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PT BOARD ISSUES RULES ON DIRECT ACCESS: The NJ Physical Therapy Board has fully implement the 2003 statute that removed the requirement that physical therapy can only be provided under the specific direction of a referring licensed health care provider. Physical therapists can now establish a prognosis, a plan of care, and all PT interventions, including the use of electro-therapeutic modalities. Invasive testing, such as EMG, remains prohibited. Only in specified circumstances, must a PT refer a patient to another health care professional and, not more than 30 days from the date of initial treatment, a PT must inform the patient’s provider of record regarding the patient’s plan of care. If there is no identified provider, the PT must recommend that the patient consult with a licensed health care professional of the patient’s choice. PT’s must obtain 30 continuing education hours per biennial period and can no longer practice with a temporary license. Rules regarding the responsibilities of PT’s employed by corporate entities have been deferred. The PT Board rules do not govern reimbursement for PT services.

FINAL HIPAA ENFORCEMENT RULE ISSUED: The US Department of Health & Human Services has adopted a final rule for enforcement of HIPAA privacy, security, and other HIPAA rules. A complaint and investigation–or a compliance review–may result in an informal resolution, a finding of no violation, or a finding of violation. Civil money penalties will be sought for violations, but can be challenged by the covered entity through a formal hearing and appellate review process. When a penalty becomes final, HHS will notify the public and organizations, such as licensing agencies and local or state medical societies, of the penalty and the reason it was imposed. HHS can use information gained from a HIPAA investigation for other HHS investigations, such as for fraud. The rule confirms that a covered entity is not liable for the actions of its business associate, so long as the covered entity has complied with the business associate rules. KACS offers a prepaid HIPAA legal services plan; contact Bill at 908-704-8585 for information.

CMS ISSUES NEW CONSULTATION SERVICES GUIDANCE: CMS has issued new guidance on consultation services, including new documentation requirements, what constitutes a transfer of care, second opinion evaluation and management (E/M) service requests, and consultations for preoperative clearance. Although an initial consult request may be oral, the request and the reason for the consultation service must be documented by the consultant and included in the requesting practitioner’s plan of care. A qualified nonphysician practitioner may perform consultation services within his/her license and scope of practice. A consultation may not be performed as a split/shared E/M visit, nor billed as a CPT code 99211 because it would not meet the consultation service criteria.

NEW TAX LAWS AND MEDICAID PLANNING RULES FOR 2006: The annual gift tax exclusion and Federal estate tax credit have increased for 2006, as have limits on contributions to retirement plans. There are also new restrictions on the ability of the elderly to transfer assets in order to qualify for Medicaid reimbursement for long-term care. If you have questions about tax planning, retirement plans, or long-term care planning, contact Sheila Mints of our Tax & Transactional Department, at 908-704-8585.

KACS’ SHEREN RECEIVES ABA APPOINTMENT: Lorne Sheren, M.D., J.D., is the new editor of the American Bar Association’s Medicine and Law Committee which focuses on all aspects of law that relate to the delivery of health care. Dr. Sheren is of counsel to Kern Augustine. Among the major topics considered by the Committee are medical malpractice; fraud and abuse; medical staff issues; managed care organizations; public health issues; and forensic medicine. The newsletter, published twice yearly as well as on-line, provides a forum for attorneys to share their expertise and experience in these fields. The Committee also provides specialized expertise to attorneys not otherwise familiar with the intersection of law and medicine.

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