Healthcare Law Briefs

Meeting the Challenge of Health Law

	What's Inside
	Specialty Hospitals Revitalize Con Debate

	CMS Clarifies Incident-To Billing
	Feds Plan New HIPAA Rules for Fall

Healthcare Law Briefs

July 23, 2004

*READ PAST ISSUES OF THE HEALTHCARE LAW BRIEFS

1. Specialty Hospitals Revitalize Con Debate

Certificate of Need (CON) laws, which generally required health care facility proponents to prove the need for a particular facility before it would receive state licensing approval, waned with the implementation of prospective and fee for service payment models. The increasing development of specialty hospitals, which have been accused of skimming the most profitable service areas and leaving general or community hospitals to bear the burden of unprofitable service areas (e.g. Emergency and Trauma Services), have re-stimulated interest in CON legislation.

The PA legislature is considering several CON proposals. Florida has recently passed new legislation banning new facilities providing only cardiac, orthopedic or cancer services. New Jersey did not reinstitute CON requirements, but its legislature did impose a new tax or surcharge on ambulatory surgical center revenue to subsidize community hospitals.

<Top

2. CMS Clarifies Incident-To Billing

On June 18, 2004, CMS issued Transmittal 17, Pub. 100-2, which clarifies the definitions and procedures for "incident to" billing. Transmittal 17 reverses Chapters 60.1 and 60.3 of the CMS Medicare Claims Processing Manual. The Transmittal is available online at www.cms.hhs.gov/manuals/ or contact us and we will mail you a copy.

<Top

3. Feds Plan New HIPAA Rules for Fall

The Centers for Medicare and Medicaid Services expects in November to publish proposed rules for a national health payer identifier and a standardized claims attachment transaction format. Further, the centers expects in February 2005 to publish a proposed rule making periodic modifications to the HIPAA transactions and code sets rule, and to publish in September 2006 a �final action� rule mandating electronic submission of most Medicare claims. That rule would replace an interim final rule published in August 2003 that's now in effect. All the rules are authorized under the HIPAA administrative simplification provisions. Notice of the centers� planned HIPAA rules was included in the Department of Health and Human Services� semi-annual regulatory agenda, published June 28 in the Federal Register, available at www.gpoaccess.gov/fr/index.html. It should be noted that the November publication date is only a goal for the Centers for Medicare and Medicaid Services, which has missed numerous self-imposed deadlines in the past for publishing HIPAA rules.

Health Data Management (June 29, 2004)

<Top

>For more information about the topics presented in this newsletter please contact one of the Healthcare Attorneys: