The rising cost of prescription medicine was the issue of the day before the House Health Policy Committee as it took up two bills March 4, one to bar so-called copay “accumulators” and a second to require drug makers to report price increases to the state.

HB 4353, sponsored by Rep. Bronna Kahle (R-Adrian), would require all copays to count toward an insured’s deductible and out-of-pocket costs. HB 4347, by Rep. Angela Witwer (D-Delta Twp.), would require manufacturers to report price increases to the Department of Insurance and Financial Services.

The bills are reintroductions of legislation considered last term.

Sarah Procario of the Hemophilia Foundation of Michigan told the committee many patients rely on copay assistance programs run through nonprofits or the drug manufacturers themselves in order to be able to afford their medicines.

“Unfortunately, . . . a growing insurance trend is jeopardizing the benefits of copay assistance,” Procario said. “Copay accumulator adjustment programs bar all copay assistance from counting toward patients’ out-of-pocket costs making it harder for them to access their life-saving and life-enhancing medications.”

Insurance companies don’t prohibit the use of copay assistance, she explained, “but when it runs out, typically a few months into the year, the patient will still be responsible for their full deductible [Read More]

By LIZ SZABO
There’s a reason soldiers go through basic training before heading into combat: Without careful instruction, green recruits armed with powerful weapons could be as dangerous to one another as to the enemy.

The immune system works much the same way. Immune cells, which protect the body from infections, need to be “educated” to recognize bad guys — and to hold their fire around civilians.

In some covid patients, this education may be cut short. Scientists say unprepared immune cells appear to be responding to the coronavirus with a devastating release of chemicals, inflicting damage that may endure long after the threat has been eliminated.

“If you have a brand-new virus and the virus is winning, the immune system may go into an ‘all hands on deck’ response,” said Dr. Nina Luning Prak, co-author of a January study on covid and the immune system. “Things that are normally kept in close check are relaxed. The body may say, ‘Who cares? Give me all you’ve got.’”

While all viruses find ways to evade the body’s defenses, a growing field of research suggests that the coronavirus unhinges the immune system more profoundly than previously realized.

Some covid survivors have developed serious autoimmune diseases, which occur when an overactive immune system attacks [Read More]

By EWA MATUSZEWSKI
“If they close a door, go through the window. If the window is closed, check the chimney.” When faced with an obstacle, these were the words of wisdom from my mother, a native of Poland who spent time in a displaced persons’ camp after World War II. While I haven’t gone down the chimney yet, I’ve certainly gone through many windows in the past year. So now, a look back.

Mid-March 2020 adds another meaning to the famed Ides of March, which alternatively refers to the assassination of Julius Caesar, a lunar celebration in ancient history marking a new year, or simply a very bad omen – which would fittingly describe a looming pandemic. One year in, it is still with us, although it appears we have tamed the beast to a significant degree, thanks to multiple effective COVID-19 vaccination options. My mind wanders down various paths when I think of all that I have learned or observed, yet several words or phrases capture the essence of my observations: leadership, partnerships, trust, bureaucracy, and patient advocacy. I highlight key take-aways:

-Leadership: Its definition is broad and varied, but true leaders didn’t wait to be asked; they took charge. Whereas typical times may have presented bureaucratic [Read More]

By STEPHEN SHAVER
In an effort to increase the availability of COVID-19 testing and decrease the cost of testing to individual consumers, Congress required group health plans and commercial health insurers to provide coverage for COVID-19 testing with no cost-sharing, prior authorization, or other medical management requirements. However, months of ambiguous guidance have opened the door for inconsistent implementation and left providers, especially the clinical laboratories doing the testing, in a precarious position.

