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OHA Voices Concerns on Medicaid Co-Pay Procedures OHA continues expressing its concerns with rules that require hospitals to collect $3 co-pays from Medicaid enrollees who are using hospital emergency departments (EDs) for non-emergencies. The association submitted a letter to the Ohio Department of Job and Family Services (ODJFS) late last week seeking clarification on hospitals’ reporting requirements and responsibilities related to non-emergency use of EDs. In addition, OHA is working with the legislature to amend language in the budget corrections bill to modify the requirement that hospitals enforce the $3 co-pay. Hospitals currently must identify, collect, bill and follow up on Medicaid recipients’ potentially inappropriate use of an ED, tasks that may ultimately impact waiting times and care for all patients. ODJFS requires that hospitals accept not only the responsibility but the administrative cost of patrolling Medicaid recipients’ use of the emergency room. According to Ohio law, hospitals can not delay care to collect a co-pay, refuse services because a patient is not able to pay the $3 co-pay or waive the co-pay amount after services are provided. Most hospital computer systems will not produce bills for amounts as small as $3 and hospitals incur additional costs in pursuing the $3 co-pays. OHA will provide additional information to hospitals as it becomes available. (Charles Cataline, charlesc@ohanet.org; Bridget Gargan, bridgetg@ohanet.org) zed to set the framework to implement a statewide health care benefits pool for public school employees.
Transparency Legislation Passes Ohio House, OHA Seeks Final Changes Legislation that would require hospitals to report additional quality and pricing information to the Ohio Department of Health passed the Ohio House of Representatives today and now moves to the Senate. The version of Rep. Jim Raussen’s (R-Cincinnati) House Bill 197 passed by the House addresses many of OHA’s concerns related to costly reporting requirements and unreliable data, but OHA will seek several final tweaks before the Senate finalizes the bill. Read more on this legislation and the broader issue of hospital reporting of quality and charge data in OHA’s February Healthbeat article, which will appear in this publication Friday. Revamped False Claims Bill Expected Soon In an attempt to address concerns raised by OHA, a state senator last week discussed his plans to revamp legislation expanding Ohio's False Claims Act. As introduced, Senate Bill 39, sponsored by Sen. David Goodman (R-Bexley), would expand existing statutes that allow the state to bring suit against providers who falsely bill for a service. The bill contains whistleblower provisions, whereby an individual could file the suit against a provider and receive up to 30 percent of any awards or settlements. The legislation also includes a lesser standard of fraud than other state and federal fraud statutes, which OHA advocates could allow the state Attorney General to inappropriately apply the False Claim Act to billing mistakes or disputes. Sen. Goodman this week announced that he will soon offer a new version of SB 39, with what appears to be changes requested by OHA. Based on statements made by the sponsor this week, the changes would:
Sen. Goodman's office has indicated the new version will be available to OHA and other interested parties this week. OHA will review the language to ensure it addresses the numerous concerns raised by OHA over the past year. (Jeff Klingler, jeffk@ohanet.org) Wednesday, February 15, 2006 Medical Bylaws Field Review Open to Hospitals Hospitals and critical access hospitals are invited to participate in a Joint Commission on Accreditation of Healthcare Organizations (JCAHO field review of Proposed Revisions to Standard MS.1.20, which could require some facilities to revise their medical staff bylaws in order to comply with the revised standard. JCAHO’s field review is open until March 10 to determine if the revisions are sufficiently clear and if the revisions necessitate changes to hospitals’ existing medical staff bylaws. Also in question is whether the Jan. 1, 2007 implementation date allows for enough time to make necessary bylaw changes. Hospitals may comment online at www.jcaho.org/accredited+organizations/field_reviews.htm. Please forward a copy of your comments to Rosalie Weakland. (Rosalie Weakland, rosaliew@ohanet.org) Hospital Receives Critical Access Designation Pike Community Hospital in Waverly was granted Critical Access Hospital (CAH) designation, effective Dec. 31, 2005. The federal CAH program entitles select small, rural hospitals to Medicare cost-based reimbursement. To become a CAH, hospitals must provide 24-hour emergency services along with inpatient care, laboratory and radiology services, and meet other specific criteria. Pike Community Hospital is the 35th and final hospital in Ohio to receive the CAH designation. For a complete list of Ohio CAHs, go to www.ohanet.org/about_oha/cah.asp. (David Hendershot, davidh@ohanet.org) Hospitals’ Heartbeat A 2005 nominee for the Albert E. Dyckes Health Care Worker of the Year Award
