HEALTH APP CONFUSION: (ANOTHER) REASON FOR A COMPREHENSIVE FEDERAL DATA PRIVACY FRAMEWORK

Chase Millea recently published a blog post for the Arizona Society of Healthcare Attorneys on the current state of U.S. data privacy laws and their impact on consumers. The full article is available at https://azsha.org/health-app-confusion-another-reason-for-a-comprehensive-federal-data-privacy-framework/

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Post-Roe Access to Abortion in Arizona: Implications for Patients and Providers

            In a 5-4 decision on Friday, June 24, 2022, the United States Supreme Court overturned Roe v. Wade. As a result of the ruling, many individuals across the country will not have access to abortions within 30 days and many states have laws that will ban abortions effective immediately. However, the legal landscape for both patients and providers in Arizona is less clear.             With Friday’s ruling, many reproductive health and abortion providers have halted abortion procedures for women in Arizona, citing the complexity of this state’s current entanglement of laws.             The first issue comes from a 1901 law that was passed before Arizona was even a state. The Territorial Legislature’s law made it illegal to perform an abortion or administer any medication that induced a miscarriage unless the procedure was being used to save a woman’s life. Any person who violated this law could be punished with a two-to-five-year prison sentence. In 1973, the pre-Roe law was superseded by Roe v. Wade, found to be unconstitutional by the Arizona Court of Appeals, and was subsequently enjoined by an Arizona superior court judge.             In March 2022, the … Continue reading

Posted in Governance, Health Care

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The Supreme Court of Arizona Holds That Hospitals May Not Use Liens Against Third-Party Tortfeasors to Balance Bill Medicaid Patients

On March 9, 2020, the Supreme Court of Arizona issued its ruling in Ansley, et al. v. Banner Health Network, et al., 2020 WL 1126300 (2020), finding that hospitals may not utilize Arizona Revised Statutes § § 33-931(A) and 36-2903.01(G)(4) to secure liens against third-party tortfeasors in order to balance bill patients for medical bills beyond the negotiated reimbursements provided by Medicaid. The Plaintiffs consisted of patients covered by the Arizona Health Care Cost Containment System (“AHCCCS”), Arizona’s Medicaid agency, who were treated at the defendant hospitals. After AHCCCS negotiated payments to the hospitals on behalf of the patients, the hospitals placed a lien on the third-party tortfeasors who caused the patients’ injuries in order to “recover the remainder of their customary fees” beyond AHCCCS’ reimbursement. Plaintiffs filed the class action lawsuit against the hospitals alleging that 42 U.S.C. § 1396a(a)(25)(C) and 42 C.F.R. § 447.15 (federal Medicaid law and regulations), prohibited hospitals from balance billing patients, or in other words, collecting payments beyond reimbursement from AHCCCS. Hospitals previously operated in accordance with A.R.S. § 33-931(A), which provides that medical providers are “entitled to a lien for the care and … Continue reading

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HHS Seeks Public Comment on the HIPAA Privacy Rule

Earlier today the U.S. Department of Health and Human Services Office of Civil Rights (HHS OCR) issued a Request for Information (RFI) seeking public input on the HIPAA Privacy Rule. Specifically, HHS OCR is interested in how the HIPAA Privacy Rule could be modified to further Secretary Azar’s goal of promoting coordinated, value-based health care mirziamov.ru. This is the latest RFI issued as part of the “Regulatory Sprint to Coordinated Care” initiative being spearheaded by Deputy Secretary Eric Hargan. Previous RFIs have sought information regarding the Stark Law and Anti-Kickback Statute. In the press release announcing the HIPAA RFI, HHS OCR emphasized its ongoing commitment to protect individual privacy and health information, while recognizing that current rules “may limit or discourage information sharing needed for coordinated care or to facilitate the transformation of value-based health care.” The announcement cites stories heard in addressing the opioid crisis about how the HIPAA Privacy Rule stood in the way of needed care. Health care providers and entities are encouraged to submit any information regarding HIPAA provisions that currently present barriers to coordinated, value-based care without meaningfully adding to patient privacy and security of … Continue reading

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Required Reporting of Privileged Information

Arizona physicians must report to the Medical Board “any information that appears to show that a doctor of medicine is or may be medically incompetent, is or may be guilty of unprofessional conduct or is or may be mentally or physically unable to safely engage in the practice of medicine.”   A.R.S. § 32-1451(A).  In fact, failure to make such a report is an act of unprofessional conduct.  Id. Physicians typically learn of the unprofessional or incompetent practice of others either: (1) when seeing a new patient for the first time and learning of their past providers’ practices; or (2) witnessing the potentially unprofessional practices of colleagues or peers.  Occasionally, however, a physician may have another provider as her patient.  In this case, if a medical condition is causing the patient to be “mentally or physically unable to safely engage in the practice of medicine,” the treating physician likely has an obligation to report her patient to the Arizona Medical Board rusbankinfo.ru. See id. The obligation and potential report, however, raise concerns for physician-patient privilege, HIPAA protections, and other privacy issues.  The Arizona Medical Board has taken the position that these … Continue reading

Posted in direct primary care, Health Care, HIPAA

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Telemedicine Reimbursement and Regulation: an Overview for Providers