Congress’s efforts began with the Families First Coronavirus Relief Act (FFRCA), enacted on March 18, 2020. The FFCRA required group health plans and commercial insurers to provide coverage of FDA-approved tests “for the detection of SARS–CoV–2 or the diagnosis of the virus that causes COVID–19,” as well as items and services relating to a visit that results in such a test, at no cost to the beneficiary. Congress built on this requirement in the Coronavirus Aid, Relief, and Economic Security Act (CARES Act), enacted on March 27, 2020. The CARES Act expanded the types of approved tests that were covered by the FFCRA and set the reimbursement rate for COVID-19 testing by out-of-network laboratories. Under the CARES Act, an insurer must reimburse an in-network laboratory at the negotiated rate that existed before the [Read More]

By BILLEE LIGHTVOET WARD, ESQ.
One year ago, in March of 2020, the Secretary of the U.S. Department of Health and Human Services (Secretary) declared that, because of the public health emergency resulting from the number of confirmed cases of 2019 Novel Coronavirus (COVID), circumstances exist to justify the authorization by the Food and Drug Administration (FDA) of emergency use of drugs and biological products during the COVID-19 pandemic. This action followed similar declarations permitting so-called “Emergency Use Authorizations” or “EUAs” for in vitro diagnostics and for ventilators, respirators and other medical devices. Since that time, the FDA has issued hundreds of EUAs for the use of various medical products in the diagnosis, treatment or prevention of COVID. Last week, the FDA issued an EUA authorizing the use of a third vaccine for the prevention of COVID. There are now 3 COVID vaccines available for use in the prevention of COVID in Americans over 18 years of age (note that the Moderna and Janssen vaccines are authorized for individuals 18 and older, while the Pfizer vaccine is authorized for individuals 16 and older).

Americans have experienced different stages of “pandemic-life” over the past year, and are currently experiencing differing stages of opportunity in relation to the [Read More]

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

Pressure Builds On DHHS Director Confirmation Vote

Three more Republican senators urged for the rejection of the appointment of Department of Health and Human Services Director Elizabeth Hertel March 4, while Democratic legislators are beginning to rally around her confirmation.

Sens. Tom Barrett (R-Potterville), Jim Runestad (R-White Lake) and Dale Zorn (R-Ida) joined three other colleagues in urging for a vote to reject Hertel based on her support, in part, on “her absurd and blatantly unconstitutional belief” that DHHS directors can, theoretically, issue public health orders that restrict public movement “forever.”

“The Senate should decline to consent to Director Hertel’s appointment and advise Gov. (Gretchen) Whitmer to appoint a director who will uphold the separation of powers and collaborate with the Legislature to address public health issues,” the letter reads.

Meanwhile, Senate Minority Leader Jim Ananich (D-Flint) stood up for Hertel as someone “qualified, capable and dedicated” to the state.

“Her resume is a mile long and she’s proven to be extremely successful working with Republicans and Democrats, in the private and public health sectors, in both policy and administration,” Ananich said.

“Should Senate Republicans manipulate the advice and consent process to achieve a political goal, that [Read More]

Michigan is ranked 42nd among the states according to how much it’s reopened from COVID-19 restrictions, according to one site tracking pandemic-related restrictions on a state-by-state basis.

However, Michigan isn’t necessarily an outlier among the states when it comes to particular COVID-related restrictions, according to a MIRS review of sites tracking restrictions, such as the Kaiser Family Foundation (KFF), the National Academy for State Health Policy (NASHP), The New York Times and USA Today.

The state openness rankings compiled by Virginia-based government relations firm Multistate is based on a score derived from 11 factors, ranging from whether state residents are under a stay-at-home order, to the extent of specific restrictions on industries like bars and restaurants and large crowd venues, for instance.

On a scale of 0 to 100, with zero the equivalent of a full lockdown, Michigan scored 49, which was tied with Colorado and New York, and ahead of states like Vermont, Oregon, Hawaii, Illinois, Washington, California and New Mexico, with the lowest score belonging to New Mexico with 28.

According to the other sites MIRS reviewed, Michigan is in the majority of states when it comes to requiring masks broadly. All but a handful of states mandate masks, according to this map from the NASHP.

