Health Care

On November 29, 2011 the Department of Health and Human Services (HHS) announced its award of nearly $220 million in Affordable Insurance Exchange Grants to 13 states to help them implement Insurance Exchanges pursuant to the Patient Protection and Affordable Care Act (PPACA). States receiving funds from the November 29th grant include Alabama, Arizona, Delaware, Hawaii, Idaho, Iowa, Maine, Michigan, Nebraska, New Mexico, Rhode Island, Tennessee and Vermont. Of those states, 12 are receiving Level One grants, which provide one year of funding to states that have already made progress using their Exchange planning grant. The 13th state, Rhode Island, is receiving the first Level Two grant, which provides multi-year funding to states further along in the planning process.

Under the PPACA, states have the freedom to design Affordable Insurance Exchanges, where consumers can choose a private health insurance plan that fits their health needs. In the Exchanges, insurers will provide new information such as an easy-to-understand summary of benefits and costs to consumers. 

HHS also released a set of Frequently Asked Questions in anticipation of state legislative sessions beginning in January. The answers are designed to help advance state policy development for Exchanges.  Some examples include: that Exchange grants can be used to build a state Exchange that is operational after 2014; that state-based Exchanges will not be charged for accessing Federal data needed to run Exchanges in 2014; and that state insurance rules and operations will continue even if the Federal government is facilitating an Exchange in the state.  HHS will also allow greater flexibility in eligibility determinations, allowing, for example, an Exchange to permit the federal government to determine eligibility for premium tax credits.

States have many opportunities to apply for funding. To accommodate state legislative sessions and to give states more time to apply, HHS also announced a six-month extension for Level One establishment grant applications. Applications now will be accepted until June 29, 2012.

 
For more information on Affordable Insurance Exchanges, click here.

On September 20, 2011, HHS Secretary Kathleen Sebelius announced PPACA grant awards of $109 million to 20 states and the District of Columbia that will help fight health insurance premium increases and protect consumers. HHS also released its report Rate Review Works, which details how previous rate review grants are fighting premium hikes and helping the health insurance marketplace become more transparent.

As of September 2011, the PPACA requires health insurers seeking to increase their rates by 10 percent or more in the individual and small group market, to submit requests to experts to determine whether the rates are unreasonable. The PPACA also requires insurance companies to publicly justify unreasonable premium rate increases.

The PPACA provides states with $250 million in Health Insurance Rate Review Grants, $48 million of which has previously been awarded to 42 states, the District of Columbia and five territories. The grants awarded on September 20 will improve how states review proposed health care insurance rates and hold insurance companies accountable for disclosing information about unjustified rate increases. States are proposing to use these grants in the following ways:

• Introduce legislation: Seven states are introducing legislation to strengthen their authority to review and/or publicize proposed rate increases.
• Expand scope of rate review: Nineteen states and the District of Columbia are proposing to use grant funds to expand the scope of rate review, for example, by reviewing rates in new markets or by reviewing rates for new products.
• Improve rate filing requirements: All 28 states and the District of Columbia are proposing to use grant funds to improve rate filing requirements, such as requiring insurers to provide additional information on administrative costs and requiring insurers to file rate increases in a standardized format.
• Improve transparency and consumer interfaces: All 28 states and the District of Columbia are proposing to use grant funds to improve consumer interfaces, such as developing a Rate Review Home Page at the Department of Insurance Website and providing opportunities for consumers to comment on proposed rate hikes via the website.
• Hire new staff: Twenty-three states and the District of Columbia are proposing to hire new staff during Cycle II to help review rates and protect consumers.
• Improve IT: Twenty-seven states and the District of Columbia are proposing to use grant funds to enhance IT capacity through the development of new or improved rate reporting systems designed to collect more robust rate data and allow for advanced analysis of rate filings. 

The Rate Review Works report contains a summary of how each state will use the new resources. Other steps the PPACA takes to help make insurance more affordable include:

• Insurers are generally required to meet a medical loss ratio standard to spend at least 80 percent of premium dollars on health care and quality-improvement activities as opposed to overhead, advertising, and executive bonuses.  Insurers that fail to meet that standard must either reduce premiums or pay rebates to consumers and employers;

• Small businesses are eligible for Federal tax credits of up to 35 percent of the cost of coverage for their workers. That amount rises to 50 percent by 2014; and

• In 2014, the Affordable Insurance Exchanges will use competition and transparency, including information on excessive or unjustified premium increases, to help make insurance more affordable.

