COBRA/Patient Dumping

11/10/1999 - OIG Releases Patient Dumping Special Advisory Bulletin The Federal Register for November 10, 1999 contains a notice, developed jointly by the OIG and HCFA, setting forth the Special Advisory Bulletin addressing requirements of the patient anti-dumping statute and the obligations of hospitals to medically screen all patients seeking emergency services and provide stabilizing medical treatment as necessary to all patients, including enrollees of managed care plans, whose conditions warrant it. Download the PDF version of this notice here or visit the Federal Register website to view the HTML version. (You must have Adobe Acrobat Reader to view the PDF version.)

External Appeal

The New York External Appeal Law was enacted as Chapter 586 of the Laws of 1998. The external appeal program took effect on July 1, 1999, and applies to all "final adverse determinations" made by health plans on or after that date.

03/01/2000 - Revisions to External Appeal Regulations Revisions to the regulations governing the New York external appeal program were published in today's State Register. The following documents are available for download here in PDF:

• Revised regulations, effective February 10, 2000 (51KB)
• Discussion of Public Comments (33KB)
• Redline of Changes from the November 1999 regulations (49KB)

01/10/2000 - URAC Releases Revised External Review Standards URAC released revised external review accreditation standards for a second round of public comment. The revised standards are available at the URAC website. URAC has also made available a Draft Interpretive Guide to further explain how some of the standards will impact external appeal entities. Comments on the revised materials must be submitted to URAC by February 25, 2000.

11/24/1999 - Insurance Department Publishes Proposed External Appeal Regulations The New York Insurance Department has released proposed regulations implementing the state's external appeal program. Unlike previous releases, these regulations were not published on an emergency basis and are therefore subject to a public comment period. View the regulations at the Insurance Department's website.

10/19/1999 - URAC Releases External Review Standards for Public Comment WASHINGTON -- As the Congress and state legislatures across the country debate whether patients should be able to appeal their health plans' coverage decisions to outside organizations, one of the nation's leading accreditors of managed care organizations has unveiled draft standards to apply to those organizations. To view the standards visit the URAC website.

Fraud and Abuse/Anti-kickback Regulations

02/08/2000 - OIG Posts Fraud and Abuse Control Report Department of Health and Human Services and Department of Justice Health Care Fraud and Abuse Control Program Annual Report for Fiscal Year 1999. View the report at the HHS/OIG website.

12/21/1999 - Correction to 11/19 Regulations The Office of Inspector General published a notice in today's Federal Register making corrections to the November 19, 1999 regulations (see below). View the correction at the Federal Register website.

12/10/1999 - HCFA Solicits Proposals for New Safe Harbors The Health Care Financing administration has solicited proposals for new safe harbors under the federal anti-kickback statute. Download the request here in PDF or visit the Federal Register for the HTML version.

11/19/1999 - OIG Releases Anti-kickback Regulations The Office of Inspector General of the U.S. Health and Human Services Department today released regulations establishing new safe harbors from the anti-kickback law (section 1128(B)(b) of the Social Security Act). The OIG release includes an Interim Final Rule and Request for Comments as well as a Final Rule. You must have Adobe Acrobat Reader to view these documents.

N.Y. Health Care Reform Act of 2000 (HCRA)

Click here for a summary of HCRA 2000.

12/30/1999 - Governor Signs HCRA Bill A.9093 The Governor signed A.9093 into law as Chapter 1 of the Laws of 1999. A formal signing ceremony will take place sometime in the future.

12/28/1999 - Senate Passes HCRA Bill The Senate passed A.9093 without amendment. The bill will be sent to the Governor to be signed before the existing law expires on December 31, 1999.

12/22/1999 - Assembly Finalizes HCRA Bill Text Early this morning the Assembly passed A.9093, its version of the HCRA 2000 bill. Download the bill text in PDF format here in the three parts: Part I - Part II - Part III

Health Insurance Portability and Accountability Act (HIPAA)

12/15/1999 - HCFA Publishes MOU The Health Care Financing Administration published a memorandum of understanding jointly with the Department of the Treasury/IRS and Department of Labor/PBWA regarding administration and enforcement of HIPAA. Download the MOU here in PDF.

Healthcare Integrity and Protection Data Bank

03/2/2000 - HIPDB to Accept Report Requests According to an OIG Media Advisory, the HIPDB will begin accepting requests Monday, March 6, for final adverse action reports on health care practitioners, providers or suppliers. Visit the data bank online by clicking here.

