Removing a patient from your practice: A physician’s legal and ethical responsibilities

Posted on March 15, 2018 by Pharmaciststeve

http://medicaleconomics.modernmedicine.com/medical-economics/news/removing-patient-your-practice-physicians-legal-and-ethical-responsibilities

While a doctor may discharge a patient for any nondiscriminatory reason, termination is not without pitfalls. Physicians should follow a careful process so as to avoid claims of patient abandonment.

March 16, 2015
By Samantha N. Tomey, JD
 

A myriad of situations might bring about a doctor’s discharge of a patient and termination of the physician-patient relationship. The physician might move, leave the insurance network, or determine that the patient needs the care of a different specialist. The physician also might want to end the relationship due to inappropriate patient conduct such as disruptive or violent behavior; repeatedly missing appointments and/or nonadherence to treatment plans; or refusal to pay for medical services.

Avoid discrimination

Physicians must avoid discriminatory practices that are prohibited by law, including refusing to treat or discharge of a patient based upon the patient’s race, nationality, religion, age, sex or sexual orientation.

What defines patient abandonment?

Patient abandonment generally is defined as the unilateral severance by the physician of the physician-patient relationship, without giving the patient sufficient advance notice to obtain the services of another practitioner, and at a time when the patient still requires medical attention.

While individual states have their own definitions of patient abandonment, the concept of reasonable notice is common to most jurisdictions. In New York, for example, the following is considered professional misconduct: “Abandoning or neglecting a patient under and in need of immediate professional care, without making reasonable arrangements for the continuation of such care, or abandoning a professional employment by a group practice, hospital clinic or other healthcare facility, without reasonable notice and under circumstances which seriously impair the delivery of professional care to patients or clients.”

Related: Firing an employee: protecting your practice from a lawsuit

Significant liability, fines and/or restrictions or loss of the physician’s professional license can result. In states such as California, Texas and Washington, D.C., patient abandonment is addressed in the medical malpractice laws, and significant liability may result if the physician abandons a patient without sufficient notice in advance of termination and injury results.

While some jurisdictions require a specific amount of time for providing notice to the patient, others simply allude to “reasonable” notice. In the absence of a specific legal notice period, 30 days generally is considered a reasonable amount of time to provide adequate notice to the patient in advance of termination.

The physician also should check his or her managed care contracts, which may include specific requirements concerning the termination of covered patients.

Most importantly, during the “notice” period, the physician must continue treating the patient and remain available for office visits.

NEXT: Practical tips to protect physicians from accusations of patient abandonment

 

Practical tips

The following strategies can help protect physicians from liability and accusations of patient abandonment:

  • Provide written notice

The physician should issue a written termination letter to the patient prior to the effective date of termination. The letter should clearly state a termination date (we suggest 30 days in advance) and the reason for termination.

  • Include a list of suitable alternative providers

We suggest that the letter also contain a list of alternative healthcare providers in the area and if appropriate, referral to the patient’s insurance network.

In addition, physicians can provide the patient with contact information from the local and state medical societies, which can be resources for finding a provider that fits their needs.

  • Time the termination properly

Avoid withdrawing from treating the patient when the patient is in medical crisis, unless the patient requires the services of a different specialist and arrangements are made for transferring the patient’s care to such specialist.

Continue providing effective treatment during the intermediate period following issuance of the termination letter and prior to the effective date of termination. Advise your office staff members that the patient is still welcome to schedule an office visit and/or arrange for services before the effective date of termination.

  • Examine managed care contracts and communicate with health plans

If you are a participating provider in a managed care network in which the patient is covered, review the managed care agreement for specifications concerning termination of the physician-patient relationship. Some managed care contracts contain language requiring suitable justification for termination as well as specific notice requirements.

Related: Firing a patient: when it’s needed and how physicians can handle it

The best strategy is to contact the payer, explain the situation, and ensure everything is done properly per the contract to prevent problems later.

  • Provide access to medical records

Offer to send a copy of the discharged patient’s medical records to the patient’s new doctor. Numerous states have laws which require that records not be withheld solely because of a patient’s inability or refusal to pay.

  • Communicate with everyone else in the practice

Be sure to apprise all physicians and office staff members of the termination to avoid inadvertent reestablishment of the physician-patient relationship.

