College Bound Disabled Students Get Started Early Learning Rules For Seeking Accommodations

Finding reported in the new Mobile Health Applications for Self-Management of Diabetes Report from the Agency For Healthcare Research and Quality (AHRQ).

The findings raise questions about whether patient, health plan, employer or other amounts invested to acquire and use in these applications as tools to help diabetes patients better manage their disease provide sufficient return on investment.

College bound or enrolled students with disabilities and their families should get moving to become familiar with, request and arrange for any needed accommodations at their planned university, college or other post secondary education program.

Students with disabilities continue to enjoy many protections against discrimination and rights to accommodation when applying for admission and pursuing education or training in college or other post secondary education settings.  However disabled students and their families generally should expect to need to learn about some differences in the federal rules as well as be prepared to deal with different procedures their post secondary educational institutions use to comply with these requirements in order to understand and utilize these rights effectively.

While completing their primary and secondary school education, many disabled students and their families probably relied heavily upon rules established and enforced by the Office of Special Education and Rehabilitative Services (OSERS), the Department of Education also administers the under the Individuals with Disabilities Education Act (IDEA), which provides funds to states to assist in making a free appropriate public education (FAPE) available to eligible children with disabilities.  IDEA requirements apply to state education agencies, school districts and other public agencies that serve IDEA-eligible children.  Institutions of postsecondary education have no legal obligations under IDEA.

While the IDEA no longer applies, qualifying disabled students attending colleges or other post secondary education continue to enjoy valuable rights and protections under Section 504 of the Rehabilitation Act of 1973 (Section 504) and Title II of the Americans with Disabilities Act of 1990 (Title II) interpreted and enforced by the Department of Education.  Section 504 and Title II both generally prohibit disability discrimination by any colleges, universities and other postsecondary education institutions receiving federal funds in the United States.  While these rules generally reach most institutions, private institutions of postsecondary education that do not receive federal financial assistance are not subject to Section 504 or Title II, these nonfederally funded private educational institutions are subject to the prohibitions of Title III of the Americans with Disabilities Act against discrimination on the basis of disability by private entities that are not private clubs or religious entities.  Thus, these private, nonfederally funded entities covered by these civil rights laws also have an obligation to comply with legal requirements and to carry out their programs and activities in a manner that does not discriminate on the basis of disability, but the Department of Justice, rather than the Department of Education interprets and enforces those rules.

Section 504 and Title II may provide qualifying students with disabilities attending federally funded colleges, universities and other post secondary education institutions a wide range of disability discrimination protections and other rights.

For example, prior to admission:

  • Institutions of post secondary education may not make inquiries about prospective students’ disabilities prior to admitting them.  Prospective students may choose to provide an institution with information about disabilities, but any disclosure of disability is voluntary.
  • Institutions of post secondary education may inquire about whether prospective students can meet the academic and technical standards that are required for admission, provided that such inquiries are not designed to reveal the existence of disabilities.
  • Prospective post secondary students may obtain changes in standardized testing conditions in the administration of entrance examinations if they can provide documentation from a qualified professional that supports the existence of a disability and the need for the specific change.

Following Admission:

  • Institutions of post secondary education do not have a legal duty to identify students with disabilities.  These institutions’ obligations are different from those of school districts, which must identify elementary and secondary school students with disabilities. As a result, students generally will need to be prepared to demonstrate their disability and request accommodations.
  • After admission, institutions of postsecondary education may make confidential inquiries of students about disabilities that may require accommodation.  A post secondary student does not have to disclose that he or she has a disability.  To obtain academic adjustments, however, students must identify themselves to institutions of post secondary education as having disabilities and must make a request for an academic adjustment.  A student may request an academic adjustment at any time, but advising the institution as soon as possible of the need for an academic adjustment can help to ensure that the institution has adequate time to review the request and provide an appropriate academic adjustment.
  • Section 504 and IDEA require school districts to conduct an evaluation of a student suspected of having a disability at no cost to the student or his or her parents to determine whether the student has a disability and, because of that disability, needs special education and-or related services.  Institutions of postsecondary education, however, are not required to pay for such evaluations.  Therefore, if funding from other sources, such as the state vocational rehabilitation (VR) agency, is not  available to a post secondary student, the student may have to pay for the evaluation.
  • To comply with the requirements of IDEA, a school district or other public agency must have in effect an individualized education program (IEP) for children with disabilities.  School districts may also create a plan or other document describing the evaluation and placement decisions they make for elementary and secondary school students pursuant to Section 504.  Institutions of postsecondary education have no obligation to create these documents.
  • Institutions of post secondary education must provide appropriate academic adjustments based on students’ disabilities and individual needs when necessary to avoid discrimination.  In providing an academic adjustment, a post secondary institution does not have to eliminate or lower essential requirements, or make modifications that would result in a fundamental alteration of the programs or activities being offered or impose an undue burden on the institution.
  • Institutions of postsecondary education may establish reasonable procedures for requesting academic adjustments, and students are responsible for knowing these procedures and following them.  Postsecondary institutions may require students who request academic adjustments to provide documentation of their current disabilities and the need for academic adjustments.  The institutions must inform students of the documentation they require.  Elementary and secondary school IEPs generally will not be sufficient documentation, due to the different contexts and requirements of postsecondary education.  However, existing assessment reports and a summary of the student’s academic achievement provided in compliance with IDEA may meet some documentation requirements.
  • Institutions of post secondary education may not require students with disabilities to pay part or all of the costs of academic adjustments.  Post secondary institutions may not condition their provision of academic adjustments on the availability of funds, refuse to spend more than a certain amount to provide academic adjustments, or refuse to provide academic adjustments because they believe other providers of such services exist.

These are just a few examples of the changes students with disabilities may encounter as they make the transition from high school to post secondary education.

To start getting a better understanding of the rules applicable when a disabled student attends a federally funded college, university or other post secondary educational institution, students and their families should consider reading the he explanations of the legal requirements of Section 504 and Title II in the post secondary education context  Students with Disabilities Preparing for Postsecondary Education:  Know Your Rights and Responsibilities and a guide entitled Transition of Students with Disabilities to Postsecondary Education: A Guide for High School Educators.

Students and their families also are likely to benefit from reviewing the following questions and answers provided by the Department of Education to assist students with disabilities and their families and educational institutions to understand the disabled student’s rights while attending postsecondary institutions.

As a student with a disability leaving high school and entering postsecondary education, will I see differences in my rights and how they are addressed?

Yes. Section 504 and Title II protect elementary, secondary, and postsecondary students from discrimination. Nevertheless, several of the requirements that apply through high school are different from the requirements that apply beyond high school. For instance, Section 504 requires a school district to provide a free appropriate public education (FAPE) to each child with a disability in the district’s jurisdiction. Whatever the disability, a school district must identify an individual’s educational needs and provide any regular or special education and related aids and services necessary to meet those needs as well as it is meeting the needs of students without disabilities.

Unlike your high school, however, your postsecondary school is not required to provide FAPE. Rather, your postsecondary school is required to provide appropriate academic adjustments as necessary to ensure that it does not discriminate on the basis of disability. In addition, if your postsecondary school provides housing to nondisabled students, it must provide comparable, convenient, and accessible housing to students with disabilities at the same cost.

Other important differences that you need to know, even before you arrive at your postsecondary school, are addressed in the remaining questions.

May a postsecondary school deny my admission because I have a disability?

No. If you meet the essential requirements for admission, a postsecondary school may not deny your admission simply because you have a disability.

Do I have to inform a postsecondary school that I have a disability?

No. But if you want the school to provide an academic adjustment, you must identify yourself as having a disability. Likewise, you should let the school know about your disability if you want to ensure that you are assigned to accessible facilities. In any event, your disclosure of a disability is always voluntary.

What academic adjustments must a postsecondary school provide?

The appropriate academic adjustment must be determined based on your disability and individual needs. Academic adjustments may include auxiliary aids and services, as well as modifications to academic requirements as necessary to ensure equal educational opportunity. Examples of adjustments are: arranging for priority registration; reducing a course load; substituting one course for another; providing note takers, recording devices, sign language interpreters, extended time for testing, and, if telephones are provided in dorm rooms, a TTY in your dorm room; and equipping school computers with screen-reading, voice recognition, or other adaptive software or hardware.

In providing an academic adjustment, your postsecondary school is not required to lower or substantially modify essential requirements. For example, although your school may be required to provide extended testing time, it is not required to change the substantive content of the test. In addition, your postsecondary school does not have to make adjustments that would fundamentally alter the nature of a service, program, or activity, or that would result in an undue financial or administrative burden. Finally, your postsecondary school does not have to provide personal attendants, individually prescribed devices, readers for personal use or study, or other devices or services of a personal nature, such as tutoring and typing.

If I want an academic adjustment, what must I do?

You must inform the school that you have a disability and need an academic adjustment. Unlike your school district, your postsecondary school is not required to identify you as having a disability or to assess your needs.

Your postsecondary school may require you to follow reasonable procedures to request an academic adjustment. You are responsible for knowing and following those procedures. In their publications providing general information, postsecondary schools usually include information on the procedures and contacts for requesting an academic adjustment. Such publications include recruitment materials, catalogs, and student handbooks, and are often available on school websites. Many schools also have staff whose purpose is to assist students with disabilities. If you are unable to locate the procedures, ask a school official, such as an admissions officer or counselor.

When should I request an academic adjustment?

Although you may request an academic adjustment from your postsecondary school at any time, you should request it as early as possible. Some academic adjustments may take more time to provide than others. You should follow your school’s procedures to ensure that the school has enough time to review your request and provide an appropriate academic adjustment.

Do I have to prove that I have a disability to obtain an academic adjustment?

Generally, yes. Your school will probably require you to provide documentation showing that you have a current disability and need an academic adjustment.

What documentation should I provide?

Schools may set reasonable standards for documentation. Some schools require more documentation than others. They may require you to provide documentation prepared by an appropriate professional, such as a medical doctor, psychologist, or other qualified diagnostician. The required documentation may include one or more of the following: a diagnosis of your current disability, as well as supporting information, such as the date of the diagnosis, how that diagnosis was reached, and the credentials of the diagnosing professional; information on how your disability affects a major life activity; and information on how the disability affects your academic performance. The documentation should provide enough information for you and your school to decide what is an appropriate academic adjustment.

An individualized education program (IEP) or Section 504 plan, if you have one, may help identify services that have been effective for you. This is generally not sufficient documentation, however, because of the differences between postsecondary education and high school education. What you need to meet the new demands of postsecondary education may be different from what worked for you in high school. Also, in some cases, the nature of a disability may change.

If the documentation that you have does not meet the postsecondary school’s requirements, a school official should tell you in a timely manner what additional documentation you need to provide. You may need a new evaluation in order to provide the required documentation.

Who has to pay for a new evaluation?

Neither your high school nor your postsecondary school is required to conduct or pay for a new evaluation to document your disability and need for an academic adjustment. You may, therefore, have to pay or find funding to pay an appropriate professional for an evaluation. If you are eligible for services through your state vocational rehabilitation agency, you may qualify for an evaluation at no cost to you. You may locate your state vocational rehabilitation agency at http://rsa.ed.gov by clicking on “Info about RSA,” then “People and Offices,” and then “State Agencies/ Contacts.”

Once the school has received the necessary documentation from me, what should I expect?

To determine an appropriate academic adjustment, the school will review your request in light of the essential requirements for the relevant program. It is important to remember that the school is not required to lower or waive essential requirements. If you have requested a specific academic adjustment, the school may offer that academic adjustment, or it may offer an effective alternative. The school may also conduct its own evaluation of your disability and needs at its own expense.

You should expect your school to work with you in an interactive process to identify an appropriate academic adjustment. Unlike the experience you may have had in high school, however, do not expect your postsecondary school to invite your parents to participate in the process or to develop an IEP for you.

What if the academic adjustment we identified is not working?

