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NPR just did a program about how rural patients are turning to telehealth because of a dearth of health care resources in rural areas.  Showcased was one woman’s use of telehealth for therapy services to assist her with depression.

“Hill says knew she needed therapy to deal with her deepening depression. But the main health center in her rural town had just two therapists. Hill was told she’d only be able to see a therapist once a month.”

NPR also did a poll on the subject and shared the results:

“A recent NPR poll of rural Americans found that nearly a quarter have used some kind of telehealth service within the past few years; 14% say they received a diagnosis or treatment from a doctor or other health care professional using email, text messaging, live text chat, a mobile app, or a live video like FaceTime or Skype. And 15% say they have received a diagnosis or treatment from a doctor or other health professional over the phone.”

The post Rural Patients Turning to Telehealth appeared first on Garlo Ward, P.C..

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American Declaration of Independence

The post Happy Independence Day!!! appeared first on Garlo Ward, P.C..

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On June 10, Governor Greg Abbott signed a bill legalizing hemp production.  

Texas House Republican Charles Perry was the author of House Bill 1325 and has been a huge advocate for the hemp industry in Texas. The bill passed with flying colors.

“The hemp industry is rapidly growing and we need to ensure our farmers are able to participate. We hope this agricultural commodity will help boost rural communities now that there is a new viable crop option for our farmers,” Perry told the Dallas Observer. “

In West Texas, farmers are already making plans for the growing of hemp.

Village Farms International (VFF) is moving into greenhouse-grown hemp in Texas, as the state officially sanctions growing hemp as a crop. Village Farms stock edged down as the biggest marijuana stocks traded broadly lower.  Village Farms has begun converting half its 1.3-million-square-foot greenhouse for cannabidiol (CBD) cultivation. It will apply for required cultivation and production licenses as soon as it can do so.”

The legalization has thrown a wrench into the prosecution of marijuana offenses as now the State will have to prove the percentage of THC:

“Inside the Houston Forensic Science Center, where technicians test marijuana every week, scientists look at the plant under a microscope to detect small hairs unique to the Cannabis Sativa plant. A quick chemical test detected only the presence of THC, the potency was never captured. It didn’t have to be.

Under old laws, “it didn’t really matter (how potent it was),” said Peter Stout, president and CEO of the Houston Forensic Science Center, which tests criminal evidence in Houston.

Now that hemp is legal, it does matter. The microscopic analysis is not helpful as hemp and marijuana are the same plant and look identical under microscopic analysis, according to lab technicians.”

The post Three Interesting Stories on the Texas Legalization of Hemp appeared first on Garlo Ward, P.C..

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Modern Healthcare magazine is reporting that the results of a study published in Health Affairs are indicating that staffing levels are “often lower than reported” and “below what CMS expects.”  One area of special concern is staffing of RN’s:

“The numbers were most stark for RNs, where 91% of the organizations met expectations less than 60% of the time.

Almost all facilities are required to have at least one RN on site for at least eight hours every day. But nearly 4% of those analyzed met the federal requirement in less than 80% of the days over the period of a year. While most are satisfying that mandate, three-fourths of nursing homes were almost never in compliance with what the CMS expected their RN staffing levels to be based on residents’ acuity, suggesting that measure should be updated, researchers said.”

The post Nursing Home Staffing Levels Lower than Reported? appeared first on Garlo Ward, P.C..

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Financial statement with stethoscope and calculator

I discussed SB 1264 passed by the Texas Legislature regarding balance billing(surprise billing)  in the first Grand Rounds Legal podcast by Garlo Ward.  The bill was signed by the governor on June 16, 2019 and will be effective on September 1, 2019.  Congress is also addressing the issue in a bipartisan bill filed by Frank Pallone (D-NJ) and Greg Walden (R-OR).  Go here to read the details in this blog post by Obsurvus Solutions.

The post Senate Bill 1264 Signed into Law & Surprise Billing Scrutinized by Congress appeared first on Garlo Ward, P.C..

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HB 29 has been signed by Gov. Abbott granting increased direct access to patients under certain conditions:

  • Professional liability coverage in the minimum amount required by board
  • Doctoral degree through program accredited by the Commission on Accreditation in Physical therapy or agency or association recognized by the US Secretary of Education or completion of 30 hours of continuing competence activities in the area of differential diagnosis.
    • with doctoral degree may treat for not more than 15 consecutive business days.
    • without, for not more than 10
    • Both must have professional liability insurance.
  • Signed disclosures in form prescribed by Board will be necessary.

