Facebook Privacy is Public Knowledge, but when Baton Rouge General and Our Lady of the Lake explains YOUR Patient Rights, You'll wish Mark Zuckerberg was holding the scalpel: 6-Month Toolkit Against Largest & Number 1 Worst Healthcare Systems in United States

 

Baton Rouge General Physicians Group (BRGP) Benjamin Levron, MD is board certified in Family Medicine.

1. He is originally from Thibodaux, Louisiana, and received his undergraduate degree in Biology from Nicholls State University.
2. He completed his doctorate degree from St. George’s University Medical school in True Blue, Grenada in 2017.
3. He returned to Louisiana where he completed his residency training at Baton Rouge General’s Family Medicine Program.
4. He is a member of the American Academy of Family Physicians, and Louisiana Association of Family Physicians.
5. General Health System, Corporate Compliance Department Attn: Privacy Officer 8490 Picardy Avenue 
6. Requesting a consultation from the Ethics Committee for help with difficult medical decisions.
7. Ethics Representative: (225) 387-7742 Request family member, friend or other individual to be present with you for emotional support during the course of your stay unless medically contraindicated.
8. Expressing concerns or asking questions about care or service.
9. Patient Experience Department: (225) 387-7911 or (225) 763-4272  
   
10. You have the right to information regarding your care which includes: Knowing the name and the roles of the people treating you.
11. Being informed of your health status, diagnosis and prognosis.
12. This includes being informed about any continuing health care requirements after discharge.
13. Being informed about unanticipated outcomes of care (sentinel event).
14. Lodging a concern or grievance about care or service.
15. Patient Experience Department: (225) 387-7911 or (225) 763-4272 Your Health Information Rights: When it comes to health information, you have certain rights.
16. This section explains your rights and some of our responsibilities to help you.
17. • Right to Inspect and Copy.
18. You have the right of access to inspect and copy your Protected Health Information that may be used to make decisions regarding your treatment and plan of care.
19. To do this, you must complete an “Authorization for Use or Disclosure of Protected Health Information” form obtained by contacting the Front Desk of the Physician Office.
20. We will make every reasonable attempt to provide you with access to your medical information within thirty (30) days of your request if the records are stored on site.
21. We also reserve the right to charge a reasonable and cost-based fee for the costs of copying, mailing, and other supplies and resources associated with your request.
22. We may deny your request in certain circumstances, for example when the information contains psychotherapy notes.
23. • Right to an Electronic Copy of Electronic Medical Records.
24. If your Protected Health Information is maintained in electronic format, you have the right to request a copy of that information to be given to you or transmitted to another individual or entity in electronic form.
25. We will make every effort to provide you with the information in the form or format you request, if it is readily available in such form or format.
26. If the information is not readily producible in the form or format you request, your record will be provided in either our standard electronic form or a readable hard copy.
27. We reserve the right to charge you a reasonable, cost-based fee for the labor and resources associated with transmitting the electronic record.
28. • Right to Request Amendments.
29. If you feel that the Protected Health Information we have about you is incorrect, inaccurate, or incomplete, you may ask us to amend that information.
30. You have the right to request this amendment as long as the information is kept by us and for our records.
31. A request for amendment must be made in writing.
32. To do this, you must complete a “Request for Amendment of Health Information” form.
33. We may say “no” to your request, but we’ll tell you why in writing within 60 days.
34. In certain cases, we may deny your request for amendment.
35. If we deny your request, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal.
36. • Right to Request Restrictions
37. You have the right to ask us to limit the Protected Health Information we use or disclose about you for treatment, payment, research, or other healthcare operations.
38. You may also request that any part of your Protected Health Information not be released to family members or friends who may be involved in your care or for notification purposes as described in this Notice.
39. Your request must state the specific restriction requested and to whom you want the restriction to apply.
40. We are not required to agree to a restriction that you may request.
41. If your health care provider believes it is in your best interest to permit use and disclosure of your protected health information your protected health information will not be restricted.
42. If we agree to the requested restriction, we may not use ...  
43.  

Family Medicine - Baton Rouge General Medical Center is a private company that has been in the industry for 38 years.

1. The company currently specializes in the Hospital & Health Care area.
2. The position of the CEO is occupied by Edgardo Tenreiro.
3. Its headquarters is located at Baton Rouge, Louisiana, USA.
4. The number of employees ranges from 100 to 250.
5. The annual revenue of Baton Rouge General Medical Center varies between 5.0M and 25M.
6.  A growing number of people now get their health care through some form of managed care plan – a health maintenance organization, preferred provider organization, or point-of-service option.
7. And most of the time, these people receive the care they need.
8. But whenever an insurer will pay only for care that is considered medically necessary or has the right to limit that care, the potential for a disagreement exists.
9. The health plan may refuse or limit treatment, sometimes for good reasons.
10. In other cases, a procedure is not covered under the terms of your policy.
11. The cases most likely to end up in dispute are often not clear-cut, such as new treatments that may not be widely available and have unproven therapeutic value.
12. In 1973, the federal government first authorized what were called federally- qualified HMOs and required them to establish rules and procedures for handling their enrollee’s complaints and grievances inside the health plan, known as an “internal review.” States legislated similar rules for what were called state-qualified health plans, and in recent years most have gone further, setting up additional procedures outside of the health plan.
13. These “external reviews” or “independent reviews,” as they are often called, provide an unbiased way to resolve disputes between patients and their health plans.
14. An external review is a reconsideration of a health plan’s denial of service, with the review conducted by a person or panel of individuals who are not part of the managed care organization.
15. Anyone enrolled in a managed health care plan should be familiar with their plan’s internal review process and any external review program in their state in case problems later arise.
16. This Guide includes state external review programs that provide an independent review of health plan denials of coverage on the basis that the service was not medically necessary or was experimental.
17. The External Review Process 
18. Whom to contact: The Medical Necessity Review Organization (MNRO)  
19. Who can appeal: You, your provider (with consent), or your authorized representative What you can appeal: Denials of coverage for services the health plan determines are not medically necessary.
20. When you can appeal: After denial for coverage has been appealed through all the levels of the health plan’s internal process, you must file within 60 days from receipt of the second level appeal adverse determination.
21. What to send: File a request with the MNRO  
22. What you must pay: No charge  
23. What will happen: 1) The MNRO will send all pertinent information to its designated independent review organization within 7 days of the request.
24. The review organization will evaluate the information and respond with a recommendation to you, the MNRO, and your provider.
25. When you will get a decision: Within 30 days after receiving the necessary information, unless everyone involved agrees to a longer period.
26. In urgent situations: If you receive an adverse determination involving an emergency medical condition while being treated in an emergency room, during hospital observation, or as a hospital inpatient, your provider may request an expedited review.
27. A decision will be made and you will be notified within 72 hours after the review organization receives the necessary medical information.
28. State: Louisiana 
29. Louisiana requires health plans to be authorized as Medical Necessity Review Organizations (MNRO) or to use an approved MNRO to make medical determinations about the appropriateness of care.
30. If your request is denied, your provider may ask for an informal reconsideration of the decision.
31. If you receive an adverse determination, Louisiana provides for both a first level internal appeal and a second level review process.
32. In the second level review process, you have the right to discuss your situation in person.
33. If your second level review upholds the adverse determination, you can request an external review.
34. If a delay will seriously jeopardize your life, health, or ability to regain maximum function, an expedited appeal is available.
35. It is possible that your health plan has an approved internal procedure that allows you to begin the external review process without completing a second level review, or will agree to waive requirements for the internal appeal or review.
36. Baton Rouge General Announces New Member BATON ROUGE, La.
37.  The Baton Rouge General Foundation new Board of Governors member elected to serve a three-year term beginning January.
38. The new member is Lucie Kantrow, general counsel for Bernhard Capital.
39. Kantrow is member of Episcopal School Rotary Boys & Girls Club
40. Baton Rouge General Medical Center is the area’s first community hospital with 588 licensed beds between two campuses.
41. Baton Rouge General opened its doors in 1900, and has provided the Greater Baton Rouge community with high-quality healthcare for generations.
42. An accredited teaching hospital since 1991, Baton Rouge General serves as an affiliate of Tulane University School of Medicine, and offers other medical education programs, including a School of Nursing, School of Radiologic Technology, Family Medicine Residency Program, Internal Medicine Residency Program, and Sports Medicine Fellowship Program.
43. The licensing agency for our facilities is: Louisiana Department of Health and Hospitals, Health Standards Section PO Box 3767, Baton Rouge, LA.
44. 70821 (225) 342-0138, toll free (866) 280-7737 The accrediting agency for our facilities is: The Joint Commission Office of Quality and Patient Safety.
45. Concerns may be reported, in writing, at using the Report a Patient Safety Event link in the Action Center on the home page; by fax to 630-792-5636; or mail to Office of Quality and Patient Safety, The Joint Commission, One Renaissance Blvd, Oakbrook Terrace, IL 60181.
46. You have the right to maintain your dignity which includes: Receiving considerate and respectful care in a clean and safe environment.
47. Privacy and confidentiality during consultation, examination, personal hygiene activities, treatments and discussions concerning your diagnosis and treatment.
48. Your treatment records are confidential unless you have given permission to release information or reporting is required by law.
49. You may review your medical record upon request.
50. Being free from neglect, exploitation and abuse.
51. Respect for your dignity and worth regardless of your diagnosis.
52. Being free from restraints that are not medically necessary.
53. Access to religious and/or spiritual services and support.
54. Your responsibilities as a patient are to: The best of your knowledge, provide accurate and complete information about present and past medical conditions.
55. Ask questions when you do not understand information or instructions.
56. Follow the treatment plan recommended by the physician or to inform your doctor if you believe you cannot follow through with your treatment.
57. Notify the physician or nurse of any unexpected changes in your condition.
58. Be considerate and respectful of the rights and needs of other patients and healthcare workers.
59. This includes being sensitive to noise level, being respectful of others' property, limiting the number of visitors and abiding by the smoke-free environment.
60. Follow the hospital policies regarding patient care and conduct.
61. Other Permitted Uses and Disclosures: • Required by law: As required by law, we may use and disclose your health information.
62. • Business associates: There are some services provided in our physician offices through contracts with business associates.
63. Examples include physician services in the emergency department and radiology, certain laboratory tests, collection agencies, and a copy service we use when making copies of your health record.
64. When these services are contracted, we may disclose your health information to our business associate so that they can perform the job we’ve asked them to do and bill you or your third-party payer for services rendered.
65. To protect your health information, however, we require the business associate to appropriately safeguard your information.
66. • Notification: We may use or disclose information to notify or assist in notifying a family member, personal representative, or another person responsible for your care, your location, and general condition.
67. • Communication with family: Health professionals, using their best judgment, may disclose to a family member, other relative, close personal friend or any other person you identify, health information relevant to that person’s involvement in your care or payment related to your care.
68. • Genetic test results: Louisiana law provides special protection for genetic test results and we will not release these results without specific authorization from you.
69. • Minors: We may disclose Protected Health Information of children, who are considered to be minors, to their parents or legal guardians unless such disclosure in prohibited by law.
70. • Photographs: We may use photography or other means of image recording to capture pictures and imaging in an effort to offer better patient identification for work force members, security purposes, and billing procedures.
71. • Electronic mail (email) messages: You may request for us to communicate certain information with you via email messages.
72. We use a secure network to transmit email messages containing Protected Health Information.
73. • Health Information Exchange: We participate in Louisiana’s Health Information Exchange (HIE) which facilitates participating health care providers with a timely, secure, and authorized exchange of patient health information for treatment and operational purposes.
74. The services offered by the Louisiana Health Information Exchange are based on national standards for secure exchange of health information.
75. Patients will have the opportunity to opt-in to the Health Information Exchange.
76. Patients who opt-in will be required to provided written authorization and may revoke their authorization at any time.
77. • Research: We may disclose information to researchers when the research proposal or protocol has been reviewed by an institutional review board and protocols to ensure the privacy of your health information.
78. • Sale of PHI: General Health System strictly prohibits any sale of PHI to a third party.
79. • Psychotherapy notes: Most sharing of psychotherapy notes requires your written permission.
80. • Health oversight activities: Wemay disclose your health information to health agencies during the course of audits, investigations, inspections, licensure and other proceedings.
81. • Judicial and administrative proceedings: We may disclose your health information in the course of any administrative or judicial proceeding.
82. • Public safety: We may disclose your health information to appropriate persons in order to prevent or lessen a serious and imminent threat to the health or safety of a particular person or the general public.
83. • Patient portal to the electronic health record.
84. We have established a web-based system, called a Patient Portal, which allows us to securely communicate and transfer health care information to you.
85. We make certain portions of the medical record available electronically through the patient portal.
86. In order to access records through the patient portal, the patient (or patient’s representative) must provide their written authorization.
87. • • Public health: As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.
88. Leadership Our leadership team is comprised of administrators, physicians and trustees that are dedicated to the health of our community and the continued success of Baton Rouge General as its hospital.
89. Each day we work as a team, together with more than 3,500 others, to carry on the General's legacy as a pillar in the Baton Rouge community.
90. Strengthen Your Case with Federal Court Findings There are a number of patient and provider guides for navigating the appeals process that contain complimentary guidance, much of which aligns with the considerations below.
91. The following proposed appeals strategy builds on current guidance by offering language and approaches for incorporating Wit case findings as a motivating factor for insurers to reconsider care denial decisions.
92. Dr.
93. Plakun’s 4 Tools to Maximize Appeal Success Appealing Treatment and Reimbursement Denials (American Psychiatric Association) A Patient’s Guide to Navigating the Insurance Appeals Process (Patient Advocate Foundation) What to Do if You’re Denied Care by Your Insurance (National Alliance on Mental Illness) Appeal Strategy Concepts Apply the following strategies when preparing for and responding to excessively restrictive claims denials.
94. Examine your organization’s claims denial data to identify where insurers’ reasons for denials are at odds with one or more of the eight principles stipulated by the court in the Wit case and how often appeals are granted or denied.
95. execute appeal strategy informed by challenges you face attention to trends in populations increased risk for denial of necessary care.
96. appeal strategies; consider denial and appeal data analysis as longer-term goal Understand insurer’s utilization review criteria.
97. Wit case involved one insurer, standard of care concepts applied across behavioral health insurers.
98. guidelines compliant on paper, must be compliant in operations denial mental health medically necessary, four tools maximize success appeal: patient voice as party to binding contract.
99. Anchor appeals to third-party resources Invoke parity law 800.51.RIGGS contract access to necessary care, meeting accepted standards.
100. Insist access to written criteria to determine medical necessity for treatment to which your case doesn’t meet.
101. Your voice and voices of those supporting treatment matter.
102. You, family, and treating referring clinicians write letters for treatment, on challenging reasons for denial.
103. insurance agent benefits manager or state insurance review board offer assistance.
104. document all interaction with insurance reviewing agency—including hold times, referrals to other phone numbers, and the like.
105. Show will and wherewithal stand up for your rights.
106. Research benchmarks to back up medical necessity in appeals process.
107. level-of-care using objective methodology Level of Care Utilization System (LOCUS) American Association of Community Psychiatrists American Psychiatric Association (APA) Clinical Practice Guidelines evidence-based components of treatment for disorders.
108. Guidelines for Assessment of and Intervention With Persons With Disabilities Assessment Table of Contents Disability, Awareness, Training, Accessibility, and Diversity Guideline  