Reggie Case,
RRT, RCP
A look inside
Reggie’s nomination –
Don’t forget to make your nomination for 2006! The deadline is THIS
FRIDAY, Feb. 17. Thursday, February 16, 2006 Award Nomination Deadline Tomorrow The clock is ticking for hospitals to make a nomination for one of OHA’s prestigious awards, to be presented at the fifth annual OHA Recognition Dinner Monday, June 12 as part of the OHA Annual Meeting June 12 and 13. The deadline to submit a nomination for any of the following awards is Friday, Feb. 17: Albert E. Dyckes Health Care Worker of the Year Award, Distinguished Service Award, Donald R. Newkirk Award, John Chapman Award, Meritorious Service Award, and William C. Kelley Safety Leadership Award. OHA is also collecting nominations for the Ohio Society for Healthcare Consumer Advocacy’s award. Download nomination materials at www.ohanet.org/annualmeeting/Awards/. (Tiffany Himmelreich, tiffanyh@ohanet.org)
Hospitals’ Heartbeat A 2005 nominee for the Albert E. Dyckes Health Care Worker of the Year Award
Lisa Petronio Supervisor, Radiology Lakewood Hospital, Lakewood
A look inside Lisa’s nomination – Lisa Petronio has been employed as a supervisor in the Lakewood Hospital Department of Radiology for 12 years. During that time, Lisa has instinctively and consistently demonstrated her dedication to patients and patient care. She has done this with a positive attitude and effective communication. Lisa takes the time to understand and help others. She takes pride in her work and the work of her colleagues. She links the members of her department together with the common goal of providing quality patient care and caring for each other.
Don’t forget to make your nomination for 2006! The deadline is TOMORROW, Feb. 17. Visit www.ohanet.org/annualmeeting/Awards/ to download nomination materials.
Happy Heart Month: Medicare Covers Preventive Screenings February is National Heart Month and health care providers are reminded that Medicare beneficiaries are covered for certain cardiovascular screening blood tests. The total cholesterol test, cholesterol test for high-density lipoproteins and triglycerides test enable early detection of cardiovascular disease or abnormalities associated with an elevated risk of heart disease and stroke.
The Centers for Medicare & Medicaid Services asks providers to encourage eligible Medicare patients to take advantage of this potentially life-saving benefit. Educational resources such as a quick reference guide to Medicare preventive services, brochures and Web-based training courses are available for free online at http://www.cms.hhs.gov/medlearnProducts/ and may be reprinted and redistributed as needed.
Though supportive of the concept to bring more information to the public, OHA initially voiced concerns with HB 197, sponsored by Rep. Jim Raussen (R-Cincinnati). Rep. Raussen worked with the hospital community on revamping HB 197 to avoid duplication of existing efforts and to ensure the accuracy of the information ultimately released. HB 197 builds on efforts already underway to establish national reporting standards. The federal Hospital Compare Web site currently allows consumers to compare hospitals nationwide on 22 quality measure in five areas of care: heart attack, heart failure, pregnancy, pneumonia and surgical infection prevention. One-hundred percent of eligible Ohio hospitals submit data to CMS for this Web site, and under HB 197, hospitals would forward this data as well as AHRQ measures and pricing information to ODH for release on an Ohio-specific public Web site. Efforts by the hospital community, the legislature and national health care organizations to increase the amount of information available to consumers will likely continue and even increase as the health care landscape continues to evolve. To learn more about current and future changes to hospital reporting requirements, view OHA’s February Healthbeat article at www.ohanet.org/healthbeat/2006/0206.htm. OHA Leaders Address Public Health Issues OHA Senior Vice President Reed Fraley was one of three members appointed by Gov. Taft to the School Employee Health Care Board created by House Bill 66, the state budget. The board is authori © 2001-2008 OHA. Last updated
January 03, 2008. |
