We offer this publication as a member service of the West Virginia Primary Care Association (WVPCA).

On Jan. 17, CMS released the 2020 Notice of Benefit and Payment Parameters Proposed Rule to finalize standards for issuers and Exchanges in the Health Insurance Marketplace. A version of these proposed rules was made final on April 18, 2019. In the past, these rules were finalized earlier, meaning this year the window of time allotted for insurers and department of insurances to approve rates for 2020 is reduced. Insurers still must submit their qualified health plans (QHPs) to the Centers for Medicare and Medicaid Services (CMS) by June 19, 2019. Here are some highlights from the final rule:

CMS also released a Fact Sheet of the Final Rules to provide a brief overview of the regulatory changes. See the official Final Rule.

Wild and wonderful is used to describe the state of West Virginia and is promoted as having some of the very best and most beautiful outdoors there is. There is growing research that our state's greatest asset could positively impact one's mental health. Recent research findings suggest that "Experiencing the awe in nature is a powerful way to impact people's psychology" according to Jill Suttie Psy.D. Have you taken advantage of this intervention to improve your mental health? Read the entire article, originally published by the Greater Good Science Center at UC Berkeley  here.

According to a recent news alert by Jackson Kelly PLLC, a federal just ruled on April 25 that employers are required to provide 2018 pay data to the U.S. Equal Employment Opportunity Commission (EEOC) by September 30. This report should detail how much workers were paid as well as the number of hours worked and must be broken down by gender, race and ethnicity.  The judge also ordered the EEOC to collect a second year of pay data and is allowing the Commission to decide whether to collect employers' 2017 data or collect 2019 data in the future. 

Read the entire alert here. 

CONTINUITY OF CARE FOR FEDERALLY QUALIFIED HEALTH CENTERS

Federally Qualified Health Centers (or "FQHCs") must be able to ensure a full continuum of care for their patients. To this end, every FQHC must provide required primary health services promptly, and in a manner which will assure continuity of service to patients within the FQHC's service area. FQHCs must also develop an ongoing referral relationship with one or more hospitals to ensure that patients are able to receive a full spectrum of care and are able to receive emerge ncy and other inpatient  health care services that the FQHC is not able to offer.

First, to demonstrate a proper continuum of care, FQHCs should maintain documentation of hosp ital admitting privileges. This  could be achieved through employment contracts or other files which explicitly indicate that FQHC providers have admitting privileges at one or more hospitals. FQHCs could also have formal arrangements with hospitals or other related entities (e.g., hospitalists and obstetrics hospitalist practices) for the purposes of hospital admission of FQHC patients.

Second, FQHCs should adopt internal operating procedures that address the care of patients who are hospitalized as inpatients or who visit a hospital's emergency department ("ED"). Agreements between FQHCs and external entities related to inpatient or ED care should set forth the FQHC's coordination of care internal operating procedures. Specifically, FQHCs should have internal operating procedures that ensure the FQHC's receipt and recording of medical information related to the hospital or ED visit, such as discharge follow-up instructions, and the transmission of laboratory, radiology, or other results. Procedures indicating the extent and type of follow-up care that will be implemented by FQHC staff ancillary to a patient's hospital or ED visit, when appropriate, are also necessary.

Finally, FQHCs must not only have these internal operating procedures and external arrangements in place but must document that they are following such procedures and arrangements. FQHCs can document compliance by saving and recording all transmitted medical information related to the patient's hospital or ED visit, and by thoroughly detailing any follow-up care that was received by the patient from FQHC staff.

By implementing, adopting, and following these procedures and arrangements, the FQHC, its patients, and the entire community will benefit from its ability to provide of a full continuum of care. Additionally, the FQHC will comply with the applicable continuity of care requirements.

Authority: Sections 330(k)(3)(A) and 330(k)(3)(L) of the PHS Act; 42 C.F.R. § 51.c.303(a); 42 C.F.R. §56.303(a). See also Chapter 8 of the HRSA Health Center Program Compliance Manual

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Rachel Ludwig and Neil Brown are members of the healthcare group at Jackson Kelly PLLC.  They are available for consultation through a special retainer relationship with the WVPCA.  Rachel and Neil can be reached at (304) 340-1000.

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