109. 1: Psychologists strive to learn about various disability paradigms and models and their implications for service provision Guideline 2: Psychologists strive to examine their beliefs and emotional reactions toward various disabilities and determine how these might influence their work Guideline 3: Psychologists strive to increase their knowledge and skills about working with individuals with disabilities through training, supervision, education, and expert consultation Guideline 4: Psychologists strive to learn about federal and state laws that support and protect people with disabilities Guideline 5: Psychologists strive to provide a barrier-free physical and communication environment in which clients with disabilities may access psychological services Guideline 6: Psychologists strive to use appropriate language and respectful behavior toward individuals with disabilities Guideline 7: Psychologist strive to understand both the common experiences shared by persons with disabilities, and the factors that influence an individual’s personal disability experience Guideline 8: Psychologists strive to recognize social and cultural diversity in the lives of persons with disabilities Guideline 9: Psychologists strive to learn how attitudes and misconceptions, the social environment, and the nature of a person’s disability influence development across the lifespan Guideline 10: Psychologists strive to recognize that families of individuals with disabilities have strengths and challenges Guideline 11: Psychologists strive to recognize that people with disabilities are at increased risk for abuse and address abuse-related situations appropriately Guideline 12: Psychologists strive to learn about the opportunities and challenges presented by assistive technology Testing and Assessment Guideline 13: In assessing persons with disabilities, psychologists strive to consider disability as a dimension of diversity together with other individual and contextual dimensions Guideline 14: Depending on the context and goals of assessment and testing, psychologists strive to apply the assessment approach that is most psychometrically sound, fair, comprehensive, and appropriate for clients with disabilities Guideline 15: Psychologists strive to determine whether accommodations are appropriate for clients to yield a valid test score Guideline 16: Consistent with the goals of the assessment and disability-related barriers to assessment, psychologists in clinical settings strive to appropriately balance quantitative, qualitative, and ecological perspectives, and articulate both the strengths and limitations of assessment Guideline 17: Psychologists in clinical settings strive to maximize fairness and relevance in interpreting assessment of data of clients who have disabilities by applying approaches which reduce potential bias and balance and integrate data from multiple sources Interventions Guideline 18: Psychologists strive to recognize that there is a wide range of individual response to disability, and collaborate with their clients who have disabilities, and when appropriate, with their clients’ families to plan, develop, and implement psychological interventions Guideline 19: Psychologists strive to be aware of the therapeutic structure and environment’s impact on their work with clients with disabilities Guideline 20: Psychologists strive to recognize that interventions with persons with disabilities may focus on enhancing strengths well being as well as reducing stress and ameliorating skill deficits Guideline 21: When working with systems that support, treat, or educate people with disabilities, psychologists strive to keep clients’ perspectives paramount and advocate for client self-determination, integration, choice, and least restrictive alternatives Guideline 22: Psychologists strive to recognize and address health promotion issues for individuals with disabilities 
110. American Psychological Association.
111. (2021).
112. Professional Practice Guidelines for Evidence-Based Psychological Practice in Health Care.
113. Retrieved from APA GUIDELINES on Evidence-Based Psychological Practice in Health Care WORKGROUP OF THE COMMITTEE ON PROFESSIONAL PRACTICE AND STANDARDS (COPPS) AND THE BOARD OF PROFESSIONAL AFFAIRS (BPA) APPROVED BY APA COUNCIL OF REPRESENTATIVES FEBRUARY 2021  
114. THE INTERVENTION PROCESS • 
115. Guideline 1: Psychologists are mindful of the principles and importance of evidence-based practice.
116. • Guideline 2: Psychologists strive to maintain and enhance their knowledge of the research and scholarly literature applicable to their practice.
117. • Guideline 3: Psychologists endeavor to conduct assessments that are appropriate for the setting, purpose, and population.
118. • Guideline 4: Psychologists seek to participate in collaborative treatment planning with patients and others when appropriate.
119. • Guideline 5: Psychologists aim to cultivate and maintain effec- tive therapeutic relationships, therapist characteristics, and change principles.
120. • Guideline 6: Psychologists endeavor to adapt their clinical approach to patient characteristics, culture, and preferences in ways that increase effectiveness.
121. • Guideline 7: Psychologists aim to monitor the treatment process and clinical outcomes routinely.
122. • Guideline 8: Psychologists seek to modify their clinical approach when appropriate and terminate treatment when the patient is no longer benefitting or when treatment goals have been met COLLABORATION AND WHOLE HEALTH • Guideline 9: Psychologists endeavor to collaborate with other professionals when appropriate to facilitate effective care.
123. • Guideline 10: Psychologists strive to promote overall patient health, functioning, and well-be Both methodologies can provide an objective frame of reference–in fact, medicaid and reviewing agencies claim to use both in developing their own criteria.
124. Current peer-reviewed research can also anchor appeals to an evidence base for specific kinds of treatment.
125. building a case for treatment that you believe to be medically necessary.
126. The Mental Health Parity and Addiction Equity Act (MHPAEA) requires that the quantitative (e.g., number of office visits, or inpatient days) and non-quantitative (e.g., hurdles like prior authorization or concurrent review) limits applied to access to mental health care be comparable to those applied to medical coverage.
127. if z says someone with a mental health issue cannot receive treatment unless he stops drinking, but continues to cover treatment for someone with diabetes who is not following his diet, the policy is likely out of compliance with the parity law.
128. “intermediate” level of care like residential treatment is excluded except for those meeting criteria for acute inpatient treatment, but intermediate levels of care are covered for medical issues, the policy is likely out of compliance with the parity law.
129. If you believe a denial does not comply with the parity law, raise this concern in the appeal.
130. speak with an attorney familiar with parity law violations or your State Attorney General’s Office.
131. Reference Judge Joseph Spero’s verdict in the Wit v. UBH/Optum case verdict says about restrictive access to care criteria focus treatment on limited goal of crisis stabilization “ • Patients should receive treatment for mental health and substance use disorders at the least intensive and restrictive level of care that is safe and effective– the fact that a lower level of care is less restrictive or intensive does not justify selecting that level if it is also expected to be less effective.
132. Below are selected quotes and highlights from the verdict: 
133. Several factors contribute to disenrollment, including consolidation and failure of health plans, employer-directed changes in health plans in order to obtain better value, enrollees' search for better drug benefits 
134. (1), psychiatric diagnosis
135.  (2,3), and overall dissatisfaction with the plan (4).
136. For behavioral health care in particular, disruption to treatment may have dire consequences.
137. It threatens the therapeutic relationship (5), may result in some anxiety and insecurity on the part of the patient (6), and could even cause serious damage to the therapeutic process.
138. Persons with mental illness are especially vulnerable.
139. For example, one study showed that persons with symptoms of depression were less likely to disenroll from a health plan when they were dissatisfied than were enrollees with physical symptoms A careful literature review found no further research addressing the transition of behavioral health care from one plan to another.
140. Presented here is a model that was used during the transition of 4,075 active commercial and Medicare enrollees from a large medical managed care organization (MCO) to an academic managed behavioral health care organization (MBHO).
141. best-practices model to guide the transition of behavioral health enrollees between plans.
142. The impact of withdrawals by Medicaid managed care plans on behavioral health services.
143. Abstract Background: Persons with disabilities experience health disparities while having usual providers more frequently than persons without disabilities.
144. Provider discontinuity may help to explain these paradoxical findings, but research on the topic is nascent.Objective: To provide initial insight into whether persons with disabilities more frequently experience provider discontinuity than persons without disabilities.
145. Policies and practice must be attentive to how proposed changes to the healthcare system potentially reduce access to care among persons with disabilities.
146. Keywords: Disability; Provider continuity; Reason for no provider; Usual source of care.
147. Prevalence and reasons for delaying and foregoing necessary care by the presence and type of disability among working-age adults. 
148. Provider (dis)continuity was defined by 2 reports of having a health-care provider during the period.
149. Results: Persons who lost providers were more likely to forego medical care and prescription medications, forego care due to cost, and report that delaying care was a big problem than their peers who experienced continuity.
150. Persons who gained providers were more likely to delay dental care than those who always had, lost, or never had providers.
151. Conclusions: Persons who experience discontinuity have poorer access to care than their peers who experience continuity.
152. Keywords: cost as barrier to care; provider continuity; provider discontinuity; unmet needs for care; unmet needs for care problems. 
153. The impact of insurance type and forced discontinuity on the delivery of primary care 
154. Individuals forced to change their physician because of changes in their health care insurance scored significantly lower on all five indicators of primary care quality 
155. Conclusions: The quality of primary care appears to be less dependent on the payment system than on the maintenance of the patient-physician relationship. 
156. Forced disruption of continuity of care is detrimental to patient receipt of quality primary care, and is a potential negative consequence of annual bidding for managed care contracts. 
157.  
158. Best Practices: Transition of Enrollees From a Managed Care Organization to an Academic Managed Behavioral Health Carve-Out Several factors contribute to disenrollment, including consolidation and failure of health plans, employer-directed changes in health plans in order to obtain better value, enrollees' search for better drug benefits (1), psychiatric diagnosis (2,3), and overall dissatisfaction with the plan 
159. When a person's health plan is replaced, there may be a sudden disruption to treatment if the enrollee's current behavioral health care provider is not part of the new provider network.
160. For behavioral health care in particular, disruption to treatment may have dire consequences.may result in some anxiety and insecurity on the part of the patient (6) and could even cause serious damage to the therapeutic process.
161.  
162. Enrollee satisfaction with MCOs and its relationship with disenrollment.
163. Appealing Treatment and Reimbursement Denials Appeal Strategies 
164. The APA recommends the following: 
165. 1.
166. Request and review a copy of the MCO’s appeals procedures and utilization review (UR) criteria before initiating any appeals.
167. 2.
168. Ask for the case manager’s credentials.
169. Denials of psychiatrists’ services should be made only by psychiatrists.
170. 3.
171. Request written notification of the reasons for denial and a description of the information required for approval.
172. This will ensure that subsequent submissions “fit the bill.” 4.
173. Request names and addresses of the people who should receive applications for an appeal and find out the MCO’s deadline for appeals.
174. 5.
175. Meet all UR and appeal deadlines.
176. If you do not, the merits of your case may not matter.
177. Certification denials due to “administrative noncompliance” are rarely overturned.
178. If the case is denied on an administrative basis (i.e., a request for continued certification was not made within the specified time, precertification procedures were not followed, or there were benefit coverage exclusions), you’ll need to explain any extenuating circumstances in your appeal.
179. 6.
180. If your appeal is denied, appeal again.
181. Many companies offer three or four levels of appeal.
182. It is advisable to exhaust all levels of appeal before initiating litigation, should you be forced to proceed that way.
183. 7.
184. Be concise.
185. Don’t send more information than necessary and be sure to get permission from your patient to release that information.
186. 8.
187. Request peer review with a psychiatrist trained in the same subspecialty who has experience in the treatment requested.
188. 9.
189. In an emergency situation, request an “expedited appeal” over the telephone with the consulting psychiatrist.
190. Most MCOs have such services.
191. 10.
192. If applicable, ask the patient to enlist the support of his or her Personnel/ Human Resources Department.
193. MCOs are often more responsive to their paying clients’ complaints than to complaints from physicians.
194. 11.
195. In cases that are slow to respond to standard treatments, ask the company to “flex benefits” by working with you to find a cost-effective, alternative treatment approach.
196. 12.
197. If coverage is denied after appealing, some companies may allow you to request an external review of the case with or without some cost-sharing.
198. 13.
199. In truly egregious cases, copy your appeal to the state insurance commissioner.
200. Seeing such a “cc” may elicit a more rapid and favorable response.
201. 14.
202. Contact any professional association you belong to and any consumer advocacy groups that may be helpful.
203. A complaint lodged by several parties will be stronger.
204. Letter of Appeal The following are some suggestions for inclusion in a letter of appeal:  
205. • Include any literature that supports your case, including references to the APA’s practice guidelines.
206. This may help convince the reviewer that the proposed treatment will result in the desired outcome.
207. • Be candid about the patient’s condition.
208. Describe any changes in diagnosis, comorbidities, progression, or regression of the patient’s condition; special treatments such as suicide restraints and seclusion; neurological testing and other medical tests; medications; and any self-injury or assaultive behavior.
209. • Clearly relate the level of care requested to the patient’s condition.
210. Information should be based on objective reasoning, not just opinion.
211. • Describe the next step of treatment, providing goals and an approximate time frame for the completion of treatment.
212. This will promote the idea that you have an action-oriented approach.
213. • If applicable, recommend alternative treatments for the patient.
214. • Present evidence of similar cases where the care was approved by the same plan.
215. • Appeal with a collaborative spirit.
216. If you need further assistance, call the APA Practice Management HelpLine at (800) 343-4671.
217. Independent Review Organizations (IROs) Most states have enacted independent review laws that require disagreements over what constitutes a health plan coverage to be decided by a review done by a medical expert or panel of medical experts who have no affiliation with the health plan.
218. Laws vary from state to state as to whether the review decisions are binding, but they are in most states.
219. Currently, approximately 50 percent of the disputes taken to independent review result in the reversal of a coverage denial.
220. An independent, external review, however, can only be accessed after the internal appeals process established by individual MCOs has been completely exhausted.
221. Although independent reviews have been around for years, there is still a lack of public awareness about the process, and patients generally do not take advantage of the reviews despite claims denial letters that inform them about their availability.
222. In 2005 the Kaiser Family Foundation published a guide to handling health plan disputes that provides specific information about how to access the independent review organizations in each state that has mandated the independent review process.
223. Mental Health and Substance Use Disorder Insurance Coverage and Model Legislation APA has created parity-implementation legislation for all 50 states and the District of Columbia.
224. The legislation is designed to require transparency and accountability from insurers and state regulators.
 
