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HIPAA Series Part II: Effect on Business Associates
The three part HC Topics Series: HIPAA examines the background and recent changes to the Health Insurance Portability and Accountability Act (HIPAA), which was introduced in 1996, and is widely used for safeguarding the privacy of health information. Part I discussed the history and background of HIPAA, as excerpted from the book authored by HCC CEO Bob Cimasi, entitled, "Healthcare Valuation: The Financial Appraisal of Enterprises, Assets, and Services," to be published by John Wiley & Sons later this year; Part II of the series addresses the implications of the new rule affecting the definition and treatment of business associates under HIPAA; and, Part III will assess various compliance concerns and other related privacy laws.

PDF Icon SmallHIPAA Series Part II: Effect on Business Associates
Following Part I, which discussed the history and background of HIPAA, the second installment of the HC Topics three part series focuses on the latest amendment to the HIPAA legislation. The implications of the January 25, 2013 Federal Register, which goes into effect on March 26, 2013, are discussed. This amendment significantly alters previously published requirements affecting business associates and their subcontractors. Next month, the final part of the series will assess various compliance concerns and other related privacy laws. (Read more...)

PDF Icon Clinical Integration Beyond ACOs: The New Frontier
The Federal Trade Commission (FTC) recently released an advisory opinion approving the May 26, 2011 proposal for clinical integration of Norman Physician Hospital Organization (Norman PHO). The approval of Norman PHO's integration plan represents the "first advisory opinion on a proposed clinically integrated network (CIN) since the [Affordable Care Act] was enacted." The FTC noted the plan's potential to increase interdependence and cooperation among providers, increasing efficiency without significant encroachment on market competition. The novel decision provides guidance to other provider networks that may choose to forego an ACO model in lieu of alternate CIN structures. (Read more...)

PDF Icon 2013 Medicaid Changes Under ACA
State Medicaid programs currently provide health insurance for over 62 million individuals, although coverage and cost have historically varied by state. The Medicaid program will undergo several changes in 2013 in anticipation of the implementation of expanded eligibility requirements in 2014, as proposed in healthcare reform legislation. These changes are expected to include enhanced technology to streamline enrollment, increasing physician reimbursement rates for primary care, and adoption of managed care and care coordination strategies to enhance delivery of healthcare to beneficiaries. Despite proposed expansion to states' Medicaid programs, growth may be hampered by the nation's slow economic recovery and challenging fiscal environment, requiring continued attention to cost containment strategies. (Read more...)

PDF Icon CO-OP Health Insurance Program: October 2013 Implementation
The Affordable Care Act of 2010 created funding for the creation of Consumer Operated and Oriented Plan (CO-OP) programs in every state in lieu of a public health insurance option. The intent of CO-OPs is to expand consumer options and enhance competition and accountability among insurance carriers. However, recent legislation passed on January 1, 2013 rescinded all but 10 percent of unobligated CO-OP funds, presenting significant financial hurdles for CO-OPs scheduled to begin consumer enrollment on October 1, 2013. (Read more...)

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