On September 22, 2011 HHS Secretary Kathleen Sebelius announced $224 million to help at-risk families voluntarily receive home visits from nurses and social workers to improve maternal and child health, child development, school readiness, economic self-sufficiency, and child abuse prevention. These grants are funded by the PPACA and awarded to state agencies that applied for the health care grants as part of the Maternal, Infant and Early Childhood Home Visiting (MIECHV) Program.

The competitive grants will be used by state agencies to support home visiting programs that bring nurses, social workers and other health care professionals to meet with at-risk families that agree to meet with them in their homes. They work with families to evaluate their circumstances, help parents gain the skills they need to succeed in promoting healthy development in their children, and connect families to the kinds of help that can positively influence a child’s health, development and ability to learn. 

Under the MIECHV program, states must use at least three-quarters of the funding provided to implement one or more of these evidence-based programs.  The program also supports continued innovation by allowing up to 25 percent of funding to carry out and evaluate promising new approaches.  Formula grant awards totaling $124 million were awarded to 55 eligible agencies including 49 states, the District of Columbia, Puerto Rico, Guam, the Virgin Islands, the Northern Mariana Islands, and America Samoa.

A total of $100 million in competitive funding was awarded to those states that have sufficiently demonstrated the interest and capacity to expand and/or to enhance the development of their home visiting efforts.

• Expansion Grants: Approximately $66 million was awarded to nine states and jurisdictions that have already made significant progress towards implementing a high-quality home visiting program as part of a comprehensive, early childhood system. These states will serve as models to the rest of the nation on how to build a robust home visiting program integrated into other efforts designed to ensure that children get off to a good start.

• Development Grants: Approximately $34 million was awarded to 13 states and jurisdictions that currently have modest home visiting programs and want to build on existing efforts.  States that successfully complete development grants can compete for future expansion grants. 

Lists of grant awardees are available here.  For more information on the MIECHV program,  click here. 

Secretary of Health and Human Services, Kathleen Sebelius, announced Tuesday, April 12, 2011  the Partnership for Patients (The Partnership), a new national partnership expected to save 60,000 lives by stopping millions of preventable injuries and complications in patient care over the next three years.  The Partnership is also expected to save up to $35 billion in health care costs, including up to $10 billion for Medicare.  Over the next ten years, the Partnership could reduce Medicare costs by almost $50 billion and result in billions more in Medicaid savings.  So far, over 500 hospitals, physicians and nurses groups, consumer groups, and employers have committed to the new initiative.

To launch The Partnership, HHS announced it would invest up to $1 billion in federal funding, made available under the PPACA.  Yesterday, $500 million of that $1 billion was made available through the Community-based Care Transitions Program.  Up to $500 million more will be dedicated from the CMS Innovation Center to support new demonstrations related to reducing hospital-acquired conditions.  HHS has committed $500 million to community-based organizations partnering with eligible hospitals to help patients safely transition between settings of care.   The funding will be invested in reforms that help achieve two shared goals: (1) keeping hospital patients from getting injured or sicker; and (2) helping patients heal without complication. 

The Partnership will target all forms of harm to patients but will start by asking hospitals to focus on nine types of medical errors and complications where the potential for dramatic reductions in harm rates has been demonstrated by pioneering hospitals and systems across the country.  Examples include preventing adverse drug reactions, pressure ulcers, childbirth complications and surgical site infections.  As of yesterday, community-based organizations and acute care hospitals that partner with community-based organizations could begin submitting applications for HHS funding.  Applications are being accepted on a rolling basis, and awards will be granted on an ongoing basis, as funding permits.

For more information about the Community-based Care Transitions Program funding opportunity, click here. 

In 2010, The Office of the Indiana Attorney General (AG’s Office) instituted a one-time only Unclaimed Property Amnesty Program to help businesses, including medical practices, holding unclaimed property to come into compliance with the Unclaimed Property Act, without the consequence of payment of accrued interest and penalties. The deadline for participation was November 1, 2010.    Under the Unclaimed Property Act, businesses are required to report and remit unclaimed property when the property owner cannot be found, and there are reporting requirements even if the business owner has no property to report.  The AG’s Office recently mailed letters and invoices to businesses that did not take part in the amnesty program and have no unclaimed reporting history.

