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What you need to know about Health Care Reform Shawn DeGroot Vice President of Corporate Responsibility Regional Health, South Dakota Jeffrey L. Kapp Partner, Jones Day, Cleveland, Ohio Frank E. Sheeder Partner, Jones Day, Dallas, Texas
Background
Agenda ,[object Object],[object Object],[object Object],[object Object],[object Object]
The Process Wasn’t Pretty Source:  Minnpost.com
Bill weighs 20.3 lbs. Values based on that amount of sausage Amount Per Serving Calories  31,180   Calories from Fat 25,009   % Daily Value* Total Fat  2933g   4222% Saturated Fat  974g   4872% Cholesterol  7145mg   2273% Sodium   76,003mg     3248% Total Carbohydrate  300g   220% Dietary Fiber  300g   350% Sugars  0g Protein  1624g  New Commitments Compliance Issues  110%  New Meetings  70% Initiative Changes  90%  Chaos   974% Compliance Calories Serving Size 20.3 lbs (324.8 oz) *Percent Daily Values are based on a 60-hour work week.  Your daily values may be higher or lower depending on your organization’s resources.
Introduction
Patient Protection and Affordable Care Act ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Congressional Findings ,[object Object],[object Object],[object Object],[object Object],[object Object]
Commercial Insurance
Improving Coverage ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Improving Coverage Compliance ,[object Object],[object Object],[object Object]
Four Levels of Coverage ,[object Object],[object Object],[object Object],[object Object],Source:  Travelogue.com
Essential Health Services  (Note:  Apply to Medicaid too) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Essential Health Services Compliance ,[object Object],[object Object],[object Object],[object Object]
Individual Responsibility ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Provisions Affecting Providers
Quality Reporting ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Quality Reporting  Compliance ,[object Object],[object Object],[object Object],[object Object],[object Object]
Prevention Services ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Prevention Services  Compliance ,[object Object],[object Object],[object Object],[object Object]
Publication of Standard  Hospital Charges ,[object Object],Compliance ,[object Object],[object Object]
Better Claim Appeal Procedures re: Insurance Companies ,[object Object],[object Object],[object Object],Compliance ,[object Object],[object Object],[object Object],[object Object]
Demonstration Programs ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Demonstration Programs Compliance ,[object Object],[object Object],[object Object],[object Object],[object Object]
Enrollment – HIT ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Improved Access to Medicaid ,[object Object],[object Object]
Improved Access to Medicaid Compliance ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Home and Community Based Services ,[object Object],[object Object],[object Object],[object Object]
Reduction of DSH ,[object Object],[object Object],[object Object],Compliance ,[object Object],[object Object],[object Object]
State Option to Provide  Health Homes ,[object Object],[object Object],Compliance ,[object Object],[object Object],[object Object]
Quality ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Compliance ,[object Object]
Accountable Care Organizations ,[object Object],[object Object],Compliance ,[object Object],[object Object],[object Object]
More Quality/Efficiency ,[object Object],[object Object],[object Object],[object Object],[object Object]
Transparency ,[object Object],[object Object]
Fraud and Abuse ,[object Object],[object Object],[object Object],[object Object]
Fraud and Abuse Compliance ,[object Object],[object Object]
Fraud and Abuse ,[object Object],[object Object],[object Object],[object Object]
Fraud and Abuse Compliance ,[object Object],[object Object]
Fraud and Abuse ,[object Object],[object Object],[object Object],[object Object],Compliance
Fraud and Abuse ,[object Object],[object Object],Compliance
Fraud and Abuse ,[object Object],[object Object],[object Object],[object Object]
Fraud and Abuse ,[object Object],[object Object],[object Object]
Fraud and Abuse Compliance ,[object Object],[object Object]
Fraud and Abuse ,[object Object],[object Object],[object Object],Compliance
Fraud and Abuse ,[object Object],[object Object],[object Object]
Fraud and Abuse ,[object Object],[object Object],[object Object]
Fraud and Abuse ,[object Object],[object Object],[object Object],[object Object],[object Object]
Fraud and Abuse ,[object Object],[object Object],[object Object]
Fraud and Abuse ,[object Object],[object Object]
Fraud and Abuse ,[object Object],[object Object]
Fraud and Abuse ,[object Object],[object Object]
Fraud and Abuse Compliance ,[object Object],[object Object]
Program Integrity  ,[object Object],[object Object],[object Object],[object Object]
Implementation Timeline ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Implementation Timeline ,[object Object],[object Object],[object Object],[object Object],[object Object]
Implementation Timeline ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Implementation Timeline ,[object Object],[object Object],[object Object],[object Object]
Implementation Timeline ,[object Object],[object Object],[object Object],[object Object],[object Object]
Implementation Timeline ,[object Object],[object Object],[object Object],[object Object]
Implementation Timeline ,[object Object],[object Object],[object Object],[object Object],[object Object]
Implementation Timeline ,[object Object],[object Object],[object Object],[object Object]
Implementation Timeline ,[object Object],[object Object],[object Object],[object Object],[object Object]
Implementation Timeline ,[object Object],[object Object]
Implementation Timeline ,[object Object],[object Object],[object Object],[object Object]
Implementation Timeline ,[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]

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Compliance Implications Of Health Care Reform

  • 1. What you need to know about Health Care Reform Shawn DeGroot Vice President of Corporate Responsibility Regional Health, South Dakota Jeffrey L. Kapp Partner, Jones Day, Cleveland, Ohio Frank E. Sheeder Partner, Jones Day, Dallas, Texas
  • 3.
  • 4. The Process Wasn’t Pretty Source: Minnpost.com
  • 5. Bill weighs 20.3 lbs. Values based on that amount of sausage Amount Per Serving Calories 31,180 Calories from Fat 25,009 % Daily Value* Total Fat 2933g 4222% Saturated Fat 974g 4872% Cholesterol 7145mg 2273% Sodium 76,003mg 3248% Total Carbohydrate 300g 220% Dietary Fiber 300g 350% Sugars 0g Protein 1624g New Commitments Compliance Issues 110% New Meetings 70% Initiative Changes 90% Chaos 974% Compliance Calories Serving Size 20.3 lbs (324.8 oz) *Percent Daily Values are based on a 60-hour work week. Your daily values may be higher or lower depending on your organization’s resources.
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