The bill takes effect on September 1, 2019

The post HB 29 Direct Access Legislation for Physical Therapists in Texas appeared first on Garlo Ward, P.C..

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On June 5, HHS posted Provider Letter No. 19-13 impacting the HCS, LIDDA and TxHmL handbooks. The letter gave notification of additions regarding requirements to “Train Staff, Member, Service Providers, and Volunteers” regarding Abuse, Neglect and Exploitation.

On June 7, HHS posted  Long-Term Care Regulator Provider letter PL 19-14 affecting Nursing Facilities (NF) regarding Proper Authorization of Applied Income from Resident Trust Fund(s).  Remember that NF residents have the right to determine how their trust fund money is spent, including the right to make small monthly payments towards overdue applied income balances.

On June 14, 2019, HHS posted Information Letter No. 19-11 to numerous providers that gives direction regarding preparation for the “Upcoming Fiscal Year 2019 Fee-for Service Claims Billing Closeout.  

On June 17, 2019, HHS posted Information Letter No. 19-12 regarding new requirements regarding abuse, neglect, and exploitation for the CLASS and DBMD programs.  This is similar to the June 5 letter as it regards adding new appendices to the manuals regarding training of staff and volunteers.

The post June 2019 Provider Letter from Texas HHS appeared first on Garlo Ward, P.C..

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The libertarian-leaning Citizen’s Council for Health Freedom is reporting on a massive patient data hack at a clinic in Michigan.  The doctors refused to pay the ransom demanded by hackers that attacked the clinic’s EHR with ransomware.  The hackers then wiped the entire system, deleting all patient data.  This blow caused the two doctors running the clinic to retire early:

“Rather than rebuild their practice from scratch, the doctors retired early, leaving their patients to find care, and scheduled surgery elsewhere,” said CCHF president and co-founder Twila Brase. “When Congress mandated that doctors use electronic health records, it opened the door to hacking. This is just one of the many dangers electronic health records (EHRs) pose to patients, and nearly everyone’s private medical information has been entered into an EHR sometime in the course of their care, and therefore, is at risk.”

Other practices have been attacked causing huge losses of revenue, even though they paid the demanded ransom to the hackers.

Be cognizant of the security of your systems.

The post EHR Hack Causes Clinic to Close appeared first on Garlo Ward, P.C..

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New regulations have been finalized to allow employers to pay into employee accounts:

The Trump administration finalized some new regulations late last week for those tax-preferred accounts. In short, employers can pay money into their employees’ health reimbursement accounts, and then the workers can take that money and use it to buy insurance on the individual market. Companies can alternatively pay into a different kind of HRA that their workers can then use to pay directly for health care or for a “short-term limited duration” insurance plan that does not have to comply with Obamacare’s rules about preexisting conditions.

Employers must be aware that:

The regulations do put some important standards in place. For example, employers can’t pick and choose individual workers to provide HRA money to, and they cannot offer the same employees both a traditional employer-sponsored insurance plan and an HRA. 

The post Employers Can Now Reimburse Employees for Individual Insurance Plans appeared first on Garlo Ward, P.C..

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After instances of hemp and CBD companies encountering problems with local post offices regarding the legality of mailing hemp and CBD products, the US Postal Service has clarified and promulgated a new policy with the relevant provision below:

453.37 Hemp-based Products
For purposes of this section, “hemp” shall have the
meaning provided under federal law, including Section
10113 of the Agricultural Improvement Act of 2018, Pub.
L.115-334 (7 U.S.C. § 1639o), or any successor provision.
Hemp and hemp-based products, including cannabidiol
(CBD) with the tetrahydrocannabinol (THC) concentration
of such hemp (or its derivatives) not exceeding a 0.3 percent limit are permitted to be mailed only when:
a. The mailer complies with all applicable federal, state,
and local laws (such as the Agricultural Act of 2014
and the Agricultural Improvement Act of 2018) pertaining to hemp production, processing, distribution,
and sales; and
b. The mailer retains records establishing compliance
with such laws, including laboratory test results,
licenses, or compliance reports, for no less than 2
years after the date of mailing.

HT U.S. Hemp Roundtable

The post US Post Office Clarification Regarding Mailing of Hemp and CBD Products appeared first on Garlo Ward, P.C..

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