On May 10, 2012, the U.S. Court of Appeals for the Ninth Circuit held that an individual may be criminally convicted of knowingly obtaining health information in violation of HIPAA, even if the individual did not know that the access was illegal.  The decision serves as a reminder to health care providers, health plans, and their business associates that ignorance of the law is no excuse to avoid criminal prosecution with respect to HIPAA, and that serious repercussions may result from accessing patient information without a legally valid reason. 

On May 10, 2012, the Centers for Medicare & Medicaid Services (CMS) issued two final rules that are intended to reduce unnecessary, obsolete, and burdensome regulations on hospitals and health care providers participating in Medicare and/or Medicaid.  According to CMS, the rules will save approximately $5 billion across the health care system over five years and help implement the President’s Executive Order No. 13563, issued in January 2011, calling on all federal agencies to achieve a more effective and cost-saving regulatory framework.

The final rules amend 42 CFR Parts 482 and 485 by, among other changes to the Conditions of Participation, allowing one governing body to oversee multiple hospitals in a multi-hospital system and adding a requirement for a member or members of a hospital’s medical staff to be included on the governing body as a means of ensuring communication and coordination between a single governing body and the medical staffs of the individual hospitals in the system.  The rule also broadens the concept of “medical staff” to permit other practitioners to be included as staff members with hospital privileges pursuant to State law.  These rules will become effective 60 days after publication in the Federal Register.

A May 2012 report by the U.S. Department of Education (ED) concludes that, despite challenges, states, school districts, and schools are making progress in identifying and addressing the educational needs and tracking the academic achievement of English learner (EL) students.  Title III of the Elementary and Secondary Education Act (ESEA), as amended by the 2001 No Child Left Behind Act, funds EL programs and holds school districts accountable for the progress of EL students in acquiring English language proficiency (ELP) and achieving established state academic standards.  The report found, however, that variations in the processes used to identify EL students may impact Title III funding levels, accountability, and service delivery; e.g., a student considered an EL in one school district may not be eligible for, or may be exited from, special instructional services in another district, sometimes, even within the same state. 

The report cited several findings regarding state and district implementation of, and compliance with, Title III as of the 2009-10 school year.  School districts that receive Title III funding must provide special instructional services to EL students; choosing from three broad categories of instructional services, 98 percent of Title III districts provided English as a Second Language instruction to EL students.  Title III districts are required to develop English language proficiency (ELP) standards; 45 states and the District of Columbia had developed ELP standards and linked them to, or aligned them with, state content standards in at least one core subject such as English, math, or science.  States are required to establish accountability systems to monitor state and district performance in supporting EL students’ ELP development and academic achievement in accordance with the individual state’s Annual Measurable Achievement Objectives (AMAO); in 2008-09, 55 percent of Title III districts fully met their state’s AMAOs.

According the report, the Title III accountability requirements, with supplemental funding for educating EL students, resulted in a “dramatic shift” for many states in how they approached serving this growing population.  “States and districts, particularly those that did not have a long history of serving this student population, thus had the impetus to focus attention and resources on EL policies and practices.  Title III also raised awareness around EL issues in states and districts, prompting state, district, and school administrators to pay attention to this historically underserved population.”

ED’s full report, National Evaluation of Title III Implementation – Report on State and Local Implementation, is available at http://tinyurl.com/cvv3z5z.
PCG Education provides web-based tools and professional consulting services to assist state and local education agencies to identify and assess the service needs and monitor the academic achievement of all students, including EL students.