Let the school know as soon as you become aware that the results are not what you expected. It may be too late to correct the problem if you wait until the course or activity is completed. You and your school should work together to resolve the problem.

May a postsecondary school charge me for providing an academic adjustment?

No. Nor may it charge students with disabilities more for participating in its programs or activities than it charges students who do not have disabilities.

What can I do if I believe the school is discriminating against me?

Practically every postsecondary school must have a person—frequently called the Section 504 Coordinator, ADA Coordinator, or Disability Services Coordinator—who coordinates the school’s compliance with Section 504,Title II, or both laws. You may contact that person for information about how to address your concerns.

The school must also have grievance procedures. These procedures are not the same as the due process procedures with which you may be familiar from high school. But the postsecondary school’s grievance procedures must include steps to ensure that you may raise your concerns fully and fairly, and must provide for the prompt and equitable resolution of complaints.

School publications, such as student handbooks and catalogs, usually describe the steps that you must take to start the grievance process. Often, schools have both formal and informal processes. If you decide to use a grievance process, you should be prepared to present all the reasons that support your request.

If at student is dissatisfied with the outcome of the school’s grievance procedures or wish to pursue an alternative to using those procedures, the student may file a complaint against the school with OCR or in a court following the OCR complaint process explained in the brochure How to File a Discrimination Complaint with the Office for Civil Rights.

In addition to understanding their rights, including differences in the rules from those that applied before college, college students with disabilities and their families need to anticipate that the student will need to learn to negotiate new rules and procedures that work differently from what their experience was in primary or secondary school.  Beyond the actual differences in the procedures, students generally can expect much more diversity in the procedures, as post secondary institutions tend to delegate significant authority and responsibility for design, implementation and application of these requirements to schools, departments and even individual professors.  Students also should be prepared to take on much greater responsibility for advocating for his or her own rights and needs.  For these reasons, most students and their families will want to start learning and pursuing the process early and well in advance of commencement of their initial semester of attendance as well as be proactive to communicate with instructional staff and others throughout the process leading up to and attending these institutions.

 

About The Author

Recognized by LexisNexis® Martindale-Hubbell® as a “AV-Preeminent” (Top 1%/ the highest) and “Top Rated Lawyer,” with special recognition  as “LEGAL LEADER™ Texas Top Rated Lawyer” in Health Care Law and Labor and Employment Law; as among the “Best Lawyers In Dallas” for her work in the fields of “Health Care,” “Labor & Employment,” “Tax: Erisa & Employee Benefits”  and “Business and Commercial Law” by D Magazine, the author of this update is widely known for her 29 plus years’ of work in health care, health benefit, health policy and regulatory affairs and other health industry concerns as a practicing attorney and management consultant, thought leader, author, public policy advocate and lecturer.

Throughout her adult life and nearly 30-year legal career, Ms. Stamer’s legal, management and governmental affairs work has focused on helping health industry, health benefit and other organizations and their management use the law, performance and risk management tools and process to manage people, performance, quality, compliance, operations and risk. Highly valued for her rare ability to find pragmatic client-centric solutions by combining her detailed legal and operational knowledge and experience with her talent for creative problem-solving, Ms. Stamer supports these organizations and their leaders on both a real-time, “on demand” basis as well as outsourced operations or special counsel on an interim, special project, or ongoing basis with strategic planning and product and services development and innovation; workforce and operations management,  crisis preparedness and response as well as to prevent, stabilize and cleanup legal and operational crises large and small that arise in the course of operations. Her experience encompasses  helping health industry clients manage workforce, medical staff, vendors and suppliers, medical billing, reimbursement, claims and other provider-payer relations, business partners, and their recruitment, performance, discipline, compliance, safety, compensation, benefits, and training ;board, medical staff and other governance;   compliance and internal controls; strategic planning, process and quality improvement; change management;  assess, deter, investigate and address staffing, quality, compliance  and other performance;  meaningful use, EMR, HIPAA and other data security and breach and other health IT and data; crisis preparedness and response; internal, government and third-party reporting, audits, investigations and enforcement; government affairs and public policy; and other compliance and risk management, government and regulatory affairs and operations concerns.

The American Bar Association (ABA) International Section Life Sciences Committee Vice Chair, a Scribe for the ABA Joint Committee on Employee Benefits (JCEB) Annual OCR Agency Meeting, former Vice President of the North Texas Health Care Compliance Professionals Association, past Chair of the ABA Health Law Section Managed Care & Insurance Section, past ABA JCEB Council Representative, past Board President of Richardson Development Center (now Warren Center) for Children Early Childhood Intervention Agency, past North Texas United Way Long Range Planning Committee Member, and past Board Member and Compliance Chair of the National Kidney Foundation of North Texas, Ms. Stamer has worked closely with a diverse range of physicians, hospitals and healthcare systems, DME, Pharma, clinics, health care providers, managed care, insurance and other health care payers, quality assurance, credentialing, technical, research, public and private social and community organizations, and other health industry organizations and their management deal with governance; credentialing, patient relations and care; staffing, peer review, human resources and workforce performance management; outsourcing; internal controls and regulatory compliance; billing and reimbursement; physician, employment, vendor, managed care, government and other contracting; business transactions; grants; tax-exemption and not-for-profit; licensure and accreditation; vendor selection and management; privacy and data security; training; risk and change management; regulatory affairs and public policy and other concerns.

As a core component of her work,  Ms. Stamer has worked extensively throughout her career with health care providers, health plans and insurers, managed care organizations, health care clearinghouses, their business associates, employers, banks and other financial institutions, management services organizations, professional associations, medical staffs, accreditation agencies, auditors, technology and other vendors and service providers, and others on legal and operational compliance, risk management and compliance, public policies and regulatory affairs, contracting, payer-provider, provider-provider, vendor, patient, governmental and community relations and matters including extensive involvement advising, representing and defending public and private hospitals and health care systems; physicians, physician organizations and medical staffs; specialty clinics and pharmacies; skilled nursing, home health, rehabilitation and other health care providers and facilities; medical staff, accreditation, peer review and quality committees and organizations; billing and management services organizations; consultants; investors; technology, billing and reimbursement and other services and product vendors; products and solutions consultants and developers; investors; managed care organizations, insurers, self-insured health plans and other payers; and other health industry clients to establish and administer compliance and risk management policies; comply with requirements, investigate and respond to Board of Medicine, Health, Nursing, Pharmacy, Chiropractic, and other licensing agencies, Department of Aging & Disability, FDA, Drug Enforcement Agency, OCR Privacy and Civil Rights, Department of Labor, IRS, HHS, DOD, FTC, SEC, CDC and other public health, Department of Justice and state attorneys’ general and other federal and state agencies; JCHO and other accreditation and quality organizations; private litigation and other federal and state health care industry investigation, enforcement including  insurance or other liability management and allocation; process and product development, contracting, deployment and defense; evaluation, commenting or seeking modification of regulatory guidance, and other regulatory and public policy advocacy; training and discipline; enforcement, and a host of other related concerns for public and private health care providers, health insurers, health plans, technology and other vendors, employers, and others.and other compliance, public policy, regulatory, staffing, and other operations and risk management concerns.

Past Chair of the ABA Managed Care & Insurance Interest Group and, a Fellow in the American College of Employee Benefit Counsel, the American Bar Foundation and the Texas Bar Foundation, Ms. Stamer also has extensive health care reimbursement and insurance experience advising and defending health care providers, payers, and others about Medicare, Medicaid, Medicare and Medicaid Advantage, Tri-Care, self-insured group, association, individual and group and other health benefit programs and coverages including but not limited to advising public and private payers about coverage and program design and documentation, advising and defending providers, payers and systems and billing services entities about systems and process design, audits, and other processes; provider credentialing, and contracting; providers and payer billing, reimbursement, claims audits, denials and appeals, coverage coordination, reporting, direct contracting, False Claims Act, Medicare & Medicaid, ERISA, state Prompt Pay, out-of-network and other nonpar insured, and other health care claims, prepayment, post-payment and other coverage, claims denials, appeals, billing and fraud investigations and actions and other reimbursement and payment related investigation, enforcement, litigation and actions.

Heavily involved in health care and health information technology, data and related process and systems development, policy and operations innovation and a Scribe for ABA JCEB annual agency meeting with OCR for many years who has authored numerous highly-regarded works and training programs on HIPAA and other data security, privacy and use, Ms. Stamer also is widely recognized for her extensive work and leadership on leading edge health care and benefit policy and operational issues including meaningful use and EMR, billing and reimbursement, quality measurement and reimbursement, HIPAA, FACTA, PCI, trade secret, physician and other medical confidentiality and privacy, federal and state data security and data breach and other information privacy and data security rules and many other concerns.  Her work includes both regulatory and public policy advocacy and thought leadership, as well as advising and representing a broad range of health industry and other clients about policy design, drafting, administration, business associate and other contracting,  risk assessments, audits and other risk prevention and mitigation, investigation, reporting, mitigation and resolution of known or suspected violations or other incidents and responding to and defending investigations or other actions by plaintiffs, DOJ, OCR, FTC, state attorneys’ general and other federal or state agencies, other business partners, patients and others.

Ms. Stamer has worked extensively with health care providers, health plans, health care clearinghouses, their business associates, employers and other plan sponsors, banks and other financial institutions, and others on risk management and compliance with HIPAA, FACTA, trade secret and other information privacy and data security rules, including the establishment, documentation, implementation, audit and enforcement of policies, procedures, systems and safeguards, investigating and responding to known or suspected breaches, defending investigations or other actions by plaintiffs, OCR and other federal or state agencies, reporting known or suspected violations, business associate and other contracting, commenting or obtaining other clarification of guidance, training and enforcement, and a host of other related concerns. Her clients include public and private health care providers, health insurers, health plans, technology and other vendors, and others. In addition to representing and advising these organizations, she also has conducted training on Privacy & The Pandemic for the Association of State & Territorial Health Plans, as well as HIPAA, FACTA, PCI, medical confidentiality, insurance confidentiality and other privacy and data security compliance and risk management for Los Angeles County Health Department, MGMA, ISSA, HIMMS, the ABA, SHRM, schools, medical societies, government and private health care and health plan organizations, their business associates, trade associations and others.

A former lead consultant to the Government of Bolivia on its Pension Privatization Project with extensive domestic and international public policy and governmental and regulatory affairs experience, Ms. Stamer also is widely recognized for regulatory and policy work, advocacy and outreach on healthcare, education, aging, disability, savings and retirement, workforce, ethics, and other policies.  Throughout her adult life and career, Ms. Stamer has provided thought leadership; policy and program design, statutory and regulatory development design and analysis; drafted legislation, proposed regulations and other guidance, position statements and briefs, comments and other critical policy documents; advised, assisted and represented health care providers, health plans and insurers, employers, professional. and trade associations, community and government leaders and others on health care, health, pension and retirement, workers’ compensation, Social Security and other benefit, insurance and financial services, tax, workforce, aging and disability, immigration, privacy and data security and a host of other international and domestic federal, state and local public policy and regulatory reforms through her involvement and participation in numerous client engagements, founder and Executive Director of the Coalition for Responsible Health Policy and its PROJECT COPE: the Coalition on Patient Empowerment, adviser to the National Physicians Congress for Healthcare Policy, leadership involvement with the US-Mexico Chamber of Commerce, the Texas Association of Business, the ABA JCEB, Health Law, RPTE, Tax, Labor, TIPS, International Life Sciences, and other Sections and Committees, SHRM Governmental Affairs Committee and a host of other  involvements and activities.

