Understanding the Hearing Officer/Presiding Officer Role

As Medical Staff Service Professionals, the peer review process is well understood. The majority of the time, upon completion of a peer review, performance improvement measures/actions are determined and acted upon with no additional steps needed. There are times, however, when the peer review process is extended and additional procedural due process is provided in […]

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Final Rules for Adult Cardiac Catheterization Services in Ohio

On April 30, 2016, new quality rules for adult cardiac catheterization services became effective. The final rules, under section 3701-84-30 to 3701-84-34.2, OAC, can be reviewed at http://www.odh.ohio.gov/en/rules/final/3701-80-to–89/f3701-84.aspx. The new rules establish three service level classifications for adult cardiac catheterization services: Level I service – Diagnostic only services without on-site open heart surgery services Level […]

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Colliding Worlds, Peer Review and Medical Necessity

QMCG Executive Director Catherine Ballard and Bricker & Eckler attorney Steve Kleinman presented the “Colliding Worlds, Peer Review and Medical Necessity” webinar on April 27, 2016. The live webinar, hosted by NAMSS, provided insightful information related to physician peer review, explanation of medical necessity review, and the similarities and benefits of both. The webinar also […]

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New Quality Measures for Cardiac Catheterization Services in Ohio: Our Recommendations

On September 21, 2015, the Ohio Department of Health (ODH) posted draft rules for public comment regarding adult cardiac catheterization services. The draft rules propose new quality performance measures and reporting requirements for all cardiac catheterization services. Public comment is due by October 21, 2015. At this time, we recommend a review of your cardiac […]

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New Rules for Ohio Nursing Homes

New provisions in the nursing home licensure rules went into effect on September 1, 2015: one expedites the nursing home licensure process for new facilities, while the others impose additional requirements on all nursing homes. OAC Rule 3701-17-03.1: Effective September 1, 2015, a provider may request for a new nursing home an expedited initial licensure […]

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Community Health Needs Assessment: New Requirement #3

26 CFR §1.501(r) -3(b)(6)(i)(F) requires that the CHNA report must include an evaluation of the impact of any actions that were taken to address the significant health needs identified in the hospital facility’s prior CHNA(s). Be sure that your actions identified in the implementation strategy are resulting in an impact on the significant health needs […]

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Community Health Needs Assessment: New Requirement #2

26 CFR §1.501(r) -3(b)(6) (iii) provides in the event a hospital facility solicits, but cannot obtain, input from a required source, the hospital facility’s CHNA report must describe the hospital facility’s efforts to solicit input from such source. A hospital facility must solicit and take into account input received from all of the following sources […]

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Community Health Needs Assessment: New Requirement #1

26 CFR §1.501(r) -3(b) (5) provides that a hospital facility must solicit and take into account input received from persons representing the broad interests of the community in: Identifying significant health needs; Prioritizing significant health needs; and Identifying resources potentially available to address those health needs. (New requirements in bold italics) Under the final regulations, […]

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