Most U.S. public schools measure students’ average daily attendance for purposes of school report cards and federal accountability.  However, according to a May 2012 John Hopkins University Report, schools’ failure to measure chronic absenteeism “can wreak havoc” that “may have already undermined school reform efforts of the past quarter century and negated the positive impact of future efforts.” Chronic absenteeism is defined as missing 10 percent of the school year, or missing a month or more in the previous year, for any reason. A school can have a positive average daily attendance rate of 90 percent, but still have a 40 percent rate of chronic absenteeism.  Students who are chronically absent in one year are often chronically absent in multiple years, potentially missing six months to over a year in school over a five year period.  Students may be absent for reasons such as illness, work responsibilities, bullying fears, or a preference not to attend school.  High absenteeism is linked to increases in student achievement gaps and high school drop-out rates.

According to the report, chronic absenteeism is most prevalent among low-income students, regardless of gender and ethnicity. Chronic absenteeism begins to rise in middle school and climbs continuously through 12th grade; of all students, high school seniors have the highest absenteeism rates. The report suggests that, if low-income students are in school every day, “This alone, even without improvements in the American education system, will drive up achievement, high school graduation, and college attainment rates.”

The full report, The Importance of Being in School, is available at https://getschooled.com/attendance-counts/report.
PCG Education’s EdPlan™ Instructional Management System can assist schools in monitoring student attendance and implementing appropriate interventions to reduce or stop chronic absenteeism.

The spring 2012 issue of the Future of Children Journal, Children with Disabilities, explores the prevalence, nature, treatment, and consequences of childhood disability. The Journal, released on May 6th, consists of a series of nine articles addressing various aspects, trends, and the long-term financial impact of childhood disability. The Journal reveals that the most prevalent conditions in children with disabilities are mental health disorders, as opposed to physical conditions such as asthma. In 2008-09, the top five reported disabilities in children were behavioral or developmental; more than one in five parents reported that their child had attention-deficit/hyperactivity disorder (ADHD). According to the Journal, ADHD is almost three times more likely than asthma to contribute to childhood disability.

One article in the Journal addresses disability and the education system and documents a significant movement from exclusion of children with disabilities to inclusion.  The 1975 Individuals with Disabilities Education Act (IDEA) made public education more accessible to children with disabilities by establishing the rights of children with disabilities to receive a free appropriate public education and, to the extent possible, to be included in classroom instruction alongside their peers without disabilities. Before the enactment of IDEA, 3.5 million children with disabilities attended public schools; many “were warehoused in segregated facilities with little or no effective instruction.” Thirty years later, in the 2004-05 school year, more that 6.7 million children were receiving special education and related services in public schools, almost 14% of all students nationally.  However, according to the article, the number of special education students has been declining in recent years; for the 2009-10 school year, there were 6.5 million special education students (about 13% of all students).  The decline may be partially reflective of changes in the definitions of disabilities and how children with disabilities are identified.

Other articles in the Journal include discussions on the economic costs of childhood disability, disability and health insurance, and emerging technologies and their impact on disability.  The full Journal is available at http://futureofchildren.org.

On May 2, 2012, U.S. District court Judge Nancy Torresen approved a settlement in a class-action lawsuit brought on behalf of people with long-term disabilities, who claimed that the state should create opportunities for them to live outside nursing homes.  Class members included individuals with cerebral palsy, epilepsy, and other conditions. 

The settlement requires the state to offer home-and-community-based services to those individuals who now reside in nursing homes or are at risk of having to move into nursing homes. The Maine Department of Health and Human Services also agreed to improve the types of services the class members receive while they live in nursing homes.

The U.S. Department of Health and Human Services (DHHS) recently gave preliminary approval to a five-year $1.9 billion demonstration project aimed at coordinating care for Oregon Medicaid beneficiaries. Governor John Kitzhaber said the demo mirrors reforms in the Affordable Care Act and is expected to yield $11 billion in savings while improving health outcomes.

The OR plan would create “coordinated care organizations” to manage all mental, physical, and dental care for 600,000 low-income patients on the Orgegon Health Plan, the state’s Medicaid program. It would focus particularly on the sickest patients with the highest costs, especially people with chronic conditions, such as diabetes and asthma or with mental health concerns.