The Indiana Medical Group Management Association (IMGMA) received further instructions from the AG's Office, indicating businesses that did not participate in the amnesty program, and have unclaimed property, may be eligible for a one-time waiver. If an Indiana health care medical practice can confirm it holds no liabilities to report,  the AG’s Office is willing to waive and void the penalty assessment.

Medical practices that wish to request a waiver must send a response letter to the AG’s Office (1) confirming its FEIN and a corporate contact person; (2) recognizing an understanding of annual unclaimed property compliance and reporting obligations; and (3) stating the medical practice has thoroughly reviewed its records and finds nothing to report for the past 10 years. Letters should be mailed to the address on the invoice form.

A letter dated March 11, 2011 from the Director of The Center for Medicare and Medicaid Services (CMS) establishes that CMS will issue further guidance on necessary procedures for implementation of reporting requirements contained in the Elder Justice Act of 2009 (EJA). The EJA, as part of the PPACA, adds new provisions and specific Federal nursing home requirements by amending various sections of the Social Security Act (SSA).   The primary objective of the EJA is to detect, prevent and prosecute elder abuse, neglect, and exploitation.

The reporting crimes requirement of the EJA requires each individual owner, operator, employee, manager, agent, or contractor of long term nursing homes receiving at least $10,000 in annual federal long term care funding, to report to the Secretary of HHS and local law enforcement entities any reasonable suspicion of crimes occurring in such facility.  Reports of reasonable suspicion of a crime must be made to the Secretary and at least one local law enforcement entity within two hours of suspicion if there is serious bodily injury, and within twenty-four hours of suspicion if no serious bodily injury has occurred.

The EJA also requires compliance with enhanced prohibitions against retaliation for reporting suspected criminal acts.  A facility is prohibited from retaliating, discriminating, or filing a complaint or a report against an employee who makes a report, causes a report to be made or takes steps in furtherance of making a report according to the EJA’s requirements. Failure of a covered individual to report a suspected crime results in a civil money penalty of up to $200,000, and may cause exclusion from participation in any Federal health care program. If failure to report results in further injury to a victim of the crime, the civil money penalty increases to $300,000.   

To increase effectiveness of State Medicaid Fraud Control Units (MFCU) in eliminating Medicaid fraud, on Thursday, March 17, 2011, the Office of Inspector General issued a proposed rule to permit Federal Financial Participation (FFP)  for data mining activities. For purposes of the proposed rule, data mining refers to electronically sorting Medicaid claims through statistical models and intelligent technologies to uncover patterns and relationships contained within the Medicaid claims activity and history to identify aberrant utilization and billing practices that are potentially fraudulent.

Under the proposed rule, the conditions under which an MFCU may claim FFP in costs of data mining include the following: (1) The MFCU describes the duration of the data mining activity and the amount of staff time to be expended; (2) the MFCU identifies the methods of cooperation between the MFCU and Medicaid agency, and between the MFCU and review contractors selected by the CMS Medicaid Integrity Group; and (3) MFCU employees engaged in data mining receive specialized training in data mining techniques.

HHS is soliciting public comments on this proposed rule until 5 p.m. on May 16, 2011.

President Obama recently endorsed legislation which would give states the freedom to opt out of the health care reform law, although not entirely, by 2014.  Under the original law, states could not opt out until 2017.  Obama’s endorsement comes after a number of states, most with Republican Attorneys General, have filed suit to invalidate the law, arguing it is unconstitutional to require Americans to purchase health care coverage.  Other lawmakers claim the legislation does not give states enough freedom to create their own solutions to the health care crisis.  This is the first time Obama has called for a change to a principle part of the health care legislation.

If you have questions about the possible state waivers, please contact Leigh Ann O'Neill.

On February 8, 2011, the Office of the National Coordinator for Health Information Technology (ONC) published a notice announcing the 30-day period for submission of requests for ONC-Approved Accreditor (ONC-AA) status.

The ONC-AA will accredit entities wishing to become a health information technology ("HIT") certification body.  Once an entity is accredited by the ONC-AA, it can apply to ONC to become an ONC-Authorized Certification Body (“ONC-ACB”).  Certification bodies currently operating under the temporary program must go through the same processes as other entities to become a certifier under the permanent program.  Under the permanent certification program, ONC-ACBs will certify Complete Electronic Health Records and EHR Modules, and potentially other types of HIT at some point in the future.