For example, a receptionist or appointment scheduler who is unaware that a patient has been issued a withdrawal letter might schedule a new appointment for that patient following the termination date. In some jurisdictions, this has been construed as renewing the physician-patient relationship, regardless of whether such a result was intended.

Finally, the treating physician should always be the one who makes the determination to terminate the physician-patient relationship rather than another staff member. By remaining personally involved, the physician can ensure that all of the above concerns are addressed appropriately.

Eve Green Koopersmith, JD, is a partner, and Samantha N. Tomey, JD, is an associate with Garfunkel Wild, P.C., in Great Neck, New York. Send your legal questions to medec@advanstar.com.

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Nothing personal… it is just a business decision… our bottom line is more important than your QOL

Posted on March 15, 2018 by Pharmaciststeve

Erin Gard and Joanne Guthrie-GardHer daughter’s epilepsy was under control, but then their insurer stopped covering the drug: ‘It’s devastating.’

http://www.chicagotribune.com/business/ct-biz-illinois-nonmedical-switching-bill-0315-story.html

It took four years for Joanne Guthrie-Gard to find the right seizure medication for her daughter, whose epilepsy, during the worst of it, caused her to have 20 seizures a week.

That medication started to have bad side effects — dizzy spells, slurred speech, unsteadiness — when Erin Gard reached high school, but she was able to switch to an extended-release form that proved a good substitute.

The family’s insurance plan covered the new drug. Until it didn’t.

About four months in, Gard was told to go back to the original drug or pay out of pocket for the extended-release version, which at the time cost about $10,000 for a three-month period.

That’s a practice known as nonmedical switching — when an insurance company changes coverage in the middle of a plan year, even though most plan participants are locked in.

“To have someone come in and say, ‘We’re not covering that drug now,’ it’s devastating,” said Guthrie-Gard, who lives in the northwest suburb Lake in the Hills.

Illinois lawmakers are considering a bill that would guard against those types of abrupt coverage changes, which are typically driven by efforts to cut costs.

The proposed bill would prohibit commercial health insurers from modifying coverage of a drug during the plan year if it has previously approved the drug for a medical condition. It would not prevent plans from requiring pharmacists to give generic substitutions or from adding new drugs for coverage. It does not apply to Medicaid or other public insurance.

The goal is to end what advocates say has become a growing practice of making midyear coverage adjustments to encourage people to switch to lower-cost medicines. Sometimes the plan removes coverage of a drug altogether, though it might also switch it to a different coverage tier that requires higher out-of-pocket costs, or add prior authorization requirements.

Illinois’ bill, which was modeled after legislation in other states, last week passed out of the House Rules Committee and now awaits a hearing in the House Insurance: Health and Life Committee. It has more than 50 co-sponsors.

The Pharmaceutical Care Management Association, which represents pharmacy benefit managers, opposes the bill and others like it.

“This bill would undermine patient safety and force employers, unions and others that provide pharmacy benefits to cover expensive brand drugs, even when more affordable, equally effective competing brand drugs or new over-the-counter options become available,” association President and CEO Mark Merritt said in an emailed statement.

“It would prohibit health plans from upgrading prescription drug lists even when safer, more affordable alternatives come to market,” he said. “Similar legislation in other states has failed largely because it was viewed as a giveaway to drug companies that would raise costs at the expense of consumers.”

A handful of states, including Louisiana and Texas, have laws or protections limiting midyear drug changes. Bills were introduced in at least nine states last year but have not passed.

Blue Cross and Blue Shield of Illinois spokeswoman Colleen Miller declined to comment on proposed legislation, but said “it’s important to remember there are current options for people who want to appeal or request exemptions regarding their pharmacy benefits.”

Illinois legislators approved a similar law last year that went into effect Jan. 1. It says patients who are stable on a drug will be exempt from so-called step-therapy requirements, which is when insurers require them to try more cost-effective drugs before approving the costlier ones.

Rep. Laura Fine, D-Glenview, chief sponsor of the new bill, said the two bills “go hand in hand but they solve slightly different problems.”

The issue is personal for Fine. She said her husband was startled when he went to the pharmacy to pick up medication he’d been taking for years and found the price had skyrocketed because it suddenly was no longer covered.

He was able to get another covered drug that worked, but Fine, who is chairwoman of the House insurance committee, said she has heard similar stories from other people who were not so fortunate.

“People might pick their plan based on the medications that are covered,” Fine said. “Then it changes and they can no longer afford their medication.”

