May 15, 2014 Legislation





The CMS Evidence Development and Coverage Advisory Committee is not going to pay for CT screening for lung cancer in smokers.  Their rationale is that there is only one study to show the efficacy of the test.  This runs against the USPSTF recommendation that it be a covered service. It remains covered for private insurers.

The House has not passed a law that would have enabled VA physicians to prescribe medical marijuana. The reason is that the drug is still illegal under federal law and should not be paid for by federal monies.

The Oregon Legislative Council has decided that Oregon may not abandon its state run Obamacare web site and join  However if the feds determine that Oregon's site is not up to snuff they may then join the fed site as then fed law supercedes state law.

The FBI and the IG have gotten together to investigate the Covered Oregon website and the possibility of Oregon showing a false demonstration to the feds to continue to get money.

CMS has decided October 1, 2015 is the date for the onset of the ICD-10.  This is one year later than originally prior to the SGR yearly repeal.  ICD-9 will be required through September, 2015.

CMS has issued regs on what business must tell people who have been insured via employer based insurance and are either laid off or quit.  They must tell the employee about the alternatives of going on COBRA or joining Obamacare.

CMS has issued regs on how more people may sign up under hardship for Obamacare outside of the proscribed periods.  These are people who have signed up for COBRA, or whose plan renew outside of the Obamacare open enrollment period or people who participate in national service programs.  CMS also issued regs on giving more people not being fined if they got Obamacare insurance through April.

CMS has sent a reminder to physicians of the deadline for hardship exemptions for the meaningful use in 2013.  They have until July 1 or face a penalty starting in 2015.  The exemption is only good for one year and then must be renewed.  Starting in 2014 physicians need to be certified in both meaningful use 1 and 2.  Good luck on that.  How does it mean better patient care?

CMS has issued multiple clean up regs.  Among them are important regs regarding medical staffs and their relationships with hospitals especially with multi-hospital organizations.  Basically, the new regs state that a hospital does not have to have a physician on the board but must meet at least once a year with the medical staff representative to discus patient quality of care.  The board itself does not have to meet with the representative but a committee of the board may be the ones meeting with the representative.  Each hospital in a organization must have a medical staff leader meet with the board but this may be done in a group meeting and not necessarily individually.  Also now under the Conditions of Participation a organization may have just one medical staff and not one per hospital.  The medical staff must agree to this and vote on either becoming unified or a stand alone staff.  The hospital may not dictate this.  The CMS also cleared up the issue of permitting non-physicians on the medical staff.  It is OK to have all medical personnel on the staff as long as the state and the medical staff allows it.  This also means that those medical staffs currently in an integrated system may opt out.  If unified the medical staff will still be in charge of the quality of care and must still be accountable to the board.  This does not relieve the duty of each hospital in a system to be individually in compliance with all COPs.

The People's Republic of Massachusetts also had major problems with their website.  They are starting over with a basic site and at the same time are planning to go to the site if the state site is not finished in time for the next round of sign-ups.

California's Governor has asked in his budget for an additional $1.8 Billion for Medicaid.  This is to pay for the pre Obamacare increase in Medicaid of 800,000 more people.  The state pays for half of the cost of new Medicaid beneficiaries who qualified for the program before Obamacare went into effect.   Medicaid is now used by almost 1/3 of the state's inhabitants.  That is scary.        Top


The Boston Globe has a story on the Massachusetts Medical Board removal of the license and the investigation of Dr. Roger Hardy.  Dr. Hardy is the head of a large fertility clinic and has been charged in the press with inappropriate touching of patients and in one case a nurse.  He has not responded to the charges.        Top


The JC has just announced a new hospital requirement for sterilization.  The new EP for EC.02.04.03 requires hospitals to inspect, test, and maintain according to manufacturers standards all lasers, imaging and radiological equipment no matter the use and all new medical equipment with insufficient maintenance history to support the use of alternative maintenance strategies.  Also in EP for EC.02.05.05 hospitals must inspect, test and maintain all new operating components of utility systems in accordance with manufacturers recommendations.

Hospitals will be required under CMS Obamacare rules to either release a standard list of prices or allow the public access to all data if an inquiry is made.

California has fined three hospitals for violations of state health and safety codes.  Sutter General Hospital was fined $50,000 for a nursing error in the ED.  Alta Bates Hospital was fined $75,000 not following policies on medication distribution and another $100,000 for failing to follow policies on patient evaluation.  Desert Regional Hospital was fine $50,000 for failing to follow preventative policies.         Top 


DISCLAIMER: Although this article is updated periodically, it reflects the author's point of view at the time of publication. Nothing in this article constitutes legal advice. Readers should consult with their own legal counsel before acting on any of the information presented.