The HHS Permanent Certification Program final rule became effective February 7, 2011.  Certification of Health IT will provide assurance to purchasers and other users that a medical information technology system has the necessary technological capability, functionality, and health data protection ability to help purchasers meet the meaningful use criteria established for a given phase.  Eligible professionals and eligible hospitals who seek to qualify for incentive payments under the Medicare and Medicaid EHR Incentive Programs are required to use Certified EHR Technology.

For purposes of the permanent certification program, the National Coordinator has requested the National Institute of Standards and Technology (NIST) develop a laboratory accreditation program (LAP) for organizations to be accredited to test HIT.  NVLAP develops specific LAPs for testing and calibration laboratories in response to legislative or administrative actions, requests from government agencies or, in special circumstances, from private sector entities. 

To be considered for ONC-AA status, an accreditation organization must submit a written request to the National Coordinator no later than March 10, 2011.  Additional information about ONC-AA status requirements and the permanent certification program can be found here.

If you have questions about the Permanent Certification Program, please contact Leigh Ann O'Neill at 317-238-6346.

On February 17, 2011, the Centers for Medicare & Medicaid Services (“CMS”) and the Department of Health and Human Services (“HHS”) announced a proposed rule under the Patient Protection and Affordable Care Act ("PPACA") that would grant states the authority to codify Other Provider Preventable Conditions (“OPPCs”) and Provider Preventable Conditions (“PPCs”) that include, at minimum, the Hospital Acquired Conditions (“HACs”) defined by Medicare, but also state-identified conditions.  HHS believes establishing Medicare requirements as the minimum for the application of the policy is appropriate because many states that have implemented Hospital Care Acquired Condition (“HCAC”) policies have adhered to Medicare requirements, because the conditions are generally accepted by the provider community.

PPCs are defined under two categories; HCACs and OPPCs. The proposed rule would include a definition for an HCAC that would not be limited to those specifically outlined by Medicare, but also include conditions identified by states for prevention of health care reimbursement under state plans, as approved by CMS through the state plan review process. Accordingly, the proposed definition would establish Medicare requirements as the floor, but allow further state innovation as determined by each state.

Such a policy would extend to applying nonpayment provisions to service settings beyond the inpatient hospital setting.  Under the proposed rule, states may identify similar OPPCs related to services furnished in settings other than inpatient hospitals, such as nursing home facilities.  State plans would have to provide for nonpayment for care and services related to these OPPCs and federal financial participation would not be available in state expenditures for such care and services related to OPPCs.

The proposed definition of an OPPC would include, at a minimum, wrong surgical or other invasive procedure performed on a patient, a surgical or other invasive procedure performed on the wrong body part, and a surgical or other invasive procedure performed on the wrong patient.   As of January 15, 2009, Medicare no longer covers the above mentioned surgical or invasive procedures, or hospitalizations and other services related to these non-covered procedures as defined by Medicare.

The proposed criteria for other OPPCs would be similar to the criteria for HCACs, including that a condition or event identified by a state must be; (1) a discrete, auditable, quantifiable, and clearly defined occurrence, (2) clearly adverse, resulting in a negative consequence of care that results in unintended injury or illness, and (3) reasonably preventable, meaning an event that could have been anticipated and prepared for, but that occurs because of an error or other system failure.

HHS hopes to make these requirements effective July 1, 2011, and is currently soliciting comments.

If you have questions about the proposed rule, or about how the PPACA may impact your organization, please contact one of our health care reform lawyers, Leigh Ann O'Neill at 317-238-6346. 

The U.S. Department of Health and Human Services (HHS) announced yesterday it has awarded seven cooperative agreements worth approximately $241 million, to help a group of “Early Innovator” states design and implement the information technology (IT) infrastructure needed to operate Health Insurance Exchanges (“Exchanges”). Early Innovator states will use the funds to develop Exchange IT models that can be adopted and tailored by other states. 

The Early Innovator states include, Kansas, Maryland, New York, Oklahoma, Oregon, Wisconsin, and a consortium of New England states. The states were chosen based on their representation of different regions of the country, as well as different Exchange governance structures and Information Systems. This diversity is intended to ensure that a wide range of IT models are developed, and every state will benefit.