A popular lecturer and widely published author on health industry concerns, Ms. Stamer continuously advises health industry clients about compliance and internal controls, workforce and medical  staff performance, quality, governance, reimbursement, privacy and data security, and other risk management and operational matters. Ms. Stamer also publishes and speaks extensively on health and managed care industry regulatory, staffing and human resources, compensation and benefits, technology, public policy, reimbursement and other operations and risk management concerns. Her insights on these and other related matters appear in the Health Care Compliance Association, Atlantic Information Service, Bureau of National Affairs, The Wall Street Journal, Business Insurance, the Dallas Morning News, Modern Health Care, Managed Healthcare, Health Leaders, and a many other national and local publications.

A Fellow in the American College of Employee Benefit Counsel, the American Bar Foundation and the Texas Bar Foundation, Ms. Stamer also shares her thought leadership, experience and advocacy on these and other related concerns by her service in the leadership of the Solutions Law Press, Inc. Coalition for Responsible Health Policy, its PROJECT COPE:  Coalition on Patient Empowerment, and a broad range of other professional and civic organizations including North Texas Healthcare Compliance Association, a founding Board Member and past President of the Alliance for Healthcare Excellence, past Board Member and Board Compliance Committee Chair for the National Kidney Foundation of North Texas; former Board President of the early childhood development intervention agency, The Richardson Development Center for Children (now Warren Center For Children);  current Vice Chair of the ABA Tort & Insurance Practice Section Employee Benefits Committee, current Vice Chair of Policy for the Life Sciences Committee of the ABA International Section, Past Chair of the ABA Health Law Section Managed Care & Insurance Section, a current Defined Contribution Plan Committee Co-Chair, former Group Chair and Co-Chair of the ABA RPTE Section Employee Benefits Group, past Representative and chair of various committees of ABA Joint Committee on Employee Benefits; a ABA Health Law Coordinating Council representative, former Coordinator and a Vice-Chair of the Gulf Coast TEGE Council TE Division, past Chair of the Dallas Bar Association Employee Benefits & Executive Compensation Committee, a former member of the Board of Directors of the Southwest Benefits Association and others.

Ms. Stamer also is a highly popular lecturer, symposium and chair, faculty member and author, who publishes and speaks extensively on health and managed care industry, human resources, employment and other privacy, data security and other technology, regulatory and operational risk management. Examples of her many highly regarded publications on these matters include “Protecting & Using Patient Data In Disease Management: Opportunities, Liabilities And Prescriptions,” “Privacy Invasions of Medical Care-An Emerging Perspective,” “Cybercrime and Identity Theft: Health Information Security: Beyond HIPAA,” as well as thousands of other publications, programs and workshops these and other concerns for the American Bar Association, ALI-ABA, American Health Lawyers, Society of Human Resources Professionals, the Southwest Benefits Association, the Society of Employee Benefits Administrators, the American Law Institute, Lexis-Nexis, Atlantic Information Services, The Bureau of National Affairs (BNA), InsuranceThoughtLeaders.com, Benefits Magazine, Employee Benefit News, Texas CEO Magazine, HealthLeaders, the HCCA, ISSA, HIMSS, Modern Healthcare, Managed Healthcare, Institute of Internal Auditors, Society of CPAs, Business Insurance, Employee Benefits News, World At Work, Benefits Magazine, the Wall Street Journal, the Dallas Morning News, the Dallas Business Journal, the Houston Business Journal, and many other symposia and publications. She also has served as an Editorial Advisory Board Member for human resources, employee benefit and other management focused publications of BNA, HR.com, Employee Benefit News, Insurance Thought Leadership and many other prominent publications and speaks and conducts training for a broad range of professional organizations.

For more information about Ms. Stamer or her health industry and other experience and involvements, see here or contact Ms. Stamer via telephone at (469) 767-8872 or via e-mail here.

Call To Action: Become a Project COPE Healthcare Hero

Follow, like and share our articles and resources in this ProjectCOPE.blog, and follow, like, share your comments and ideas, and participate in our Facebook page @ProjectCOPECOALITION or on LinkedIn to

  • Learn and share tips, tools and other information on how you and your family can manage your health and wellness needs.
  • Get and share ideas on how to understand, shape and use your healthcare and health coverage.
  • Share your ideas and input about health and health coverage issues and policies with elected leaders and regulators?
  • Monitor health, wellness and other developments.
  • Help your providers, family,  friends and community cope with health care, disability, aging and wellness challenges.
  • Get educated! Learn about what’s happening in Washington and communities across the country to help or hurt healthcare quality and access and how you can help make things better or influence how these developments affect people you care about.
  • Get involved and recruit others to join the cause!

Despite an endless stream of well-meaning market and governmental reforms over the past 25 years, the U.S. health care system is in crisis. American patients, their families and other caregivers, their employers, their health benefit programs, their health care providers, the communities and even our federal health care budget increasingly are burdened and overwhelmed by the mounting obstacles to caring for our ill, disabled, and aging citizens within our health care system and the extraordinary expense of maintaining and using that system.

As Congress takes up reform again, it is critical that Americans act to protect their own and their families’ health care and control the financial burdens of health care by getting informed, providing clear and consistent direction to Congress and other reformers and taking other actions to empower and care for themselves and their loved ones within our evolving health care system.

About Solutions Law Press, Inc.™

Solutions Law Press, Inc.™ provides human resources and employee benefit and other business risk management, legal compliance, management effectiveness and other coaching, tools and other resources, training and education on leadership, governance, human resources, employee benefits, data security and privacy, insurance, health care and other key compliance, risk management, internal controls and operational concerns. If you find this of interest, you also be interested reviewing some of our other Solutions Law Press, Inc.™ resources here such as:

©2018 Cynthia Marcotte Stamer. Image credit to collegedirection.org.  Non-exclusive right to republish granted to Solutions Law Press, Inc.™  All other rights reserved.   For information about republication or other use, please contact Ms. Stamer here.

Diabetes Management Apps: Tech Tools or Toys?

Finding reported in the new Mobile Health Applications for Self-Management of Diabetes Report from the Agency For Healthcare Research and Quality (AHRQ).

The findings raise questions about whether patient, health plan, employer or other amounts invested to acquire and use in these applications as tools to help diabetes patients better manage their disease provide sufficient return on investment.

AHRQ Report Questions Diabetes Management Mobile Apps Effectiveness

Using current diabetes self-management mobile applications generally does not improve the life, blood pressure, weight, or body mass index outcomes of diabetes patients and the effect of the use of these applications is not demonstrated to work any better than health care provider support regardless of the app or type of diabetes. That’s a key finding reported in the new Mobile Health Applications for Self-Management of Diabetes Report (Report) of the Agency For Healthcare Research and Quality (AHRQ).

The findings raise questions about whether the time and Money patient, health plan, employer or others invest in to acquire and for patients to use these applications as tools to help diabetes patients better manage their disease provide sufficient return on investment are justified.

While hundreds of mobile applications currently are available that purport to help diabetes patients self manage their disease, AHRQ says “patients lack information on which apps are effective in improving diabetes-related outcomes.”

In an effort to address this concern, AHRQ commissioned a review of the efficacy, usability, and features of 11 of hundreds of the currently available commercial applications for diabetes self-management commercially available mobile applications (apps) for diabetes self-management.  The Study evaluated the performance of the applications by reviewing 15 studies/analyses evaluating 11 unique apps: six apps for type 1 diabetes and five for type 2 diabetes.  Two apps had multiple tiers of access (free and paid), which resulted in the evaluation of features of 13 apps. Common features of apps include the ability to track blood glucose, HbA1c, medications, physical activity, and weight. Studies were 2-12 months long.

In addition to the Report, findings from the study also are discussed the Rapid Evidence Review of Mobile Applications for Self-Management of Diabetes article published in the May 3, 2018 issue of the Journal of General Internal Medicine.

According to the Report, the findings from this review raise significant questions about the value and effectiveness of diabetes self-management mobile apps.  Significantly, while AHRQ says the study raises significant questions about the efficacy of current diabetes self-management mobile applications, it concludes that the research showed “[p]atients did not experience improvements in quality of life, blood pressure, weight, or body mass index outcomes, regardless of the app or type of diabetes.

Other key findings shared in the report include:

  • Of the 11 apps, studies showed only 5 were associated with clinically significant improvements in HbA1c, an important clinical test for monitoring diabetes. (For Type 1 diabetes- Glucose Buddy, Diabeo Telesage; For Type 2 diabetes- Blue Star, WellTang, Gather Health);
  • For type 1 diabetes, patients had clinically significant improvement in HbA1c if they used either of two apps and statistically significant improvement using one additional app. For type 2 diabetes, patients using any of three apps experienced clinical and statistical improvement in HbA1c.
  • Patients using two apps for type 1 diabetes experienced improvements in hypoglycemic episodes.
  • The quality of studies was variable. Study design and presentation made it difficult to distinguish the effect of the app and the effect of additional interactions with study personnel or health care providers. Of the eight apps available for usability testing, three apps (two for type 1 and one for type 2 diabetes) were scored by researchers as “acceptable,” two apps (type 1 diabetes) as “marginal,” and three apps (one for type 1 and two for type 2 diabetes) as “not acceptable.”
  • More rigorous and longer-term research studies could determine whether apps help people manage their diabetes and reduce complications.
  • Studies had methodological issues: they were short (2-12 months); inconsistent in reporting of randomization, allocation, masking, and drop-out analysis; and often used co-interventions that hindered interpretation of results. None of the included studies are considered to be high quality.

Based on these and other findings from the Study, the Report concludes that while
some apps for diabetes self-management may improve outcomes in the short-term, the effect cannot be distinguished from the concomitant effect of additional support from a health care provider. AHRQ also says more rigorous and longer-term evaluations are needed to determine how these apps affect weight, blood pressure, quality of life, and complications of diabetes.

In light of these findings, patients and health plans, employer and other health plan sponsors, health care providers should weigh critically the value of investing in or relying upon diabetes mobile apps to help patients manage diabetes.  While these apps offer shiny attractiveness as tools, the Report’s findings that evidence does not show these applications produce sustainable improvements in the status of diabetes patients using them suggests that expenditures of time and money to uses these applications may not be justified.  Patients and their families and caregivers also should weigh whether patients relying on these applications may be foregoing seeking or using other measures for management that work more effectively.

About The Author

Recognized by LexisNexis® Martindale-Hubbell® as a “AV-Preeminent” (Top 1%/ the highest) and “Top Rated Lawyer,” with special recognition  as “LEGAL LEADER™ Texas Top Rated Lawyer” in Health Care Law and Labor and Employment Law; as among the “Best Lawyers In Dallas” for her work in the fields of “Health Care,” “Labor & Employment,” “Tax: Erisa & Employee Benefits”  and “Business and Commercial Law” by D Magazine, the author of this update is widely known for her 29 plus years’ of work in health care, health benefit, health policy and regulatory affairs and other health industry concerns as a practicing attorney and management consultant, thought leader, author, public policy advocate and lecturer.

Throughout her adult life and nearly 30-year legal career, Ms. Stamer’s legal, management and governmental affairs work has focused on helping health industry, health benefit and other organizations and their management use the law, performance and risk management tools and process to manage people, performance, quality, compliance, operations and risk. Highly valued for her rare ability to find pragmatic client-centric solutions by combining her detailed legal and operational knowledge and experience with her talent for creative problem-solving, Ms. Stamer supports these organizations and their leaders on both a real-time, “on demand” basis as well as outsourced operations or special counsel on an interim, special project, or ongoing basis with strategic planning and product and services development and innovation; workforce and operations management,  crisis preparedness and response as well as to prevent, stabilize and cleanup legal and operational crises large and small that arise in the course of operations. Her experience encompasses  helping health industry clients manage workforce, medical staff, vendors and suppliers, medical billing, reimbursement, claims and other provider-payer relations, business partners, and their recruitment, performance, discipline, compliance, safety, compensation, benefits, and training ;board, medical staff and other governance;   compliance and internal controls; strategic planning, process and quality improvement; change management;  assess, deter, investigate and address staffing, quality, compliance  and other performance;  meaningful use, EMR, HIPAA and other data security and breach and other health IT and data; crisis preparedness and response; internal, government and third-party reporting, audits, investigations and enforcement; government affairs and public policy; and other compliance and risk management, government and regulatory affairs and operations concerns.