Michigan is [Read More]

By JONEL ALECCIA
Kaitlyn Romoser first caught COVID-19 in March, likely on a trip to Denmark and Sweden, just as the scope of the pandemic was becoming clear. Romoser, who is 23 and a laboratory researcher in College Station, Texas, tested positive and had a few days of mild, coldlike symptoms.

In the weeks that followed, she bounced back to what felt like a full recovery. She even got another test, which was negative, in order to join a study as one of the earliest donors of convalescent blood plasma in a bid to help others.

Six months later, in September, Romoser got sick again, after a trip to Florida with her dad. This second bout was much worse. She lost her sense of taste and smell and suffered lingering headaches and fatigue. She tested positive for COVID once more — along with her cat.

Romoser believes it was a clear case of reinfection, rather than some mysterious reemergence of the original infection gone dormant. Because the coronavirus, like other viruses, regularly mutates as it multiplies and spreads through a community, a new infection would bear a different genetic fingerprint. But because neither lab had saved her testing samples for genetic sequencing, there was no way to confirm her [Read More]

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

School Outbreaks, Sports Guidance
The number of ongoing COVID outbreaks in school settings went up for the fourth week in a row, according to numbers released by the state Feb. 8.

With 32 new outbreaks among the 131 overall the first week of February, that eclipses the 105 from last week, the 70 from Jan. 25, and the 60 the week before that.

The 32 new outbreaks in schools were down from the 35 new ones reported the prior week, however. Before that, the numbers had been on the rise, up from the 26 from the week of Jan. 25, which was up from the nine reported from the week of Jan. 18. There were three reported the week of Jan. 11.

Youth Sports
Youth sports are back on, but the state is encouraging athletes to refrain from pre- or post-game handshakes, hugs, fist bumps, high fives, or other celebrations involving contact.

The Michigan Department of Health and Human Services issued its COVID-19 guidance for resuming youth sports after Gov. Gretchen Whitmer said competitions were a go starting Feb. 8.

As announced in early February, the newest order allowing sports requires masks to be worn during practices [Read More]

By EWA MATUSZEWSKI
I hope as you are reading this that Michigan primary care physicians are vaccinating their patients against COVID-19. However, as I write this, the primary care community has been shut out of offering solution-oriented strategies for maximizing vaccinations among Michigan residents. Note, I do not include publicly traded primary care companies here, which was tapped early on by large health systems for vaccination administration assistance. If you sense irritation on my part, you are correct.

For those vaccines that do not require polar temperature refrigeration, the physician’s office should not have been overlooked. Not only are primary care physicians experienced in vaccination storage, monitoring and distribution, they know their patient population and can easily identify their most vulnerable patients for vaccinations by using their electronic patient registry platforms.Further, they can immediately log in each vaccination through the state’s MCIR data base.

Michigan is supported by an outstanding network of primary care physicians and Advanced Practice Providers (APP) who lead the nation in following the patient-centered medical home model. Our PO member physicians and APP were trained by the state (MCIR training) through internally developed webinars and other communication channels earlier this year on how to prepare for large scale vaccination initiatives. Not one physician or [Read More]

By ROLF LOWE
The Department of Health and Human Services (HHS) released proposed changes to the Health Insurance and Portability Accountability Act (HIPAA) Standards for Privacy of Individually Identifiable Health Information (the Privacy Rule) on December 10, 2020. The proposed modifications to the Privacy Rule are intended to address existing standards HHS has identified as impeding the transition to value based care, while continuing to protect the privacy and security of individuals’ protected health information (PHI). HHS specifically identified obstacles currently in place hindering care coordination and case management communications among individuals and covered entities, (which include hospitals, physicians, other health care providers, payors and insurers). The proposed rule changes also address unnecessary burdens associated with communicating PHI between covered entities and individuals.