Guthrie-Gard could not afford her daughter’s new epilepsy drug out of pocket. So Gard went back to the original drug and the side effects returned, causing her to miss hours of school and putting her at risk of falling down.

“There was a huge safety issue, to the point that I didn’t want to send her to school,” Guthrie-Gard said.

Guthrie-Gard, an executive assistant who had private insurance through her then-employer, appealed the coverage decision and after a few months her daughter’s extended-release drug was covered again. But for 10 years she has lived with the worry that it could be yanked again, and hopes that the proposed legislation would give families like hers peace of mind.

Gard, now 26, still takes the same medication — plus five others — to control her epilepsy, her mom said. She has been seizure-free for more than a year.

Case managers at the Epilepsy Foundation of Greater Chicago handle patient concerns about midyear drug coverage changes on a daily basis, said President and CEO Bryan Anderson. It is often difficult for people to find the right drugs to control their seizures, and being switched to a different drug might not only set them back but make their symptoms worse, he said.

The Epilepsy Foundation joined more than a dozen state and national patient and provider organizations to form the Illinois Fair Care Coalition to lobby for the bill to ensure stable drug coverage for the plan year. The groups include those that advocate about diabetes, arthritis, cancer and lupus.

Keeping stable patients on medications they know work saves money in the end, Fine said.

An analysis by the Institute for Patient Access, which supports limits on nonmedical switching, found that people with varied conditions — including chronic pain, Crohn’s disease and multiple sclerosis — spent more on nondrug health care during the year after switching to a lower-cost drug than people who didn’t switch.

A 2012 study found that people with rheumatoid arthritis who switched drugs for nonmedical reasons had 42 percent more emergency room visits over six months than people who didn’t switch. That study was authored by consultants to Abbott, which at the time was making the blockbuster rheumatoid arthritis drug Humira (Abbott spun off its pharmaceutical business, AbbVie, a year later).

Failure to adhere to treatment regimens — which can happen if people can’t afford their medicine — costs the health care system $100 billion a year, according to a fact sheet compiled by the U.S. Pain Foundation.

aelejalderuiz@chicagotribune.com

Twitter @alexiaer

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Human Rights Watch Investigating U.S. Pain Treatment

Posted on March 15, 2018 by Pharmaciststeve

www.painnewsnetwork.org/stories/2018/3/15/human-rights-watch-investigating-treatment-of-pain-patients

Human Rights Watch is well-known internationally for its groundbreaking reports on human rights violations around the world. The organization has recently reported on the torture of prisoners in Sri Lanka, forced labor in Thailand, and corruption and mass arrests in Saudi Arabia.

Pain News Network has learned the New York-based non-profit is turning its attention closer to home – by launching an investigation into the treatment of chronic pain patients in the United States.

The impetus for the investigation began when researchers were studying the treatment of cancer and palliative care patients – and began to see poorly treated pain as a human rights issue.

“People we interviewed who didn’t have access to appropriate medications for their pain were essentially giving testimony that was almost exactly the same as the testimony we were getting from the victims of police torture,” says Diederik Lohman, Director of Health and Human Rights for Human Rights Watch.

“And we realized this was actually one of those issues that almost no one was paying attention to. People were facing tremendous suffering that actually could be relieved pretty easily through very inexpensive palliative care and pain management.”

bigstock--156251561.jpg

In many third world countries, Lohman says opioid pain medications like morphine are difficult to obtain, even for patients dying of cancer.

“They would say the pain was just unbearable, that they would do anything to make it stop, and many of them would tell us that they asked their doctors to give them something to put them out of their misery,” he told PNN.

Recently those same stories have been coming from pain patients in the United States.  

“As we started looking at this issue more closely, we started hearing more and more stories of chronic pain patients in the U.S. who had been on opioids, who were being told by their physicians that we have to take you off. And we started hearing stories of patients who were having a lot of trouble finding a doctor who’s willing to accept them as a patient,” said Lohman.

Lohman says Human Rights Watch is well aware of the addiction and overdose crisis in the U.S. But he says the “right balance” needs to be found between keeping opioids off the street and making sure medications are still available to legitimate patients.

‘CDC Clearly Knows What’s Going On’

Part of the investigation will focus on the role played by the opioid guidelines released by the Centers for Disease Control and Prevention in 2016, which discourage doctors from prescribing opioids for chronic pain.

