Washington Supreme Court Bans “Psychiatric Boarding”

August 8, 2014 By

On August 7, 2014, the Washington State Supreme Court ruled that “psychiatric boarding” under Washington’s Involuntary Treatment Act (“ITA”) is unlawful.

“Psychiatric boarding” is a term used to describe the practice of leaving mentally ill patients in hospital emergency rooms because there is no space at certified evaluation and treatment facilities.  Certified evaluation and treatment facilities are the facilities authorized under the ITA to detain involuntary mental health patients.

County mental health officials began using authority granted under the ITA to issue “single-bed certifications,” which permits mental health officials to leave patients at hospitals which are not certified evaluation and treatment facilities, to address the increasing – and now common – problem of insufficient space at the certified facilities.

In its clear opinion, the court held that the ITA does not authorize single bed certifications to avoid overcrowding at certified facilities.  In doing so, the court recognized that the ITA repeatedly provides that persons who are involuntarily detained under the ITA must be held in certified evaluation and treatment facilities in order to receive the proper evaluation, stabilization and treatment afforded to these patients under the ITA:  “Patients may not be warehoused without treatment because of lack of funds.”

Although the court’s opinion may be a catalyst towards forcing the state to address failures and flaws in its mental health system, the immediate impact of the ruling has left hospitals and county mental health professionals scrambling to figure out what to do.  If mental health professionals are unable to detain psychiatric patients who present at hospital emergency departments and who otherwise meet the criteria for detention but no evaluation and treatment bed is available, hospitals will find themselves in the difficult position of choosing between either allowing a mentally ill patient to leave the hospital or detaining the patient without clear legal authority under the ITA to do so.  The issue is further complicated for hospitals as they must also consider their EMTALA obligations in this situations.

A copy of the court’s ruling can be found here.   For more information about Washington’s Involuntary Treatment Act or mental health services, please contact Lee Kuo.

Filed Under: Mental Health, Washington Tagged With: , ,

WA Certificate of Need Waiver for Psych Beds

July 18, 2014 By

The Washington Certificate of Need (“CN”) Program recently announced a temporary change in the CN requirements for acute care hospitals to change the use of existing licensed beds to psychiatric care beds.  Acute care hospitals choosing to convert some of their acute care beds to psychiatric beds will not have to undergo the CN review process.  This exemption however does not extend to the addition of new beds added to the hospital’s licensed bed count, only the conversion of existing beds.  Hospitals will also be allowed to return the use of the exempt psychiatric beds to general acute care services (i.e. med/surg) without full CN review.

In order to take advantage of this exemption, acute care hospitals will still have to submit a “Hospital Change of Use Exemption Hospitals Licensed Under RCW 70.41 Proposing Psychiatric Beds” application to the CN Program with an application fee of $1,925.  If the project is approved it must commence within two years of the exemption issue date (unless a 6 month extension is otherwise granted).  Hospitals applying for this exemption will still need to meet the physical plan standards and staffing ratios required for providing psychiatric care.

For more information about this exemption or Certificate of Need generally please contact Elana Zana.

Filed Under: Certificate of Need, Mental Health, Washington Tagged With: , , , ,

Providing Telemedicine Services? Pay Attention To State Licensing Requirements

May 7, 2014 By

Advancements in telemedicine offer exciting treatment possibilities for rural communities. Through audio-visual technology, patients in small communities now have the opportunity to access the expertise of specialists at large medical facilities in metropolitan areas.

However, along with all of the promise of telemedicine technologies, there are also some important legal issues that health care providers need to understand.  One of the most important issues is whether physicians who provide treatment advice to a patient through telemedicine must be licensed in the state where the patient is located.  For example, if a patient is located in Washington State, can a physician who is only licensed in Oregon provide telemedicine services to the patient?

The Federation of State Medical Boards (FSMB) has recently addressed the licensure issue in the Model Policy for the Appropriate Use of Telemedicine Technologies.  The Policy  makes it clear that a physician must be licensed by, or under the jurisdiction of, the medical boards of the state where the patient is located.

