04-14-2021 Council Packet - Laserfiche WebLink

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16 Managed Care Nursing facilities throughout the United States are facing a health care environment that is becoming increasingly dominated by the development of risk-based managed care plans. The necessity for nursing facilities to contract with managed care plans is increasing not only for privately insured residents but also for Medicaid and Medicare beneficiaries. States are experimenting with innovative delivery and payment systems to provide care to such beneficiaries, and in Minnesota there are certain plans that provide for contractual risk sharing in the delivery of services to individuals who are eligible for both Medicaid and Medicare. The current trend in health care reimbursement is for the federal government to enable the states to use managed care as a way to reduce costs without the need for federal interference and approval. There can be no assurances that over time the Corporation will be able to enter into satisfactory contracts with such managed care plans or that the revenues generated by any such managed care plans with which it may choose to contract will be sufficient to meet the actual operating costs of the Corporation’s nursing facilities. Privacy and Security Regulations The confidentiality of patient medical records and other health information is subject to considerable regulation by state and federal governments. Legislation and regulations governing the dissemination and use of medical record information are being proposed continually at both the state and federal levels. For example, the administrative simplification provisions of HIPAA mandate that health care providers use and disclose certain protected health information in accordance with DHHS standards and requirements. These rules require the implementation of policies and procedures by covered entities for coding, maintaining, storing and transmitting medical information, as well as policies and procedures designed to protect the security, data integrity and confidentiality of patient medical information and to permit patients to exercise their specific rights under HIPAA. HIPAA. The Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) mandates the adoption of federal privacy and security standards to protect the confidentiality of protected health information. Regulations designed to protect health information impose very complex procedures and operational requirements. Failure to protect the privacy and security of protected health information could result in damages or civil or criminal penalties. In particular, HIPAA imposes civil monetary penalties for violations and criminal penalties for knowingly obtaining or using individually identifiable health information. Any violation of HIPAA or the regulations promulgated thereunder is subject to civil and criminal penalties that include monetary penalties and/or imprisonment. Violations may increase operating expenses as necessary to notify affected individuals of privacy or security breaches, correct problems, comply with federal and state regulations, defend against potential claims and implement and maintain any additional requirements imposed by government action. HIPAA, along with privacy rules arising under federal and various state statutes, addresses the confidentiality of individuals’ health information. Use or disclosure of individually identifiable health information is prohibited unless expressly permitted under the provisions of the HIPAA statute and regulations or authorized by the patient. HIPAA’s confidentiality provisions extend not only to patient medical records, but also to a wide variety of health care clinical and financial settings where patient privacy restrictions often impose new communication, operational, accounting and billing restrictions. These add costs and create potentially unanticipated sources of legal liability. On December 10, 2020, DHHS announced a proposed rule proposing changes to HIPAA regulations in an effort to promote value-based health care. The proposed rule includes changes regarding individual rights to access health information, related to information sharing for the purposes of care coordination and case management, and relating to encouraging family and caregiver involvement in care of patients.