Although voluntary and intended only for family practice physicians, the CDC guidelines have been widely adopted as mandatory rules by other federal agencies, states and insurers.  

The impact of guidelines was sudden and powerful. Within a year of their release, a PNN survey of over 3,100 pain patients found that 71 percent had their opioid medication stopped or reduced. Nearly 85% said their pain and quality of life were worse.

“The CDC clearly knows what’s going on and they haven’t taken any real action to say, ‘That is not appropriate, involuntarily forcing people off their medications. That’s not what we recommended,'” Lohman said. “When a government puts in place regulations that make it almost impossible for a physician to prescribe an essential medication, or for a pharmacist to stock the medication, or for a patient to fill their prescriptions, that becomes a human rights issue.”

Human Rights Watch is looking for testimonials from chronic pain patients who have been forced or encouraged to stop their opioid medication by physicians or pharmacists.

They’d also like to hear from patients who have been forced or encouraged to seek alternative forms of treatment, but who then found those treatments financially or geographically inaccessible.

Input from doctors affected by the opioid guidelines, regulations and anti-opioid climate is also welcome.

Investigators are particularly interested in hearing from patients and doctors in West Virginia, Massachusetts, Maine, Washington, North Carolina, Florida and Montana.

“Our work is heavily reliant on the testimonies of people who are directly affected.

That’s been our methodology of work for many years,” says Lohman. “We would like for our work to actually help move things in the right direction. But it’s important to document what’s going on.”

Researchers hope to complete the investigation by the end of the year.

If you want to share your story with Human Rights Watch, email researcher Laura Mills at millsl@hrw.org.

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FDA to Lower Nicotine in Cigarettes

Posted on March 15, 2018 by Pharmaciststeve

https://www.medpagetoday.com/pulmonology/smoking/71778

The FDA has issued an advance notice of proposed rulemaking (ANPRM) to explore lowering nicotine levels in combustible cigarettes to non-addictive levels, FDA Commissioner Scott Gottlieb, MD, announced Thursday.

“This new regulatory step advances a comprehensive policy framework that we believe could help avoid millions of tobacco-related deaths across the country,” Gottlieb explained in a written press statement.

The FDA will conduct a comprehensive review of the scientific evidence involving nicotine’s role in cigarette addiction and seek input from the public. At this time, however, no specific nicotine limit has been set, which has led to a steady preponderance of smoking industries like 180 Smoke vapes. 

“We’re interested in public input on critical questions such as: What potential maximum nicotine level would be appropriate for the protection of public health? Should a product standard be implemented all at once or gradually? What unintended consequences — such as the potential for illicit trade or for addicted smokers to compensate for lower nicotine by smoking more — might occur as a result?” Gottlieb said in the statement.

He added that the FDA will soon issue two additional ANPRMs: one to seek data and comment on the role that flavors — including menthol — play in the initiation, use and cessation of tobacco products, and another to further explore the regulation of premium cigars. All these replacement glass australia are a must have and a high-quality vape accessory for every vape kit.

The FDA commissioner also vowed to jump start efforts to speed development and regulation of novel nicotine replacement therapies to give smokers who want to quit more options to help them do so.

“When I returned to the U.S. Food and Drug Administration last year, it was immediately clear that tackling tobacco use — and cigarette smoking in particular — would be one of the most important actions I could take to advance public health,” the statement said.

“With that in mind, we’re taking a pivotal step today that could ultimately bring us closer to our vision of a world where combustible cigarettes would no longer create or sustain addiction — making it harder for future generations to become addicted in the first place and allowing more currently addicted smokers to quit or switch to potentially less harmful products.”

Isn’t Tobacco under the control of ATF (Alcohol, Tobacco, Firearms) which is under the DOJ. Is the various federal agencies starting to merge or even worse COLLUDE on what the feds should be doing and going after a single issue from multiple directions ?

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Hi I’m Dr. Mark Isben and I’m speaking up for CPP’s!

