Arkansas Prompt Pay Rule Effective
As a reminder, the Arkansas Insurance Department’s new Prompt Payment Rule went into effect January 1, 2001. Under the rule, hospitals and physicians have the right to file complaints and collect 12% interest on late payments by insurance companies. Details include the following:

• For purposes of a hospital claim, a clean claim is one submitted on a HCFA 1450 form, or its electronic counterpart, completed in accordance with the “published” filing requirements of the carrier, and for which no additional information is needed for processing.
• Clean claims must be paid or denied within 30 calendar days of receipt for electronic claims, 45 days for paper claims. Beginning on the 61^st day after receipt, an automatic 12% per annum penalty accrues until the claim is paid.
•  If additional information is needed to process a claim, the carrier must make the request within 30 days of receipt of the claim.
• Claims that require additional information must be paid within 30 days after receiving the requested information. After the 45^th day, the 12% penalty begins.
• A carrier’s claim filing requirements must be given to contracted providers at the time of contracting and within 15 days of any change. Any provider or insured must be provided copies of the requirements upon request within 15 days.
• Complaints can be filed with the Insurance Department if a carrier’s claim filing requirements appear to be unreasonable or burdensome. If the Insurance Commissioner agrees, he/she will order the carrier to change or discontinue the filing requirements.
• Individual healthcare providers may also file complaints if a carrier exhibits a practice of not paying for the provider’s claims according to the rule.

The interest penalties and the ability to file complaints are two major wins for hospitals and physicians. The interest must be paid automatically. A provider is not required to request or file a claim to collect the penalty. Failure to pay the penalty would be a violation of the rule. However, if a carrier is not complying with the interest provision, it might be necessary to file a complaint to have the Insurance Department enforce the provision.

A provider complaint may not be filed for a single claim. However, if a provider discovers a pattern or practice that a specific carrier is not paying its claims on time, the complaint may be filed. Patients may continue filing complaints over individual claims and hospitals or physician offices may wish to assist them in doing so.

Find a copy of the new regulation on the Arkansas Insurance Department’s Web site at www.accessarkansas.org/insurance/rulesandregs/legal_rnr43_2k.html.

AHRQ Grants Available
The federal Agency for Healthcare Research and Quality (AHRQ) is seeking applications for $3.5 million in grants for demonstration research projects that use clinical informatics to promote patient safety (CLIPS). Nonprofit organizations, universities, clinics, and governmental agencies are eligible to apply.

The agency will consider research in the role of informatics in improving clinical decision-making, reducing errors, and advancing patient safety; barriers to acceptance and adoption of health information technology for improved patient safety; and use of effective strategies to improve patient safety while maintaining patient confidentiality. 

Priority will be given to applications that emphasize outpatient settings and priority populations such as women, children, the elderly, minorities, low-income, or special-needs patients. More information is available on the AHRQ Web site at www.ahrq.gov/fund.grantix.htm.

Batesville Hospital Gets $1 Million
White River Medical Center in Batesville received a unique Valentine’s Day gift when real estate developer and banker Doyle Rogers and his wife Raye announced a gift of $1 million to the hospital.  It is the largest gift in the hospital’s 25-year history. 

Gary Bebow, administrator and CEO of White River Health System, said the gift would be used as seed money for the Josephine Raye Rogers Center for Women and Imaging. The new women’s center will be a three-story facility adjoining the hospital. The $11 million facility is scheduled to open in 2002. The remaining funds for the center are to be raised through donations and grants.

 “Every hometown in America needs a Doyle and Raye Rogers.  They are role models of good citizenship, community involvement, pride and love for one’s hometown.  Doyle has long served on our hospital Board of Directors, providing wise counsel and advice.  The entire state of Arkansas, and certainly this community and surrounding counties, are immensely grateful to the Rogers family for this milestone gift,” said Bebow.

Critical Access Hospitals on the Rise in Arkansas
Arkansas’s list of Critical Access Hospitals (CAH) now includes thirteen facilities.  Hospitals achieving CAH status are:  CrossRidge Community Hospital in Walnut Ridge, Stone County Medical Center in Mountain View, McGehee Desha County Hospital, Dallas County Hospital in Fordyce, Dardanelle Hospital, Eureka Springs Hospital, Medical Center of Calico Rock, North Logan Mercy Hospital in Paris, Mercy Hospital/Turner Memorial in Ozark, Mercy Hospital of Scott County in Waldron, Lawrence Memorial Hospital in Walnut Ridge, Howard Memorial Hospital in Nashville, and Baptist Health Medical Center in Heber Springs.  Several other Arkansas hospitals are working on their applications and feasibility studies for CAH designation.