225. First, the legislation establishes reporting requirements for insurers to demonstrate how they design and apply their managed care tactics, so regulators can determine if there is compliance with the law.
226. Second, the legislation specifies how state insurance departments can implement parity and then report on their activities.
227. And third, the legislation eliminates some managed care barriers to medication-assisted treatment for substance use disorders.
228. While those provisions are not purely parity requirements, they can be a vital tool in combatting the opioid epidemic.
229. 
     
230.  APA's Department of Government Relations Team APA Director of Government Relations Erin Berry Philp at ephilp@psych.org 
231. 
     

[Date] [Name and mailing address of payer] To Whom It May Concern: I have been seeing [patient name] since [provide date care began] to treat his/her [provide diagnoses, and any problems this may cause in patient’s life if applicable.For example: Anxiety that has limited her ability to fulfill her duties at work].

[Provide a chronology of the patient’s treatment and explain why you need to either continue or initiate the denied care.

explain why you have come to the decision that it’s necessary to either continue or initiate treatment with the denied drug.

Explain any of the patient’s stated concerns/preferences that influenced your decision.

Be sure to provide examples of what might occur if care continues to be denied and how this would be detrimental to the patient’s health.

Always be as specific as you can.] I have attached articles that support provision of this care to [patient name].

[if you can find literature to support the care that is being denied, this can be a very valuable asset.

The APA’s Practice Guidelines can be a good source for support since most insurers say they use them in developing their treatment guidelines.] Sincerely, [Name and contact information] 

232. 
     