Posted on March 14, 2018 by Pharmaciststeve

Dr. Isben’s CPP patient has a failed back surgery and having uncontrollable huge amounts of pain. She’s been on opioids for over 11 years, and now her doctors are FORCE TAPERING her. She has been ABANDONED by the MEDICAL COMMUNITIES! We must UNITE to fight against these

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VA whistleblower exposes improper claim rejections

Posted on March 14, 2018 by Pharmaciststeve

 

 

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The real cause of the opioid epidemic: the government

Posted on March 14, 2018 by Pharmaciststeve

www.kevinmd.com/blog/2018/03/real-cause-opioid-epidemic-government.html

The patient is a forty-two-year-old male who works in the auto manufacturing arena. He takes one step to his left, he turns and lifts a seventy-five-pound piece of metal from a moving conveyor belt. He turns back and takes one step to his right to put the metal on his table. He tightens three screws, lifts the metal off the table to take one step to his right, turning, and places the metal back on the conveyor belt. He does this again and again, four times a minute, 240 times an hour, 2,880 times in his 12-hour shift. This is every day. If he doesn’t have a bad back or neck, he will get them very shortly. When he develops a chronic back or neck problem, he will need help to keep his job. This job keeps a roof over his family and food on their table.

This patient’s help is half of an opioid pain pill with a fourth of a muscle relaxer. He takes this every four hours while he works, with the pain medication rotated to a different pain med every four months. The alternatives to the opioid pain medication are not effective in the workplace. They have never been, and they never will be.

Every state has occupations that require heavy physical labor. Physical labor has been the backbone of the United States since 1776, and it will continue to be our backbone forever. Americans who perform physical labor are the true heroes of this country, but our backbone has developed problems of its own.

The origin

On July 1st, 2015, the Tennessee state government passed a law that closed 308 pain clinics in one day — pain clinics that had been certified by the Tennessee Department of Health. The law dictated that only pain specialists could operate pain clinics in the state of Tennessee. This law left only the sixty-three pain specialists practicing in the state. All sixty-three offices were at full capacity and did not accept any new patients, at least not without a two to six-month wait.

Closing the 308 clinics put 120,000 Americans — properly diagnosed with chronic pain, properly being treated with appropriate opioid pain medications — on the street with nowhere to go. All 120,000 went through opioid withdrawal, and some of them died. Opioid withdrawal lasts seven days.

That is seven days in which the patient cannot work. When the patient comes back to work, he begins to suffer, but he needs that roof and the food on the table for his family.

Until two weeks ago, when I was interviewed by a reporter from my local ABC affiliate, no one had talked about the 120,000 who are still out there. These 120,000 patients felt as if they didn’t count, and they didn’t matter. They feel forgotten as if they are deplorable. But in America, every one of us counts.

Tennessee was the third state to pass this law. Florida was the first state to adopt the law which resulted in 600 certified pain clinics closing with 240,000 patients, properly diagnosed with chronic pain and properly being treated with appropriate opioid pain medications, being left with nowhere to go for treatment. Alabama was the second state to pass the same law with 400 certified pain clinics being closed, leaving another 160,000 patients — also properly diagnosed with chronic pain and properly being treated with appropriate opioid pain meds — left in the cold. North Carolina (fourth) and Missouri (fifth) soon followed.

And they kept going, state after state, ultimately leaving six million Americans without appropriate treatment. These patients are still out there, and they are still suffering. The opioid epidemic began in 2015. It was started by the Federal (DEA) and state governments, not the doctors, not the pharmaceutical companies.

One year after these laws were passed, the use of heroin skyrocketed across the United States.

No one would ever guess that our government, federal and state, would promote heroin use in its people, but they did.

Who would ever guess that our media would remain silent and ignore six million people unjustly suffering? But they do.

The why is still a mystery, but I know. Someone always benefits when the people are made to suffer. That is not America, and it never will be.

Councill Rudolph is an emergency physician.

Some have suggested that one of the definitions/functions of socialism.. if for the bureaucracy to CREATE A PROBLEM and then go about CREATING A SOLUTION to the problem that they created.  In 1914 Congress passed the Harrison Narcotic Act… which basically created the “black drug market” that in 1970 Congress passed the Controlled Substance Act which officially declared a “war on drugs”… the same drugs/black market that Congress had created some 50+ yrs before.  This article just points out some actions taken by some particular states, if it included all those medical practices that have implemented strict dosing guidelines and/or DEA has determined that a particular medical practice is a “pill mill” and toss untold millions of chronic pain pts “to the curb”

No one “feels their pain”…

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75 percent of all opioid misuse starts with people using medication that wasn’t prescribed for them

Posted on March 14, 2018 by Pharmaciststeve

Opioid Addiction Is a Huge Problem, but Pain Prescriptions Are Not the Cause

https://blogs.scientificamerican.com/mind-guest-blog/opioid-addiction-is-a-huge-problem-but-pain-prescriptions-are-not-the-cause/

Cracking down on highly effective pain medications will make patients suffer for no good reason

Both the FDA and the CDC have recently taken steps to address an epidemic of opioid overdose and addiction, which is now killing some 29,000 Americans each year. But these regulatory efforts will fail unless we acknowledge that the problem is actually driven by illicit—not medical—drug use.

