Report from the Chair
By Charles Key
Health Law Forum Survey Results
Health Care Contacts & Websites
Should Tennessee Certify Attorneys as Health Law Specialists?
Since you’re reading this newsletter, you probably already have significant experience in one or more areas that currently fall under the practice specialty of health law. Potential clients, however, have little way of distinguishing between knowledgeable health lawyers and those who claim to represent health care clients because they occasionally handle a real estate deal for a physician or help a nursing home administrator draft a will. In fact, even the most skilled non-healthcare attorney may not realize what a legal minefield he or she is entering when seeking to counsel health care providers.
Certification as a health law specialist would give recognition to those attorneys who have the experience and competence necessary to provide expert legal guidance on complex health care matters. Health law has become one of the most complicated and regulated areas of the law today. To practice health law competently, an attorney must be able to recognize and cope with such diverse issues as fraud and abuse, self-
referral, corporate practice of medicine, certificates of need, licensure requirements, fee-splitting, insurance risk, specialized antitrust issues, and a myriad of Medicare reimbursement regulations — just to mention a few.
Moreover, health lawyers often comment that they feel as if they’ve wandered “through the looking glass” because of the counter-intuitive nature of health law. As I tell my health care clients, whatever makes good business sense in any other industry is probably illegal in health care. Because the cost of medical treatment is often borne by third parties, including the government, and because health care patients are deemed to need more protection than other segments of society, the health lawyer must deal with more federal and state laws and regulation than in many other areas of the law.
At present, the Tennessee Commission on Continuing Legal Education and Specialization only certifies attorneys as specialists in ten areas: Civil Trial, Criminal Trial, Consumer Bankruptcy, Business Bankruptcy, Creditors Rights, Accounting Malpractice, Legal Malpractice, Medical Malpractice, Elder Law, and Estate Planning. To qualify for recognition as a specialist in any field, an attorney must be certified by an accredited national agency. Although no national agency currently offers certification in health law, there is increasing discussion on a national level about such a possibility.
According to the Commission’s rules, an accrediting organization must require that applicants for certification in any field meet, at a minimum, the following standards:
• Substantial involvement in the specialty area during the three-year period immediately preceding application for certification. Substantial involvement means that time spent practicing the specialty must be no less than 25% of the total practice of a lawyer engaged in a normal full-time practice.
• Peer review references from at least five attorneys or judges who are knowledgeable about the practice area and familiar with the competence of the applicant, and none of whom are persons related to or engaged in legal practice with the lawyer seeking certification.
• A written examination demonstrating the applicant’s knowledge of the specialty area, including professional responsibility and ethics as it relates to the specialty.
• At least 36 hours of CLE credit in the specialty area in the three-year period preceding the lawyer’s application for certification.
• Good standing in the bar.
If certification as a health law specialist is something you and your colleagues consider worth pursuing, let the Tennessee Bar Association Health Law Section know. If enough section members express interest in the possibility, section leaders will begin preliminary discussions with the Commission and with representatives of potential national health law agencies willing to conduct accreditation and certification procedures.
Let us know if you would be interested in seeking certification as a health law specialist if that option were available in Tennessee. You can e-mail your comments to: Stephanie Smith at ssmith@tnbar.org. Also, those of you who attend the Tennessee Bar Association’s Health Law Forum in October will have the opportunity to express your opinion at the conference.
Report from the chair
As you may or may not know, the Health Law Section is governed by an Executive Committee comprised of five Section members, including at least one from each of the State’s Grand Divisions. The Executive Committee, as well as the chair and vice chair, are elected by the Section members at the annual meeting held during the Health Law Forum in October of each year. The biggest, but not the only, task undertaken by the Executive Committee each year is the planning and execution of the Health Law Forum, now in its 12th year.
As pages 3-4 show, the October 12 & 13, 2000 Health Law Forum will offer a truly outstanding program. As before, the forum is designed to provide each attending Tennessee lawyer with an entire year’s CLE. I hope that you will attend both the educational sessions and the section annual meeting, which is set during the lunch break, Thursday, October 12, 2000.