Some of the major changes to the Privacy Rule include:

-Defining electronic health records (EHR) and personal health application;

-Modifying rules concerning an individuals’ right of access to their PHI;

-Amending the definition of health care operations to broaden the permitted use and disclosure of PHI for care coordination and case management;

-Creating an exception for “minimum necessary” standard for the purpose of care coordination and case management;

-Clarification of the rules covering the ability to disclose PHI to social service agencies, community-based organizations, home and community-based services [Read More]

By JEREMY BELANGER
On Dec. 2, 2020, the CMS and the OIG published the rules modifying the safe harbors under the Anti-Kickback Statute and exceptions under the Stark Law . This article presents an overview of the value-based rules, which became effective on Jan. 19, 2021.

CMS and OIG coordinated many aspects of the value-based rules, and this section will align them as much as possible. It is important to remember that these rules do not protect remuneration based on ownership interests, only for compensation.
A value-based arrangement must be designed to achieve: (i) coordination and management of care; (ii) improve the quality of care; (iii) reduce the costs to, or growth in expenditures of, payors without reducing the quality of care; or (iv) transition from fee for service to the quality of care and control of costs of care. Cost savings that are not passed onto payors are not covered by the new rules. The arrangement must be reasonably designed to achieve one of these purposes, but failure to achieve them does not necessary violate the safe harbor or exception.

The arrangement must be designed to serve a target patient population. A “target patient population” is an identifiable patient population, developed through “legitimate and verifiable criteria,” set [Read More]

By ANERI PATTANI
The nurses at Mission Hospital in Asheville, North Carolina, declared on March 6 — by filing the official paperwork — that they were ready to vote on the prospect of joining a national union. At the time, they were motivated by the desire for more nurses and support staff, and to have a voice in hospital decisions.

A week later, as the COVID-19 pandemic bore down on the state, the effort was put on hold, and everyone scrambled to respond to the coronavirus. But the nurses’ long-standing concerns only became heightened during the crisis, and new issues they’d never considered suddenly became urgent problems.

Staffers struggled to find masks and other protective equipment, said nurses interviewed for this story. The hospital discouraged them from wearing masks one day and required masks 10 days later. The staff wasn’t consistently tested for COVID and often not even notified when exposed to COVID-positive patients. According to the nurses and a review of safety complaints made to federal regulators, the concerns persisted for months. And some nurses said the situation fueled doubts about whether hospital executives were prioritizing staff and patients, or the bottom line.

By the time the nurses held their election in September — six months after they [Read More]

It’s not just Republicans complaining about Michigan’s COVID-19 vaccination rollout so far.

Democratic leaders of some of Michigan’s population centers – Oakland County Executive Dave Coulter and Macomb County Executive Mark Hackel – have publicly railed against the speed of the distribution so far.

Gov. Gretchen Whitmer, for her part, announced she’s now asked the feds for permission to directly purchase up to 100,000 doses. She said her letter to the feds asking for more vaccines to be released hasn’t seen a response.

“We remain ready to accelerate distribution to get doses into arms,” Whitmer said she wrote in the letter. “Toward that end, I am writing to request permission for the state of Michigan to make a one-time purchase of up to 100,000 doses of COVID-19 vaccine directly from Pfizer to be distributed and administered consistent with CDC guidelines and the FDA’s Emergency Use Authorization (EUA) for the Pfizer COVID-19 Vaccine.”

Coulter, on WJR with Paul W. Smith, said from what he’s read, “if we kept up at this pace” of the vaccination rollout, “it would take 10 years to get everyone vaccinated . . . this cannot continue.”

The 10-year projection was made by NBC News back in late December and was related to the complete Operation Warp [Read More]

PO’s Adoption of BCBSM’s Blueprint for Affordability Reflects Value Of Trusted Partnerships

By EWA MATUSZWEWSKI
Amid the flurry of pandemic responses and mitigation initiatives that physician organizations added to their plates in 2020 was a separate event that had been under consideration since just before the pandemic. I’m referring to Blue Cross Blue Shield of Michigan’s Blueprint for Affordability program, which was launched in January 2020.

