In brief: OCR investigation, NHIA recommendations, SuperCare pilot

WASHINGTON – The Office of Civil Rights, which administers and enforces HIPAA private, security and breach notification rules, has announced that it will investigate the cyberattack on Change Healthcare to determine whether patient health information was compromised. 

The agency will also investigate whether Change Healthcare and UnitedHealth Group were compliant with HIPAA rules. 

“We are committed to ensuring access to care, while enforcing laws that bolster patient privacy and security,” the agency stated. “Safeguarding protected health information is a top priority.” 

OCR reminded health care providers, health plans and business associates tied to or impacted by the attack that, while they are of “secondary” concern, they also have regulatory obligations and responsibilities, including ensuring that business associate agreements are in place and that timely breach notification to the U.S. Department of Health and Human Services and affected individuals occurs as required by HIPAA rules. 

The agency also provided links to a number of resources to help these entities protect their records systems and patients from cyberattacks, including factsheets, webinars and videos. 

CMS joins roundtable on cyberattack 

WASHINGTON – CMS Administrator Chiquita Brooks-LaSure participated in a roundtable with senior administration leaders to hear from health care providers about the challenges they are facing following the cyberattack on Change Healthcare. 

At the roundtable, CMS announced that it will be issuing guidance that will provide needed flexibilities to allow states to support Medicaid providers and suppliers during this time, particularly those operating in fee-for-service delivery systems. 

“CMS recognizes that many Medicaid providers are deeply affected by the cyberattack,” the agency stated. “We are continuing to work closely with states and are urging Medicaid managed care plans to make prospective payments to impacted providers. Medicaid managed care plans do not need CMS authority make prospective payments to providers and suppliers who need them; we are encouraging Medicaid managed care plans to make prospective payments as soon as possible.” 

This announcement follows a March 9 announcement that, in addition to considering applications for accelerated payments for Medicare Part A providers, CMS will also be considering applications for advance payments for Part B practitioners and suppliers. Medicare Part A providers and Part B practitioners and suppliers may submit accelerated or advance payment requests to their respective Medicare Administrative Contractors (MACs) for individual consideration. 

Change Healthcare expects to begin testing and reestablishing connectivity to its claims network and software on March 18, restoring service through that week. It expects its electronic payment functionality will be available for connection beginning March 15.    

NHIA makes payer recommendations 

ALEXANDRIA, Va. – The National Home Infusion Association (NHIA) has developed recommendations for commercial, Medicaid and Medicare Advantage payers to improve patient outcomes and experience, reduce administrative burden, and improve timely access to home infusion services.  

The 2024 recommendations, designed to be incorporated into contracts between health plans and home and alternate site infusion providers, address value-based programs, secondary payers, prior authorization, patient care during emergencies, and more. Each recommendation includes a detailed rationale and proposed metrics to promote data collection to assess the success and impacts of these proposed policy changes. 

“NHIA appreciates the receptiveness from payers to suggestions for how infusion providers can better support health plans and their beneficiaries,” said Connie Sullivan, BSPharm, NHIA’s president and CEO. “Many health plans already recognize the value of outpatient and home-based infusion therapy, and we look forward to ongoing collaboration with payers to further align infusion contracts with the patient care capabilities of our members.” 

The recommendations are largely the result of the association’s payer summit, where payer representatives with responsibilities for benefit structure, network decisions, value-based programing, and specialty pharmacy policy were invited to discuss ways to improve access and efficiencies associated with home and alternate site infusion services. 

Among NHIA’s seven recommendations: 

• Remove prior authorization requirements for infusion nursing 
• Discontinue policies that place arbitrary caps on the number of infusion nursing visits. 
• Require Medicare Advantage plans mirror commercial health plan infusion coverage by using the HCPCS home infusion S-code billing system to offer home infusion coverage for the widest range of infused drugs, facilitate timely discharge from facilities, and improve access for rural patients and those with disabilities. 

To learn more about NHIA’s efforts to expand outreach to commercial payers and to see the 2023 payer recommendations, go to https://nhia.org/advocate/commercial-payors/. 