According to HHS Secretary Kathleen Sebelius, the health care grants to the Early Innovator states will help ensure that consumers in every state will be able to easily navigate their way through health insurance and essential benefits options. Beginning in 2014, Exchanges will provide a “one-stop shop” for individuals and small employers to shop for, select, and enroll in high-quality, affordable private health plans that fit their individual needs at competitive prices. Using an IT infrastructure, Exchanges will make purchasing health insurance easier and more understandable.  Design and implementation of the Exchanges is already underway across the country. States have requested early funding to develop the IT, particularly regarding eligibility and enrollment systems.

For more information on grant specifics and state summaries, click here.  

The Office of the National Coordinator for Health Information Technology (“ONC”) announced yesterday the allocation of an additional $12 million in new technical support assistance to help critical access hospitals (“CAH’s”) and rural hospitals adopt and utilize certified electronic health information ("EHR") technology.

Dr. David Blumenthal, MD, MPP, National Coordinator for Health Information Technology in the ONC, attributes the additional funding to the particular challenges faced by rural facilities and CAH’s that are transitioning to EHR’s.  The funding will provide a wide range of support services to the 1,777 critical access and rural hospitals in 41 states and the nationwide Indian Country, headquartered in the District of Columbia, to help them qualify for certified EHR technology incentive payments from Medicare and Medicaid.  This funding is in addition to the $20 million provided to ONC’s Regional Extension Centers (“REC”) in September 2010 to provide technical assistance to the CAH’s and Rural Hospitals.

The additional funding is provided under the Health Information Technology Economic and Clinical Health (“HITECH”) Act, part of the American Recovery and Reinvestment Act of 2009. The HITECH Act created the Medicare and Medicaid certified EHR technology incentive programs, which provide incentive payments to eligible professionals, eligible hospitals, and CAH’s that adopt and demonstrate meaningful use of certified EHR technology.  

For a complete listing of REC grant recipients and additional information about the Health Information Technology Regional Extension Centers, click here. 
 

For information about the Medicare and Medicaid Electronic Medical Record Incentive Programs, click here.

Secretary of Health and Human Services Secretary, Kathleen Sebelius announced today that President Obama’s National Coordinator for Health Information Technology, Dr. David Blumenthal, will step down this spring and return to Harvard University. Blumenthal was appointed by President Obama in March of 2009 to expedite the health care system's switch from paper to electronic medical records.  According to Blumenthal, his plan to return to Harvard this spring was planned when he accepted the position as National Coordinator.

The Office of National Coordinator oversees the standards and certification rules for providers to qualify for funding under the $27 billion electronic medical records incentive program. Under the program, incentive payments are offered to providers to encourage them to make the conversion to electronic records.  The first checks were sent to eligible professionals in January, 2011.

On December 17, 2010, the Centers for Medicare & Medicaid Services (CMS) announced new requirements for State Health Insurance Assistance Programs (SHIP) grants to increase beneficiaries’ awareness about certain provisions in the Affordable Care Act, including new changes to Medicare prevention and wellness benefits, fraud initiatives, and annual election period changes for 2011. 

These new requirements are part of the SHIP basic health care reform grant announcement and grant renewal application for fiscal year 2011. The 2011 grants are continuation grants available to the 54 existing SHIP organizations in the fifty States and territories. CMS anticipates that all SHIPs will participate in this grant renewal process.  

Basic Grant Program awards include a fixed award of $75,000. In addition, states will receive a variable portion of the grant award based on a formula that considers the percentage of nationwide persons with Medicare residing in the state; the percentage of the state’s persons with Medicare in relation to the state’s total population; the percentage of the state’s persons with Medicare who reside in rural areas. Only existing SHIP grant recipients and states without existing SHIP programs are eligible to apply for the Basic Grants.

Performance Awards provide funding opportunities for SHIPs that reflect demonstrated achievement in providing services to Medicare beneficiaries. Performance Awards will be determined based on the Overall Performance Scores calculated for SHIPs based on weighted performance measures using data reported by SHIPs to CMS through the National Performance Reporting (NPR) system. Approximately $1.5 million will be designated for the Performance Awards contingent upon the availability of funds.

Applicants may obtain a copy of the SHIP Basic Grant Announcement and Renewal Application by accessing www.SHIPTalk.org or through www.grantsolutions.gov. Responses to the SHIP Grant Renewal Application are due to CMS by February 16, 2011.