Designed to hold the line on healthcare costs as it enables improved care quality, coordination of care, and outcomes for patients, Blueprint for Affordability is a value-based compensation model where each physician organization partner has annual cost-of-care targets and clinical quality benchmarks to meet. The targets are tailored to each organization’s unique patient population. If an organization optimizes patient health to keep its overall cost below target and meets its quality performance metrics, it will receive additional financial rewards from Blue Cross. If quality metrics are not met, driving costs above target, the organization will rebate Blue Cross, and ultimately its customers, a portion of the overage.

Seven physician organizations signed on initially, but I’ll admit our organization wasn’t completely on board at the outset. Frankly, it was a risky venture and our leadership team wanted to make sure we were well positioned [Read More]

CMS Releases New Measures to Address Social Determinants of Health

By KAITLIN A. NUCCI
On January 7, 2020, CMS published a State Health Official letter to provide guidance in the adoption of policies to address social determinants of health in both Medicaid and Children’s Health Insurance Program (CHIP). The reasoning behind such strategy stems from the fact that even though the United States spends more money than almost any other country in the world on healthcare, the United States is often is outperformed on key health indicators such as life expectancy, reducing chronic heart disease, and maternal and infant mortality rates. This is due to a range of social, environmental and economic factors that have major influences on health, sometimes even more influence than the delivery of healthcare services.

This letter provides the guidance needed for states to use existing flexibilities under federal law and regulations to address social determinants of health and the adverse outcomes that are often associated with these factors. States are encouraged to enact programs and/or provide benefits that can in the long term reduce the cost of caring for high-risk populations.

Through this guidance, CMS acknowledges that social determinants of health, such as access to nutritious food, accessible housing, education, and meaningful employment, [Read More]

Baraga County Tells Whitmer: We’re Done
Lansing Lines is presented in cooperation with MIRS, a Lansing-based news and information service.

The sum of Baraga County government passed a resolution telling Gov. Gretchen Whitmer it will no longer be participating in any more shutdown orders designed to protect the population from COVID-19.

All five county commissioners signed a resolution Jan. 11 along with the county’s sheriff, prosecutor, clerk, and treasurer that “we have no intention of participating in the unconstitutional destruction of our citizen’s economic security and liberty.”

The county officials also said they will “take no action whatsoever in furtherance of this terribly misguided agenda.”

County Commission Chair Bill Rolof said the people in his county are beyond upset. Businesses are being shut down, likely to never reopen again. Meanwhile, they feel as if they have taken every safety precaution voluntarily.

“Enough is enough,” Rolof said. “The people up here are ready to move on.”

The roughly 8,500-person county has had 476 confirmed cases of COVID-19 since the pandemic began and 29 deaths. That’s roughly 5.6% of the population to test positive, putting it 18th among the state’s 83 counties in contraction rates.

Still, MIRS found other Upper Peninsula counties are in the same boat, tired of the Governor and her administration putting [Read More]

Employers Can Mandate Employees Have the COVID-19 Vaccine…With Restrictions

By SARA H. JODKA
On December 16, 2020, the Equal Opportunity Employment Commission’s (EEOC) issued “What You Should Know About COVID-19 and the ADA, the Rehabilitation Act, and Other EEO Laws” (the Guidance). The Guidance does not even specially address the question as to whether employers can mandate employees have the vaccine, rather, the Guidance jumps right in assuming employers already knew they could have mandatory vaccine policies and goes into the limited restrictions as to when an employer may have to pause and engage the employee in interactive discussion regarding the employee’s medical, religious or other reasons for not wanting the vaccine.

Specially, Section K of the guidance discussion “Vaccinations” and provides a handful of helpful Q&As that succinctly guide employers. Here are some highlights:

How should an employer respond to an employee who indicates the employee is unable to receive the vaccine because of a disability?

The ADA allows employers to have a qualification standard that includes “a requirement that an individual shall not pose a direct threat to the health or safety of individuals in the workplace.” When dealing with a vaccine, which screens out or tends to screen out an individual with a disability, the employer [Read More]

By ELISABETH ROSENTHAL
I still remember exactly where I was sitting decades ago, during the short film shown in class: For a few painful minutes, we watched a woman talking mechanically, raspily through a hole in her throat, pausing occasionally to gasp for air.

