News and information useful to Cleveland-Marshall College of Law students, faculty and staff.

Archive for the ‘Health law’


Third Circuit Rules Secular Anti-Abortion Group Must Comply with ACA Contraceptive Mandate

photo of package of birth control pillsThe U.S. Court of Appeals for the Third Circuit recently ruled that Real Alternatives, “a non-profit non-religious anti-abortion organization,” must comply with the “contraceptive mandate” of the Patient Protection and Affordable Care Act [ACA; Pub. L. No. 111-148, 3/23/10].  The ACA requires employer-provided health insurance plans to cover multiple preventive services, including FDA-approved contraceptives (see 42 U.S.C. 300gg-13 and 42 U.S.C. 18022).  The ACA allows a limited exemption for religious organizations and their integrated auxiliaries (see 45 C.F.R. § 147.131(a)), as well as additional accommodations for religious non-profit and for-profit employers who arrange for contraceptive coverage through third parties at no cost to, and with no participation of, the objecting employers (see 45 C.F.R. § 147.131(b)-(c)).  Real Alternatives argued it shared the same beliefs as religious organizations, and, pursuant to the Fourteenth Amendment’s Equal Protection Clause, was exempt from the contraceptive mandate.  The Court affirmed the 12/10/15 decision of the U.S. District Court for the Middle District of Pennsylvania to deny Real Alternatives’ motion for summary judgment, and granted the cross-motion for summary judgment filed by the U.S. Department of Health and Human Services, U.S. Department of Labor, and U.S. Department of Treasury.  For additional information, see the U.S. Court of Appeals for the Third Circuit opinion.

Proposed Ohio Regulations On Controlled Substance Prescriptions

Photo of 2 opioid prescription bottlesThe State of Ohio Board of Pharmacy recently proposed amendments to Ohio Administrative Code (OAC) regulations concerning the “manner of issuance of a prescription,” “information required for submission,” and “electronic format required for the transmission of dispensing information.”  The proposed amendments to OAC 4729-5-30 require diagnosis codes and days’ supply on all controlled substance prescriptions; specifies the portions of a prescription that a pharmacist may modify; updates requirements for prescribing via fax, orally, or electronically; and updates “dispense as written” requirements for generic substitutions, interchangeable biologics, and combined refills.  The proposed amendments to OAC 4729-37-04 and OAC 4729-37-05 require reporting of diagnosis codes to the Ohio Automated Rx Reporting System (OARRS), and the adoption of the American Society for Automation in Pharmacy 4.2A Standard for reporting dispensing data.  The Pharmacy Board believes collection of diagnosis codes in OARRS “will help to support efforts to monitor and enforce the acute pain prescribing limits currently being proposed by Ohio’s Prescriber regulatory boards,” and these “limits have the potential to reduce the number [of] opioids prescribed in Ohio by an additional 109 million doses.”  For additional information, see the information on these proposed regulation amendments in the Register of Ohio.

This Just In: An Introduction to Health Law Litigation

An Introduction to Health Law Litigation Based on Contracts and Government Claims (in our new arrivals section on the first floor in the law library), is a topical and timely selection for our patrons.  Aaron Krauss, the editor (and also author of the chapter on Partnership and Closely Held Corporation Disputes), is a member of the law firm of Cozen O’Connor‘s Health Care practice.  Each chapter can be looked at as a standalone primer on the issue covered.  Advice and strategies when facing litigation in each area are also covered.

 

 

Topics covered not already mentioned above include:

  • The pros and cons of litigation versus arbitration
  • Antitrust claims
  • Issues surrounding the licensing of healthcare facilities
  • Real estate claims
  • Privacy and cybersecurity claims
  • Intellectual property claims
  • Medicare and Medicaid audits
  • Employment law issues facing healthcare companies
  • The False Claims Act and qui tam actions
  • Narrow networks
  • Restrictive covenants and trade secrets

CMS Proposes Significant Cuts for Home Health in 2018 & 2019

The Centers for Medicare & Medicaid Services (CMS) recently issued a proposed rule (82 Fed. Reg. 35270, 7/28/17) that includes significant cuts to calendar year 2018 payment rates and the wage index for home health agencies serving Medicare beneficiaries, as well as the home health prospective payment system case-mix adjustment methodology.  CMS proposes to cut Medicare payments to home health agencies by $80 million (4%) in calendar year 2018.  Medicare currently pays for up to 60-day episodes of home health care, but CMS proposes to reduce the care unit to 30-day episodes starting 1/1/19.  Industry leaders estimate the care unit reduction would result in $950 million in cuts to home health services, thereby limiting access to care, and question CMS’s authority to make such changes without Congressional action.  Comments on the proposed rule will be received until 5pm on 9/25/17.  For additional information, see the CMS Announces Proposed Payment Changes for Medicare Home Health Agencies for 2018 and 2019 fact sheet.

Ohio’s Medicaid Expansion Program Survives Veto Override Threat

image of Seal of Ohio Medicaid DepartmentThe State of Ohio Medicaid Expansion remains intact.  On 6/30/17, Ohio Governor John Kasich (R) line-item vetoed numerous items in Amended Substitute House Bill 49, the 2018-19 state operating budget.  Item 16 was the “health care compact” provision that would have frozen enrollment in the Medicaid Expansion program.  The freeze would have kicked 500,000 people off the program, because anyone who became temporarily ineligible because of a job would not be allowed back on.  Ohio House and Senate Republicans had pledged to recruit a super-majority to override this particular veto, but recently backed down.  However, the Republicans have overridden several of Kasich’s vetos, thereby restoring a prohibition on coverage of any new groups under Medicaid, a requirement of House and Senate approval before raising Medicaid rates, and a prohibition on lowering reimbursement rates for nursing homes.  Barbara Sears, the Ohio Director of Medicaid is concerned that there will be lower reimbursement rates for hospitals and home medical services, and some home services may no longer be available for Medicaid recipients.