12/20/1999 - Technical Correction to HIPDB Regulations HHS issued a correction to the final HIPDB regulations. The correction clarifies that individuals who are the subject of a report may obtain a copy of the report in addition to the copy mailed to the subject at the time the report is filed. The Federal Register entry for this technical change may be downloaded here in PDF.

11/22/1999 - HIPDB Data Bank Goes Online The Healthcare Integrity and Protection Data Bank opened for use on November 22, 1999. Visit the data bank online by clicking here.

1999 - HIPDB Regulations Finalized Final regulations implementing the Healthcare Integrity and Protection Data Bank, authorized under HIPAA, were published in the October 26, 1999 Federal Register. Download the regulations here or visit the HIPDB website for additional information.

Managed Care

02/3/2000 - NCQA Releases PPO Accreditation Standards NCQA has released draft accreditation standards for Preferred Provider Organizations (PPOs) for public comment. The following materials are available here for download in PDF:

• Notice of Copyright (2.35KB)
• Foreword (14KB)
• Executive Summary (51.4KB)
• Program Description (120KB)
• Quality Management Requirements (154KB)
• Utilization Management Requirements (246KB)
• Credentialing Requirements (239KB)
• Member Rights & Responsibilities (209KB)
• PPO Advisory Council Members (5.9KB)

12/2/1999 - Revised Consumer Guide The Insurance Department posted a revised 1999 Managed Care Consumer Guide on its website. The revised guide resolves some ambiguities in the prior version regarding identification of the local divisions of Excellus Health Plan. Download Part I and Part II of the Guide here.

11/18/1999 - Managed Care Consumer Guide The New York State Insurance Department is gearing up to re-release the 1999 Managed Care Consumer Guide, which has been available on the Department's website since October 12. Download the report here in PDF format or visit the Insurance Department's website for additional information.

Medicare

03/10/2000 - Three OIG Medicare Reports In the first report, OIG found that the 1998 goals of Medicare's National Marketing Guide for managed care -- to expedite the review process, reduce re-submissions, ensure uniform review, and provide beneficiaries with accurate and consumer friendly marketing materials -- were not completely met. Download the first report here in PDF format (379 KB).

In the second report, OIG found that after the first year of implementation, few marketing materials were in full compliance with the Guide. OIG made a number of recommendations to address the issues identified in both reports. Download the second report here in PDF format (375KB).

In the third report, OIG looked at the influence of extra benefits on beneficiaries' decisions to join Medicare + Choice HMOs. Lower costs, more so than extra benefits, were the main reason for joining an HMO. Once enrolled, beneficiaries value prescription drugs, regular physicals, and vision benefits the most. Download the third report here in PDF format (102KB).

01/12/2000 - OIG Releases Audit Reports on 1997 Medicare MCO Payments The OIG released an audit report pointing out that the 1997 standardized county rates were based on actuarial estimates and, when compared with actual costs incurred, were overstated by 4.2 percent. Download the report, Review of Medicare Overpayments to Managed Care Organizations Due to Overstated Capitation Rates here.

12/22/1999 - HCFA Release PSO Solvency Standards The Health Care Financing Administration published in today's Federal Register solvency standards for provider-sponsored organizations participating in the Medicare+Choice program. Download the standards here in PDF.

12/03/1999 - Medicare Fiscal Intermediary/Carrier Performance Standards The Health Care Financing Administration published regulations detailing the criteria and standards for evaluating the performance of Medicare fiscal intermediaries and carriers for fiscal year 2000. Download the regulations here in PDF.

11/15/1999 - Medicare+Choice Program Guidance Published Compliance Program Guidance for Medicare+Choice Organizations offering a coordinated care plans was published in the November 15 Federal Register. You can download the Compliance Program Guidance (you must have Adobe Acrobat Reader to view the document) or visit the table of contents for today's Federal Register.

11/15/1999 - HHS Office of Inspector General Releases Medicare Audit This final report points out that Medicare fiscal intermediaries improperly paid Part A providers under Medicare's fee-for-service system for services provided to beneficiaries enrolled in health maintenance organizations (HMO) in Colorado, Florida, Missouri, and Pennsylvania $2.3 million for Calendar Years 1995 through 1997. The report, a "Review of Fee-For-Service Payments for Selected Medicare Beneficiaries Enrolled in Managed Care Risk Plans," may be downloaded here in PDF format (you must have Adobe Acrobat reader to view the report), or visit HHS Office of Inspector General for information on ordering a printed copy.

Medicaid/Child Health Plus

11/08/1999 - HCFA Publishes CHIP Regulations The Health Care Financing Administration today released proposed regulations implementing the Children's Health Insurance Program (CHIP), established under the 1997 Balanced Budget Act. Download the regulations here in PDF (you must have Adobe Acrobat Reader to view the regulations).

Medical Errors

04/06/2000 - Grassley Introduced Medical Errors Bill Senator Grassley introduced a bill intended to reduce medical errors under the Medicare program by 50% over the next five years. Download the bill here in PDF or click here to view a summary.

Patients Bill of Rights

• H.R. 2990, which includes tax provisionsand other measures designed to address the uninsured. Passed the House on October 6th by a vote of 227 to 205. H.R. 2990 will be combined with H.R. 2723 to create a package House bill for health care reform.
• H.R. 2723, the Dingell-Norwood "Bipartisan Consensus Managed Care Improvement Act", which passed the House on October 7th by a vote of 275 to 151. The bill was amended prior to passage pursuant to the agreed-upon rules in House Resolution 323.   H.R. 2723 will be combined with H.R. 2990 to create a package House bill for health care reform.
• S. 1344, the Senate health care reform proposal, which passed the Senate on July 15, 1999 by a vote of 53-47. The Senate proposal, unlike the House proposal, does not create a right of action for managed care enrollees to sue their health plans.

03/11/2000 - Side by Side Comparison of Senate/House Proposals A side-by-side comparison of the Senate and Hour Patient Bill of Rights legislation was prepared for the Kaiser Family Foundation by Phyllis Borzi and Sara Rosenbaum of the Center for Health Services Research and Policy, The George Washington University Medical Center. Download Pending Patient Protection Legislation: A Comparative Analysis of Key Provisions of the House and Senate Versions of H.R. 2990 here in PDF.

03/01/2000 - New Cost Report on Patients' Bill of Rights Enactment of the Norwood-Dingell Patients Bill of Rights legislation currently in a Senate-House Conference Committee could fundamentally change the U.S. health care system, according to a new report by the Employment Policy Foundation. Download the report here in PDF.

11/04/1999 - House Appoints Conference Committee Members for Patient's Bill of Rights Law The House appointed representatives to the conference committee that will attempt a compromise on the Patient's Bill of Rights legislation that passed each house earlier this fall. House conferees are: Bliley, Bilirakis, Shadegg, Dingell, Pallone, Archer, Thomas, JSaccocioon (CT), Rangel, Stark, Boehner, Talent, Fletcher, Clay, Andrews, Burton, Scarborough, Waxman, Goss, and Berry. Senate conferees appointed in October are: Jeffords, Gregg, Frist, Hutchinson, Nickles, Gramm, Enzi, Kennedy, Dodd, Harkin, Mikulski, and Rockefeller.

Privacy

02/24/2000 - Gramm-Leach Privacy Regs PublishedFederal Regulations governing privacy of financial information, including financial information maintained by health insurers, were published in the February 24 Federal Register. Download the regulations here in PDF.

02/07/2000 - NYSID Requests Privacy Information The New York Insurance Department posted Circular Letter No. 7 to its website on Friday, February 4. The letter requires health insurers and HMOs to report measures they have taken to protect patient privacy by February 29. Download the Circular Letter here in PDF format.

02/03/2000 - AAHP Posts Privacy Comments The American Association of Health Plans posted its comments to the draft privacy regulations to its website. Download the comments here in PDF format (125KB), or visit the AAHP website for additional information.

02/01/2000 - AHA Posts Privacy Comments The American Hospital Association posted its comments to the draft privacy regulations to its website. The comments can be downloaded from the AHA's website..

01/05/2000 - Correction to 11/03 Regulations HHS published a correction to the November 3 regulations in today's Federal Register. Download the correction here in PDF.

12/13/1999 - Comment Deadline Extended The comment period on the privacy regulations has been extended to Feb. 17, 2000. For additional information visit the HHS Administrative Simplification website.

11/03/1999 - Federal Privacy Regulations Released New federal privacy regulations were published in the November 3 Federal Register. Download the regulations here by clicking on the following links (you must have Adobe Acrobat Reader to view the regulations): Part I - Part II - Part III. Or visit the Federal Register website to view the regulations in HTML (look under the heading "Separate Parts in This Issue" and view Part IV).

Uninsured

10/04/1999 - Census Bureau Report: The Census Bureau report on the number of individuals without health insurance in 1998 has just been released. Download the report in PDF format or visit the Census Bureau website to view the report.