The American Bar Association (ABA) International Section Life Sciences Committee Vice Chair, a Scribe for the ABA Joint Committee on Employee Benefits (JCEB) Annual OCR Agency Meeting, former Vice President of the North Texas Health Care Compliance Professionals Association, past Chair of the ABA Health Law Section Managed Care & Insurance Section, past ABA JCEB Council Representative, past Board President of Richardson Development Center (now Warren Center) for Children Early Childhood Intervention Agency, past North Texas United Way Long Range Planning Committee Member, and past Board Member and Compliance Chair of the National Kidney Foundation of North Texas, Ms. Stamer has worked closely with a diverse range of physicians, hospitals and healthcare systems, DME, Pharma, clinics, health care providers, managed care, insurance and other health care payers, quality assurance, credentialing, technical, research, public and private social and community organizations, and other health industry organizations and their management deal with governance; credentialing, patient relations and care; staffing, peer review, human resources and workforce performance management; outsourcing; internal controls and regulatory compliance; billing and reimbursement; physician, employment, vendor, managed care, government and other contracting; business transactions; grants; tax-exemption and not-for-profit; licensure and accreditation; vendor selection and management; privacy and data security; training; risk and change management; regulatory affairs and public policy and other concerns.

As a core component of her work,  Ms. Stamer has worked extensively throughout her career with health care providers, health plans and insurers, managed care organizations, health care clearinghouses, their business associates, employers, banks and other financial institutions, management services organizations, professional associations, medical staffs, accreditation agencies, auditors, technology and other vendors and service providers, and others on legal and operational compliance, risk management and compliance, public policies and regulatory affairs, contracting, payer-provider, provider-provider, vendor, patient, governmental and community relations and matters including extensive involvement advising, representing and defending public and private hospitals and health care systems; physicians, physician organizations and medical staffs; specialty clinics and pharmacies; skilled nursing, home health, rehabilitation and other health care providers and facilities; medical staff, accreditation, peer review and quality committees and organizations; billing and management services organizations; consultants; investors; technology, billing and reimbursement and other services and product vendors; products and solutions consultants and developers; investors; managed care organizations, insurers, self-insured health plans and other payers; and other health industry clients to establish and administer compliance and risk management policies; comply with requirements, investigate and respond to Board of Medicine, Health, Nursing, Pharmacy, Chiropractic, and other licensing agencies, Department of Aging & Disability, FDA, Drug Enforcement Agency, OCR Privacy and Civil Rights, Department of Labor, IRS, HHS, DOD, FTC, SEC, CDC and other public health, Department of Justice and state attorneys’ general and other federal and state agencies; JCHO and other accreditation and quality organizations; private litigation and other federal and state health care industry investigation, enforcement including  insurance or other liability management and allocation; process and product development, contracting, deployment and defense; evaluation, commenting or seeking modification of regulatory guidance, and other regulatory and public policy advocacy; training and discipline; enforcement, and a host of other related concerns for public and private health care providers, health insurers, health plans, technology and other vendors, employers, and others.and other compliance, public policy, regulatory, staffing, and other operations and risk management concerns.

Past Chair of the ABA Managed Care & Insurance Interest Group and, a Fellow in the American College of Employee Benefit Counsel, the American Bar Foundation and the Texas Bar Foundation, Ms. Stamer also has extensive health care reimbursement and insurance experience advising and defending health care providers, payers, and others about Medicare, Medicaid, Medicare and Medicaid Advantage, Tri-Care, self-insured group, association, individual and group and other health benefit programs and coverages including but not limited to advising public and private payers about coverage and program design and documentation, advising and defending providers, payers and systems and billing services entities about systems and process design, audits, and other processes; provider credentialing, and contracting; providers and payer billing, reimbursement, claims audits, denials and appeals, coverage coordination, reporting, direct contracting, False Claims Act, Medicare & Medicaid, ERISA, state Prompt Pay, out-of-network and other nonpar insured, and other health care claims, prepayment, post-payment and other coverage, claims denials, appeals, billing and fraud investigations and actions and other reimbursement and payment related investigation, enforcement, litigation and actions.

Heavily involved in health care and health information technology, data and related process and systems development, policy and operations innovation and a Scribe for ABA JCEB annual agency meeting with OCR for many years who has authored numerous highly-regarded works and training programs on HIPAA and other data security, privacy and use, Ms. Stamer also is widely recognized for her extensive work and leadership on leading edge health care and benefit policy and operational issues including meaningful use and EMR, billing and reimbursement, quality measurement and reimbursement, HIPAA, FACTA, PCI, trade secret, physician and other medical confidentiality and privacy, federal and state data security and data breach and other information privacy and data security rules and many other concerns.  Her work includes both regulatory and public policy advocacy and thought leadership, as well as advising and representing a broad range of health industry and other clients about policy design, drafting, administration, business associate and other contracting,  risk assessments, audits and other risk prevention and mitigation, investigation, reporting, mitigation and resolution of known or suspected violations or other incidents and responding to and defending investigations or other actions by plaintiffs, DOJ, OCR, FTC, state attorneys’ general and other federal or state agencies, other business partners, patients and others.

Ms. Stamer has worked extensively with health care providers, health plans, health care clearinghouses, their business associates, employers and other plan sponsors, banks and other financial institutions, and others on risk management and compliance with HIPAA, FACTA, trade secret and other information privacy and data security rules, including the establishment, documentation, implementation, audit and enforcement of policies, procedures, systems and safeguards, investigating and responding to known or suspected breaches, defending investigations or other actions by plaintiffs, OCR and other federal or state agencies, reporting known or suspected violations, business associate and other contracting, commenting or obtaining other clarification of guidance, training and enforcement, and a host of other related concerns. Her clients include public and private health care providers, health insurers, health plans, technology and other vendors, and others. In addition to representing and advising these organizations, she also has conducted training on Privacy & The Pandemic for the Association of State & Territorial Health Plans, as well as HIPAA, FACTA, PCI, medical confidentiality, insurance confidentiality and other privacy and data security compliance and risk management for Los Angeles County Health Department, MGMA, ISSA, HIMMS, the ABA, SHRM, schools, medical societies, government and private health care and health plan organizations, their business associates, trade associations and others.

A former lead consultant to the Government of Bolivia on its Pension Privatization Project with extensive domestic and international public policy and governmental and regulatory affairs experience, Ms. Stamer also is widely recognized for regulatory and policy work, advocacy and outreach on healthcare, education, aging, disability, savings and retirement, workforce, ethics, and other policies.  Throughout her adult life and career, Ms. Stamer has provided thought leadership; policy and program design, statutory and regulatory development design and analysis; drafted legislation, proposed regulations and other guidance, position statements and briefs, comments and other critical policy documents; advised, assisted and represented health care providers, health plans and insurers, employers, professional. and trade associations, community and government leaders and others on health care, health, pension and retirement, workers’ compensation, Social Security and other benefit, insurance and financial services, tax, workforce, aging and disability, immigration, privacy and data security and a host of other international and domestic federal, state and local public policy and regulatory reforms through her involvement and participation in numerous client engagements, founder and Executive Director of the Coalition for Responsible Health Policy and its PROJECT COPE: the Coalition on Patient Empowerment, adviser to the National Physicians Congress for Healthcare Policy, leadership involvement with the US-Mexico Chamber of Commerce, the Texas Association of Business, the ABA JCEB, Health Law, RPTE, Tax, Labor, TIPS, International Life Sciences, and other Sections and Committees, SHRM Governmental Affairs Committee and a host of other  involvements and activities.

A popular lecturer and widely published author on health industry concerns, Ms. Stamer continuously advises health industry clients about compliance and internal controls, workforce and medical  staff performance, quality, governance, reimbursement, privacy and data security, and other risk management and operational matters. Ms. Stamer also publishes and speaks extensively on health and managed care industry regulatory, staffing and human resources, compensation and benefits, technology, public policy, reimbursement and other operations and risk management concerns. Her insights on these and other related matters appear in the Health Care Compliance Association, Atlantic Information Service, Bureau of National Affairs, The Wall Street Journal, Business Insurance, the Dallas Morning News, Modern Health Care, Managed Healthcare, Health Leaders, and a many other national and local publications.

A Fellow in the American College of Employee Benefit Counsel, the American Bar Foundation and the Texas Bar Foundation, Ms. Stamer also shares her thought leadership, experience and advocacy on these and other related concerns by her service in the leadership of the Solutions Law Press, Inc. Coalition for Responsible Health Policy, its PROJECT COPE:  Coalition on Patient Empowerment, and a broad range of other professional and civic organizations including North Texas Healthcare Compliance Association, a founding Board Member and past President of the Alliance for Healthcare Excellence, past Board Member and Board Compliance Committee Chair for the National Kidney Foundation of North Texas; former Board President of the early childhood development intervention agency, The Richardson Development Center for Children (now Warren Center For Children);  current Vice Chair of the ABA Tort & Insurance Practice Section Employee Benefits Committee, current Vice Chair of Policy for the Life Sciences Committee of the ABA International Section, Past Chair of the ABA Health Law Section Managed Care & Insurance Section, a current Defined Contribution Plan Committee Co-Chair, former Group Chair and Co-Chair of the ABA RPTE Section Employee Benefits Group, past Representative and chair of various committees of ABA Joint Committee on Employee Benefits; a ABA Health Law Coordinating Council representative, former Coordinator and a Vice-Chair of the Gulf Coast TEGE Council TE Division, past Chair of the Dallas Bar Association Employee Benefits & Executive Compensation Committee, a former member of the Board of Directors of the Southwest Benefits Association and others.

Ms. Stamer also is a highly popular lecturer, symposium and chair, faculty member and author, who publishes and speaks extensively on health and managed care industry, human resources, employment and other privacy, data security and other technology, regulatory and operational risk management. Examples of her many highly regarded publications on these matters include “Protecting & Using Patient Data In Disease Management: Opportunities, Liabilities And Prescriptions,” “Privacy Invasions of Medical Care-An Emerging Perspective,” “Cybercrime and Identity Theft: Health Information Security: Beyond HIPAA,” as well as thousands of other publications, programs and workshops these and other concerns for the American Bar Association, ALI-ABA, American Health Lawyers, Society of Human Resources Professionals, the Southwest Benefits Association, the Society of Employee Benefits Administrators, the American Law Institute, Lexis-Nexis, Atlantic Information Services, The Bureau of National Affairs (BNA), InsuranceThoughtLeaders.com, Benefits Magazine, Employee Benefit News, Texas CEO Magazine, HealthLeaders, the HCCA, ISSA, HIMSS, Modern Healthcare, Managed Healthcare, Institute of Internal Auditors, Society of CPAs, Business Insurance, Employee Benefits News, World At Work, Benefits Magazine, the Wall Street Journal, the Dallas Morning News, the Dallas Business Journal, the Houston Business Journal, and many other symposia and publications. She also has served as an Editorial Advisory Board Member for human resources, employee benefit and other management focused publications of BNA, HR.com, Employee Benefit News, Insurance Thought Leadership and many other prominent publications and speaks and conducts training for a broad range of professional organizations.

For more information about Ms. Stamer or her health industry and other experience and involvements, see here or contact Ms. Stamer via telephone at (469) 767-8872 or via e-mail here.

Call To Action: Become a Project COPE Healthcare Hero

Follow, like and share our articles and resources in this ProjectCOPE.blog, and follow, like, share your comments and ideas, and participate in our Facebook page @ProjectCOPECOALITION or on LinkedIn to

  • Learn and share tips, tools and other information on how you and your family can manage your health and wellness needs.
  • Get and share ideas on how to understand, shape and use your healthcare and health coverage.
  • Share your ideas and input about health and health coverage issues and policies with elected leaders and regulators?
  • Monitor health, wellness and other developments.
  • Help your providers, family,  friends and community cope with health care, disability, aging and wellness challenges.
  • Get educated! Learn about what’s happening in Washington and communities across the country to help or hurt healthcare quality and access and how you can help make things better or influence how these developments affect people you care about.
  • Get involved and recruit others to join the cause!