The public service message: This is what can happen if you smoke.

I had nightmares about that ad, which today would most likely be tagged with a trigger warning or deemed unsuitable for children. But it was supremely effective: I never started smoking and doubt that few if any of my horrified classmates did either.

When the government required television and radio stations to give $75 million in free airtime for antismoking ads between 1967 and 1970 — many of them terrifyingly graphic — smoking rates plummeted. Since then, numerous smoking “scare” campaigns have proved successful. Some even featured celebrities, like Yul Brynner’s posthumous offering with a warning after he died from lung cancer: “Now that I’m gone, don’t smoke, whatever you do, just don’t smoke.”

As the United States faces out-of-control spikes from COVID-19, with people refusing to take recommended, often even mandated, precautions, our public health announcements from governments, medical groups and health care companies feel lame compared with the urgency of the moment. [Read More]

More than 10,000 people have died of COVID-19 in Michigan as of Dec. 8.

The 191 deaths added to the state’s toll brought Michigan to 10,138. Another 5,909 cases brought that number to 410,295. The current fatality rate to COVID-19 is 2.47 percent.

On a nationwide scale, Michigan ranks ninth among the states by total deaths, according to The New York Times, although The Times has Michigan at 10,415 deaths as of today. On a per-capita basis, Michigan is 11th at 104 deaths per 100,000 people.

As a result, Gov. Gretchen Whitmer ordered U.S. and Michigan flags within the Capitol Complex and upon all public buildings and grounds across Michigan to be lowered to half-staff for 10 days – representing one day per 1,000 deaths – through Dec. 18 to honor and mourn the more than 10,000 people who lost their lives due to COVID-19.

The week of Dec. 8, the state added 34 new school outbreaks tied to 98 COVID-19 cases. Overall, the state has 267 school outbreaks across the state with 7,518 associated cases. Both of those numbers are up from last week’s 260 outbreaks and 7,105 cases.

Of the 267 outbreaks listed that week, 96 are traceable to high schools, or 35 percent overall, with 889 associated [Read More]

By EWA MATUSZEWSKI
The move to virtual office visits has been swift and far-reaching. But are we perhaps going too far? I know of at least two physician practices that aimed to be completely virtual (with some exceptions) from the onset of the virus until January 2021. Why? As of this writing, the case count is far higher than it was when the initial switch to virtual visits occurred in April. Even with the promise of multiple vaccines, we are likely at least a year away from getting out of pandemic mode in terms of how we work, socialize, educate and entertain. We must commit to a new era of healthcare protocols that properly address COVID and other pandemics that may follow, but do not seek to eliminate or minimize the value of an in-person encounter.

The physician’s office may never fully return to pre-COVID days of mask-less patients in crowded waiting rooms, and walk-ins – and no one will lament the passing of that piece of healthcare history. Why was that even tolerated? But, when possible, isn’t a successful physician/provider-patient contact at least partially measured by an exchange of human touch? You can see a desperate parent and crying baby on a screen and ask questions [Read More]

By DUSTIN WACHLER
Effective November 22, 2020, the Centers for Medicare & Medicaid Services’ (CMS) final rule “Modernizing and Clarifying the Physician-Self Referral Regulations” aims to reduce the regulatory burdens of compliance with the federal self-referral prohibition most commonly known as the Stark law. The final rule eliminates unnecessary requirements within the Stark law that imposed undue regulatory burdens and increased administrative costs on healthcare providers. The final rule also eliminates regulatory barriers to value-based, coordinated healthcare delivery and payments systems at the foundation of integrated care models, alternative payment systems, and other arrangements that improve patient care while reducing costs to governmental healthcare programs. ,

The final rule reflects the shared policy achievements of CMS’ “Patients over Paperwork” initiative and the U.S. Department of Health & Human Services’ (HHS) “Regulatory Sprint to Coordinated Care’. “Patients of Paperwork” is a CMS-wide initiative started in 2017 to reduce unnecessary regulatory burdens on healthcare providers. HHS’ “Regulatory Sprint to Coordinated Care” focuses on identifying and eliminating regulatory requirements and other prohibitions that act as barriers to value-based, coordinated healthcare services and payments.