The Executive Committee would like to make a special effort this year to expand the reach of our annual forum to members of our neighboring state bars, hospital and other health care administrators, physicians and medical office managers, other health professionals, consultants, and other interested persons. Please consider passing a copy of the regisstration information in this newletter and an invitation along to others who you know may be interested.
The site of the 12th Annual Health Law Forum will be the new Hilton Suites Hotel in downtown Nashville. The facility promises more space and improved audio-visual capabilities. With the additional space, exhibitors will also be invited to showcase new products and services available to health lawyers.
We hope to see you there!
Health Law Forum Survey Results
A short survey was circulated at last year’s Health Law Forum, and, while fewer than 50 responses were turned in, the survey revealed that the reason most attend the Health Law Forum is to receive the quality content that it has historically provided. The second strongest reason for attending the Forum, according to the survey, is the number of CLE units awarded for the two-day program.
The survey revealed that 40% of the Health Law Section members have been practicing law for between 10 and 15 years, while 37% have been practicing for less than 10 years.
The number of attorneys in the firms in which members practice was fairly evenly spread as follows:
Twenty-two percent of the respondents indicated that they work in an organization other than a law firm.
In response to a question about use of TBA Link, slightly more than 50% of the respondents indicated that they were not subscribers of TBA Link at the time. Several respondents commented that their firm did not subscribe to TBA Link, while others suggested that they were unfamiliar with the service and/or Internet research in general.
The survey also asked about the types of healthcare industry clients represented by the respondents. Respondents were asked to place a check beside those types of clients they represent and most checked several types of healthcare providers or organizations, with the greatest number providing services to hospitals and physician practices.
Finally, in response to the survey’s request for suggestions for Health Law Forum topics, respondents provided excellent ideas that have, in fact, been used in planning this year’s program. Respondents indicated that among the challenges facing them in their health law practices were regulatory and reimbursement developments, telemedicine, HIPAA, and issues related to care of the elderly. Look for these topics to be addressed in the upcoming Health Law Forum.
Usefule contacts and websites for health law
Federal Government
Bureau of Economic Analysis (MSA) www.bea.doc.gov/
Bureau of Primary Health Care (HPSA, MUA, MUP) bphc.hrsa.gov/bphc/database.htm
Census Tract Street Locator tier2.census.gov/ctsl/ctsl.htm
Centers for Disease Control and Prevention www.cdc.gov/
Excluded Parties (GSA) epls.arnet.gov/
Federal Bureau of Investigation www.fbi.gov/
Federal Register www.access.gpo.gov/su_docs/aces/aces140.html
Public Inspection www.nara.gov/fedreg/
Federal Trade Commission www.fbi.gov/
Antitrust Advisory Opinions www.ftc.gov/bc/advisory.htm
Statements of Antitrust Enforcement Policy in Healthcare www.ftc.gov/reports/hlth3s.htm
Food and Drug Administration www.fda.gov/default.htm
General Accounting Office www.gao.gov/
Health Care Financing Administration www.hcfa.gov/
Administrative Simplification – HIPAA aspe.os.dhhs.gov/admnsimp/
Health Insurance Portability and Accountability Act www.hcfa.gov/medicaid/hipaa/
Intermediary/Carrier Directory www.hcfa.gov/medicare/incardir.htm
Local Medical Review Policies www.lmrp.net/
Medicaid www.hcfa.gov/medicaid/medicaid.htm