Despite an endless stream of well-meaning market and governmental reforms over the past 25 years, the U.S. health care system is in crisis. American patients, their families and other caregivers, their employers, their health benefit programs, their health care providers, the communities and even our federal health care budget increasingly are burdened and overwhelmed by the mounting obstacles to caring for our ill, disabled, and aging citizens within our health care system and the extraordinary expense of maintaining and using that system.

As Congress takes up reform again, it is critical that Americans act to protect their own and their families’ health care and control the financial burdens of health care by getting informed, providing clear and consistent direction to Congress and other reformers and taking other actions to empower and care for themselves and their loved ones within our evolving health care system..

About Solutions Law Press, Inc.™

Solutions Law Press, Inc.™ provides human resources and employee benefit and other business risk management, legal compliance, management effectiveness and other coaching, tools and other resources, training and education on leadership, governance, human resources, employee benefits, data security and privacy, insurance, health care and other key compliance, risk management, internal controls and operational concerns. If you find this of interest, you also be interested reviewing some of our other Solutions Law Press, Inc.™ resources here such as:

Celebrate National Nutrition Month With Free Resources

March is National Nutrition Month! Check out free government resources here for tips and tools to help you and your employees or patients enjoy the benefits of better nutrition.

About Solutions Law Press, Inc.™

Solutions Law Press, Inc.™ provides human resources and employee benefit and other business risk management, legal compliance, management effectiveness and other coaching, tools and other resources, training and education on leadership, governance, human resources, employee benefits, data security and privacy, insurance, health care and other key compliance, risk management, internal controls and operational concerns. If you find this of interest, you also be interested reviewing some of our other Solutions Law Press, Inc.™ resources here including:

Review Your Provider Performance Data 

Bill Allowing FDA Emergency Use Authorizations To Protect Military From Biological Warfare Threats Sent to President

OIG Tells Texas Stop Paying Medicaid MCOs For Dead Patients

Michigan Doctor Pleads Guilty To Billing Medicare For Illegally Prescribed Drugs

Anesthesiology Practice Nailed For Improperly Billing For Moderate Sedation

Florida Doctor Sentenced For Multi-Million Dollar Drug & Alcohol Addiction Treatment Health Care Fraud, Money Laundering & Forced Prostitution Scheme

CMS Announces New Medicare Provider Ombudsman

CMS Publishes 2018 Updates To Home Health Prospective Payment Rates & Rules

CMS Publishes 2018 Physician Fee Schedule Rule

Check Your Medicare/Medicaid Compliance Against Against Quarterly Guidance Changes List

CDC Proposed Changes To NIOSH Occupational Health Biological Monitoring Methods for Chemical Exposures

HHS Picks Hargan As Acting HHS Secretary

OCR Gives Health Care Providers, Other Covered Entities Post-Las Vegas Shooting HIPAA Medical Privacy Guidance On Disclosures To Family, Media & Others For Notification & Other Purposes

Novo Nordisk Pays $58M+ For Not Giving FDA-Required Warnings ABout Victoza Cancer Risks

Christus Pays $12.24M Settlement Resolves False Claims Act Charges From “Donations” To New Mexico

Oklahoma Nursing Home Settles HHS HIV Discrimination Charges

HHS Issues Hurricane Irma Relief For Puerto Rico, U.S. Virgin Islands & Florida

HHS Medical Clinic to Provide Healthcare to Hurricane Harvey Victims at Houston Convention Center Starting Wednesday

CMS Proposes Cutbacks To Medicare Bundled Payment Program

CMS Releases 2017 Provider Payment Program Hardship Exception Application

RAISE Act Immigration Visa, Visa Holder Public Benefit Limits Create Potential Health Industry Concern

CardioNet $2.5M HIPAA Resolution Agreement Schools HIPAA Entities To Clean Up Their Acts

Medical Clinic HIPAA Resolution Agreement Shows Need For Current Business Associate Agreements

If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information including your preferred e-mail by creating your profile here.

NOTICE: These statements and materials are for general informational and purposes only. They do not establish an attorney-client relationship, are not legal advice or an offer or commitment to provide legal advice, and do not serve as a substitute for legal advice. Readers are urged to engage competent legal counsel for consultation and representation in light of the specific facts and circumstances presented in their unique circumstance at any particular time. No comment or statement in this publication is to be construed as legal advice or an admission. The author reserves the right to qualify or retract any of these statements at any time. Likewise, the content is not tailored to any particular situation and does not necessarily address all relevant issues. Because the law is rapidly evolving and rapidly evolving rules makes it highly likely that subsequent developments could impact the currency and completeness of this discussion. The presenter and the program sponsor disclaim, and have no responsibility to provide any update or otherwise notify any participant of any such change, limitation, or other condition that might affect the suitability of reliance upon these materials or information otherwise conveyed in connection with this program. Readers may not rely upon, are solely responsible for, and assume the risk and all liabilities resulting from their use of this publication.

Circular 230 Compliance. The following disclaimer is included to ensure that we comply with U.S. Treasury Department Regulations. Any statements contained herein are not intended or written by the writer to be used, and nothing contained herein can be used by you or any other person, for the purpose of (1) avoiding penalties that may be imposed under federal tax law, or (2) promoting, marketing or recommending to another party any tax-related transaction or matter addressed herein.

©2018 Cynthia Marcotte Stamer. Non-exclusive right to republish granted to Solutions Law Press, Inc.™ For information about republication, please contact the author directly. All other rights reserved.

Got The Flu? Know What To Do!

Influenza (commonly referred to as the “flu”) continues to threaten many American families.

Highly contagious, the flu can be serious or even deadly. However, the Centers for Disease Control (CDC) is urging Americans to get a flu shot and practice good hygiene to reduce their risk.

Employers can help by arranging for sick leave, allowing sick workers to stay home, and urging workers to get flu shots and practice healthy hygiene.

For more tips and resources from the CDC, see here.

About Solutions Law Press, Inc.™

Solutions Law Press, Inc.™ provides human resources and employee benefit and other business risk management, legal compliance, management effectiveness and other coaching, tools and other resources, training and education on leadership, governance, human resources, employee benefits, data security and privacy, insurance, health care and other key compliance, risk management, internal controls and operational concerns. If you find this of interest, you also be interested reviewing some of our other Solutions Law Press, Inc.™ resources here including:

If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information including your preferred e-mail by creating your profile here.

NOTICE: These statements and materials are for general informational and purposes only. They do not establish an attorney-client relationship, are not legal advice or an offer or commitment to provide legal advice, and do not serve as a substitute for legal advice. Readers are urged to engage competent legal counsel for consultation and representation in light of the specific facts and circumstances presented in their unique circumstance at any particular time. No comment or statement in this publication is to be construed as legal advice or an admission. The author reserves the right to qualify or retract any of these statements at any time. Likewise, the content is not tailored to any particular situation and does not necessarily address all relevant issues. Because the law is rapidly evolving and rapidly evolving rules makes it highly likely that subsequent developments could impact the currency and completeness of this discussion. The presenter and the program sponsor disclaim, and have no responsibility to provide any update or otherwise notify any participant of any such change, limitation, or other condition that might affect the suitability of reliance upon these materials or information otherwise conveyed in connection with this program. Readers may not rely upon, are solely responsible for, and assume the risk and all liabilities resulting from their use of this publication.

Circular 230 Compliance. The following disclaimer is included to ensure that we comply with U.S. Treasury Department Regulations. Any statements contained herein are not intended or written by the writer to be used, and nothing contained herein can be used by you or any other person, for the purpose of (1) avoiding penalties that may be imposed under federal tax law, or (2) promoting, marketing or recommending to another party any tax-related transaction or matter addressed herein.

©2018 Cynthia Marcotte Stamer. Non-exclusive right to republish granted to Solutions Law Press, Inc.™ For information about republication, please contact the author directly. All other rights reserved.

Practice Pool Safety

Practicing water safety is critical!

Summertime means pool time.  

Splashing around in the water provides a wonderful opportunity to stay cool and have fun … as long as everyone stays safe.

News reports of an Ohio lifeguard saving a toddler the first day on the job is a timely  reminder of the importance of knowing and constantly practicing pool safety when you or someone near you is in or near a pool or other water.

Downing & Near Drowning Very Common

Centers for Disease Control (CDC) data shows the importance of water safety and vigilance:

  • Drowning ranks fifth among the leading causes of unintentional injury death in the United States.
  • 10 people die from unintentional drowning every day on average.
  • Children are particularly African American children 5-19 drown in swimming pools at rates 5.5 times higher than those of whites. This disparity is greatest among those 11-12 years where African Americans drown in swimming pools at rates 10 times those of whites. are children 14 and younger.
  • For every child who dies from drowning, another five receive emergency department care for nonfatal submersion injuries.
  • More than 50% of drowning victims treated in emergency departments (EDs) require hospitalization or transfer for further care (compared with a hospitalization rate of about 6% for all unintentional injuries).
  • Near drownings are a leading cause of permanent brain injury.  These nonfatal drowning injuries can cause severe brain damage that may result in long-term disabilities such as memory problems, learning disabilities, and permanent loss of basic functioning (e.g., permanent vegetative state).

While anyone in or around the water may get into trouble under the right circumstances, the victims overwhelmingly tend to be young children and are mostly males.  According to the CDC:

  • Children ages 1 to 4 have the highest drowning rates. In 2014, among children 1 to 4 years old who died from an unintentional injury, one-third died from drowning, most of which occur in home swimming pools.
  • Male and minorities have a higher likelihood of becoming victims.  CDC statistics show:
    • Nearly 80% of people who die from drowning are male; and
    • African American children 5-19 drown in swimming pools at rates 5.5 times higher than those of whites. This disparity is greatest among those 11-12 years where African Americans drown in swimming pools at rates 10 times those of whites.

Factors Influencing Drowning Risk

CDC data also reveals the main factors that affect drowning risk:

  • Lack of swimming ability,
  • Lack of barriers to prevent unsupervised water access,
  • Lack of close supervision while swimming,
  • Location,
  • Failure to wear life jackets,
  • Alcohol use, and
  • Seizure disorders.

Preventing Drowning Injuries

CDC data also provides helpful tips about steps people can take to reduce the risk of drowning or near drowning deaths and injuries including the following key safety measures:

  • Close supervision and vigilance is critical whether or not an individual can swim. Drowning can happen quickly and quietly anywhere there is water (such as bathtubs, swimming pools, buckets), and even in the presence of lifeguards.
  • Swimming lessons are a key tool to reduce the risk of drowning in young children.  The CDC reports participation in formal swimming lessons can reduce the risk of drowning among children aged 1 to 4 years.
  • Barriers, such as pool fencing, prevent young children from gaining access to the pool area without caregivers’ awareness. A four-sided isolation fence (separating the pool area from the house and yard) reduces a child’s risk of drowning 83% compared to three-sided property-line fencing.

CDC demonstrates that age or location may increase the need for added diligence and supervision.  The data shows that people of different ages drown in different locations.

  • Most children ages 1-4 drown in home swimming pools.
  • The percentage of drownings in natural water settings, including lakes, rivers and oceans, increases with age.
  • More than half of fatal and nonfatal drownings among those 15 years and older (57% and 57% respectively) occurred in natural water settings.
  • In 2010, the U.S. Coast Guard received reports for 4,604 boating incidents; 3,153 boaters were reported injured, and 672 died. Most (72%) boating deaths that occurred during 2010 were caused by drowning, with 88% of victims not wearing life jackets.
  • For persons with seizure disorders, bathtub drowning is not uncommon.  Drowning is the most common cause of unintentional injury death, with the bathtub as the site of highest drowning risk.

