Yearly Archives: 2016

The Medicaid Managed Care Final Rule and IMD Exclusion

Hospital location concept map pointer. 3D rendering isolated on white background

The CMS Medicaid and CHIP Managed Care Final Rule, issued in April, is the first overhaul of Medicaid managed care plans in a decade. Spanning over 400 pages in the Federal Register, the rule covers a broad range of topics related to the operation, contracting, oversight, and payment of Medicaid managed care plans. The topic that may be the most impactful for Pennsylvania is the Institution for Mental Diseases (IMD) Exclusion.

‘Tis the Season for Holiday Hackers

Christmas bag with gifts over white. computer generated image

The holiday shopping season is very attractive to hackers. In fact, approximately 40% of all online fraud each year occurs between October and December. It’s not too hard to figure out why the holiday season is prime time for hackers. The number of people shopping online is the highest just before the holidays. Shoppers tend to let down their guard more easily when tempted by “fabulous” deals, or when shopping for last minute gifts. And, with the transition to chip credit cards, it’s getting more difficult to steal credit card information in stores, so more hackers are turning to online schemes to steal your information. (more…)

HIPAA Cloud Computing Guidance Issued

Cloud antivirus concept illustration with white cross on a red hat, cloud, netbook, smartphone, computer and binary code

With more and more Covered Entities and Business Associates using Cloud Service Providers, the Department of Health and Human Services (HHS) issued guidance last week addressing issues surrounding the privacy and security of electronic protected health information (ePHI) in the cloud.

Cloud computing is simply the storage and accessing of data and/or programs over the internet instead of from your computer’s hard drive. You probably use cloud computing every day, whether you realize it or not. If you have an iPhone, Facebook page, Gmail or Netflix account, you’re in the cloud.

Opioid Use Disorder Treatment Update: Pennsylvania to Implement Additional Centers of Excellence

Render illustration of "OPIOID ADDICTION" script on head silhouette with cloudy sky as a background.

On August 29th, Governor Wolf announced that Pennsylvania will implement an additional 25 Centers of Excellence (COE) to help combat opioid-related substance abuse disorders. These centers, added to the original announced earlier this year, will bring the total to 45 centers to be implemented by January 1, 2017. As described in July’s post, COEs will coordinate care for Medicaid recipients who have an opioid use disorder, as well as co-occurring behavioral and/or physical health conditions. (more…)

Happy Birthday, HIPAA!

a red cream birthday pie with the age on top

On August 21, 1996, the Health Insurance Portability and Accountability Act of 1996 (HIPAA) was signed into law by President Bill Clinton. The original purpose of the Act, which amended the Internal Revenue Code of 1986, was to improve the portability and continuity of health insurance coverage, combat waste, fraud, and abuse, promote the use of medical savings accounts, improve access to long-term care services, and simplify the administration of health insurance. (more…)

Group Emails and HIPAA, Is it a Violation?

Distribution of Email across network in red
Last week, Crozer-Keystone Health Systems sent a group email to approximately 900 bariatric surgery patients informing them of a support group. Unfortunately, the email was sent with the recipient addresses in the carbon copy field (cc) instead of the blind carbon copy field (bcc). This exposed all email addresses to every recipient. Is this a HIPAA Violation? There are several points to consider when answering the question. (more…)

Pennsylvania Targets Opioid Use Disorder Treatment

Medicine abstract background
Pennsylvania leads the nation in drug overdose deaths among young males ages 12 to 25, and is among the leaders in the country for all age groups. The Pennsylvania Department of Human Services (DHS) is working to reverse this trend. Recently, DHS announced two programs aimed at expanding and transforming substance abuse services statewide. (more…)

Autism Spectrum Disorder and HealthChoices

Close-up of Health insurance claim form and a pen
Diagnosing a child with an Autism Spectrum Disorder (ASD) can be challenging because of the varying features of these disorders and because of the inconsistencies among the various diagnostic classification schemes (e.g. ICD-9, ICD-10, DSM-IV, DSM 5) that might apply at any point in time.