Mary
Jo Carden, RPh, JD, Assistant
Director of Government Affairs for ASCP presented an overview of Federal
Regulations & Long Term Care Practice: An Outlook from a Washington
Insider. Her list of Who’s Who on the Bush healthcare team includes
Secretary of HHS Tommy Thompson, Administrator of the Centers for Medicare
& Medicaid Services (CMS) Tom Scully, Deputy Administrator for CMS
Rubin Kin-Shaw and Mark McClellan, MD of the Council of Economic Advisers.
Mary Jo described the Health Insurance Portability & Accountability
Act (HIPAA) requirements relevant to the practice of pharmacy. She
detailed ASCP’s response to the Medical Privacy Final Rules and its
unintended consequences, including prior authorization, minimum necessary
provisions and restrictions on oral communications. She also presented an
overview of HIPAA Transaction Standards. Mary Jo went on to describe the
OSHA Needlestick Safety Rule, as well as new developments in the Medicaid
federal upper limits list. She also covered the OIG report on pharmacy
discounts to AWP with ASCP’s response and draft reimbursement formula.
President Bush’s Discount Prescription Drug Card proposal and the
outlook for health care legislation in 2002 rounded off her informative
presentation.
Mary Jo Carden gave the second
presentation on The DEA & Controlled Substances Controversies:
What’s On the Horizon? She gave a brief overview of the DEA and
controlled substance regulations in Long Term Care facilities (LTCFs). The
DEA proposals for disposal of controlled substances in LTCFs were
discussed, including the use of automated dispensing systems (ADS),
controlled substances as floor stock, satellite pharmacy registration and
limited LTCF registration. ASCP comments on these proposals were discussed
including security concerns, cost issues and administrative burdens with
the use of ADS and whether State regulations permit controlled substances
as floor stock (Wisconsin does not) or LTCFs as “Institutional
Dispensers”. The role of the DEA in regulating electronic commerce was
detailed. DEA initiatives in Electronic Prescriptions for Controlled
Substances (EPCS) and an electronic Controlled Substance Ordering System (CSOS)
for Schedule I & II medications were outlined. DEA efforts to control
the diversion of OxyContin were discussed, as well as Purdue Pharma’s
efforts to develop a product containing a sequestered antagonist that
would release when tablets were crushed.
Doug Englebert, RPh, MBA,
the Pharmacy Practice Consultant for the DHFS Bureau of Quality Assurance
presented Long Term Care Regulations: A Fresh View on the State Survey
Process. He reviewed the components and process used to train
Wisconsin State Surveyors. New areas of focus for LTCF State surveys were
outlined including Chemical & Physical Restraints, the new
Interpretive Guidelines for Psychotropic Drug Use, Adverse Drug Events,
Prompt Services and Pain Management. He went on to describe the survey
process used in Assisted Living Facilities and the current focus on
training, storage/packaging and medication misadventures. Revision of the
CBRF regulations is not expected to be complete until 2003.
Wanda Hurr, RN, JD,
Industry Consultant with a Milwaukee healthcare risk management firm
presented Contracts and Collaborative Practice Agreements in Senior
Care Pharmacy: Where to Look Before You Leap. She discussed important
issues to consider when entering into a long term care contract agreement,
including knowing your employment status. She discussed common errors,
such as agreeing to bring the facility in “total” compliance with
State and Federal regulations, when it may be more appropriate to agree to
“act reasonably to meet the requirements of applicable regulations”.
Pharmacists may wish to include language related to notification of the
survey process, requests for copies of all survey documents and
participation in exit interviews. Nursing homes may wish to include
disclaimer language in Plan of Correction documents and avoid documenting
errors or incident reports except within the QAA process in order to limit
liability. Wanda reminded practitioners that State Surveyors share
findings loosely with State Practitioner Boards and liability insurance
might not cover damages or legal costs necessary to defend your license at
this level. She also recommends using tools to assess resident
satisfaction with pain management within the QAA process.
Scott Whitmore, RPh,
PSW Director of Professional Affairs, Ted Collins, RPh, Pharmacy
Consultant to DHFS Division of Health Care Financing, and Wendy Gerlach,
RPh, Roeschens Omnicare Director of Pharmacy Operations presented Wisconsin
Medicaid & Reimbursement for Pharmaceutical Care: Policies and
Procedures in the LTC Setting. Scott reviewed the history and
background of Wisconsin’s Pharmaceutical Care (PC) payment system. He
summarized provider participation rates and Medicaid claims paid. Scott
discussed common problems with claims submission and results of the PSW PC
billing survey. Ted presented an overview of the PC billing process
including documentation requirements and limits on reimbursement. In the
Nursing Home setting, PC services are billed by the dispensing pharmacist,
who must contact the prescriber directly to secure authorization, rather
than the nursing home staff. PC codes are only billable when they
represent activity beyond that required by OBRA 87 and 90. He went on to
provide examples of billable services in the Nursing Home and Assisted
Living settings. Wendy shared her experiences implementing PC billing
procedures at Roeschen’s Omnicare. She shared examples of PC billing
opportunities and how to avoid and overcome possible pitfalls. Wendy
recommends starting slowly, involving other staff members in the
decision-making process and focusing on codes that are relevant to your
practice setting.