SuperCare pilots face scanning tech 

DOWNEY, Calif. – SuperCare Health is honoring National Sleep Awareness Week with a new pilot program testing face scanning technology for CPAP masks. During a virtual appointment with a prescribing physician or respiratory therapist, patients can use the technology to scan their faces with their own mobile devices and find a mask that fits them best from a wide selection of options. SuperCare believes the technology will make sleep apnea treatment easier, more cost effective and more efficient for patients who may otherwise have difficulty accessing care or adhering to their treatment plans. “Whenever my team and I begin testing new technology, our ultimate goal is to help patients access the health care they need,” said Sean Nahm, SuperCare’s lead on the program. “If SuperCare’s innovations can make the patient experience better, we’ll be proud leaders within the health care industry as we show how these advancements can truly change lives.” SuperCare expects efficacy rates from the program later this year and if those rates prove the technology works, it plans to launch it companywide. National Sleep Awareness Week takes place March 10-16. 

Georgia congressman to speak at NCPA fly-in 

ALEXANDRIA, Va. – Rep. Buddy Carter, R-Ga., will give remarks at the National Community Pharmacists Association Congressional Pharmacy Fly-in, which takes place April 17-18 in Alexandria, Va., and Washington, D.C. Carter has been very active in efforts to pass pro-patient, pro-pharmacy legislation, such as reforms to pharmacy benefit managers. In addition to cosponsoring other bills, he joined several of his colleagues to introduce the Drug Price Transparency in Medicaid Act (H.R. 1613), which is NCPA-priority legislation that prioritizes fair reimbursement to pharmacies and saves the government more than $1 billion. “NCPA’s fly-in this year may be the most critical one yet,” said Lea Wolsoncroft, NCPA President. “It’s falling at a time when there’s tremendous pressure on independent pharmacies and broad bipartisan support for PBM reforms, but there’s serious risk of them getting pushed behind other congressional priorities. Rep. Carter knows what’s at stake, and I’m eager to hear his perspective on where things stand and what we can do. I hope many community pharmacists will join us at the Congressional Pharmacy Fly-In to help push PBM reform across the finish line.” Carter, a pharmacist who owned Carter’s Pharmacy in southeast Georgia for more than 30 years, will speak on April 17 at 8:30 a.m. ET at the Hilton Alexandria Old Town. Before being elected to Congress, he served as the mayor of Pooler, Ga., and in the Georgia General Assembly.  

NHIA names Counce as award recipient 

ALEXANDRIA, Va. – The National Home Infusion Association (NHIA) has named Jeannie Counce, NHIA’s long-time editor in chief of Infusion magazine, as the recipient of the 2024 Gene Graves Lifetime Achievement Award. The award, which was established in 2006 and is named after Gene Graves, a home infusion pioneer instrumental in the founding of NHIA, honors a member of the profession who has dedicated their careers to working and advocating on behalf of patients and has made a lasting impact on the home infusion industry. One of the first employees of NHIA, Counce was hired in 1997 to oversee the publication of Infusion magazine, a tool created to communicate with members about the work of the association, provide education and increase awareness of home infusion. “It is an honor to be recognized with this award,” she said. “I am so grateful to my NHIA colleagues and all the fantastic members I have met over the years. It has always amazed me how willing home infusion professionals are to share their knowledge to improve patient care and advance the industry. That openness and goodwill is the secret of Infusion magazine’s longevity as much as it is to my admiration for this uniquely commonsense care model.” Counce will receive the award during NHIA’s 2024 Annual Conference at the General Session on March 27. 

Repair Authority announces new CEO 

STRONGSVILLE, Ohio — Repair Authority has named health care industry veteran Carl Kozlowski as its new CEO. Kozlowski brings nearly 40 years of experience in the health care industry, including most recently as CEO of Cardiothoracic & Surgical Associates. “I am thrilled to join the Repair Authority team to lead this company through its next stage of growth,” Kozlowski said. “After nearly 40 years working in health care, I’ve seen firsthand the essential role that home care plays in the continuum of care, and I’m proud of the role Repair Authority plays in allowing patients to receive their respiratory care at home.” As CEO, Kozlowski will lead the growth strategy for Repair Authority, which provides HME repair services to home medical equipment providers nationwide from service centers in Strongsville, Ohio; Fort Worth, Texas; and Manchester, Tenn. He will oversee the company’s plans for expansion through acquisition and organic growth, building a nationwide network of HME repair centers to serve an increasingly consolidating industry. Kozlowski replaces Jesse Keirn, who is retiring. “I am pleased to leave this company in Carl’s capable hands,” Keirn said. “After nearly 30 years in the HME industry, I feel proud of what Repair Authority has accomplished and I can’t wait to see where the company goes next.” 