You’ve probably read that 80 percent of heroin users started with prescription medications—and you may have seen billboards that compare giving pain medication to children to giving them heroin. You have probably also heard and seen media stories of people with addiction who blame their problem on medical use.

But the simple reality is this: According to the large, annually repeated and representative National Survey on Drug Use and Health, 75 percent of all opioid misuse starts with people using medication that wasn’t prescribed for them—obtained from a friend, family member or dealer. 

And 90 percent of all addictions—no matter what the drug—start in the adolescent and young adult years. Typically, young people who misuse prescription opioids are heavy users of alcohol and other drugs. This type of drug use, not medical treatment with opioids, is by far the greatest risk factor for opioid addiction, according to a study by Richard Miech of the University of Michigan and his colleagues. For this research, the authors analyzed data from the nationally representative Monitoring the Future survey, which includes thousands of students.

While medical use of opioids among students who were strongly opposed to alcohol and other drugs did raise later risk for misuse, the overall risk for this group remained small and their actual misuse occurred less than five times a year. In other words, it wasn’t actually addiction. Given that these teens had generally rejected experimenting with drugs, an increased risk of misuse associated with medical care makes sense since they’d otherwise have no source of exposure.  

But for the majority of students, who weren’t morally opposed to recreational chemicals, medical use made no difference. Here, heavy recreational drug use was what mattered, and that was probably a sign that this group was was at highest risk of addiction in the first place.

In general, new addictions are uncommon among people who take opioids for pain in general. A Cochrane review of opioid prescribing for chronic pain found that less than one percent of those who were well-screened for drug problems developed new addictions during pain care; a less rigorous, but more recent review put the rate of addiction among people taking opioids for chronic pain at 8-12 percent.

Moreover, a study of nearly 136,000 opioid overdose victims treated in the emergency room in 2010, which was published in JAMA Internal Medicine in 2014 found that just 13 percent had a chronic pain condition.

All of this this means that steps to limit prescribing opioids for chronic pain run a great risk of harming pain patients without doing much to stop addiction. The vast majority of people who are prescribed opioids use them responsibly—recent research on roughly one million insurance claims for opioid prescriptions showed that just less than five percent of patients misused the drugs by getting prescriptions for them from multiple doctors. 

If we want to reduce opioid addiction, we have to target the real risk factors for it: child trauma, mental illness and unemployment. Two thirds of people with opioid addictions have had at least one severely traumatic childhood experience, and the greater your exposure to different types of trauma, the higher the risk becomes. We need to help abused, neglected and otherwise traumatized children before they turn to drugs for self-medicatation when they hit their teens.

Further, at least half of people with opioid addictions also have a mental illness or personality disorder. The precursors to these problems are often evident in childhood, too. For example, children who are extremely impulsive are at high risk—but on the opposite end of the scale, so, too are children who are highly cautious and anxious. To reach these kids, we don’t need to label them, but we do need to provide tools that are tailored to their specific issues to prevent them from using drugs to manage those issues.

The final major risk factor for addiction is economic insecurity and poverty, particularly unemployment and the hopelessness, social marginalization and lack of structure that often accompany it. For example, heroin addiction rates among people who make less than $20,000 a year are 3.4 times higher than in people who make over $50,000. To those who study the effects of inequality on health, it is no coincidence that the collapse of the white middle class has been accompanied by a rise in all types of addictions, but especially addiction to opioids.

Many people would prefer it if we could solve addiction problems by busting dealers and cracking down on doctors. The reality, however, is that as long as there is distress and despair, some people are going to seek chemical ways to feel better. Only when we can steer them towards healthier—or at least, less harmful—ways of self-medication, and only when we reach children before they develop this type of desperation, will we be able to reduce addiction and the problems that come with it.