Medicare – Consumer www.medicare.gov/
Medicare Integrity Program www.hcfa.gov/medicare/mip/default.htm
Medicare Payment Advisory Commission www.pprc.gov/
Medicare – Professional/Technical www.hcfa.gov/medicare/mcarpti.htm
Medicare & Medicaid Program Manuals www.hcfa.gov/pubforms/progman.htm
Medicare & Medicaid Program Memoranda www.hcfa.gov/pubforms/transmit/memos/comm_date_dsc.htm
Medicare & Medicaid Program Transmittals www.hcfa.gov/pubforms/transmit/transmittals/comm_date_dsc.htm
Medicare & Medicaid Survey and Certification www.hcfa.gov/medicaid/scindex.htm
Operational Policy Letters www.hcfa.gov/medicare/index.htm
Outpatient Prospective Payment System www.hcfa.gov/medlearn/refopps.htm
Regional Office Listing www.hcfa.gov/medicare/ro-list.htm
Regulations and Notices www.hcfa.gov/regs/regsnotices.htm
Stark Advisory Opinions www.hcfa.gov/regs/aop/default.htm
State Children’s Health Insurance Program www.hcfa.gov/init/children.htm
Statutes www.hcfa.gov/regs/laws.htm
Subscribe to HCFA Press Releases www.hcfa.gov/news/news.htm
National Practitioner Data Bank www.npdb.com/
Occupational Safety and Health Administration www.osha.gov/
Office of Inspector General www.dhhs.gov/progorg/oig/
Advisory Opinions www.dhhs.gov/progorg/oig/advopn/index.htm
Anti-kickback www.dhhs.gov/progorg/oig/ak/index.htm
Audit Reports www.hhs.gov/progorg/oas/
Compliance Program Guidance www.dhhs.gov/progorg/oig/readrm/index.htm
Corporate Integrity Agreements www.dhhs.gov/progorg/oig/cia/index.htm
Fraud Alerts www.dhhs.gov/progorg/oig/frdalrt/index.htm
Hearing Testimony www.dhhs.gov/progorg/oig/testimony/index.htm
Inspection Reports www.dhhs.gov/progorg/oei/
Medicare Advisory Bulletins www.dhhs.gov/progorg/oig/frdalrt/index.htm
Program Exclusions www.dhhs.gov/progorg/oig/cumsan/index.htm
Regulations www.dhhs.gov/progorg/oig/oigreg/index.htm
Semi-Annual Reports www.dhhs.gov/progorg/oig/semann/index.htm
Special Advisory Bulletins www.dhhs.gov/progorg/oig/frdalrt/index.htm
Subscribe to OIG Press Releases list.nih.gov/cgi-bin/wa?SUBED1=hhs-oig-media-l&A=1
Work Plan www.dhhs.gov/progorg/oig/wrkpln/index.htm
Office of Management and Budget www.whitehouse.gov/OMB/index.html
Regulations Currently Under Review www.whitehouse.gov/library/omb/OMBREGS.html
THOMAS (Federal Legislation) thomas.loc.gov/home/thomas.html
U.S. Department of Health and Human Services www.dhhs.gov/
Agencies www.hhs.gov/agencies/
Employee Directory Search directory.psc.gov/employee.htm
News and Public Affairs www.hhs.gov/news/
Subscribe to DHHS Press Releases list.nih.gov/cgi-bin/wa?SUBED1=hhspress&A=1
U.S. Department of Justice www.usdoj.gov/
White House www.whitehouse.gov/index.html
State of Tennessee Government
Tennessee Home Page www.state.tn.us/
Bureau of TennCare www.state.tn.us/tenncare/
Office of Attorney General and Reporter www.attorneygeneral.state.tn.us/
Opinions www.attorneygeneral.state.tn.us/2000/OPage1.html
Tennessee Board for Licensing Health Care Facilities 170.142.76.180/cgi-bin/HCF/hcfgen.pl
Tennessee Board of Pharmacy www.state.tn.us/commerce/pharmacy/index.htm
Tennessee Code Annotated (Lexis Publishing) www.lexislawpublishing.com/resources/
Tennessee Department of Commerce and Insurance —
TennCare Division www.state.tn.us/commerce/tncardiv.htm
Tennessee Department of Health www.state.tn.us/health/
Tennessee General Assembly www.legislature.state.tn.us/
Tennessee Licensed Health Care Professionals 170.142.76.180/bmf-bin/BMFproflist.pl
Health Care Professionals Licensing Verification 170.142.76.180/cgi-bin/licensure.pl
Tennessee Secretary of State www.state.tn.us/gov.html
Tennessee Administrative Register www.state.tn.us/sos/pub/tar/tar.htm
Tennessee Rules and Regulations www.state.tn.us/sos/rules/rules.htm
Tennessee Supreme Court www.tsc.state.tn.us/
Healthcare Associations/Organizations