Summer Management Conference, June 13-15
The Arkansas Hospital Administrators Forum/Arkansas Health Executives Forum summer management conference will be held June 13-15 at the Beau Rivage in Biloxi, Mississippi. 

The educational portion of the meeting is highlighted by Dr. J. B. Silvers, former president and CEO of QualChoice and a Medicare Prospective Payment Advisory Commission (ProPAC) Commissioner, who will discuss increasing workforce challenges for top management. 

Silvers will review his belief that today’s demographics and economics now make it imperative for hospitals to examine career paths, working conditions, and role definitions that attract and retain good workers. Labor must be seen as a long-term asset to be maintained, rather than a short-run cost to be managed.

Another speaker is attorney Dan Mulholland of Horty, Springer & Mattern in Pittsburgh. He will discuss the Health Information Portability and Accountability Act of 1996 (HIPAA) privacy regulations and what hospitals can do now to comply with the new rules. 

Mulholland will also discuss Phase I of the Stark II regulations, which were finalized January 4. The new regulations are extremely complex and touch a wide variety of relationships between hospitals and physicians, as well as between physicians and their medical practices. In addition, Diane Mackey of Friday, Eldredge & Clark, will present her always-popular annual legal update.

Along with the planned educational activities, the Beau Rivage and Biloxi offer many opportunities for family entertainment: a 1,500-seat theatre featuring Michael Flatley’s "Lord of the Dance;" a fully-equipped marina offering excursions to nearby barrier islands, dolphin tours, charter fishing or sailing; golf; beach access; swimming pool and spa overlooking the Mississippi Sound; and many, many other forms of entertainment making the trip to the Gulf Coast memorable. 

Contact Beth Ingram at (501) 224-7878 for additional information.

HIPAA, EMTALA Rules Don’t Conflict
Hospital officials who have wondered to themselves or publicly whether published privacy rules of the Health Insurance Portability and Accountability Act (HIPAA) conflict with hospitals’ responsibilities under the Emergency Medical Treatment and Active Labor Act (EMTALA) may get some comfort from an American Hospital Association (AHA) interpretation on the issue.

The HIPAA privacy rule allows a hospital to refuse treatment to a patient who declines to consent to the parts of the hospital’s privacy notice that governs the use of patient information. EMTALA, however, requires that a hospital appropriately screen, treat, and stabilize all patients coming to the hospital for emergency care. 

According to AHA’s HIPAA advisory team – which cautions that its interpretation should not be considered as legal advice – there is no conflict between the two. The team believes that two exceptions under the privacy rules provide a screen against causing EMTALA violations.

The first exception provides for a waiver of the consent requirement when the hospital is required by law to provide treatment. The hospital must, however, (1) try to get the patient’s consent, (2) document the hospital’s attempt, and (3) document the reason consent was not received.

The second exception is more specific and temporarily waives the consent requirement in emergency treatment situations. This exception applies when a hospital initially is unable to get consent because of the emergency situation. But, the consent must be obtained as soon as possible after emergency treatment is provided.

The two provisions work together as follows: If a hospital emergency room provided care to a patient without the consent being signed, the regulation would not be violated unless the hospital failed to try to get consent as soon as possible. 

If the patient then refused to sign the consent, but the hospital was required to provide care because of EMTALA, the regulations allow the hospital to use and disclose the health information for treatment, payment, and healthcare operations, consistent with the hospital’s notice of information practices. A hospital that agreed to more restrictive practices in its notice would be limited by that notice.

Smoking Hurts Arkansans’ Health
The federal Centers for Disease Control and Prevention (CDC) has released a study indicating Arkansas ranks among the worst states in terms of smoking-related deaths. It has the fourth highest rate of lung cancer deaths and more than 25% of all adult Arkansans ¾ including half of all high school boys ¾ use tobacco products. Nationally, 22.7% of adults smoke or use other tobacco products. Only West Virginia, Kentucky, and Nevada have a higher rate of smoking-related deaths. 

The timing of the report coincides with efforts by some state legislators to change the voter-approved spending plan for money coming to the state from the national tobacco settlement. It offers one more reason why the Legislature shouldn’t tinker with the plan that would direct all the tobacco-settlement funds toward funding healthcare programs, according to Governor Mike Huckabee.

Among other things, the CDC report promotes smoking prevention programs as a means of reducing the number of people who choose to smoke and the healthcare costs related to their smoking-related illnesses. It says Arkansas should spend at least $17.9 million annually on prevention programs. Currently, the state spends about 58-cents per person on prevention programs. Initiated Act 1 of 2000 ¾ the spending plan ¾ would raise that to about $8 per person, which meets the study’s recommendations.

