Archive for October, 2016

What You Need to Know About Section 1557: The ACA Nondiscrimination Provisions

What You Need to Know About Section 1557: The ACA Nondiscrimination Provisions

The Affordable Care Act prohibits discrimination on the basis of race, color, national origin, sex, age, or disability in certain health programs or activities. Section 1557 builds on long-standing Federal civil rights laws: Title VI of the Civil Rights Act of 1964, Title IX of the Education Amendments of 1972, Section 504 of the Rehabilitation Act of 1973 and the Age Discrimination Act of 1975. Individuals may either file a complaint with the Office of Civil Rights (OCR) or the law creates a private cause of action.

Who must comply?

Physicians receiving financial assistance from HHS (except solely Medicare Part B).

When?

By October 16, 2016

What must be done?

Post notices, taglines, and take steps to provide meaningful access to individuals with limited English proficiency. This may mean you need to enter into a contract with a call center.

What does Section 1557 require?

By October 16, 2016, all covered entities must post notice and taglines in the top 15 languages in conspicuously visible font size for individuals with limited English proficiency (LEP). The rules require language assistance for persons with LEP. A provider may not require an individual with LEP to provide his or her own interpreter. The Office of Civil Rights website contains sample notices, statements and taglines in multiple languages. (See link below). The rules require using a “qualified translator” when translating written content. The rule itself is lengthy and specific. Any physicians, hospitals or entities receiving any financial assistance with HHS, including Medicare Parts A, C & D; Medicaid grants; loans; subsidies; meaningful use payments; payments for research offered through NIH; payments for any health program administered by HHS; etc. must comply. If a physician’s only financial assistance from HHS is to receive Part B, he or she is not covered. If a physician or entity is principally engaged in health care then all of the operations are covered minus certain limited exceptions.

Covered entities must offer a qualified interpreter to an individual with LEP when oral interpretation is a reasonable step to provide meaningful access. The interpreter need not be licensed under state law, but must have relevant proficiency. Simply having above average familiarity with speaking or understanding the relevant foreign language does not necessarily qualify him or her as an interpreter. HHS has regulations that apply to covered entities choosing to provide interpreters through remote video. See 45 C.F.R. § 92.201(f)

What are the basics?

  1. Do not discriminate on the basis of race, color, national origin, sex, age, or disability. Treat men and women equally in healthcare and treat individuals consistent with gender identity. Provide language assistance. Provide auxiliary aids to those with disabilities. Make newly constructed or altered facilities accessible to those with disabilities.
  2. Sign a form with HHS that you will comply – HHS-690 Form.
  3. Entities with 15 or more employees must appoint a compliance coordinator and establish a grievance coordinator.
  4. “Taglines” and statements must be included on “significant” documents and communications. HHS is working on guidance as to what is a “significant” publication. Information on services or treatment, or the administration of drugs, is considered significant.
  5. Post notices of nondiscrimination. A sample notice is available from the link set forth below.
  6. The entity must take reasonable steps to provide meaningful access to LEP persons.

What is a tagline?

All covered entities must post short statements written in non-English informing individuals that language assistance services are available free of charge. These taglines should be posted in the top 15 languages spoken by LEP persons in that state. (See list below). The entity should post the taglines in physical locations with interaction with the public, websites and other significant communications. The top two languages should be posted in small sized publications.

Is there guidance?

OCR has translated a sample notice of nondiscrimination and the taglines for use by covered entities into 64 languages: www.hhs.gov/civil-rights/for-individuals/section-1557/translated-resources/index.html

HHS has provided a training guide (http://www.hhs.gov/sites/default/files/section1557-presenters-guide.pdf and http://www.hhs.gov/sites/default/files/section1557-training-slides.pdf).

What are the current top 15 languages for Alabama?

  • Spanish — 75,000
  • Chinese — 5,405
  • Korean — 4,554
  • Vietnamese — 3,708
  • Arabic — 1,440
  • German — 1,411
  • French — 1,278
  • Gujarati — 888
  • Tagalog — 856
  • Hindi — 818
  • Laotian — 681
  • Russian — 586
  • Portuguese — 516
  • Turkish — 505
  • Japanese — 484

http://www.hhs.gov/sites/default/files/resources-for-covered-entities-top-15-languages-list.pdf

Posted in: Legal Watch

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Zika Update: New Study Supports Biological Link Between Zika Infection, Guillain-Barré Syndrome

Zika Update: New Study Supports Biological Link Between Zika Infection, Guillain-Barré Syndrome

In a collaborative effort with scientists at six Colombian hospitals, Johns Hopkins Medicine researchers report what they believe to be the strongest biological evidence to date linking Zika virus infection and Guillain-Barré syndrome.