The data also makes clear drinking and water sports are a dangerous cocktail.   According to the CDC, among adolescents and adults:

  • Alcohol use is involved in up to 70% of deaths associated with water recreation;
  • Nearly 1/4 of emergency room visits for drowning; and
  • About 1/5 of reported boating deaths.

Alcohol influences balance, coordination, and judgment, and its effects are heightened by sun exposure and heat. Of course alcohol consumption by others around a swimmer who has been drinking undermine the awareness of those that would be available to rescue and impaired swimmer too.
The bottom line:  Alcohol and water don’t mix.

Water Safety To-Do List

In light of the known risks, Americans, and their employers, health plans, health care providers, and communities should take steps to keep themselves and others safe while enjoying pools, lakes and other rivers this Summer.

Practice water safety and urge others to do the same by taking the following common sense steps:

  • Supervise When in or Around Water 

Designate a responsible adult to watch young children while in the bath and all people swimming or playing in or around water.

Supervisors of preschool and other young children should  be close enough to reach the child at all times (@touch supervision”).

Because drowning occurs quickly and quietly, supervising adults should not be involved in any other distracting activity (such as drinking, reading, playing cards, talking on the phone, or mowing the lawn) while supervising children, even if lifeguards are present.

Parents considering authorizing swimming field trips led by childcare providers or allowing their children to swim under the supervision of others should investigate the adequacy and training of staff to meet these guidelines.

  • Use the Buddy System. 

Always swim with a buddy. 

  • Lifeguards

Select swimming sites that have lifeguards when possible.  When hosting a social or workplace event near or involving swimming or other water activities, consider hiring one or more lifeguards to monitor the activity and be prepared to respond in case of an emergency.

  • Seizure Disorder Safety

If you, a worker or a family member has a seizure disorder, provide one-on-one supervision around water, including swimming pools. Consider taking showers rather than using a bath tub for bathing. Wear life jackets when boating.

  • Learn to Swim & Make Sure Others In Or Near The Water Can Swim

Formal swimming lessons can protect young children from drowning. However, even when children have had formal swimming lessons, constant, careful supervision when children are in the water, and barriers, such as pool fencing to prevent unsupervised access, are still important.

  • Learn Cardiopulmonary Resuscitation (CPR)

In the time it takes for paramedics to arrive,  CPR skills could save someone’s life. Many free or low-cost options for learning CPR are readily available from the American Red Cross and others.  If you host people around your pool or other water related event, consider hosting a CPR training at one of your upcoming gatherings.

  • Use Life Jackets, Not Air-Filled or Foam Toys.

Provide an wear Coast Guard approved life jackets in good condition as needed.

Don’t use air-filled or foam toys, such as “water wings”, “noodles”, or inner-tubes, instead of life jackets. These toys are not life jackets and are not designed to keep swimmers safe.

  • Don’t Mix Water & Alcohol

Avoid drinking alcohol before or during swimming, boating, or water skiing.  Do not drink alcohol while supervising children.  Do not serve or control the consumption of alcohol by guests when hosting events involving boating, swimming or other water sports.

  • Guard Against “Hypoxic Blackout”

Teach your children and don’t let swimmers hyperventilate before swimming underwater or try to hold their breath for long periods of time. This can cause them to pass out (sometimes called “hypoxic blackout” or “shallow water blackout”) and drown.

  • Prevent Recreational Water Illnesses

Learn how to and act to prevent recreational water illnesses by following the CDC’s recommended 12 Steps for Prevention of Recreational Water Illnesses.

  • Watch For Hazardous Weather And Conditions

Know the local weather conditions and forecast before swimming or boating. Strong winds and thunderstorms with lightning strikes are dangerous.

  • Practice and Maintain Home Pool Safety

If you have a swimming pool at home, consider the following special safeguards:

  • Install a four-sided pool fence at least four feet high with that completely separates the pool area from the house and yard. The fence should be at least 4 feet high with self-closing and self-latching gates that open outward with latches out of reach of children. Also consider additional barriers such as automatic door locks and alarms to prevent access or alert you if someone enters the pool area.
  • Remove floats, balls and other toys from the pool and surrounding area immediately after use so children are not tempted to enter the pool area unsupervised.
  • Stay vigilant at all times.  Supervise your family and guests.  Require adult guests to provide touch supervision for their children in the pool.   Hire a lifeguard during parties or at other times when your ability to provide touch supervision isn’t sufficient.
  • Don’t swim or allow others to swim after or while consuming alcohol.

Keep in mind that a drowning or near drowning of a family member or guest in your pool presents both a substantial legal exposure as well as risks an irreversible personally devastating experience for all involved.  Don’t let fun get ahead of common sense or safety.

  • Practice Natural Water Safety

If you are in and around natural water settings:

  • Use U.S. Coast Guard approved life jackets regardless of the distance to be traveled, the size of the boat, or the swimming ability of boaters.
  • Know the meaning of and obey warnings represented by colored beach flags. .
  • Watch for dangerous waves and signs of rip currents such as water that is  discolored  choppy, foamy, or filled with debris and moving in a channel away from shore.
  • If you are caught in a rip current, swim parallel to shore. Once free of the current, swim diagonally toward shore.

Also plan ahead and take some common sense steps to prepare for the possible need for a timely rescue before pushing off the boat from the shore or entering the water. Among other things:

  • Let at least a couple people not participating know where you are, where you are going, what you plan to do and when you should be back or checkin;
  • Confirm that at least one cellphone has service and keep it with you and working;
  • Consider using the share my location or other feature on your cellphone or other device to help emergency or other rescue personnel find you in the event of an emergency;
  • Discuss safety rules with all participants before getting started;and
  • Enforce safety throughout the activity.

Remember and remind guests that a drowning or near drowning isn’t worth the risk.

  • Be Prepared: Know CPR & Plan Ahead

Since seconds matter when a drowning or near drowning happens, be prepared for a possible emergency before anyone gets in the water.  At minimum:

  • Know CPR and encourage others to do the same;
  • Prominently your address and keep a telephone available in your pool area; Drop a locator pin on your cell phone or otherwise take note of your location if you were on natural water.

Cooling off in the pool or lake can be a fun way to stay comfortable in the summer. Plan ahead and practice water safety as you and your friends enjoy the fun.

Empowering Dying Patients Through Choice

The self-composed obituary of Sonia Todd is a touching reminder of the power and importance of patient choice even for patients facing death.  

The success of our health science and the ever extraordinary miracles it achieves to delay death often dupes Americans into forgetting that life is a process that ultimately leads to death.   Regardless of the ultimate pathway traveled from life to death by any particular person, health care ultimately is mostly about delaying death and hopefully, wringing out as much joy and functionality for the afflicted individual with the minimum of pain and suffering. 

Aging, illness, injury and disability often disempower those afflicted and those who love and care for them.   Eventually, everyone runs out of options to keep living. The realization that this time has come for a patient often is devastating for patients and their families. 

When the fight for life becomes futile, loved ones often don’t know what to do next to help the patient.

When death ultimately can not be avoided, empower the patient by supporting reasonable choices about their death and dying.  Allowing patients to make choices about how to live out their last days or moments, their treatment, and other details of their impending death and to plan and talk about what will happen after their death can empower many patients and their families through the process of death and coping after death.  

About The Author

Recognized by LexisNexis® Martindale-Hubbell® as a “AV-Preeminent” (Top 1%/ the highest) and “Top Rated Lawyer,” with special recognition as “LEGAL LEADER™ Texas Top Rated Lawyer” in Health Care Law and Labor and Employment Law; as among the “Best Lawyers In Dallas” for her work in the fields of “Health Care,” “Labor & Employment,” “Tax: Erisa & Employee Benefits” and “Business and Commercial Law” by D Magazine, Cynthia Marcotte Stamer is nationally and internationally known for her 29 plus years’ of work as a practicing attorney on health care, health benefit, health policy and regulatory affairs and other health industry concerns as a practicing attorney as well as her lifelong involvement as a health, disability  and retirement and workforce thought leader, management consultant, author, public policy advocate and lecturer.

Throughout her adult life and nearly 30-year legal career, Ms. Stamer’s legal, management and governmental affairs work has focused on helping health industry, health benefit and other organizations and their management use the law, performance and risk management tools and process to manage people, performance, quality, compliance, operations and risk. Highly valued for her rare ability to find pragmatic client-centric solutions by combining her detailed legal and operational knowledge and experience with her talent for creative problem-solving, Ms. Stamer supports these organizations and their leaders on both a real-time, “on demand” basis as well as outsourced operations or special counsel on an interim, special project, or ongoing basis with strategic planning and product and services development and innovation; workforce and operations management, crisis preparedness and response as well as to prevent, stabilize and cleanup legal and operational crises large and small that arise in the course of operations. Her experience encompasses helping health industry clients manage workforce, medical staff, vendors and suppliers, medical billing, reimbursement, claims and other provider-payer relations, business partners, and their recruitment, performance, discipline, compliance, safety, compensation, benefits, and training ;board, medical staff and other governance; compliance and internal controls; strategic planning, process and quality improvement; change management; assess, deter, investigate and address staffing, quality, compliance and other performance; meaningful use, EMR, HIPAA and other data security and breach and other health IT and data; crisis preparedness and response; internal, government and third-party reporting, audits, investigations and enforcement; government affairs and public policy; and other compliance and risk management, government and regulatory affairs and operations concerns.

The American Bar Association (ABA) International Section Life Sciences Committee Vice Chair, a Scribe for the ABA Joint Committee on Employee Benefits (JCEB) Annual OCR Agency Meeting, former Vice President of the North Texas Health Care Compliance Professionals Association, past Chair of the ABA Health Law Section Managed Care & Insurance Section, past ABA JCEB Council Representative, past Board President of Richardson Development Center (now Warren Center) for Children Early Childhood Intervention Agency, past North Texas United Way Long Range Planning Committee Member, and past Board Member and Compliance Chair of the National Kidney Foundation of North Texas, Ms. Stamer has worked closely with a diverse range of physicians, hospitals and healthcare systems, DME, Pharma, clinics, health care providers, managed care, insurance and other health care payers, quality assurance, credentialing, technical, research, public and private social and community organizations, and other health industry organizations and their management deal with governance; credentialing, patient relations and care; staffing, peer review, human resources and workforce performance management; outsourcing; internal controls and regulatory compliance; billing and reimbursement; physician, employment, vendor, managed care, government and other contracting; business transactions; grants; tax-exemption and not-for-profit; licensure and accreditation; vendor selection and management; privacy and data security; training; risk and change management; regulatory affairs and public policy and other concerns.

As a core component of her work, Ms. Stamer has worked extensively throughout her career with health care providers, health plans and insurers, managed care organizations, health care clearinghouses, their business associates, employers, banks and other financial institutions, management services organizations, professional associations, medical staffs, accreditation agencies, auditors, technology and other vendors and service providers, and others on legal and operational compliance, risk management and compliance, public policies and regulatory affairs, contracting, payer-provider, provider-provider, vendor, patient, governmental and community relations and matters including extensive involvement advising, representing and defending public and private hospitals and health care systems; physicians, physician organizations and medical staffs; specialty clinics and pharmacies; skilled nursing, home health, rehabilitation and other health care providers and facilities; medical staff, accreditation, peer review and quality committees and organizations; billing and management services organizations; consultants; investors; technology, billing and reimbursement and other services and product vendors; products and solutions consultants and developers; investors; managed care organizations, insurers, self-insured health plans and other payers; and other health industry clients to establish and administer compliance and risk management policies; comply with requirements, investigate and respond to Board of Medicine, Health, Nursing, Pharmacy, Chiropractic, and other licensing agencies, Department of Aging & Disability, FDA, Drug Enforcement Agency, OCR Privacy and Civil Rights, Department of Labor, IRS, HHS, DOD, FTC, SEC, CDC and other public health, Department of Justice and state attorneys’ general and other federal and state agencies; JCHO and other accreditation and quality organizations; private litigation and other federal and state health care industry investigation, enforcement including insurance or other liability management and allocation; process and product development, contracting, deployment and defense; evaluation, commenting or seeking modification of regulatory guidance, and other regulatory and public policy advocacy; training and discipline; enforcement, and a host of other related concerns for public and private health care providers, health insurers, health plans, technology and other vendors, employers, and others.and other compliance, public policy, regulatory, staffing, and other operations and risk management concerns.