Arkansas Continuous Survey Readiness Program Grows
Seventeen Arkansas hospitals have joined the Arkansas Continuous Survey Readiness (CSR) Program, with three additional hospitals expressing an interest in the program.

The CSR program is designed to help hospitals achieve a continuous state of survey readiness, particularly for preparation for Joint Commission and HCFA validation surveys.  Program benefits include consistent, timely preparation assistance from a dedicated regional representative and surveyor cadre; initial and annual educational workshops/seminars at a very low cost; quarterly consulting visits tailored to meet an organization’s specific needs; self-assessment tools; and the potential to reduce expenses and consulting fees necessary with full compliance with JCAHO and other regulatory activities.

For an information packet about CSR, contact Beth Ingram at 501-224-7878 or bingram@arkhospitals.org.

RWJ Launches Coverage Ad Campaign
The Robert Wood Johnson Foundation (RWJ), with co-sponsorship from the American Hospital Association (AHA) and nine other nationwide organizations, March 5 began an extensive ad campaign to draw attention to the problem of the nation's uninsured.

The campaign is scheduled to run through the first week of May with ads in the Washington Post, New York Times, Washington Times, Roll Call, Congress Daily, National Journal, Congressional Quarterly (weekly edition), New Republic, and the Weekly Standard.

Besides the AHA and the RWJ, sponsors are the AFL-CIO, American Medical Association, American Nurses Association, Business Roundtable, Catholic Health Association of the United States, Families USA, the Health Insurance Association of America, the Service Employees International Union, and the U.S. Chamber of Commerce.

Boy Scout Program Suggestion
Hospitals experiencing acute shortages of registered nurses and other medical professionals might want to look to the Boy Scouts of America for some relief. The Boy Scouts have an Exploring Program that could serve as a first step in interesting young people in a career as a health professional.

Hospitals interested in establishing or supporting a hospital-based Exploring program can find more information by visiting the Boy Scout Web site, www.learning-for-life.org. After accessing the Web site, click on "exploring," then click on "health." For further information, call your local Boy Scout office or Don Adams at the Arkansas Hospital Association at (501) 224-7878.

New BIPA Analysis For Arkansas
A new analysis of the Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA) shows that Arkansas hospitals could see at least $133 million in Medicare payments restored as a result of the act. The Arkansas Hospital Association obtained the information from the Hospital Association of New York State (HANYS) which developed its own modeling tool to assess the BIPA impact and initially used it to estimate how hospitals in New York will fare under the law.

The estimate for Arkansas based on the HANYS model differs from one previously provided by the American Hospital Association (AHA). That analysis showed a $100 million BIPA impact in the state. Unlike the AHA estimate, the HANYS model includes payments related to direct medical education, skilled nursing, and home health services. It also includes data from more recent Medicare cost reports.

According to the HANYS analysis, the following BIPA provisions should generate additional payments to Arkansas hospitals over the next five years:

• Increase the hospital inpatient prospective payment system (PPS) update factor ($41.0 million)
• Increase the hospital outpatient PPS update factor for FY 2001 ($4.1 million)
• Increase in reimbursement for bad debts ($10.3 million)
• Increase payments related to new disproportionate share provisions ($47.0 million)
• Adjust indirect medical education payments upward ($2.5 million)
• Raise floor for direct medical education to 85% of national amount ($2.2 million)
• Allow a higher Skilled Nursing Facility update factor and nursing component rate ($6.1 million)
• Increase home health PPS update; 10% rural home health add-on; delay 15% home health reduction ($20 million)

The Arkansas Hospital Association has prepared and mailed estimates showing the BIPA’s expected impact on all community hospitals in the state. The estimates are based on the HANYS information and show how each of the above items is expected to impact individual facilities.

Arkansas Receives First Tobacco Payment
Arkansas received its first payment from the national tobacco settlement fund January 11 with the deposit of $88 million into a trust fund set up as part of the state’s spending plan for the money. The payment was the first of two installments coming to Arkansas during 2001. A second payment of $31 million is due in April, bringing the total to $119 million for the year. The first $100 million is to be placed into a trust fund to generate revenues for future years. After that, yearly payments will go toward healthcare and health-related programs.

Beginning in 2002, the state should receive annual payments ranging between $55 million and $65 million, depending on national sales figures of the major tobacco companies. Those funds are to be divided among such purposes as expansion of the Arkansas Medicaid program, tobacco-use prevention programs, tobacco-related medical research, minority health, and programs for the elderly. Over a 25-year period, the tobacco settlement should bring about $1.62 billion to the state.