Epidemiology data have long suggested a close relationship between rising Zika virus infection rates and instances of Guillain-Barré. The new study’s results, published on Oct. 5 in The New England Journal of Medicine, support the correlation with immunologic and viral evidence of Zika infection in a substantial number of people with Guillain-Barré, the investigators said.

Guillain-Barré is a very rare but potentially paralyzing disorder of the nervous system that appears days to weeks after infection with viruses or bacteria. A so-called post-infectious immune condition, it occurs when a person’s own immune system attacks the myelin sheaths that protect the body’s nerve cells, often resulting in muscle weakness, pain, sensory deficiencies and, in very acute cases, paralysis.

Guillain-Barré, which affects an estimated one or two out of 100,000 people after infections, is diagnosed with electrodiagnostic neurological tests that measure the conductive speed and activity of nerve signals. Scientists do not know why it strikes some people and not others. “At the beginning of the Zika outbreak in South America, my colleagues in Colombia contacted me with concern about the increasing number of patients with neurological complications in their hospitals,” said Carlos A. Pardo, M.D., associate professor of neurology and pathology at the Johns Hopkins University School of Medicine, who earned his medical degree in Colombia and is an expert in neuroimmune and infectious diseases, including Guillain-Barré.

For the new study, Pardo’s team designed strategies with colleagues in Colombia to evaluate patients with suspected neurological problems associated with Zika and provided tools for viral tests of blood, cerebrospinal fluid and urine samples from 68 people with symptoms of Guillain-Barré. Of the 68 patients initially evaluated in Colombia, virus and immunology studies were conducted using the body fluids from 42. After some evaluation, the researchers found urine to be the most reliable fluid to diagnose Zika infection in patients with Guillain-Barré.

Seventeen patients tested positive for Zika virus in their urine. Another 18 had no evidence of Zika virus in urine but showed the immunologic footprints of Zika infection through the presence of virus-specific antibodies in their blood or spinal fluid. Most of the patients were adults — 38 were males, and 30 were females of an average of 47 years old. Almost all patients displayed two or more clinical symptoms of Zika infection, which include fever, headache, rash and conjunctivitis.

The researchers said that almost one-half of the study participants complained of neurologic symptoms within four days of the onset of Zika symptoms — an unusually fast response, they said, than is found in people who develop Guillain-Barré symptoms after other viral infections, such as influenza and herpes viruses.

Tests also revealed that most of the 46 patients whose Guillain-Barré was confirmed by electrodiagnostic neurological tests had the acute inflammatory demyelinating polyneuropathy variant of the disorder. This type of Guillain-Barré attacks the myelin, a protective group of cells that insulates the surface of the nerve fibers, like the plastic coating on a copper wire.

Pardo said the study is believed to be the largest of its kind to document the role of Zika infection in increased rates of Guillain-Barré so far. But he cautions that although the study demonstrates a biological and viral association between Zika infection and Guillain-Barré, it does not reveal the biological mechanisms through which Zika might initiate an immune attack on the nerves.

The research team, he said, continue to collect clinical data and samples from the Colombian hospitals’ patients, but the work is constrained by the limited availability of resources, which is further strained by the severe and ongoing Zika outbreak in South America.

Colombian researchers involved in this study include Beatriz Parra, Andreas F. Zea-Vera and Lydia Osorio, Universidad del Valle in Cali; Jairo Lizarazo, Hospital Universitario Erasmo Meoz, Universidad de Pamplona in Cucuta; Jorge Jimenez and Reydmar Lopez-Gonzales, Universidad de Antioquia and NeuroClinica in Medellin; Guillermo Gonzalez-Manrique and Cindy Beltran, Universidad Surcolombiana, Hospital Universitario de Neiva; Jose Vargas, Karen H. Rizcala and Maria T. Morales, Clinica La Misericordia Internacional, Universidad Libre de Colombia in  Barranquilla; Jorge Angarita, Clinica MediLaser in Neiva; Gonzalo Zuñiga, Universidad del Valle, Hospital de Universitario del Valle in Cali; Oscar Pacheco and Martha Ospina Martinez, Instituto Nacional de Salud in Bogota. Other researchers at Johns Hopkins included Anupama Kumar, David Cornblath, Laura S. Muñoz and Paula Barreras from the Johns Hopkins University School of Medicine.

