities, auditors and evaluators. As a rule of thumb, if you have Part 2 data—whether you created that data or are in receipt of that data— you should assume you are obligated to protect that Part 2 data.

 What Is New? A Few Highlights: 

• Re-disclosure Allowed as per HIPAA. Part 2 records may now be re-disclosed as permitted by the HIPAA privacy rule, [Read More]
  

Senate Dems Want Expanded Contraception Insurance Coverage

This feature courtesy of MIRS, a Lansing-based news and information service.

This week, Sens. Mary Cavanagh (D-Redford Twp.) and Jeff Irwin (D-Ann Arbor) introduced the “Freedom to Plan Act,” a bill package that would require both Medicaid and private insurers to provide coverage for oral hormonal and emergency contraception – with or without a prescription.

If passed, Michigan would join six other states to enact similar legislation requiring covered contraception.

The two Senate Democrats said they believe expanding coverage for contraception will break down financial barriers to over-the-counter (OTC) contraceptives, providing Michigan residents with the autonomy to make their own medical decisions.

“People should have access to every tool to plan and make informed decisions about their reproductive health,” Irwin said. “By expanding access to basic health care such as birth control, we can ensure everyone in our state has the ability to determine what their future looks like.”

Currently, federal law requires Medicaid and most private health insurance plans to cover Food and Drug Administration (FDA)-approved contraceptive methods with a prescription.

However, there is no federal requirement for covering non-prescription contraception.

SB 973 and SB 974 , which were introduced on July 31, would expand that requirement to also include oral hormonal contraception and oral emergency [Read More]

More than 2.6 million Michiganders were enrolled in Medicaid in May 2024 after the year-long redetermination, which means the state added more than 400,000 people since before the 2020 COVID-19 pandemic and dropped 500,000 people since the end.

No one had to reapply during the COVID-19 pandemic emergency orders and by May 2023, when the emergency orders ended, 3.1 million residents were enrolled in Medicaid. Redeterminations for the medical program restarted and after the year-long “unwind” there were more people enrolled than prior to the pandemic .

“This was the largest renewal process our state has ever conducted, with 1.8 million beneficiaries renewing their coverage during the past year. MDHHS employed numerous successful strategies to help ensure those families continued to have health care coverage,” said Michigan Department of Health and Human Services (MDHHS) Director Elizabeth HERTEL.

The MDHHS reported 12,402 people in May were dropped from Medicaid and Healthy Michigan Plan and 1,954 people were found ineligible because of procedural reasons. There were 141,992 people up for renewal during the month.

The MDHHS said there were several tactics used to help the renewal process, which reduced the number of people dropped from the program.

Some of the strategies, which the MDHHS said were approved by the federal Centers for [Read More]

By CHRISTINE SPOLAR

PHILADELPHIA — Zarinah Lomax is an uncommon documentarian of our times. She has designed dresses from yellow crime-scene tape and styled jackets with hand-painted demands like “Don’t Shoot” in purple, black, and gold script. Every few months, she hauls dozens of portraits of Philadelphians — vibrant, bold, bigger-than-life faces — to pop-up galleries to raise an alarm about gun violence in her hometown and America.

In a storage unit, Lomax has a thousand canvasses, she estimates, mostly of young people who died from gunfire, and others of the mothers, sisters, friends, and mourners left to ask why.

“The purpose is not to make people cry,” said Lomax, a Philadelphia native who has traveled to New York, Atlanta, and Miami to collaborate on similar exhibitions on trauma. “It is for families and for people who have gone through this to know that they are not forgotten.”

Each person “is not a number. This is somebody’s child. Somebody’s son, somebody’s daughter who was working toward something,” she said. “The portraits are not just portraits. They are telling us what the consequences are for what’s happening in our cities.”

Firearms in 2020 became the No. 1 cause of death for children and teens under 18 — from both suicides [Read More]

By SUSAN ADELMAN, MD
I just got off the phone after talking to a distant cousin and his wife, who recited a frustrating list of the medical and surgical problems that dominate their lives. They are my age, but neither can walk without a walker. My cousin is in a nursing home. I am active and traveling. Why? It is not clear.  Some of their conditions obviously are not preventable. Some, I am not sure. Of limited means, they are trying not to spend more than their insurance will cover. In today’s environment, that may mean rushed 15-minute appointments, which make it hard for their doctors to deal in a calm, unhurried manner with complicated issues, prioritize them, and go over their treatments in detail.

They both have back problems. One of them received a series of steroid shots in the spine every three months until they no longer were effective. What about physical therapy? An effective course of therapy would have been good, but their benefits have run out. Do they go to the type of doctor we used to call general practitioners? I doubt it. If they really went to doctors with whom they could sit down and talk about their problems, they would not [Read More]

 By JESSE ADAM MARKOS, ESQ.
Wachler & Associates, P.C.

Healthcare providers employed by a hospital or on staff at one, who believe that they will be terminated, may try to get ahead of that decision by resigning in lieu of termination.  At first glance, a resignation under such circumstances may appear to be an option that offers greater dignity and minimizes professional harm. However, in today’s highly regulated environment, there is often very little benefit to resigning. In fact, a resignation can, on its own, create significant problems for providers as it can trigger the filing of a report to the National Practitioner Data Bank or Michigan’s Department of Licensing and Regulatory Affairs regarding termination, peer review actions or other reportable events.

While a resignation in lieu of termination always has the potential to damage a provider’s reputation, it can have a disproportionately adverse impact on providers employed by or on staff at a hospital as hospitals are required to report certain actions. For example, pursuant to the Michigan Public Health Code, a hospital that employs, contracts with, or grants privileges to a provider must report certain actions to LARA, including disciplinary action that results in a change of employment status or a case in which a [Read More]