233. The following ten steps will advance mental health parity by improving the appeals process for all: 
234. 1.
235. Increase Awareness of the Appeal Process.
236. The appeals process is enormously complex.
237. Many individuals do not know they have the right to file an appeal upon receiving an adverse benefit determination.
238. Health plans and regulators should work together to ensure that all enrollees are aware of their rights through targeted public education campaigns.
239. Regulators should also reinforce health plans’ parity disclosure requirements and make clear that in both internal and external appeals, a parity violation is grounds for reversal of a coverage denial.
240. 2.
241. Promote More Due Process and Transparency.
242. When an adverse benefit determination or denial takes place, more transparency must be provided surrounding how the decision was made and documented.
243. At a minimum, health plans must disclose the clinical and/or coverage criteria used in the decision and clearly explain the specific steps required to file an appeal.
244. Regulators should also enforce requirements that denial letters include a detailed explanation of why the patient does not meet the plan’s clinical criteria, a description of the evidence reviewed by the plan, and address evidence submitted by the patient or their provider.
245. Otherwise, consumers cannot avail themselves of their appeal rights.
246. Filing An Appeal Based On a Parity Violation The Kennedy Forum • 3.
247. Allow Attending Providers and other Advocates to File Appeals.
248. In some instances, ordering or attending providers are not allowed to file an appeal on behalf of their patients.
249. This is counterintuitive and inefficient as the provider is often in the best position to understand the denial decision and then explain why the service or treatment is still recommended or why the care was already delivered.
250. Providers also have a “leg-up” as they are familiar with the medical jargon used in the denial letter or throughout the appeals process.
251. 4.
252. Simplify the Appeals Process.
253. Many patients and ordering providers complain that too many bureaucratic hurdles and inconsistent requirements exist within the appeals process.
254. These obstacles have a chilling effect that discourages patients or their representatives from filing an appeal.
255. Originally, the appeals process made clear that utilization management (UM) appeals handled medical necessity or clinical denials, and grievance procedure appeals handled administrative denials.
256. Today, model laws from the National Association of Insurance Commissions (NAIC) and many jurisdictions have issued regulations that have eroded this formerly clear bifurcation.
257. We recommend that one integrated and streamlined appeals process apply no matter the basis of the initial denial.
258. 5.
259. Standardize the Appeal System Across Market Segments and State Lines.
260. A national and consistent standard must be implemented to make the appeals process effective.
261. At present, many different appeal pathways exist.
262. These pathways vary based on how the health plan is regulated, the type of coverage provided, the type of plan sponsor, the jurisdiction, the type of denial (e.g., based upon a medical necessity or benefit determination), the timing of the denial (e.g., prospective, concurrent and retrospective), the urgency of the care being requested (i.e. standard care versus urgent care), and where the patient is in the appeals process.
263. Our goal should be to establish one national appeals standard that promotes transparency, fairness and due process to all parties involved.
264. We can accomplish this unified system through new model legislation, accreditation standards and Requests for Proposal (RFP) requirements.
265. 6.
266. Upgrade the External Review Appeals Process.
267. Currently, the patient or their authorized representative must specifically request an external review of their claim.
268. In most cases, the external review appeal only can be pursued after a patient first successfully completes an appeal through the health plan.
269. In some instances, the aggrieved party may not even know they have the right to appeal to an external party.
270. One simple way to address this confusion is to automatically refer the appeal to an independent review organization after the internal appeal is completed.
271. For example, Medicare beneficiary appeals are automatically referred to the external review level, resulting in more due process.
272. Filing An Appeal Based On a Parity Violation The Kennedy Forum • In addition, the external review process as currently regulated should be re-examined and potentially upgraded to better protect consumers.
273. Ideas include: n Reviewer Identification.
274. In many cases, the patient does not know who made the final ruling during the external review.
275. Should the identity of the external reviewer be revealed or remain anonymous? Does due process require the person making the judgment to be disclosed like a judge in court? The Kennedy Forum recommends that the identity of the reviewer be routinely disclosed.
276. n Public Disclosure of Decisions.
277. In some states, regulators post de-identified external appeal decisions on their websites, a practice that allows consumers and providers to understand the types of issues being sent to external appeals, how external decisions are made, and to identify trends (such as frequent overturns of denials of coverage for specific treatments).
278. Greater disclosure of external appeal decisions would benefit individual consumers and help frame dialogue with health plans regarding practices that should be reformed.
279. Payment.
280. In most cases, health plans contract with two or more external review organizations to handle the external reviews of their insured population.
281. Does the external review organization have an incentive to rule in favor of the health plan if the health plan also is paying for the cost of the external review? Should the patient’s health plan pay for the external review? Or should it be funded by a government agency or through some sort of fund supported by all health plans in a particular jurisdiction?  
282. Exhausting Internal Review.
283. Should the patient or their advocate always have to exhaust the health plan internal appeals process before filing an external appeal? Should the patient have the right to skip right to external review? The Kennedy Forum recommends that the patient be permitted to skip the internal UM appeals process and go right to external review if that is their decision.
284. However, once this decision is made, the patient or their advocate loses the right to use the health plan’s internal appeal system for that particular issue under dispute.
285. Filing An Appeal Based On a Parity Violation The Kennedy Forum • 
286. 7.
287. File More Appeals.
288. While working to lower the number of denials issued on claims, stakeholders should simultaneously work to ensure that every questionable denial is subjected to the appeals process so that enrollees receive the care they are entitled to.
289. Each stakeholder group should do the following to promote the filing of appeals: n Consumer/Provider.
290. Every patient who has experienced a denial or care restriction of mental health or addiction services should file a complaint at and/or with the applicable government agency.
291. Filing a complaint will help us develop comprehensive data to better understand the different types of parity denials.
292.  Industry.
293. When an appeal is filed, health plan personnel must make a good faith effort to respond in a timely and meaningful manner.
294. Health plans and medical management organizations must ensure they are complying with existing regulations and the patient’s plan documents on how these appeals should be processed (e.g., timeframes, disclosure requirements).
295. Policymakers/Regulators.
296. Policymakers and public officials must ensure they enforce existing state and federal regulations on how appeals should be filed and processed.
297. In addition, the current regulatory and accreditation requirements should be updated to create a more efficient and effective appeals process for all parties.
298. Leverage Technology to Improve the Efficiency of the Appeals Process.
299. Much like TurboTax has helped tax filers, it is time to leverage technology to promote a more efficient appeals process.
300. All too often, the appeals process is still paper-based or otherwise very fragmented.
301. While is one step in the right direction, more can be done.
302. 9.
303. Update Regulatory Oversight Mechanisms.
304. It is time to update regulations to capture recent trends in how best to monitor and promote the appeals process.
305. This could include updating the model laws, regulations and accreditation standards covering utilization management, grievance procedures, external review and mental health parity compliance, both at the federal and state levels.
306. It also could include promoting value-based and outcome measures.
307. Regulations need to keep pace with changes in health care delivery, technology capabilities, and communication platforms.
308. Filing An Appeal Based On a Parity Violation 
309. 10.
310. Promote Advocacy and Sponsor Education Programs.
311. States should sponsor and subsidize experts who can help patients understand, file, and process appeals by creating consumer advocate offices, like the Office of the Health Care Advocate in Connecticut or Health Law Advocates in Massachusetts.
312. Regulators and health insurers can support this effort through customer service lines, supplemental educational programs, broker materials and other resources that are specific to their agency or plan.
313. These agencies should also actively connect consumers interested in filing an appeal with non-profits capable of supporting individuals throughout the process.
314. Final Thoughts 
315. The appeals process, especially for parity violations, remains a complex and confusing system for most stakeholders.
316. It is time to rethink and improve on existing appeal systems with an eye towards making the appeals process more efficient, transparent and meaningful.
317. The impact of doing so will be meaningful for individuals—and their families—who need and deserve care and are entitled to services.
318. For more information on this topic, contact Garry Carneal, JD, Senior Policy Advisor, The Kennedy Forum, at info@thekennedyforum.org. 
319. Organize Your Materials 
320. What papers do I need? Keep copies of all information related to your claim and the denial.
321. This includes information your insurance company provides to you, and information you provide to your insurance company, such as: The Explanation of Benefits (EOB) forms or letters showing what payment(s) or service(s) were denied A copy of the request for an internal appeal that you send to your insurance company Any additional information you send to the insurance company (such as a letter or other information from your doctor) A copy of any letter or form you are required to sign, if you choose to have your doctor or anyone else file an appeal for you.
322. Keep a diary of phone conversations you have with your insurance company or your doctor that relate to your appeal (include the date, time, name, and title of the person you talked to, as well as details about the conversation) Keep your original documents and submit copies to your insurance company.
323. You will need to send your insurance company the original request for an internal appeal, and your request to have a third party (such as your doctor) file an internal appeal for you.
324. Make sure you keep copies of all documents for your records.
325. What kinds of denials can be appealed? You can file an internal appeal if your health plan won’t pay some or all of the cost for health care services you believe should be covered.
326. The plan might issue a denial because: The benefit is not offered under your health plan Your medical problem began before you joined the health plan You received health services from a health provider or facility that is not in your health plan’s approved network Your health plan determines the requested service or treatment is “not medically necessary” Your health plan determines the requested service or treatment is an “experimental” or “investigative” treatment You are no longer enrolled or eligible to be enrolled in a health plan Your health plan revokes or cancels your coverage, going back to the date you enrolled, because the insurance company claims you gave false or incomplete information when you applied for coverage
     
327. LA Health Care Services Division Agency The LSU Health Care Services Division (LSU HCSD) includes Executive Administration and General Support (Central Office) and six (6) hospitals that have entered into cooperative endeavor agreements (CEA) for public-private partnerships and the Lallie Kemp Regional Medical Center.
328. The six hospitals that currently have CEAs are 

329. Earl K.Long Medical Center, University Medical Center, W.O. Moss Regional Medical Center, Washington-St. Tammany Regional Medical Center, Leonard J. Chabert Medical Center, and the Medical Center of Louisiana at New Orleans LSU A M LSU Agricultural Center LSU Alexandria LSU Eunice LSU Shreveport LSU Health Sciences Center, New Orleans LSU Health Sciences Center, Shreveport LSU Pennington Biomedical Research Center  

330. 
     
331. The LSU Health System is working with the University Healthsystem Consortium to further define performance indicators and peer group comparisons.
332. Patient satisfaction is measured using The Myers Group, a Centers for Medicare and Medicaid Services (CMS) approved vendor, and is summarized in "overall rating of hospital" and "willingness to recommend hospital." 
333.  LSU-HCSD has set its performance standards above the state, national and west south regional averages.
334. LSU-HCSD will follow the CMS rules for reporting;
     

335. Many psychiatrists care for a highly vulnerable population of patients who experience high rates of unemployment high and where socioeconomic challenges are common.We know that individuals with serious mental illness have substantial physical health comorbidities and a lifespan that is as much as 20 years less than that of the population as a whole.Cognitive aspects of aging also appear to be accelerated in these individuals.Efforts to reduce costs of care in these individuals may place them at even further disadvantage, with even greater disparities among Blacks, Latinx, and Indigenous People as has been starkly evident in health care delivery during the pandemic.