This study was funded by the Bart McLean Fund for Neuroimmunology Research, Johns Hopkins Project Restore, VIREM, the Virology Laboratory Fund and the Department of Microbiology at the Universidad de Valle.

Posted in: Zika Virus

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Flu Shots Recommended for Those 6 Months of Age and Older

Flu Shots Recommended for Those 6 Months of Age and Older

The Alabama Department of Public Health encourages annual vaccination of all persons 6 months of age and older against influenza. One major change for the 2016-2017 season is that children and adults should receive a flu shot instead of nasal spray vaccine. This national recommendation was made because the nasal spray vaccine did not work well for the past three flu seasons.

“It is important for parents to protect their children and themselves by taking flu shots. My advice as a physician is to immunize all eligible family members,” Assistant State Health Officer Dr. Karen Landers said. “The consequences of influenza are worse in certain age groups, both young and old. An annual flu vaccine is the first and most important step in protecting individuals and the community against this serious disease.”

Over a period of 31 seasons between 1976 and 2007, estimates of flu-associated deaths in the United States range from a low of about 3,000 to a high of about 49,000 people. During recent flu seasons, between 80 and 90 percent of flu-related deaths have occurred in people 65 years and older.

“Flu season” in the United States can begin as early as October and end as late as May. During this time, flu viruses are circulating at higher rates. A person with the flu may have some or all of these symptoms: fever, cough, sore throat, runny or stuffy nose, headache, muscle aches and often extreme fatigue.

An annual seasonal flu vaccine is the best way to reduce the chances of getting flu and spreading it to others. Vaccination can reduce the risk of influenza-associated hospitalizations for children and adults. It is also associated with a lowered risk of hospitalizations for people with chronic health conditions including heart disease, diabetes and chronic lung disease. Vaccination also helps protect women during and after pregnancy.

In addition to immunization, the public is reminded to follow basic infection control measures to help prevent the spread of the flu. These include covering the mouth and nose with a tissue or cloth when coughing and sneezing, washing hands frequently, and staying at home when sick.

Contact your private physician or your local county health department for a flu clinic schedule. For more information, contact the ADPH Immunization Division at (334) 206-5023 or toll-free at 800-469-4599.

Posted in: Health

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Reading Gives You Wings with Marsha Raulerson, M.D.

Reading Gives You Wings with Marsha Raulerson, M.D.

BREWTON — According to Dr. Seuss in I Can Read with My Eyes Shut!, “The more that you read, the more things you will know. The more you learn, the more places you’ll go.” That’s a philosophy Brewton pediatrician Marsha Raulerson can easily get behind.

For more than 30 years, Dr. Raulerson has celebrated her young patients and encouraged their sense of adventure through reading by providing them with new books during their visits to her clinic. What began as the STARS program, or Steps to Achieve Reading Success, has for the past 20 years been affiliated with the National Reach Out and Read Program. Ten years ago, Dr. Raulerson, working with Polly McClure, launched the Alabama Chapter, American Academy of Pediatrics’ Reach Out and Read Alabama, that gives young children a foundation for success by incorporating books into pediatric care and encouraging families to read aloud together.

“We’ve given out truckloads of books to our patients,” Dr. Raulerson said. “I give a book to every child for every visit, no matter what the age of the child. My community probably contributes about $10,000 a year so we can buy new books because every patient can have a new book.”

In fact, no child who visits Dr. Raulerson’s clinic leaves empty handed. The books she chooses for her patients are not only age appropriate, but also story appropriate to each patient’s particular situation. The majority of her patients have special needs, and each book is intended to give her patients hope.

“I was a reading specialist before I went to medical school, and I would give books to my patients when I was a resident at the University of Florida. I’ve been giving books away since 1978, so my whole career, really. My feeling is that if you can read, you can do anything. I tell my patients that I majored in English in college, not science or math. But, when I went to medical school and had to take biology and chemistry, I could never have done that without the ability to read. If you can read, you can do anything you want!”