It is unclear whether state medical boards will follow the Model Policy from FSMB.  For example, Washington State law currently allows physicians licensed in another state to “practice medicine” in Washington so long as they do not open an office or appoint a place of meeting patients or receiving calls within Washington. (RCW 18.71.030). Of course, this provision could change in the future.

In order to avoid the unlawful practice of medicine when providing telemedicine services, physicians and healthcare facilities should take time to understand the licensing regulations in the state where the patient is located.

For more information on the legal issues related to telemedicine, please contact Casey Moriarty.

Filed Under: Health Information Technology, Telemedicine, Washington Tagged With: ,

Skagit County Agrees to Pay $215,000 for HIPAA Violations

March 14, 2014 By

On March 6, 2014, the U.S. Department of Health and Human Services, Office for Civil Rights (“OCR”) reached a $215,000 settlement with Skagit County in northwest Washington state for violations of the HIPAA Privacy, Security and Breach Notification Rules, according to terms of the Resolution Agreement.  This represents the first OCR settlement with a county government for HIPAA non-compliance. For two weeks in September 2011, the electronic protected health information (“ePHI”) for 1,581 individuals was exposed after the ePHI had been inadvertently moved to a publicly accessible web server maintained by Skagit County.  The accessible files included protected health information about the testing and treatment of infectious diseases.

The OCR investigation revealed that Skagit County failed to provide notification to individuals as required by the Breach Notification Rule and that the county failed to implement sufficient policies and procedures to prevent, detect, contain, and correct security violations. Further, Skagit County failed to provide necessary and appropriate security awareness and training for its workforce members.  As part of the settlement, the county has agreed to enter into a Corrective Action Plan to address deficiencies in various HIPAA compliance areas, including written policies and procedures, documentation requirements, training, and other measures.

This settlement highlights the importance for all covered entities and business associates, whether in the government or private sector, to implement policies and procedures to safeguard ePHI and, in case of a breach, to respond promptly and effectively. For more information about this OCR settlement or for assistance with HIPAA compliance, please contact Jefferson Lin or David Schoolcraft.

Filed Under: Breach Notification, HIPAA, HITECH, Washington Tagged With: , ,

HHS Issues HIPAA Guidance For Mental Health

February 21, 2014 By

HHS recently issued HIPAA guidance for mental health practitioners, in an effort to help providers wade through complicated decisions of when disclosures of patient information are permissible.  This guidance, set up in a FAQ format, is designed to incorporate common questions related to the intersection of mental health and privacy laws.  The guidance addresses when healthcare providers are permitted to:

  • Communicate with a patient’s family members, friends, or others involved in the patient’s care;
  • Communicate with family members when the patient is an adult;
  • Communicate with the parent of a patient who is a minor;
  • Consider the patient’s capacity to agree or object to the sharing of their information;
  • Involve a patient’s family members, friends, or others in dealing with patient failures to adhere to medication or other therapy;
  • Listen to family members about their loved ones receiving mental health treatment;
  • Communicate with family members, law enforcement, or others when the patient presents a serious and imminent threat of harm to self or others; and
  • Communicate to law enforcement about the release of a patient brought in for an emergency psychiatric hold.

The guidance also addresses FERPA (privacy laws in a school setting), Federal alcohol and drug abuse confidentiality (42 CFR Part 2 Programs) and the rights of parents to have access to a minor child’s information.    Though not addressed in the guidance, those mental health practitioners practicing in Washington State should also be aware of  the new statutes regulating mental health record disclosures which take effect on July 1, 2014.

For assistance in navigating these privacy rules please contact Elana Zana or Dave Schoolcraft.

Filed Under: Compliance, HIPAA, Mental Health, Washington Tagged With: , ,

Washington Medicaid EHR Incentive Program Webinar

February 11, 2014 By

The Washington State Health Care Authority announced that it will be hosting a webinar to aid in the registration for the Medicaid EHR Incentive Program.  This will help providers who are registering and attesting to both adopt, implement and upgrade and meaningful use.

