The February issue of the American Health Lawyers Association’s AHLA Connections features a list of the top ten issues that will impact healthcare law in 2015. We summarized the first five topics in a previous blog. (Miss our summary of the first five? Please click here.)
Here are the remaining trends to think about:
- HIPAA Compliance Audits. As with fraud and abuse (#5), it is no surprise that HIPAA compliance will continue as a critical concern in 2015. Covered entities and business associates should be prepared for HIPAA audits since the Office for Civil Rights (“OCR”) announced in early January that OCR audits are forthcoming and “will be an important compliance tool.” While the timing and scope of OCR audits may remain uncertain, there is no question the audits are coming and both covered entities and business associates should be prepared. The audit of business associates is a new development, especially as to compliance with the HIPAA Security Rule. 2015 will also see more OCR investigations stemming from breach notifications.
- Health Care Mergers and Acquisitions. The wave of health care mergers, acquisitions, affiliations, and other consolidation transactions will continue in 2015. Providers are responding to the new initiatives and changes in health care delivery and reimbursement driven by the Affordable Care Act (“ACA”). The primary goals are to effectively manage the health of large populations; enhance physician alignment and integration; implement clinical quality/performance-based programs; assume and manage greater risk; enhance information technology and data analytic capabilities; and develop strategies to reduce costs.
- Supreme Court Review of Medicaid Rate Challenges by Private Parties. While the ACA challenge in King v. Burwell has drawn the most attention, there is another Supreme Court case to follow. In Armstrong v. Exceptional Child Center, the Supreme Court will decide whether Medicaid providers have a private right of action to enforce the “equal access” provision. 42 U.S.C. § 1396a(a)(30)(A) requires that Medicaid fee-for-service payment rates must be consistent with economy, efficiency, and quality of care and be sufficient to enlist enough providers so that care and services are as available to Medicaid patients as they are to the general public in that same geographic area. Allowing providers to bring legal action to compel payment of adequate rates would be a fundamental landmark.
- Mobile Health. Mobile medical technology will be a key growth area in 2015. Like the rest of society, both providers and patients depend more and more on mobile devices like smartphones and tablets. There is a growing expectation that healthcare encounters and transactions can be handled on mobile devices. There will be substantial capital investment by insurers, payors, health systems and providers in developing these technologies. As an unavoidable side effect, health and technology lawyers will need to assist clients in understanding and complying with applicable privacy and security requirements.
- Employment-Based Wellness Programs. The ACA encourages employment-based wellness programs as a way to reduce the healthcare costs associated with unhealthy behaviors. Employers are also expanding workplace wellness programs with the goal of reducing absenteeism, improving productivity, and reducing health care costs. The roll-out of such programs will accelerate in the year ahead.