Dr. Raulerson laughed when she first realized how long she had been practicing in Brewton, and how many patients had come through her clinic. She shook her head and smiled an easy smile when she admitted that it didn’t initially dawn on her just how many generations of patients she had treated.

“I have grand-patients!” she laughed! “I have a lot of families of three generations of patients, and I remember them all. All my patients are so special to me, and they’ve all received so many books from the clinic. Now, when they tell me that those books helped to create a special bond with their children and grandchildren, that’s heartwarming.”

Given her years of advocacy for children, it’s difficult to imagine the landscape of medicine in Alabama without Dr. Raulerson, but she in fact very nearly did not get accepted into medical school. A native of Jacksonville, Fla., she took her qualifying exams for her doctorate when she ultimately settled on medical school. While she said she felt she was always meant to be a medical doctor, one person sealed the deal for her. Her name was Robbie.

Dr. Raulerson taught school to help put her husband through medical school, and then her husband was drafted and sent to Vietnam. While there, the Raulersons decided to adopt a Vietnamese child. When her husband found the youngest female child in the nursery of an orphanage, he knew this was their child. She was only a few weeks old. The Catholic priest agreed to the adoption to the Baptist couple, and Dr. Raulerson flew to Tokyo to meet her daughter, Robbie.

When Dr. Raulerson got home with Robbie, she was 5 months old and weighed only 8 lbs., was malnourished and very ill. She knew exactly what to do to take care of her daughter, but if any doubt was left as to whether she could be a physician, she wouldn’t doubt much longer. Dr. Raulerson said when she began applying to medical school, she knew the odds would not be in her favor. It was a time when there were not many women in the medical field, and she had a family. Every school she applied to turned her down, except one.

“I was accepted at Emory because of Robbie. They had a different way of interviewing at Emory. They would interview three applicants sitting at a long table. Each applicant was asked what was an event in your life that was really important. There was a football player at the end of the table that talked about being a quarterback. The other girl at the table talked about being homecoming queen. Then they asked me,” Dr. Raulerson paused. The story hanging in her throat fighting to get free. “I told them about when I saw my daughter for the first time. And, I got a telegram that night admitting me to Emory.”

Ironically, Dr. Raulerson transferred to one of the schools that initially rejected her application. Dr. Raulerson’s husband was already a standout fellow at the University of Florida, and his department petitioned the admissions committee to consider an applicant from Emory. She still laughs when she tells the story of being admitted to a school that initially rejected her because she had a family.

Many in Alabama haven’t had the pleasure of meeting this woman who loves to laugh and read to her patients. But after her work with the #IAmMedicaid social media campaign this spring, more people in the state definitely know her name. She estimates between 70 and 80 percent of her patients are Alabama Medicaid recipients, and many of the children in the campaign are her patients. In the end, BP oil money was partially used to reinstate the physician cut that was implemented on Aug. 1 and to shore up the embattled Medicaid budget. Still, according to Dr. Raulerson, it won’t be enough.

“That campaign had to work. It had no choice BUT to work,” she said. “Many of my patients’ families can’t pay their bills. We don’t have enough doctors now, so what happens when we can’t fund the ones who choose to stay? The system is broken.”

During the Regular and Special Legislative Sessions, Dr. Raulerson’s editorials about the importance of fully funding Alabama Medicaid appeared in many of the state’s newspapers. Although the Alabama Legislature is not in session today, there is still work that can, and should, be done, according to Dr. Raulerson.

Perhaps it’s because of her and her husband’s early struggles with starting their own family, or seeing so many of their patients live below the poverty level in Escambia County. Either way, as long as Dr. Raulerson can string together her outspoken words, the children of Alabama will always have another advocate.

“I’m doing a lot more writing now,” she explained. “I feel like I have to. An article I wrote in 1997 about the importance of fully funding Medicaid is just as important today as it was 20 years ago. Nothing has really changed in all that time other than the number of our patients on Medicaid. Something has to change. We have to change. We have to choose to support our kids.”

Dr. Raulerson is a past president of the Medical Association of the State of Alabama, the Alabama Chapter, American Academy of Pediatrics, and VOICES for Alabama’s Children. She is a board member of The Children’s First Foundation.

Posted in: Physicians Giving Back

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