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McBrayer Blogs
Showing 59 posts in Health Care Law.
Part II: Understanding All-Payer Claims Databases
Earlier this week, we discussed the benefits of all-payer claims database (“APCD”) systems. Nine states currently have APCDs in place, but Kentucky is not one of them. These systems provide a multitude of information on the cost, use, and quality of health care in a given state, but the question remains: how do providers feel about APCDs? More >
Part I: Understanding All-Payer Claims Databases
Over the last decade, many states have established all-payer claims database (“APCD”) systems that collect medical, pharmaceutical, and dental eligibility and claims information. Payers, including insurance providers, third-party administrators, prescription drug plans, Medicaid, and Medicare, are responsible for depositing eligibility and claims data into a collective system. The data can then be used to generate important information about cost and quality of care. By gathering detailed information in one place, a statewide picture emerges – information on service providers, patient demographics, and other important healthcare data. More >
Are U.S. Providers Ready to Catch Up in Medical Coding?
After the bungled introduction of HealthCare.gov, providers are unquestionably leery of other technical health care-related requirements on the horizon. If there is a lesson to be learned in the wake of the Health Exchange debacle, it is this: it is never too early to prepare for change. More >
"Essential Benefits" Will Lead to More Patients for Some Providers
In a 2009 speech to the American Medical Association, President Obama promised, “If you like your health-care plan, you’ll be able to keep your health-care plan, period. No one will take it away, no matter what.” This declaration came as the health care law was being written and similar statements were repeated by the President after the bill became law. More >
Controlling Compounding: The Drug Quality and Security Act, Part II
Earlier this week we discussed the new Drug Quality and Security Act (“DQSA”) that establishes and regulates a new class of compounding pharmacies called “outsourcing facilities.” To qualify as an “outsourcing facility”, the entity must compound sterile drugs with or without patient prescriptions and comply with the DQSA’s new rules, including registering with the FDA. An outsourcing facility is not required to be a licensed pharmacy. Registering as an outsourcing facility is completely voluntary, but entities that do not register may be prohibited from compounding drugs for office use and will be required to obtain prescriptions for individual patients. More >
Controlling Compounding: The Drug Quality and Security Act
In October 2012, a fatal meningitis outbreak killed 64 people in the United States and infected more than 750 in 20 states. The outbreak was traced back to contaminated vials of an injectable painkilling steroid that was compounded by the New England Compounding Center (“NECC”). More >
Arbitration and Interlocutory Appeals in Kentucky
Earlier this week, we wrote about the recent Kentucky Court of Appeals case Kindred Healthcare, Inc. v. Cherolis, No. 2012-CA-002074-MR (Ky. Ct. App. Oct. 11, 2013). In Cherolis, the Daviess Circuit Court denied a motion by Kindred to compel arbitration of the claims brought by Cherolis (as Executrix of her mother’s estate). Immediately following the trial court’s ruling on the motion, Kindred appealed to the Kentucky Court of Appeals. More >
Complying with KASPER, Part II
On Tuesday, I provided some common sense tips for prescribers to use when issuing a KASPER-regulated medication. Now, let’s take a look at how the prescriber can better understand the KASPER report.[1] More >
Complying with KASPER
The Kentucky General Assembly passed House Bill 1, also known as the “pill mill bill” in 2012. Following its enactment, the Cabinet for Health and Family Services and various licensure boards issued regulations implementing its requirements. It was soon realized that the law would need some refinement to address concerns raised by the provider community and stakeholders. In 2013, House Bill 217 amended portions of House Bill 1 to address some unintended consequences of the original legislation. One of those amendments was giving an exemption to hospitals, long-term care facilities and approved researchers from the law’s requirement to report controlled substances administered directly to patients through the state’s description drug monitoring system, KASPER. However, for those licensees not exempt from the reporting, it remains a stringent requirement that a KASPER report is filed within one day of dispensing a controlled substance. (See more on HB 217 here.) More >
The Young and the Restless
HealthCare.gov’s technical woes are expected to be fixed by November 30th. But, those fixes might come too late for a certain subset of needed enrollees – the young and healthy. The purpose behind the Affordable Care Act’s individual health insurance mandate was to ensure that private insurers would get enough young, healthy people in the system who could offset the costs of covering older and sicker, Medicaid-eligible patients. More >