The advent of telemedicine supplies a unique and convenient gateway for patients and providers to connect. The benefits of telemedicine range from increased access to care for patients, to increased efficiency and lower overhead costs for providers. However, as is common with new models of health care delivery, navigating the regulatory landscape can be a challenge. As with regulation of almost any health care delivery model, there will be aspects of compliance that involve federal regulation, state regulation, payor specific regulation, and provider specific regulation. In telemedicine, this regulatory scheme is no different. Providers may wish to consider what regulations are applicable to their telemedicine practice by tracking enrolled patients by payor type. This may help providers assure that they are not only in compliance with applicable contractual or regulatory schemes, but could also assure that they receive reimbursement for provided telemedicine services. One way to do this is to have patients designate which payor type they will be using for their healthcare coverage on a telemedicine specific patient acknowledgement form when they sign up for telemedicine services. Although there is not comprehensive federal regulation specific to the topic of … Continue reading

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Protecting Vulnerable Adults While Protecting Their Physicians – A Proposed Statutory Amendment

The Arizona Supreme Court’s recent decision in Delgado v. Manor Care of Tucson AZ, LLC, subjects health care providers to liability for ordinary negligence under the Adult Protective Services Act.  This decision therefore creates a potential new strategy for plaintiffs’ attorneys and subjects providers to more severe consequences than previously available in malpractice suits.  A simple statutory amendment is available to limit this source of liability without impacting plaintiffs’ ability to pursue legitimate malpractice claims. Arizona’s Adult Protective Services Act (A.R.S. §§ 46-451 – 503) was enacted to protect incapacitated adults from caregivers who endanger their lives or health through abuse, neglect, or exploitation. Claims arising out of health care providers’ ordinary negligence, on the other hand, are covered by the Medical Malpractice Act (A.R.S. §§ 12-561 – 573).  Although legislative history is sparse, there is evidence that the legislature never intended APSA to encompass medical malpractice actions.  This position is supported by the legal meanings of the terms “neglect,” as used in the APSA, and “negligence,” which is required for malpractice liability.  Although they share a common root word, the legal definitions of “neglect” and “negligence” are not the … Continue reading

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Making Informed Decisions About Informed Consent

Patients have come to expect that they will be actively involved in making decisions about their health care. Informed consent aids patient involvement and provides a process whereby a health care provider discusses a treatment or procedure with a patient, including the nature of the proposed procedure, reasonable alternatives, and the relevant risks and benefits of that procedure. The provider uses this process to assess the patient’s understanding of the treatment plan, while the patient uses this process to become actively involved in the treatment process.  The process, in addition, may help protect providers from claims that patients did not understand the pertinent risks in the event of adverse outcomes resulting from the procedure. Recent court decisions in Pennsylvania and Missouri are worth consideration for providers, and serve as a reminder that providers may wish to review their informed consent practices if there have been recent state law changes regarding informed consent. A recent Pennsylvania Supreme Court decision determined that physicians cannot delegate the informed consent process to another provider in their practice without still retaining liability. The court found that the physician providing the treatment or procedure has the … Continue reading

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Nevada’s Direct Primary Care Crisis

In 2012, Turntable Health opened its doors in downtown Las Vegas with one goal—providing preventive healthcare at a reasonable cost. As a direct primary care (“DPC”) clinic, Turntable Health offered unlimited access to primary care physicians for a monthly fee. Only five years after opening, Turntable permanently closed in January 2017, citing an inability to reconcile its practice with the economic demands of the healthcare industry.  Following Turntable’s lead, an industry forerunner based out of Seattle, Qliance Medical Management, closed in May.  These closures leave medical professionals and patients in Nevada questioning DPC’s viability and, in consequence, its future. While large-scale DPC providers like Turntable and Qliance are a relatively new concept, small DPC practices have existed for decades.  Under the DPC practice model, physicians offer contracts that allow patients to pay low monthly fees for unlimited access to primary care services, discounted blood work, and prescriptions.  However, DPC memberships do not cover all healthcare needs, including costly hospitalizations, specialist visits, and surgery. For that reason, providers suggest—and federal law requires—that patients hold, at a minimum, high-deductible health plans.  Rather than a standalone healthcare solution, a DPC membership is one … Continue reading

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Arizona Enacts “Surprise Out-Of-Network” Balance Billing Law

by Paul Giancola Arizona has joined the national trend of trying to solve the “problem” of “surprise medical out-of-network bills.” The prevalence of this concern was reported in the New England Journal of Medicine which stated that 22% of patients who visited an emergency department received a surprise bill from an out-of-network provider.  A “surprise bill” arises when an enrollee of a health plan receives care, and a medical bill, from a health care provider who does not belong to their health insurer’s provider network.  These bills are typically for medical services that are rendered at an in-network health care facility or at the request of an in-network physician.  The enrollee is then billed by the out-of-network provider for the remaining amount of the charge that is the difference or the “balance” of the charge less the allowable insurance amount paid under the enrollee’s health plan.  In contrast, in-network providers are generally prohibited from balance billing a patient under their plan contracts. The Arizona Senate Bill 1441, signed on April 24, 2017 by Governor Ducey, amends Title 20 of the Insurance Law, Section 20-3102 by adding Article 2 “out-of-network claim … Continue reading

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