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How to File a Health Care Discrimination Complaint under Section 1557

Posted on March 14, 2018 by Pharmaciststeve

http://familiesusa.org/blog/2016/06/how-file-health-care-discrimination-complaint-under-section-1557

In May, the Obama administration released new regulations that prohibit discrimination by health plans, health facilities, and health care programs. The rules implement Section 1557 of the Affordable Care Act, and build upon existing civil rights law.

Our previous blog describes how this section of the ACA protects people from discrimination on the basis of gender, race, ethnicity, national origin, English language proficiency, and disability. One important feature of this provision is that individuals who believe they have suffered discrimination when seeking health care can take action.  

What can people do if they think they’ve been discriminated against?

Anyone who feels they have been discriminated against in health care has the right to file a complaint with the Office of Civil Rights (OCR) at HHS, as can those with information about discriminatory actions.  Complaints can be filed online through the OCR complaint portal, by mail, by fax, or in writing. The online filing portal will lead you through a number of questions, including:

  • What kind of discrimination did you experience?
  • When did it happen? Is it ongoing?
  • Which health insurer, program, or facility do you think discriminated against you?
  • What happened and why do you believe your civil rights were violated?
  • Are you filling it out for yourself or someone else?

A complaint must be filed within 180 days of the discrimination occurring, but the OCR can extend the filing period if the complainant can show good cause. The OCR will review the complaint, investigate if it believes it has merit, determine whether any violation has occurred, and if so, take action to remedy it.

What action can the federal government take when health care discrimination happens?

If the OCR finds that you’ve been discriminated against, the guilty party will be ordered to take corrective action and comply with the law. If the guilty party does not comply, the federal government may take away funding or take further enforcement action through the courts.

In practice, OCR complaints have resulted in a variety of corrective actions, such as these:

  • Medical centers in Arkansas, Louisiana, Georgia, Colorado, and New York adopted new policies to prevent discrimination from occurring, particularly in the area of gender bias.
  • In Louisiana, the Touro Infirmary Emergency Department introduced new quality and safety measures to ensure gender neutral treatment, especially in cases involving domestic abuse, during healthcare procedures.
  • The OCR instituted two-year long monitoring periods to ensure that non-compliant hospitals provide ethical, nondiscriminatory treatment to patients regardless of sex or gender identity.

Are there any state agencies that might also help investigate a complaint?

Yes, for complaints about discrimination by health insurers, you may also want to notify your state department of insurance, which may have the authority to make their own investigation and help resolve the matter. It may also have the power to fine insurance companies that do not comply with state laws.

Similarly, if the situation involves a Medicaid managed care plan, also notify your state Medicaid agency. Many states have their own civil rights laws, so you should also check into whether there is a state human rights or civil rights office that can get involved.

How Florida handled discrimination against people with HIV/AIDS

One recent example of effective state level intervention happened in Florida. In 2014, the AIDS Institute filed a complaint with OCR and with the Florida Office of Insurance Regulation alleging that four Florida health plans discriminated against enrollees with HIV/AIDS. 

Who: The four health plans were CoventryOne, Cigna, Humana, and Preferred Medical 

Type of discrimination: They imposed excessively high cost-sharing on patients with HIV/AIDS for antiretroviral medications. 

Action taken: Before the OCR completed its investigation, the Florida regulatory agency determined that the practice was discriminatory. It now requires that all plans cap cost-sharing for HIV medication. The plans engaging in this type of discrimination were required to verify that their plans do not discourage people with chronic conditions from enrolling.

Resources for more information about Section 1557

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Opioid Bills Would Up Feds’ Control Over Quotas, Imports

Posted on March 13, 2018 by Pharmaciststeve

https://www.law360.com/lifesciences/articles/1021311/opioid-bills-would-up-feds-control-over-quotas-imports

Law360 (March 13, 2018, 7:55 PM EDT) — Federal lawmakers this week introduced bills to tackle the national opioid crisis, with a bipartisan group of senators pushing to give the Drug Enforcement Administration more control over manufacturing quotas and a Democratic congressman looking to give the U.S. Food and Drug Administration more power to block unapproved drug imports.

Monday’s Senate legislation, brought by Judiciary Committee Chair Chuck Grassley, R-Iowa, and members Dick Durbin, D-Ill., John Kennedy, R-La., and Dianne Feinstein, D-Calif., would make the DEA consider public health factors — like diversion, abuse and…

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