American Association of Health Plans www.aahp.org/menus/index.cfm
American Association of Medical Colleges www.aamc.org
American Bar Association www.abanet.org
American College of Radiology www.acr.org
American Health Information and Management Association www.ahima.org/
American Health Lawyers Association www.healthlawyers.org
American Hospital Association www.aha.org
HIPAA Standards www.aha.org/hipaa/hipaa_home.asp
Outpatient PPS www.aha.org/opps/OPPS_home.asp
American Nurses Association www.nursingworld.org
CIGNA Healthcare Medicare Administration www.cignamedicare.com/
Federation of American Health Systems www.fahs.com
Federation of State Medical Boards www.fsmb.org
Healthcare Financial Management Association www.hfma.org
Joint Commission on Accreditation of Healthcare Organizations www.jcaho.org
Medical Group Management Association www.mgma.com/
Nashville Health Care Council www.healthcarecouncil.com/
National Association of Attorneys General www.naag.org/index2.html
National Association of Boards of Pharmacy www.nabp.net/
National Association of Insurance Commissioners www.naic.org/
National Guideline Clearinghouse www.guideline.gov/index.asp
Palmetto Government Benefits Administrators www.pgba.com/
Tennessee Bar Association www.tba.org
Tennessee Hospital Association www.tha.com/
Tennessee Medical Association www.medwire.org/index.html
The following is a list of very useful contact information and Internet addresses compiled by individuals that dedicate their time to health law issues and research. They have graciously shared their lists with the Health Law Section membership. Thanks to Robert Q. Wilson at The Bogatin Law Firm, for sending in “Agency Contacts” and to Pam Casey at Bass Berry & Sims, for sending in her personal list of Internet sites.
Agency Contacts: Tennessee
Tennessee Department of Health
Cordell Hull Building, 3rd floor 425 5th Avenue North Nashville, TN 37247
Phone:(615) 741-3111, Fax:(615) 741-2491, www.state.tn.us/health
Division of Health Care Facilities
Licenses health care facilities and certifies providers for participation in Medicare and TennCare.
Phone: (615) 741-7221, www.state.tn.us/health/hcf
Regional Office for West TN — Jackson
West 365 North Parkway, Jackson, TN 38305
Phone: 901-423-6454, Fax: 901-423-6572
Nancy McClain, General Counsel; Celia Skelly, Home Medical Equipment
Regional Office for Central TN —Nashville
710 Hart Lane, 1st Floor, Nashville, TN 37242-0530
Phone: 615-650-7100, Fax: 615-650-7101
Regional Office for EastTN — Knoxville
1522 Cherokee Trail, Knoxville, TN 37950-9019
Phone: 423-549-5311, Fax: 423-594-5739
Office of Attorney General
Dennis Garvey, Deputy, Antitrust Division, 450 Fifth Avenue, Nashville, Tennessee 37243
Phone: (615) 751-3491
For list of Divisions and corresponding personnel, see: www.attorneygeneral.state.tn.us/divisions.html
Library/Records Division will fax A.G. Opinions: (615) 751-2518
Department of Commerce & Insurance
For managed care regulation: Robert Moore, Chief Counsel for 4 C&I Divisions (including TennCare)
Phone: (615) 741-5917
TennCare Division: Lisa Jordan, C.P.A., Acting Assistant Commissioner, 500 James Robertson Parkway Davy Crockett Tower, Suite 750 Nashville, TN 37243-1169, Phone (615) 741-2677, e-mail: ljordan5@mail.state.tn.us
Federal
Division of Quality Assurance — oversees NPDB and HIPDB
Phone: (301) 443 2300, www.npdb.com
Tom Croft, Director; Marc Pincus, Policy; Cynthia Grubbs, Policy
Internet
American Health Lawyers Association Suite 600, 1025 Connecticut Avenue NW, Washington, DC 20036-5405, Phone: (202) 833-1100 Fax: (202) 833-1105, www.healthlawyers.org/home.htm
www.findlaw.com: This site contains links to numerous State and Federal websites, containing resources including caselaw, codes, regulations, outlines, and many others.
Office of Inspector General Website:
www.dhhs.gov/progorg/oig