336. We urge CMS to avoid implementing measures or policies that have the potential to deepen inequities in access to care.
337. If, during the course of the redetermination, the reviewer suspects a civil or criminal law violation, the reviewer shall render a decision only on the coverage or payment issues raised by the redetermination request.
338. Although the reviewer cannot make a determination of civil or criminal fraud, he/she may still deny or reduce payment if he/she believes that the items or services at issue were not rendered, or were not rendered as billed (as discussed above).
339. In making this determination, the reviewer may consider all available evidence that is included in the case file, including witness testimony, medical records, and evidence compiled through a fraud investigation, as discussed above.
340. (See §310.4.B below.) In addition to denying the claims because the services were not rendered as billed, if the reviewer suspects fraud, he/she shall forward information regarding the potential civil or criminal violation to the UPIC.
341. For further discussion on Medicare fraud issues, refer to the Medicare Program Integrity Manual, IOM 100-08, Chapter 4.
342. 280.5 - Requests to Suspend the Appeals Process (Rev.
343. 2729, Issued: 06-21-13, Effective: 07-23-13, Implementation: 07-23-13) The MAC does not have the authority to suspend redeterminations at the request of the Office of the Inspector General (OIG) or the Department of Justice (DOJ) without approval and direction from CMS central office (CO).
344. If the OIG or DOJ submits a request to suspend a redetermination, the MAC shall first bring that request to the attention of CO through the RO.
345. 280.6 - Continuing Appeals of Providers, Physicians, or Other Suppliers Who are Under Fraud or Abuse Investigations (Rev.
346. 1274, Issued: 06-29-07, Effective: 07-01-07,
     
347. 290 - Guidelines for Writing Appeals Correspondence (Rev.
348. 1274, Issued: 06-29-07, Effective: 07-01-07, Implementation: 10-01-07) The guidelines in this section are to be used when preparing appeals correspondence, which includes redeterminations decisions and inquiries about the status of appeals.
349. These shall be handled as expeditiously as possible without lowering the quality of the response.
350. General instructions on responding to beneficiary and provider/supplier communications are found in CMS Medicare Pub.
351. 100-09.
352. All other CMS-issued instructions on correspondence guidelines apply as well, including instructions on correspondence letterhead requirements.
353. 290.1 - General Guidelines (Rev.
354. 2729, Issued: 06-21-13, Effective: 07-23-13, Implementation: 07-23-13) MACs shall prepare appeals correspondence so the appellant can easily understand both the reason why any of the services were not covered or could not be fully reimbursed, and what action the appellant can take if the appellant disagrees with that decision.
355. In addition, the guidelines listed here should be followed to the extent possible: • Keep the language as simple as possible; • Do not use abbreviations or jargon; • Choose a positive rather than a negative tone, whenever possible.
356. Avoid words or phrases that emphasize what cannot be done by the MAC or the appellant; • If possible, avoid one sentence paragraphs, uneven spacing between paragraphs, etc.; • Apologize when appropriate, e.g., if the response is late.
357. However, do not apologize for enforcing Medicare guidelines that may be adverse to the appellant’s claim; • Summarize the question before providing a response; and, • Use correct spelling, grammar, and punctuation.
358. 290.2 - Letter Format (Rev.
359. 4278, Issued: 04-12-19, Effective: 06-13-19, Implementation: 06-13-19) Appeals correspondence shall follow the instructions issued by CMS for MAC written correspondence letterhead requirements unless otherwise instructed and/or agreed to by CMS.
360. In addition, observe the following information: • Numerical dates must not be used (i.e., instead of 6/16/13, use June 16, 2013), except when included in a table; • Type/font size must be 12 point or larger (all responses are to be processed using a font size of 12 and a font style of Universal or Times New Roman or similar style for the ease of reading by the beneficiary and the provider); • When the subject matter is lengthy or complicated, bullet points should be used to clarify, if possible; • For long letters, headings should be used to break it up (e.g., DECISION, BACKGROUND, RATIONALE); • If procedure codes are cited, the actual name of the procedure must be associated with the code; • Span dates may not be used for 1 day of service; and • The MAC should not use all capital letters.
361. Letters that contain all capital letters appear impersonal and computer generated.
362.  The MMA requires that appeals correspondence be written in a manner calculated to be understood by beneficiaries.
363. MACs shall write appeals correspondence that is understandable to beneficiaries.guidance to MACs on writing letters that are easy for beneficiaries to understand.
364. To achieve this goal, MACs shall: (1) Write in plain English/plain language with a clear, simple, conversational writing style with good communication of key points.
365. (2) Get reading levels of letters as low as you can without losing important content or distorting the meaning and without sounding condescending to the reader.
366. NOTE: This requirement does not apply to providers.
367. MACs can use a cover sheet for the beneficiary, when sending a copy of the decision.
368. 290.3.1 - Writing in Plain Language (Rev.
369. 1274, Issued: 06-29-07, Effective: 07-01-07, Implementation: 10-01-07) The following are some tips to help MACs to write letters in plain language: • Include definitions or explain terms you must use that are not familiar with your intended audience.
370. • Use heading, subheadings, or other devices to signal what's coming next.
371. Labels for sections, headings, and subheading should be clear and informative to the intended audience.
372. • Write in an active voice and in a conversational style.
373. For example, conversational style uses contractions (I'd instead of I would) and informal vocabulary (find out instead of determine).
374. • Use a friendly and positive tone.
375. • Use words that are familiar to your intended audience.
376. Shorter words tend to be more common, and they are generally preferable.
377. For example, use doctor instead of physician.
378. Pay back instead of reimburse.
379. Can get instead of eligible.
380. There are exceptions.
381. For example, access is a short word, but it is health care jargon that is hard for many consumers to understand.
382. Organization is a five-syllable word, but is probably familiar to most readers.
383. • When a term is best known to your intended audience by its acronym, use the acronym and spell out the word that it represents in parenthesis with the letters that form the acronym in bold.
384. For example: PCP (Primary Care Provider).
385. • Be on alert for words that are abstract or vague, or that may mean different things to different people.
386. Replace these words with more specific words to be sure your readers understand the key messages.
387. • Keep your sentences simple and direct.
388. Most should be reasonably short; about eight to ten words per sentence for most sentences.
389. When sentences are long, the main point gets lost in all the words.
390. Active voice makes the style more direct.
391. • Vary the length of your sentences.
392. Somewhat longer, natural-sounding sentences of about 12 to 15 words can effectively break up the choppy effect of using many short sentences.
393. • Paragraphs should be relatively short.
394. Short paragraphs are more inviting to your reader and give the visual appearance of being easier to read.
395. • Use simpler words rather than technical terms whenever you can without losing the content or distorting the meaning.
396. Sometimes it's important to use a technical term, such as the words mammogram, or cholesterol.
397. • Appearance should be appealing at first glance.
398. Pages should be uncluttered with generous margins and plenty of white space.
399. • The graphic design should use contrast, indentation, bullets, and other devices to signal the main points and make the text easier to skim.
400. • Use a large type and spacing between lines.
401. 290.4 - Required Elements in Appeals Correspondence (Rev.
402. 2926, Issued: 04-11-14, Effective: 07-14-14, Implementation: 07-14-14) The following should be used in all appeals correspondence: • The name of the beneficiary/provider/physician/supplier to whom the letter is addressed rather than “Dear Sir/Madam;'' • Correspondence is identified by either the date on written correspondence or the date the written correspondence was received; • The name of the provider, physician or supplier as well as the date(s) of service; • When appropriate, an explanation in letters to beneficiaries, explaining why he/she is being sent a letter if the appeal came from the provider, physician or other supplier; • The appeal determination/decision is placed in the beginning of the letter; • Explicit rationale that describes why the items or services at issue do not meet Medicare guidelines.
403. Merely stating that an item or service is “not medically reasonable and necessary under §1862(a)(1)” or “not medically reasonable and necessary under Medicare guidelines” does not provide any rationale.
404. As part of the Franciscan Missionaries of Our Lady Health System Brand Team, the Video Producer works to vision, develop, produce and execute long-form and short-form video content that drives brand, culture, volume and engagement for our multi-state healthcare system.
405. The Video Producer's responsibilities include ideation, creation and production of various types of videos, such as social videos, patient stories, PR event support videos, physician videos, internal communication videos and additional web-based videos.
406. The Video Producer should understand how to script, storyboard, produce and recommend optimal forms of media for each video project.
407. They will work closely with members of the larger Marketing and Communications department as well as those in other departments across FMOLHS to further our mission of providing healthcare to communities across Louisiana and Mississippi.
408. They should be able to develop effective working relationships with others, assist in developing video strategy, and strive to promote personal performance quality in an effort toward promoting a positive brand.
409. Video Producer Responsibilities: Create and develop multimedia (audio/video) content for brand campaigns, social media advertising, internal communication and culture projects, and other health system project, including filming, editing and publishing Brainstorm, ideate, write and develop clear and engaging video concepts and scripts that extends our health system's strategic content goals, including but not limited to activities like: Capturing/importing media, organizing raw media, editing footage and sound files, creating motion graphics or other digital or sound effects, media management and publication Plan video shoots; scout, select and reserve shoot locations, manage production schedules and department video equipment Partner with other content strategists and designers to include video in cohesive marketing and advertising strategies Understand building content for different audience personas, including consumers, employers and clinical focuses that support personalized and engaging content Perform audits to assess how well existing content is performing; partnering with Digital Team to provide ongoing counsel and analytics related to content performance; Understand keyword research tools, social media platforms, search engine optimization (SEO), and search engine marketing (SEM); Understand or have experience in video animation a bonus, but not a must For this role, success looks like: the ability to work under pressure; strong content presentation skills; organizational and time management skills; open to collaboration among team members and internal clients; strong deadline ethic and understanding of/adherence to due dates.
410. 
     