Past Chair of the ABA Managed Care & Insurance Interest Group and, a Fellow in the American College of Employee Benefit Counsel, the American Bar Foundation and the Texas Bar Foundation, Ms. Stamer also has extensive health care reimbursement and insurance experience advising and defending health care providers, payers, and others about Medicare, Medicaid, Medicare and Medicaid Advantage, Tri-Care, self-insured group, association, individual and group and other health benefit programs and coverages including but not limited to advising public and private payers about coverage and program design and documentation, advising and defending providers, payers and systems and billing services entities about systems and process design, audits, and other processes; provider credentialing, and contracting; providers and payer billing, reimbursement, claims audits, denials and appeals, coverage coordination, reporting, direct contracting, False Claims Act, Medicare & Medicaid, ERISA, state Prompt Pay, out-of-network and other nonpar insured, and other health care claims, prepayment, post-payment and other coverage, claims denials, appeals, billing and fraud investigations and actions and other reimbursement and payment related investigation, enforcement, litigation and actions.

Heavily involved in health care and health information technology, data and related process and systems development, policy and operations innovation and a Scribe for ABA JCEB annual agency meeting with OCR for many years who has authored numerous highly-regarded laws, regulations, policies, programs, publications and training programs on HIPAA and other data security, privacy and use, EMR, billing and reimbursement, quality measurement,  privacy and other health , HIPAA, FACTA, PCI, trade secret, physician and other medical confidentiality and privacy, federal and state data security and data breach and other information privacy and data security rules and many other data, technology and systems concerns.  

A former lead consultant to the Government of Bolivia on its Pension Privatization Project with extensive domestic and international public policy and governmental and regulatory affairs experience, Ms. Stamer also is widely recognized for regulatory and policy work, advocacy and outreach on healthcare, education, aging, disability, savings and retirement, workforce, ethics, and other policies. Throughout her adult life and career, Ms. Stamer has provided thought leadership; policy and program design, statutory and regulatory development design and analysis; drafted legislation, proposed regulations and other guidance, position statements and briefs, comments and other critical policy documents; advised, assisted and represented health care providers, health plans and insurers, employers, professional. and trade associations, community and government leaders and others on health care, health, pension and retirement, workers’ compensation, Social Security and other benefit, insurance and financial services, tax, workforce, aging and disability, immigration, privacy and data security and a host of other international and domestic federal, state and local public policy and regulatory  reform and enforcement.      Her work includes both regulatory and public policy advocacy and thought leadership, as well as advising and representing a broad range of health industry and other clients about policy design, drafting, administration, business associate and other contracting, risk assessments, audits, breach prevention and mitigation and other risk prevention and mitigation, investigation, reporting, mitigation and resolution of known or suspected violations or other incidents and responding to and defending investigations or other actions by plaintiffs, DOJ, OCR, DOL, HHS, FTC, Insurance Departments, state attorneys’ general and other federal or state agencies, other business partners.  Her advocacy and regulatory affairs and public policy work, involvement and participation also includes numerous client engagements, as well as as founder and Executive Director of the Coalition for Responsible Health Policy and its PROJECT COPE: the Coalition on Patient Empowerment, adviser to the National Physicians Congress for Healthcare Policy, leadership involvement with the US-Mexico Chamber of Commerce, the Texas Association of Business, the ABA JCEB, Health Law, RPTE, Tax, Labor, TIPS, International Life Sciences, and other Sections and Committees, SHRM Governmental Affairs Committee and a host of other involvements and activities.

A Fellow in the American College of Employee Benefit Counsel, the American Bar Foundation and the Texas Bar Foundation, Ms. Stamer also shares her thought leadership, experience and advocacy on these and other related concerns by her service in the leadership of the Solutions Law Press, Inc. Coalition for Responsible Health Policy, its PROJECT COPE: Coalition on Patient Empowerment, and a broad range of other professional and civic organizations including North Texas Healthcare Compliance Association, a founding Board Member and past President of the Alliance for Healthcare Excellence, past Board Member and Board Compliance Committee Chair for the National Kidney Foundation of North Texas; former Board President of the early childhood development intervention agency, The Richardson Development Center for Children (now Warren Center For Children); current Vice Chair of the ABA Tort & Insurance Practice Section Employee Benefits Committee, current Vice Chair of Policy for the Life Sciences Committee of the ABA International Section, Past Chair of the ABA Health Law Section Managed Care & Insurance Section, a current Defined Contribution Plan Committee Co-Chair, former Group Chair and Co-Chair of the ABA RPTE Section Employee Benefits Group, past Representative and chair of various committees of ABA Joint Committee on Employee Benefits; a ABA Health Law Coordinating Council representative, former Coordinator and a Vice-Chair of the Gulf Coast TEGE Council TE Division, past Chair of the Dallas Bar Association Employee Benefits & Executive Compensation Committee, a former member of the Board of Directors of the Southwest Benefits Association and others.

Ms. Stamer also is a highly popular lecturer, symposium and chair, faculty member and author, who publishes and speaks extensively on health and managed care industry, human resources, employment and other privacy, data security and other technology, regulatory and operational risk management. She has authored, published and presented s hundreds of publications, programs and workshops on these and other concerns for the American Bar Association, ALI-ABA, American Health Lawyers, Society of Human Resources Professionals, the Southwest Benefits Association, the Society of Employee Benefits Administrators, the American Law Institute, Lexis-Nexis, Atlantic Information Services, The Bureau of National Affairs (BNA), InsuranceThoughtLeaders.com, Benefits Magazine, Employee Benefit News, Texas CEO Magazine, HealthLeaders, the HCCA, ISSA, HIMSS, Modern Healthcare, Managed Healthcare, Institute of Internal Auditors, Society of CPAs, Business Insurance, Employee Benefits News, World At Work, Benefits Magazine, the Wall Street Journal, the Dallas Morning News, the Dallas Business Journal, the Houston Business Journal, and many other symposia and publications. She also has served as an Editorial Advisory Board Member for human resources, employee benefit and other management focused publications of BNA, HR.com, Employee Benefit News, Insurance Thought Leadership and many other prominent publications and speaks and conducts training for a broad range of professional organizations.

For more information about Ms. Stamer or her health industry and other experience and involvements, see here or contact Ms. Stamer via telephone at (469) 767-8872 or via e-mail here.

About Solutions Law Press, Inc.™

Solutions Law Press, Inc.™ provides human resources and employee benefit and other business risk management, legal compliance, management effectiveness and other coaching, tools and other resources, training and education on leadership, governance, human resources, employee benefits, data security and privacy, insurance, health care and other key compliance, risk management, internal controls and operational concerns. If you find this of interest, you also be interested reviewing some of our other Solutions Law Press, Inc.™ resources here.

If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information including your preferred e-mail by creating your profile here.

©2017 Cynthia Marcotte Stamer. Non-exclusive right to republish granted to Solutions Law Press, Inc.™ All other rights reserved. For information about republication or other use, please contact Ms. Stamer here.

6/10 Americans Want Drug Costs Fixed

A new Kaiser Foundation poll shows six in ten Americans say lowering the cost of prescription drugs is a “top priority.”   Support for prescription drug pricing reform spans majorities of Democrats, Republicans, and independents.

Learn more about the study and its results here.

About The Author

Recognized by LexisNexis® Martindale-Hubbell® as a “AV-Preeminent” (Top 1%/ the highest) and “Top Rated Lawyer,” with special recognition as “LEGAL LEADER™ Texas Top Rated Lawyer” in Health Care Law and Labor and Employment Law; as among the “Best Lawyers In Dallas” for her work in the fields of “Health Care,” “Labor & Employment,” “Tax: Erisa & Employee Benefits” and “Business and Commercial Law” by D Magazine, the author of this update is widely known for her 29 plus years’ of work in health care, health benefit, health policy and regulatory affairs and other health industry concerns as a practicing attorney and management consultant, thought leader, author, public policy advocate and lecturer.

Throughout her adult life and nearly 30-year legal career, Ms. Stamer’s legal, management and governmental affairs work has focused on helping health industry, health benefit and other organizations and their management use the law, performance and risk management tools and process to manage people, performance, quality, compliance, operations and risk. Highly valued for her rare ability to find pragmatic client-centric solutions by combining her detailed legal and operational knowledge and experience with her talent for creative problem-solving, Ms. Stamer supports these organizations and their leaders on both a real-time, “on demand” basis as well as outsourced operations or special counsel on an interim, special project, or ongoing basis with strategic planning and product and services development and innovation; workforce and operations management, crisis preparedness and response as well as to prevent, stabilize and cleanup legal and operational crises large and small that arise in the course of operations. Her experience encompasses helping health industry clients manage workforce, medical staff, vendors and suppliers, medical billing, reimbursement, claims and other provider-payer relations, business partners, and their recruitment, performance, discipline, compliance, safety, compensation, benefits, and training ;board, medical staff and other governance; compliance and internal controls; strategic planning, process and quality improvement; change management; assess, deter, investigate and address staffing, quality, compliance and other performance; meaningful use, EMR, HIPAA and other data security and breach and other health IT and data; crisis preparedness and response; internal, government and third-party reporting, audits, investigations and enforcement; government affairs and public policy; and other compliance and risk management, government and regulatory affairs and operations concerns.

The American Bar Association (ABA) International Section Life Sciences Committee Vice Chair, a Scribe for the ABA Joint Committee on Employee Benefits (JCEB) Annual OCR Agency Meeting, former Vice President of the North Texas Health Care Compliance Professionals Association, past Chair of the ABA Health Law Section Managed Care & Insurance Section, past ABA JCEB Council Representative, past Board President of Richardson Development Center (now Warren Center) for Children Early Childhood Intervention Agency, past North Texas United Way Long Range Planning Committee Member, and past Board Member and Compliance Chair of the National Kidney Foundation of North Texas, Ms. Stamer has worked closely with a diverse range of physicians, hospitals and healthcare systems, DME, Pharma, clinics, health care providers, managed care, insurance and other health care payers, quality assurance, credentialing, technical, research, public and private social and community organizations, and other health industry organizations and their management deal with governance; credentialing, patient relations and care; staffing, peer review, human resources and workforce performance management; outsourcing; internal controls and regulatory compliance; billing and reimbursement; physician, employment, vendor, managed care, government and other contracting; business transactions; grants; tax-exemption and not-for-profit; licensure and accreditation; vendor selection and management; privacy and data security; training; risk and change management; regulatory affairs and public policy and other concerns.