Federal officials have not yet agreed to grant Oregon a waiver from standard Medicaid regulations, which is needed for the program to be implemented and the money to be spent.

The U.S. Department of Health and Human Services (HHS) announced on May 8 the first 26 awards under a $1 billion competitive grant program administered by the Center for Medicare and Medicaid Innovation (CMMI) under section 3021 of the Affordable Care Act (ACA). The first 26 awards are for $122.6 million over 3 years and are estimated to achieve savings of $254 million within the same periods. The top awards were to the University Hospitals of Cleveland ($12.7 million), the Emory University Center for Critical Care ($10.7 million), the Pittsburgh Regional Health Initiative ($10.4 million), and Duke University ($9.7 million). The Duke University project seeks to help 57,000 persons with diabetes in four counties in North Carolina, Mississippi, and West Virginia, using informatics systems to stratify patients and neighborhoods by risk, target communities in need of interventions, and develop appropriate decision support and real-time monitoring systems. The Emory University project will deploy 40 critical care professionals to offer training and support in the use of tele-ICU services for critically ill persons in rural and underserved areas in northern Georgia in order to improve access to specialized care and reduce medical transportation costs. The next recipients in this on-going series of innovation awards will be announced in June 2012.

On May 4, the Massachusetts House of Representatives released its first draft of the Health Care Quality Improvement and Cost Reduction Act of 2012 (H. 04070), a long-awaited bill to reform the Commonwealth’s health care financing system. The House bill reflects extensive hearings on Beacon Hill since the reform proposal presented by Governor Deval Patrick in February 2011. The release of a Senate bill may be imminent. After additional hearings in June, legislative action could be completed by the end of the current session on July 31. Estimates indicate that the House bill could save Massachusetts consumers $160 billion over 15 years.

The multi-faceted House bill would create an independent Division of Health Care Cost and Quality, governed by a public board with industry and consumer representation, charged with the responsibility to promote payment and delivery system reform among all payers in the Commonwealth, using tools such as accountable care organizations (ACOs), patient-centered medical homes, and innovative bundled, global, and pay-for-performance financing strategies. It would also create a wellness and prevention trust fund to expand community-based initiatives targeting preventable diseases, a health care workforce trust fund to improve primary care in medically underserved areas, a distressed hospital trust fund, and a health information technology fund.  

The House bill would limit aggregate health care spending in the Commonwealth to growth rates below the Commonwealth’s overall economic growth rates beginning in 2015 and extending beyond 2027; impose 10 percent assessments on charges for hospitals and other facilities that exceed 120 percent of statewide medians, to be transferred to the distressed hospital trust fund; promote integration of behavioral health and primary care; create a consumer health information website; increase transparency for consumers about charges and cost-sharing that they may be liable for; standardize prior authorization procedures; require meaningful use of electronic health record (EHR) systems and proficiency in computerized physician order entry (CPOE) and e-prescribing through state licensure standards; create a statewide interoperable health information exchange and data storage capability; and reform Massachusetts malpractice law to adopt successful disclosure and settlement methods pioneered by the University of Michigan health care system.  

The bill would also require the state Medicaid agency, which won approval from the Centers for Medicare and Medicaid Services (CMS) for a delivery system transformation strategy last December 20, to attribute each Medicaid recipient to a primary care practitioner; to develop a shared savings program with respect to recipients not enrolled in managed care organizations; and to implement an accountable care organization (ACO) or a medical/health home model for 25 percent of Medicaid recipients by January 1, 2013, 50 percent of Medicaid recipients by January 1, 2014, and 80 percent of Medicaid recipients by January 1, 2015.         

The Administration for Children and Families (ACF) is proposing a new data collection activity as part of the development of an early care and education quality measurement tool to assess family-provider relationships that support positive child developmental outcomes and family wellbeing. More details are available at http://www.gpo.gov/fdsys/pkg/FR-2012-05-01/pdf/2012-10305.pdf