Wheel it Forward launches national directory 

STAMFORD, Conn. – Wheel It Forward, a volunteer-run community library that lends out and accepts donations of DME, has launched the GotDME National Directory (www.GotDME.org). This resource aims to connect individuals in need with organizations across the country that offer free borrowing and donation options for essential DME like wheelchairs, walkers, hospital beds, rollators, knee scooters, shower safety equipment and more. "This directory fills an important gap by providing easy access to existing lending organizations, most of which don’t have their own websites and are not easy to find through a Google search,” said Elliot Sloyer, founder & CEO of Wheel It Forward. “Based on Wheel it Forward’s inquiry data, there are likely millions of people every year scrambling to borrow and donate durable medical equipment across the USA.” GotDME's National Directory will also be collecting data about each lending organization related to how many people they serve, and how much and what types of equipment they lend out and accept. The goal is to identify data points and trends in DME lending to make the industry more impactful. To learn more about the GotDME National Directory, please visit www.GotDME.org. 

Ascensia extends PASS program 

PARSIPPANY, N.J. – Ascensia Diabetes Care and Senseonics Holdings will extend the Eversense Payment Assistance and Simple Savings (PASS) Program. Designed to help people in the U.S. access the Eversense E3 CGM System more affordably, the program offers major savings for eligible individuals looking to experience the unique benefits of the only long-term CGM system available. Eligible individuals will pay only $99 out of pocket for an unlimited number of six-month Eversense E3 systems under the program. This is equivalent to an average monthly cost of $16.50 and a total out-of-pocket cost of less than $200 for each entire year of continuous glucose monitoring with Eversense E3, excluding the costs of insertion and removal. “Traditional, short-term CGMs don’t work for everyone, and we are proud to bring a truly unique CGM option in Eversense E3 to people with diabetes,” said Rudy Thoms, vice president, CGM Commercial U.S. at Ascensia Diabetes Care. “We are significantly extending the Eversense PASS program to provide major savings for people in the U.S., beyond when they first try the six-month CGM to their subsequent Eversense E3 CGM systems. We believe that long-term CGMs are the future, and so we are pleased to further improve access to and affordability of Eversense, allowing more people to experience the future today.”  The Eversense PASS Program was first introduced in April 2022 to cover one initial Eversense system, which includes a sensor and transmitter. In May 2023 the $99 offer was extended to cover a whole year of continuous glucose monitoring, through the first two sensor/transmitter combinations, and expanded to include more commercially insured people with diabetes. Following the success of the program, those who are eligible will now be able to access these savings for all further Eversense E3 systems, as long as this program remains in effect.  

RESNA implements new SMS cert exam 

WASHINGTON – RESNA has launched the updated Seating and Mobility Specialist (SMS) certification exam. RESNA placed the SMS certification exam on hiatus in November 2023, while it underwent an update to align with the latest industry standards and technological advancements. A panel of subject matter experts revised the exam to cover the full spectrum of seating and mobility delivery, as well as professional conduct. For a limited time, SMS exam candidates will receive $50 off the cost of the exam because they will have to wait until May 2024 for their score report to allow RESNA to complete the standard setting process for this updated exam. RESNA launched the SMS certification exam in 2010 as a a specialty certification for professionals working in seating and mobility, whereas the Assistive Technology Professional (ATP) certification is a broad-based certification exam covering all major areas of assistive technology. There are currently more than 230 certified ATP/SMS professionals in the United States and Canada. For more information and requirements, go here. 

F&P board chair to retire 

AUCKLAND, N.Z. – Fisher & Paykel Healthcare’s chairman of the board, Scott St. John, will retire at the close of the company’s annual shareholder’s meeting in August. Current Director Neville Mitchell will succeed St. John, who has held the role since August 2020 and who has been on the board since 2015.  Under St. John’s leadership, Fisher & Paykel Healthcare supplied products that helped millions of patients during the pandemic, purchased land for a second New Zealand campus and expanded its manufacturing footprint in Mexico and China. “I’m grateful to have played a part in the company’s growth trajectory and to have worked alongside an exceptional team,” said St. John. “Neville will be an excellent board chair. He has a strong track record in the medical devices industry and has outstanding corporate governance experience. I am confident the company will continue to thrive under his leadership.”