Topics Include: Navigating the WA ST EHR Attestation Application-eMIPP (MU Stage 1)

  • Attestation
  • Navigating the eMIPP application
  • How to get paid correctly
  • Live Q & A after presentation

To register click here.

The state of Washington has also published helpful tools for registration, including user guides and state specific worksheets (for example the .95 multiplier).

These webinars are very informative and it is recommended that all first time applicants (and those applicants that need a refresher) attend.

Also, note that though the Medicare EHR Incentive Program has extended registration through March 31, 2014, the Washington Medicaid EHR Incentive Program requires registration and attestation by February 28, 2014.

For assistance with registration and attestation for the Medicare or Medicaid EHR Incentive Program please contact Elana Zana.

 

Filed Under: EHR, Health Information Technology, HITECH, Incentive Payments, Meaningful Use, Medicaid, Washington Tagged With: , ,

DOH Issues New Hospital CN Rule & Transparency Requirements

January 6, 2014 By

Prior to the end of the year, and in compliance with Governor Inslee’s directive, the Washington Department of Health (DOH) issued new hospital Certificate of Need (CN) rules and transparency requirements for existing hospitals.

Effective January 23rd, hospitals wishing to affiliate with one another (or other types of corporate restructuring) will now have to undergo full CN review.  The new rules modify WAC 246-310-010 and adopt a broad definition of “sale, purchase, or lease” to include affiliations, corporate membership restructuring, “or any other transaction.”  DOH, in response to the over 1,000 public comments received on these new rules (including the transparency rules below) explained:

The purpose of this clarification is to focus on the outcome of these transactions to bring them within CoN review.  CoN evaluation includes review of the reduction or loss of services and the community’s access to alternatives if there is a reduction or loss.

In addition, DOH issued a modification to the hospital licensing requirements.  This modification now requires hospitals to submit to DOH and publish on their own websites (“readily accessible to the public”) the following policies related to access to care:  admission, nondiscrimination, end of life care, and reproductive health care.  Hospitals must comply with this requirement no later than March 24, 2014.  Hospitals that make changes to these policies must also notify DOH of those changes within thirty days.

Since the amendment to the hospital licensing rules require online access to hospitals’ nondiscrimination policies, now is an excellent time for hospitals to review nondiscrimination policies to be sure they are consistent with all applicable laws.  Hospitals are “places of accommodation” under local, state, and federal nondiscrimination laws, which vary by jurisdiction.  For example, federal law prohibits genetic discrimination, which is not covered by Washington state law; state law prohibits discrimination on the basis of marital status, sexual orientation, and gender expression or identity, which are not covered under federal law; and the City of Seattle prohibits discrimination on the basis of political ideology, which is not covered under state or federal law.  Hospital nondiscrimination policies should be tailored to cover all the jurisdictions in which you provide services.  For assistance with drafting a nondiscrimination policy please contact Karen Sutherland.

For more information about the access to care policies or certificate of need generally please contact Elana Zana.

 

 

Filed Under: Certificate of Need, Compliance, Hospitals, Washington Tagged With: , ,

Proposed CN Rules on Hospital Change of Control & Transparency

November 5, 2013 By

The Washington State Department of Health recently released its proposed rules and letter to Governor Inslee with regard to his directive to open rule making on the Certificate of Need (“CN”) hospital change of control regulations and transparency.  The catalyst for these modifications is the recent spate of affiliations among Washington state hospitals.  The Department of Health was instructed to consider “how the structure of affiliations, corporate restructuring, mergers, and other arrangements among health care facilities result in outcomes similar to the traditional methods of sales, purchasing and leasing of hospitals.”  The current rules require a CN for any “sale, purchase, or lease” of a hospital, but does not provide a definition to explain what is encompassed by a “sale, purchase, or lease”.   The Department of Health has issued its proposed rules creating a definition of “sale, purchase, or lease” in WAC 246-310-010 as follows:

“Sale, purchase, or lease” means any transaction in which the control, either directly or indirectly, of part or all of any existing hospital changes to a different person including, but not limited to, by contract, affiliation, corporate membership restructuring, or any  other transaction.”  WAC 246-310-010(54) (proposed)

The Governor’s directive also focused on transparency for consumers:

The Department’s rulemaking process shall also consider ways to improve transparency for consumer information and ease of use, specifically the Department shall ensure hospitals supply non-discrimination, end of life care and reproductive health care policies; and the Department shall ensure that consumers have access to the policies on its webpage. The Department’s rulemaking process shall also consider the factors in RCW 43.06.155, the principles and policies in the implementation of health reform, including the guarantee of choice for patients.