First enacted in 1989, Stark was intended to combat increased utilization within fee-for-service healthcare payment systems that rewarded volume-based care. Due to Stark’s draconian penalties and strict-liability [Read More]

Opinions expressed in the article below are those of the author and do not necessarily reflect those of Healthcare Michigan, its publisher or staff.

By ALLAN DOBZYNIAK, MD
The motives driving the battle to control healthcare are suspect. Many physicians—likely the majority—do not buy into the public deception that has been attributed to them. In fact, a small contingent of progressive, “woke” physicians amplify this deception.

Most doctors are too busy with their own lives, families and professions to get involved with politics and leftist, “politically correct” healthcare thinking. They have become disinterested in the deteriorating professional organizations charged with guiding them through healthcare’s questionable evolution.

Physicians who try to participate in hospital decision-making—with few exceptions—are, in a single word: “excluded.” Unfortunately, they have conceded turf to physicians who can take the time and to hospital management bureaucracies operating in self-preservation mode. Often those who can take the time are not necessarily the most talented people, but are those with a political agenda dedicated to changing traditional medical professional objectives.

However, all is not lost if our clinicians understand the stakes and begin to redirect the profession back to patient care in ways that underscore trust and confidence in physicians and reinvigorate physician morale. Taxpayers, parents, donors, communities—all who are [Read More]

By KIMBERLY RUPPEL
New and modified safe harbors to the Stark Law and Anti-Kickback statue allow healthcare providers and entities more flexibility to create and expand telehealth platforms in compliant fashion.

On Nov. 20, 2020, the Centers for Medicare & Medicaid Services and the Office of the Inspector General (OIG) finalized the rules modifying the safe harbors under the Anti-Kickback Statute and exceptions under the Stark Law, creating seven new safe harbors for value-based arrangements, modifying four already in place and codifying one new exception.

These changes offer opportunities for healthcare providers and entities to make better use of telehealth options in a “value-based enterprise” as opposed to the former regulatory framework which was tailored to a fee-for service environment. Providers will benefit from a reduced burden of regulatory compliance. Patients will benefit from improved outcomes and reduced cost of care.

By way of background, the Stark Law, otherwise known as the physician self-referral law, prohibits referrals by a physician to another provider if the physician or his immediate family has a financial relationship with the provider (with certain exceptions). The Anti-Kickback Statute (AKS), meanwhile, bars the exchange of remuneration – which according to this law is anything of value – for referrals that are payable by a [Read More]

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

Nesbitt Calls On Gordon To Resign
Senate President Pro Tem Aric Nesbitt (R-Lawton) called on Department of Health and Human Services Director Robert Gordon to resign after extending by 12 days the three-week shutdown of restaurants, entertainment venues, in-person high school instruction, and youth sports.

Just as former Unemployment Insurance Agency director Steve Gray “recently resigned in shame,” Nesbitt said Gordon has overseen a state department that’s experiencing “bureaucratic disasters . . . directly linked to poor leadership.”

Nesbitt flagged Gordon for putting seniors at risk for contracting COVID by putting positive patients in nursing homes with a vulnerable population. That policy has changed. Nesbitt also said Gordon oversaw the initial contact-tracing contract, which went to a firm with Democratic ties. It was quickly revoked and re-awarded to another company.

The Senator’s biggest gripe is that the partial shutdown is being continued through a “one-size-fits-all-approach” that “lacks collaboration, thoughtfulness, and empathy.”

“The time for Director Gordon to resign is way past due, and the governor should replace him with an independent leader who will bring much-needed organization and a spirit of partnership to this administration,” said Nesbitt, who also is the co-chair of the joint [Read More]