($)4 21 U.S.C.: 333(b)(2)(A) FDA Penalty for violations related to drug samples resulting in a conviction of any representative of manufacturer or distributor in any 10-year period 2019 105,194 107,050 333(b)(2)(B) FDA Penalty for violation related to drug samples resulting in a conviction of any representative of manufacturer or distributor after the second conviction in any 10-yr period 2019 2,146,800 2,184,670 333(b)(3) FDA Penalty for failure to make a report required by 21 U.S.C. 353(d)(3)(E) relating to drug samples 2019 210,386 214,097 333(f)(1)(A) FDA Penalty for any person who violates a requirement related to devices for each such violation 2019 28,413 28,914 Penalty for aggregate of all violations related to devices in a single proceeding 2019 1,894,261 1,927,676 333(f)(2)(A) FDA Penalty for any individual who introduces or delivers for introduction into interstate commerce food that is adulterated per 21 U.S.C. 342(a)(2)(B) or any individual who does not comply with a recall order under 21 U.S.C. 350l 2019 79,875 81,284 Penalty in the case of any other person other than an individual) for such introduction or delivery of adulterated food 2019 399,374 406,419 Penalty for aggregate of all such violations related to adulterated food adjudicated in a single proceeding 2019 798,747 812,837 333(f)(3)(A) FDA Penalty for all violations adjudicated in a single proceeding for any person who violates 21 U.S.C. 331(jj) by failing to submit the certification required by 42 U.S.C. 282(j)(5)(B) or knowingly submitting a false certification; by failing to submit clinical trial information under 42 U.S.C. 282(j); or by submitting clinical trial information under 42 U.S.C. 282(j) that is false or misleading in any particular under 42 U.S.C. 282(j)(5)(D) 2019 12,103 12,316 333(f)(3)(B) FDA Penalty for each day any above violation is not corrected after a 30-day period following notification until the violation is corrected 2019 12,103 12,316 333(f)(4)(A)(i) FDA Penalty for any responsible person that violates a requirement of 21 U.S.C. 355(o) (post-marketing studies, clinical trials, labeling), 21 U.S.C. 355(p) (risk evaluation and mitigation (REMS)), or 21 U.S.C. 355-1 (REMS) 2019 302,585 307,923 Penalty for aggregate of all such above violations in a single proceeding 2019 1,210,340 1,231,690 333(f)(4)(A)(ii) FDA Penalty for REMS violation that continues after written notice to the responsible person for the first 30-day period (or any portion thereof) the responsible person continues to be in violation 2019 302,585 307,923 Penalty for REMS violation that continues after written notice to responsible person doubles for every 30-day period thereafter the violation continues, but may not exceed penalty amount for any 30-day period 2019 1,210,340 1,231,690 Penalty for aggregate of all such above violations adjudicated in a single proceeding 2019 12,103,404 12,316,908 333(f)(9)(A) FDA Penalty for any person who violates a requirement which relates to tobacco products for each such violation 2019 17,547 17,857 Penalty for aggregate of all such violations of tobacco product requirement adjudicated in a single proceeding 2019 1,169,798 1,190,433 333(f)(9)(B)(i)(I) FDA Penalty per violation related to violations of tobacco requirements 2019 292,450 297,609 Penalty for aggregate of all such violations of tobacco product requirements adjudicated in a single proceeding 2019 1,169,798 1,190,433 333(f)(9)(B)(i)(II) FDA Penalty in the case of a violation of tobacco product requirements that continues after written notice to such person, for the first 30-day period (or any portion thereof) the person continues to be in violation 2019 292,450 297,609 Penalty for violation of tobacco product requirements that continues after written notice to such person shall double for every 30-day period thereafter the violation continues, but may not exceed penalty amount for any 30-day period 2019 1,169,798 1,190,433 Penalty for aggregate of all such violations related to tobacco product requirements adjudicated in a single proceeding 2019 11,697,983 11,904,335 333(f)(9)(B)(ii)(I) FDA Penalty for any person who either does not conduct post-market surveillance and studies to determine impact of a modified risk tobacco product for which the HHS Secretary has provided them an order to sell, or who does not submit a protocol to the HHS Secretary after being notified of a requirement to conduct post-market surveillance of such tobacco products 2019 292,450 297,609 Penalty for aggregate of for all such above violations adjudicated in a single proceeding 2019 1,169,798 1,190,433 333(f)(9)(B)(ii)(II) FDA Penalty for violation of modified risk tobacco product post-market surveillance that continues after written notice to such person for the first 30-day period (or any portion thereof) that the person continues to be in violation 2019 292,450 297,609 Penalty for post-notice violation of modified risk tobacco product post-market surveillance shall double for every 30-day period thereafter that the tobacco product requirement violation continues for any 30-day period, but may not exceed penalty amount for any 30-day period 2019 1,169,798 1,190,433 Penalty for aggregate above tobacco product requirement violations adjudicated in a single proceeding 2019 11,697,983 11,904,335 333(g)(1) FDA Penalty for any person who disseminates or causes another party to disseminate a direct-to-consumer advertisement that is false or misleading for the first such violation in any 3-year period 2019 302,585 307,923 Penalty for each subsequent above violation in any 3-year period 2019 605,171 615,846 333 note FDA Penalty to be applied for violations of 21 U.S.C. 387f(d)(5) or of violations of restrictions on the sale or distribution of tobacco products promulgated under 21 U.S.C. 387f(d) (e.g., violations of regulations in 21 CFR part 1140) with respect to a retailer with an approved training program in the case of a second regulation violation within a 12-month period 2019 292 297 Penalty in the case of a third violation of 21 U.S.C. 387f(d)(5) or of the tobacco product regulations within a 24-month period 2019 584 594 Penalty in the case of a fourth violation of 21 U.S.C. 387f(d)(5) or of the tobacco product regulations within a 24-month period 2019 2,340 2,381 Penalty in the case of a fifth violation of 21 U.S.C. 387f(d)(5) or of the tobacco product regulations within a 36-month period 2019 5,849 5,952 Penalty in the case of a sixth or subsequent violation of 21 U.S.C. 387f(d)(5) or of the tobacco product regulations within a 48-month period as determined on a case-by-case basis 2019 11,698 11,904 Penalty to be applied for violations of 21 U.S.C. 387f(d)(5) or of violations of restrictions on the sale or distribution of tobacco products promulgated under 21 U.S.C. 387f(d) (e.g., violations of regulations in 21 CFR part 1140) with respect to a retailer that does not have an approved training program in the case of the first regulation violation 2019 292 297 Penalty in the case of a second violation of 21 U.S.C. 387f(d)(5) or of the tobacco product regulations within a 12-month period 2019 584 594 Penalty in the case of a third violation of 21 U.S.C. 387f(d)(5) or of the tobacco product regulations within a 24-month period 2019 1,170 1,191 Penalty in the case of a fourth violation of 21 U.S.C. 387f(d)(5) or of the tobacco product regulations within a 24-month period 2019 2,340 2,381 Penalty in the case of a fifth violation of 21 U.S.C. 387f(d)(5) or of the tobacco product regulations within a 36-month period 2019 5,849 5,952 Penalty in the case of a sixth or subsequent violation of 21 U.S.C. 387f(d)(5) or of the tobacco product regulations within a 48-month period as determined on a case-by-case basis 2019 11,698 11,904 335b(a) FDA Penalty for each violation for any individual who made a false statement or misrepresentation of a material fact, bribed, destroyed, altered, removed, or secreted, or procured the destruction, alteration, removal, or secretion of, any material document, failed to disclose a material fact, obstructed an investigation, employed a consultant who was debarred, debarred individual provided consultant services 2019 445,846 453,711 Penalty in the case of any other person (other than an individual) per above violation 2019 1,783,384 1,814,843 360pp(b)(1) FDA Penalty for any person who violates any such requirements for electronic products, with each unlawful act or omission constituting a separate violation 2019 2,924 2,976 Penalty imposed for any related series of violations of requirements relating to electronic products 2019 996,806 1,014,390 42 U.S.C 2019 262(d) FDA Penalty per day for violation of order of recall of biological product presenting imminent or substantial hazard 2019 229,269 233,313 263b(h)(3) FDA Penalty for failure to obtain a mammography certificate as required 2019 17,834 18,149 300aa-28(b)(1) FDA Penalty per occurrence for any vaccine manufacturer that intentionally destroys, alters, falsifies, or conceals any record or report required 2019 229,269 233,313 256b(d)(1)(B)(vi) HRSA Penalty for each instance of overcharging a 340B covered entity 2019 5,781 5,883 299c-(3)(d) AHRQ Penalty for an establishment or person supplying information obtained in the course of activities for any purpose other than the purpose for which it was supplied 2019 15,034 15,299 653(l)(2) 45 CFR 303.21(f) ACF Penalty for Misuse of Information in the National Directory of New Hires 2019 1,542 1,569 262a(i)(1) 42 CFR 1003.910 OIG Penalty for each individual who violates safety and security procedures related to handling dangerous biological agents and toxins 2019 348,708 354,859 Penalty for any other person who violates safety and security procedures related to handling dangerous biological agents and toxins 2019 697,418 709,720 300jj-51 OIG Penalty per violation for committing information blocking 2019 1,063,260 1,082,016 1320a-7a(a) 42 CFR 1003.210(a)(1) OIG Penalty for knowingly presenting or causing to be presented to an officer, employee, or agent of the United States a false claim 2019 20,504 20,866 Penalty for knowingly presenting or causing to be presented a request for payment which violates the terms of an assignment, agreement, or PPS agreement 2019 20,504 20,866 42 CFR 1003.210(a)(2) Penalty for knowingly giving or causing to be presented to a participating provider or supplier false or misleading information that could reasonably be expected to influence a discharge decision 2019 30,757 31,300 42 CFR 1003.210(a)(3) Penalty for an excluded party retaining ownership or control interest in a participating entity 2019 20,504 20,866 42 CFR 1003.1010 Penalty for remuneration offered to induce program beneficiaries to use particular providers, practitioners, or suppliers 2019 20,504 20,866 42 CFR 1003.210(a)(4) Penalty for employing or contracting with an excluded individual 2019 20,504 20,866 42 CFR 1003.310(a)(3) Penalty for knowing and willful solicitation, receipt, offer, or payment of remuneration for referring an individual for a service or for purchasing, leasing, or ordering an item to be paid for by a Federal health care program 2019 102,522 104,330 42 CFR 1003.210(a)(1) Penalty for ordering or prescribing medical or other item or service during a period in which the person was excluded 2019 20,504 20,866 42 CFR 1003.210(a)(6) Penalty for knowingly making or causing to be made a false statement, omission or misrepresentation of a material fact in any application, bid, or contract to participate or enroll as a provider or supplier 2019 102,522 104,330 42 CFR 1003.210(a)(8) Penalty for knowing of an overpayment and failing to report and return 2019 20,504 20,866 42 CFR 1003.210(a)(7) Penalty for making or using a false record or statement that is material to a false or fraudulent claim 2019 57,812 58,832 42 CFR 1003.210(a)(9) Penalty for failure to grant timely access to HHS OIG for audits, investigations, evaluations, and other statutory functions of HHS OIG 2019 30,757 31,300 1320a-7a(b) OIG Penalty for payments by a hospital or critical access hospital to induce a physician to reduce or limit services to individuals under direct care of physician or who are entitled to certain medical assistance benefits 2019 5,126 5,216 Penalty for physicians who knowingly receive payments from a hospital or critical access hospital to induce such physician to reduce or limit services to individuals under direct care of physician or who are entitled to certain medical assistance benefits 2019 5,126 5,216 42 CFR 1003.210(a)(10) Penalty for a physician who executes a document that falsely certifies home health needs for Medicare beneficiaries 2019 10,252 10,433 1320a-7a(o) OIG Penalty for knowingly presenting or causing to be presented a false or fraudulent specified claim under a grant, contract, or other agreement for which the Secretary provides funding 2016 10,000 10,176 Penalty for knowingly making, using, or causing to be made or used any false statement, omission, or misrepresentation of a material fact in any application, proposal, bid, progress report, or other document required to directly or indirectly receive or retain funds provided pursuant to grant, contract, or other agreement 2016 50,000 50,882 Penalty for Knowingly making, using, or causing to be made or used, a false record or statement material to a false or fraudulent specified claim under grant, contract, or other agreement 2016 50,000 50,882 Penalty for knowingly making, using, or causing to be made or used, a false record or statement material to an obligation to pay or transmit funds or property with respect to grant, contract, or other agreement, or knowingly conceals or improperly avoids or decreases any such obligation 2016 50,000 for each false record or statement, 10,000 per day.