On November 29, 2010 the Department of Health and Human Services (HHS) announced a Teaching Health Center Graduate Medical Education grant program (THCGME), a $230 million, five-year health care grant program to support an increased number of primary care residents and dentists trained in community-based ambulatory patient care settings. 

THCGME grants will be awarded to qualified teaching health centers listed as sponsoring institutions by the relevant accrediting body for expansion of existing, or establishing of new approved, graduate medical residency training programs, such as federally-qualified health centers, community mental health centers, rural health clinics and health centers operated by the Indian Health Service, an Indian tribe or tribal organization and entities receiving funds under Title X of the Public Health Service (PHS) Act. 

Payments shall be made for both direct expenses associated with sponsoring an approved graduate medical education training program, and indirect expenses associated with the additional costs relating to teaching residents in such programs. 

On November 22, 2010, HHS Secretary Kathleen Sebelius announced the new application cycle of the National Health Service Corps (NHSC) Loan Repayment Program.  In an effort to address shortages in the primary health care workforce, the Affordable Care Act allocated $290 million in new funding for the Program.  The NHSC Program offers funding for primary care, medical, dental and mental health clinicians; up to $60,000 in medical education reimbursement in exchange for two years of service at health care facilities in medically underserved areas.

Not only are the monetary awards higher than in previous years under the Patient Protection and Affordable Care Act (PPACA), the PPACA also gives members the option of working half-time for four years to fulfill their service obligation and provides credit for some teaching hours. Additional information, tutorials, and the Loan Repayment Program application can be found on the NHSC Web Site. 

If you have questions about the Loan Repayment Program or other primary care funding initiatives under the PPACA, visit us at Health Reform Connect or contact one of our health care reform lawyers, Leigh Ann O'Neill.

The Centers for Medicare & Medicaid Services (“CMS”) announced a final rule on Monday, November 15, 2010, that withdraws two provisions from the “Medicaid Program: Prescription Drugs” final rule known as the “AMP Final Rule” published in the July 17, 2007 Federal Register.  The AMP Final Rule addressed calculation and reporting of the Average Manufacturer Price and best price for prescription drugs under Medicaid, and revised existing regulations that set Federal Upper Limit prices for certain covered outpatient drugs.

The recently issued final rule withdraws 42 C.F.R. § 447.504, “Determination of AMP,” § 447.514, “Upper limits for multiple source drugs,” and the definition of “Multiple Source Drug” in § 447.502.  The withdrawal is primarily the result of legal challenges by pharmacies to the definition of AMP and the multiple source drug provisions, and the passage of the Patient Protection and Affordable Care Act (“PPACA”), which supersedes the above mentioned AMP provisions.  The CMS indicated it intends to issue a proposed regulation in the near future that addresses the changes made by the PPACA.

If you have questions about the final rule, or about any other items relating to health care reform, please visit us at Health Reform Connect or contact one of our health care reform lawyers.

The Office of the Inspector General (“OIG”) issued a notice on November 12, 2010 that it is seeking comments, recommendations and suggestions from concerned parties and organizations on how to supplement the guidance provided in its 1999 Special Advisory Bulletin on the Effects of Exclusion from Participation in Federal Health Care Programs (the “Bulletin”).

The Bulletin contains guidance on compliance with the rules regarding excluded persons. An exclusion impacts not only the excluded person, but also entities that employ or contract with excluded persons. To date, many entities have faced liability for overpayments, and civil monetary penalties, even for merely employing a person who they did not know was excluded, or who performed only administrative tasks, and no health care related services. 

A person or entity becomes excluded by the OIG as a result of misconduct, such as a fraud conviction or patient abuse. Items and services furnished by an excluded person or entity are not reimbursable under Federal Health Care Programs.  Accordingly, employing or contracting with excluded persons or entities can effect eligibility for Medicaid and Medicare reimbursements.  An excluded individual or entity that submits a claim for reimbursement to a Federal health care program, or causes such a claim to be submitted, may be subject to a civil monetary penalty of $10,000 for each item or service furnished during the period that the person or entity was excluded.  Because of the penalties involved, onerous compliance recommendations have emerged to which providers are adhering, such as checking the OIG List of Excluded Individuals and Entities for current and potential employees' names, in some cases as often as every six months.

The deadline to submit comments is 5:00 p.m. on January 11, 2011. If your organization is interested in submitting comments with respect to this notice, please contact Leigh Ann O'Neill or your regular Krieg DeVault attorney.