As a result of comments received from stakeholders, the Department of Health determined that the submission and posting of hospital access policies should be located in the hospital licensing rules, rather than in the CN rules.  The proposed rules suggest adding new provisions to the hospital licensing regulations, specifically WAC 246-320-141 governing patient rights and organizational ethics:

(5) No later than sixty days following the effective date of this section, every hospital must submit to the department its policies related to access to care:
(a) Admission;
(b) Nondiscrimination;
(c) End of life care; and
(d) Reproductive health care.
(6) The department shall post a copy of the policies received under subsection (5) of this section on its web site.
(7) If a hospital makes changes or additions to any of the policies listed under subsection (5) of this section, it must submit a copy of the changed or added policy to the department within thirty days after the hospital approves the changes or additions.
(8) Hospitals must post a copy of the policies provided under subsection (5) of this section to its own web site where it is readily accessible to the public, without requiring a login or other restriction.
The Department of Health is soliciting feedback and hosting a hearing on November 26, 2013 at 1 PM to review the proposed rules.  It expects to file permanent rules on December 10, 2013.
If you have any questions regarding these proposed rules or Certificate of Need in general please contact Elana Zana.
Filed Under: Certificate of Need, Washington Tagged With: , , , ,

Public Hospital Districts Offering Maternity Services Must Offer Abortion Services

August 21, 2013 By

A recent Washington Attorney General Opinion concludes that a public hospital district may not administer or fund programs to provide maternity care benefits or services without making provision for abortion services, benefits, and information.  The Opinion primarily relies on RCW 9.02.100 and RCW 9.02.160 which respectively provide in part:

The sovereign people hereby declare that every individual possesses a fundamental right of privacy with respect to personal reproductive decisions.

Accordingly, it is the public policy of the state of Washington that:

(1) Every individual has a fundamental right to choose or refuse birth control;

(2) Every woman has the fundamental right to choose or refuse to have an abortion (subject to legislative limitations)

If the state provides, directly or by contract, maternity care benefits, services, or information to women through any program administered or funded in whole or in part by the state, the state shall also provide women otherwise eligible for any such program with substantially equivalent benefits, services, or information to permit them to voluntarily terminate their pregnancies.

The Opinion emphasizes that no Washington public hospital district is required to provide maternity care benefits, services, or information.  However, it endorses a broad interpretation of these benefits to include a large range of prenatal, childbirth, and postpartum services and information.  It also concludes that a public hospital district provides maternity care benefits if it financially subsidizes a healthcare provider that provides these benefits.

Accordingly, the Opinion concludes that if a public hospital district contracts for the provision of maternity care benefits and subsidizes this through the use of public funds it must provide the substantially equivalent benefits, services and information required by RCW 9.02.160.  The Opinion expresses no opinion on how public hospital districts might comply with these requirements or what might constitute substantially equivalent benefits, services and information.

For more information about this Opinion or hospital compliance requirements please contact Greg Montgomery.

Filed Under: Hospitals, Public Hospital District, Washington Tagged With: ,

PSBJ Article on HIPAA Interviews OMW Attorney David Schoolcraft

July 26, 2013 By

The Puget Sound Business Journal issued an article today on HIPAA and the impact on business associates.  The article interviewed Ogden Murphy Wallace Attorney David Schoolcraft because of his expertise in healthcare privacy law and health information technology.  The article focuses on the impact HIPAA has on health IT start-ups and their relationships with HIPAA covered entities.  To read the article click here (subscription required).

Filed Under: HIPAA, HITECH, Washington
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