ABA Health eSource - Your link to the ABA's Health Law Section
August 2012 Volume 8 Number 12
Health Law Section NewsAugust 16, 2012
August 23, 2012
Fundamentals of Tax-Exempt Healthcare Organizations
(CLE Webinar & Teleconference)
August 29, 2012
The Affordable Care Act and Health Care Fraud: The Beat Goes On
(CLE Webinar & Teleconference)
September 6, 2012
How to Structure 340B Contract Pharmacy Arrangements
(CLE Webinar & Teleconference)

Health Law Highlights

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Chair's Column: When I'm Sixty-Four

It was June 1967 when Sgt. Pepper appeared on record store shelves. Its sometimes inscrutable lyrics invited analysis and reflection, affirming a change in both popular music and culture. One song in particular, however, seemed oddly out of place: a music hall ditty called “When I’m Sixty-Four.” Its invocation of the aging process, seen from the perspective of its principal composer, Paul McCartney, whose father was 64, was odd, at best, to me, a 19 year old. Lines like “Yours sincerely, wasting away” were harrowing rather than inviting. It was best to put that picture far out of mind, which, if you are familiar with the times, was not hard to do.

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Announcing the Nursing and Allied Health Issues Task Force

I’m pleased to announce the Section’s Governing Council has approved the creation of the Nursing and Allied Health Issues Task Force. This group will focus on matters of interest to members who represent nurses, respiratory therapists, physical and occupational therapists, paramedics and related business entities such as home health agencies and ambulance services, with a focus on issues relating to administrative and regulatory actions related to licensing, fraud and abuse, insurance and Medicare/Medicaid reimbursement, medical malpractice and insurance, credentialing, HIPAA, etc.  

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This edition of eSource is brought to you by the Payment & Reimbursement Interest Group.


Medicare’s Proposed Prior Authorization of PMDs Demonstration Project Reveals a Potential New Paradigm for Claims Processing
By Esther R. Scherb, Katherine M. Gigliotti & Eric C. Greig,

Scheduled to be launched on September 1, 2012, a new Medicare demonstration project for power mobility devices (“PMDs”) will test a claims processing methodology which departs from longstanding approaches in the Medicare fee-for-service program. Through the Prior Authorization of PMDs Demonstration (the “Demonstration”), the Centers for Medicare & Medicaid Services (“CMS” or the “Agency”) has proposed to require physicians and suppliers in seven states to obtain authorization from the applicable Durable Medical Equipment Medicare Administrative Contractor (“DMAC”) before delivering a PMD to a beneficiary and submitting the claim for payment.

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Defense of Marriage Act Ruled Unconstitutional by Federal Appeals Court
By Virginia E. McGarrity, Robinson & Cole LLP, Hartford, CT

The Defense of Marriage Act (“DOMA”) is a sweeping federal law that excludes same-sex spouses from any of the federal protections of marriage. When first enacted, its impact was limited because same-sex marriage was not legal anywhere in the United States. However, same-sex marriage is now legal in eight states and in the District of Columbia, resulting in the application of DOMA and legal challenges to its constitutionality. With its unanimous ruling on May 31, 2012, the U.S. Court of Appeals for the First Circuit became the first federal appellate court to rule that DOMA is unconstitutional.

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340B Drug Pricing Program Changes under PPACA
By Amanda Swanson, J.D., LL.M., Chicago, IL

The 340B Drug Pricing Program enables eligible Medicaid participating facilities to purchase outpatient drugs at discounted prices, below those typically available to other buyers. This results in significant savings for safety-net providers, generally between 20-50 percent of the drug’s cost. In furtherance of its goals of containing rising healthcare costs, the Patient Protection and Affordable Care Act (“PPACA”) expanded the types of facilities eligible to participate in the program, and thereby enabled more providers to take advantage of the discounted drug prices.

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Body Area Network Wireless Medical Device Operators Must Comply With the HIPAA Privacy and Security Rules
By Catherine Barrett, MITRE Corporation, McLean, VA

Technology companies are creating devices and providing data analytic services that promise to lower healthcare costs and improve the quality of care for patients. One such technology is the Body Area Network (“BAN”), a “low-powered wideband network consisting of multiple body-worn sensors” that wirelessly transmit data to a wearable device.

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Did you know membership in an interest group is FREE with your Health Law Section membership?

Did you know your membership in the ABA Health Law Section qualifies you for free membership in up to three interest groups of your choice? Interest groups, which are comprised of twelve practices areas within health law, make significant contributions to the Section's programming, publications and legislative initiatives. The interest groups also provide an excellent opportunity for you to interact with and have access to some of the most outstanding lawyers in the legal community. You can enroll on our webpage by clicking here. If you have any questions or need more information, please contact Simeon Carson at simeon.carson@americanbar.org


Payment & Reimbursement Interest Group

The Payment & Reimbursement Interest Group follows trends, changes and practices in reimbursement, billing and collection under Medicare, Medicaid and other federal and state health care programs. The group also tracks major development relating to reimbursement and payment policies of other third party payors including commercial insurers and self-insured entities

The IG is led by Chair Lisa Ohrin, Health Management Associates, Inc., Naples, FL and Vice Chairs Jonell Beeler, Baker, Donelson, Bearman, Caldwell & Berkowitz, PC, Jackson, MS; Roderick T. Chen, Medstar Health, Inc., Arlington, VA; Joseph V. Geraci, Brown McCarroll LLP, Austin, TX and Preeya Noronha Pinto, King & Spalding LLP, Washington, DC.

If you would like to join the Interest Group, continue by clicking the following link: Health Law Section IG Sign-up Form.


ABA eSource Editorial Board

The ABA Health eSource Editorial Board is led by Editor, Marla Durben Hirsch, Potomac, MD; Chair Adrienne Dresevic, The Health Law Partners, PC, Southfield, MI and editorial board members Claire Castles, Jones Day, Los Angeles, CA; Michael E. Clark, Duane Morris LLP, Houston, TX; Conrad Meyer, Chehardy Sherman, LLP, New Orleans, LA; Robert T. Rhoad, Crowell & Moring LLP, Washington, DC and Jennifer Tsao, Hernandez Schaedel & Associates LLP, Pasadena, CA.

Do you want to communicate your ideas to thousands of other members? To contribute a newsletter article on a health law topic, send us your ideas to simeon.carson@americanbar.org.
The opinions expressed are those of the authors and shall not be construed to represent the policies or positions of the ABA or the ABA Health Law Section.
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