As a core component of her work, Ms. Stamer has worked extensively throughout her career with health care providers, health plans and insurers, managed care organizations, health care clearinghouses, their business associates, employers, banks and other financial institutions, management services organizations, professional associations, medical staffs, accreditation agencies, auditors, technology and other vendors and service providers, and others on legal and operational compliance, risk management and compliance, public policies and regulatory affairs, contracting, payer-provider, provider-provider, vendor, patient, governmental and community relations and matters including extensive involvement advising, representing and defending public and private hospitals and health care systems; physicians, physician organizations and medical staffs; specialty clinics and pharmacies; skilled nursing, home health, rehabilitation and other health care providers and facilities; medical staff, accreditation, peer review and quality committees and organizations; billing and management services organizations; consultants; investors; technology, billing and reimbursement and other services and product vendors; products and solutions consultants and developers; investors; managed care organizations, insurers, self-insured health plans and other payers; and other health industry clients to establish and administer compliance and risk management policies; comply with requirements, investigate and respond to Board of Medicine, Health, Nursing, Pharmacy, Chiropractic, and other licensing agencies, Department of Aging & Disability, FDA, Drug Enforcement Agency, OCR Privacy and Civil Rights, Department of Labor, IRS, HHS, DOD, FTC, SEC, CDC and other public health, Department of Justice and state attorneys’ general and other federal and state agencies; JCHO and other accreditation and quality organizations; private litigation and other federal and state health care industry investigation, enforcement including insurance or other liability management and allocation; process and product development, contracting, deployment and defense; evaluation, commenting or seeking modification of regulatory guidance, and other regulatory and public policy advocacy; training and discipline; enforcement, and a host of other related concerns for public and private health care providers, health insurers, health plans, technology and other vendors, employers, and others.and other compliance, public policy, regulatory, staffing, and other operations and risk management concerns.

Past Chair of the ABA Managed Care & Insurance Interest Group and, a Fellow in the American College of Employee Benefit Counsel, the American Bar Foundation and the Texas Bar Foundation, Ms. Stamer also has extensive health care reimbursement and insurance experience advising and defending health care providers, payers, and others about Medicare, Medicaid, Medicare and Medicaid Advantage, Tri-Care, self-insured group, association, individual and group and other health benefit programs and coverages including but not limited to advising public and private payers about coverage and program design and documentation, advising and defending providers, payers and systems and billing services entities about systems and process design, audits, and other processes; provider credentialing, and contracting; providers and payer billing, reimbursement, claims audits, denials and appeals, coverage coordination, reporting, direct contracting, False Claims Act, Medicare & Medicaid, ERISA, state Prompt Pay, out-of-network and other nonpar insured, and other health care claims, prepayment, post-payment and other coverage, claims denials, appeals, billing and fraud investigations and actions and other reimbursement and payment related investigation, enforcement, litigation and actions.

Heavily involved in health care and health information technology, data and related process and systems development, policy and operations innovation and a Scribe for ABA JCEB annual agency meeting with OCR for many years who has authored numerous highly-regarded works and training programs on HIPAA and other data security, privacy and use, Ms. Stamer also is widely recognized for her extensive work and leadership on leading edge health care and benefit policy and operational issues including meaningful use and EMR, billing and reimbursement, quality measurement and reimbursement, HIPAA, FACTA, PCI, trade secret, physician and other medical confidentiality and privacy, federal and state data security and data breach and other information privacy and data security rules and many other concerns. Her work includes both regulatory and public policy advocacy and thought leadership, as well as advising and representing a broad range of health industry and other clients about policy design, drafting, administration, business associate and other contracting, risk assessments, audits and other risk prevention and mitigation, investigation, reporting, mitigation and resolution of known or suspected violations or other incidents and responding to and defending investigations or other actions by plaintiffs, DOJ, OCR, FTC, state attorneys’ general and other federal or state agencies, other business partners, patients and others.

Ms. Stamer has worked extensively with health care providers, health plans, health care clearinghouses, their business associates, employers and other plan sponsors, banks and other financial institutions, and others on risk management and compliance with HIPAA, FACTA, trade secret and other information privacy and data security rules, including the establishment, documentation, implementation, audit and enforcement of policies, procedures, systems and safeguards, investigating and responding to known or suspected breaches, defending investigations or other actions by plaintiffs, OCR and other federal or state agencies, reporting known or suspected violations, business associate and other contracting, commenting or obtaining other clarification of guidance, training and enforcement, and a host of other related concerns. Her clients include public and private health care providers, health insurers, health plans, technology and other vendors, and others. In addition to representing and advising these organizations, she also has conducted training on Privacy & The Pandemic for the Association of State & Territorial Health Plans, as well as HIPAA, FACTA, PCI, medical confidentiality, insurance confidentiality and other privacy and data security compliance and risk management for Los Angeles County Health Department, MGMA, ISSA, HIMMS, the ABA, SHRM, schools, medical societies, government and private health care and health plan organizations, their business associates, trade associations and others.

A former lead consultant to the Government of Bolivia on its Pension Privatization Project with extensive domestic and international public policy and governmental and regulatory affairs experience, Ms. Stamer also is widely recognized for regulatory and policy work, advocacy and outreach on healthcare, education, aging, disability, savings and retirement, workforce, ethics, and other policies. Throughout her adult life and career, Ms. Stamer has provided thought leadership; policy and program design, statutory and regulatory development design and analysis; drafted legislation, proposed regulations and other guidance, position statements and briefs, comments and other critical policy documents; advised, assisted and represented health care providers, health plans and insurers, employers, professional. and trade associations, community and government leaders and others on health care, health, pension and retirement, workers’ compensation, Social Security and other benefit, insurance and financial services, tax, workforce, aging and disability, immigration, privacy and data security and a host of other international and domestic federal, state and local public policy and regulatory reforms through her involvement and participation in numerous client engagements, founder and Executive Director of the Coalition for Responsible Health Policy and its PROJECT COPE: the Coalition on Patient Empowerment, adviser to the National Physicians Congress for Healthcare Policy, leadership involvement with the US-Mexico Chamber of Commerce, the Texas Association of Business, the ABA JCEB, Health Law, RPTE, Tax, Labor, TIPS, International Life Sciences, and other Sections and Committees, SHRM Governmental Affairs Committee and a host of other involvements and activities.

A popular lecturer and widely published author on health industry concerns, Ms. Stamer continuously advises health industry clients about compliance and internal controls, workforce and medical staff performance, quality, governance, reimbursement, privacy and data security, and other risk management and operational matters. Ms. Stamer also publishes and speaks extensively on health and managed care industry regulatory, staffing and human resources, compensation and benefits, technology, public policy, reimbursement and other operations and risk management concerns. Her insights on these and other related matters appear in the Health Care Compliance Association, Atlantic Information Service, Bureau of National Affairs, The Wall Street Journal, Business Insurance, the Dallas Morning News, Modern Health Care, Managed Healthcare, Health Leaders, and a many other national and local publications.

A Fellow in the American College of Employee Benefit Counsel, the American Bar Foundation and the Texas Bar Foundation, Ms. Stamer also shares her thought leadership, experience and advocacy on these and other related concerns by her service in the leadership of the Solutions Law Press, Inc. Coalition for Responsible Health Policy, its PROJECT COPE: Coalition on Patient Empowerment, and a broad range of other professional and civic organizations including North Texas Healthcare Compliance Association, a founding Board Member and past President of the Alliance for Healthcare Excellence, past Board Member and Board Compliance Committee Chair for the National Kidney Foundation of North Texas; former Board President of the early childhood development intervention agency, The Richardson Development Center for Children (now Warren Center For Children); current Vice Chair of the ABA Tort & Insurance Practice Section Employee Benefits Committee, current Vice Chair of Policy for the Life Sciences Committee of the ABA International Section, Past Chair of the ABA Health Law Section Managed Care & Insurance Section, a current Defined Contribution Plan Committee Co-Chair, former Group Chair and Co-Chair of the ABA RPTE Section Employee Benefits Group, past Representative and chair of various committees of ABA Joint Committee on Employee Benefits; a ABA Health Law Coordinating Council representative, former Coordinator and a Vice-Chair of the Gulf Coast TEGE Council TE Division, past Chair of the Dallas Bar Association Employee Benefits & Executive Compensation Committee, a former member of the Board of Directors of the Southwest Benefits Association and others.

Ms. Stamer also is a highly popular lecturer, symposium and chair, faculty member and author, who publishes and speaks extensively on health and managed care industry, human resources, employment and other privacy, data security and other technology, regulatory and operational risk management. Examples of her many highly regarded publications on these matters include “Protecting & Using Patient Data In Disease Management: Opportunities, Liabilities And Prescriptions,” “Privacy Invasions of Medical Care-An Emerging Perspective,” “Cybercrime and Identity Theft: Health Information Security: Beyond HIPAA,” as well as thousands of other publications, programs and workshops these and other concerns for the American Bar Association, ALI-ABA, American Health Lawyers, Society of Human Resources Professionals, the Southwest Benefits Association, the Society of Employee Benefits Administrators, the American Law Institute, Lexis-Nexis, Atlantic Information Services, The Bureau of National Affairs (BNA), InsuranceThoughtLeaders.com, Benefits Magazine, Employee Benefit News, Texas CEO Magazine, HealthLeaders, the HCCA, ISSA, HIMSS, Modern Healthcare, Managed Healthcare, Institute of Internal Auditors, Society of CPAs, Business Insurance, Employee Benefits News, World At Work, Benefits Magazine, the Wall Street Journal, the Dallas Morning News, the Dallas Business Journal, the Houston Business Journal, and many other symposia and publications. She also has served as an Editorial Advisory Board Member for human resources, employee benefit and other management focused publications of BNA, HR.com, Employee Benefit News, Insurance Thought Leadership and many other prominent publications and speaks and conducts training for a broad range of professional organizations.

For more information about Ms. Stamer or her health industry and other experience and involvements, see here or contact Ms. Stamer via telephone at (469) 767-8872 or via e-mail here.
About Solutions Law Press, Inc.™

Solutions Law Press, Inc.™ provides human resources and employee benefit and other business risk management, legal compliance, management effectiveness and other coaching, tools and other resources, training and education on leadership, governance, human resources, employee benefits, data security and privacy, insurance, health care and other key compliance, risk management, internal controls and operational concerns. If you find this of interest, you also be interested reviewing some of our other Solutions Law Press, Inc.™ resources here such as:

  • New HHS Webpage Highlights HHS Administrative Actions to Empower Patients
  • $400K HIPAA Settlement Shows Need To Conduct Timely & Appropriate Risk Assessments
  • NLRB Ruling Shows Healthcare Employers Face Uphill Battle Before NLRB
  • Long-Term Care Hospitals Should Review Their Latest HHS Quality Data Reports
  • IRS Warns About Payroll Data Scam
  • Trump Administration Grants Fiduciary Rule Prohibited Transaction Relief
  • Read Latest Version of Republican Health Reform Bill
  • Teach Patients To Protect Against Healthcare Associated Illnesses
  • Update CMS Bookmarks By April 3
  • $5.5M Memorial HIPAA Resolution Agreement Shows Need To Audit
  • Learn From Children’s New $3.2M+ HIPAA CMP For “Knowing” Violation of HIPAA Security Rules
  • Applications Open For Grants to Improve Public Health Cross-Jurisdictional Sharing
  • Court Stays HHS 1557 Regs
  • New CMS Rules Targets Dialysis Provider Private Health Plan Steering
  • Prepare For Changing IRS Tax-Exempt Org & Employee Plan Audit & Exam Info Request Rules
  • 2017 CMS Hospital OPPS & ACS Payment System UProposed Determinationates Released
  • $2.7M OCR Settlement Warns HIPAA Covered Entities To Clean Up Compliance
  • $2.4M+ St. Joseph Health HIPAA Settlement Teaching Lesson For Other HIPAA-Covered Entities & Business Associates
  • Healthcare Fraud Exposures Significant & Rising For Owners, Execs & Other LeadersNew Rule Gives ONC More Power Over Electronic Health Record Providers
  • CMS Publishes Final MACRA Rule
  • Tenet To Pay $513M For Anti-kickback Law Guilty Plea
  • NY AG Opens Antitrust Investigation Into EpiPen Maker Mylan Pharmaceuticals Inc.
  • HHS, HUD and DOJ Letter Warns State/Local Agencies Against Denying Immigrants Life & Safety Benefits 
  • Colleges post 2016 can pay student health premiums without triggering ACA penalty
  • New ACA Student Health Insurance Guidance Allows College Payment Of Working Students’ Student Health Insurance Premiums Post 2016

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