Penalty for failure to grant timely access, upon reasonable request, to the Inspector General (I.G.) for purposes of audits, investigations, evaluations, or other statutory functions of I.G. in matters involving grants, contracts, or other agreements 2016 15,000 15,265 1320a-7e(b)(6)(A) 42 CFR 1003.810 OIG Penalty for failure to report any final adverse action taken against a health care provider, supplier, or practitioner 2019 39,121 39,811 1320b-10(b)(1) 42 CFR 1003.610(a) OIG Penalty for the misuse of words, symbols, or emblems in communications in a manner in which a person could falsely construe that such item is approved, endorsed, or authorized by HHS 2019 10,519 10,705 1320b-10(b)(2) 42 CFR 1003.610(a) OIG Penalty for the misuse of words, symbols, or emblems in a broadcast or telecast in a manner in which a person could falsely construe that such item is approved, endorsed, or authorized by HHS 2019 52,596 53,524 1395i-3(b)(3)(B)(ii)(1) 42 CFR 1003.210(a)(11) OIG Penalty for certification of a false statement in assessment of functional capacity of a Skilled Nursing Facility resident assessment 2019 2,194 2,233 1395i-3(b)(3)(B)(ii)(2) 42 CFR 1003.210(a)(11) OIG Penalty for causing another to certify or make a false statement in assessment of functional capacity of a Skilled Nursing Facility resident assessment 2019 10,967 11,160 1395i-3(g)(2)(A) 42 CFR 1003.1310 OIG Penalty for any individual who notifies or causes to be notified a Skilled Nursing Facility of the time or date on which a survey is to be conducted 2019 4,388 4,465 1395w-27(g)(2)(A) 42 CFR 1003.410 OIG Penalty for a Medicare Advantage organization that substantially fails to provide medically necessary, required items and services 2019 39,936 40,640 Penalty for a Medicare Advantage organization that charges excessive premiums 2019 39,121 39,811 Penalty for a Medicare Advantage organization that improperly expels or refuses to reenroll a beneficiary 2019 39,121 39,811 Penalty for a Medicare Advantage organization that engages in practice that would reasonably be expected to have the effect of denying or discouraging enrollment 2019 156,488 159,248 Penalty per individual who does not enroll as a result of a Medicare Advantage organization's practice that would reasonably be expected to have the effect of denying or discouraging enrollment 2019 23,473 23,887 Penalty for a Medicare Advantage organization misrepresenting or falsifying information to Secretary 2019 156,488 159,248 Penalty for a Medicare Advantage organization misrepresenting or falsifying information to individual or other entity 2019 39,121 39,811 Penalty for Medicare Advantage organization interfering with provider's advice to enrollee and non-managed care organization (MCO) affiliated providers that balance bill enrollees 2019 39,121 39,811 Penalty for a Medicare Advantage organization that employs or contracts with excluded individual or entity 2019 39,121 39,811 Penalty for a Medicare Advantage organization enrolling an individual in without prior written consent 2019 39,121 39,811 Penalty for a Medicare Advantage organization transferring an enrollee to another plan without consent or solely for the purpose of earning a commission 2019 39,121 39,811 Penalty for a Medicare Advantage organization failing to comply with marketing restrictions or applicable implementing regulations or guidance 2019 39,121 39,811 Penalty for a Medicare Advantage organization employing or contracting with an individual or entity who violates 1395w-27(g)(1)(A)-(J) 2019 39,121 39,811 1395w-141(i)(3) OIG Penalty for a prescription drug card sponsor that falsifies or misrepresents marketing materials, overcharges program enrollees, or misuse transitional assistance funds 2019 13,669 13,910 1395cc(g) OIG Penalty for improper billing by Hospitals, Critical Access Hospitals, or Skilled Nursing Facilities 2019 5,317 5,411 1395dd(d)(1) 42 CFR 1003.510 OIG Penalty for a hospital or responsible physician dumping patients needing emergency medical care, if the hospital has 100 beds or more 2019 109,663 111,597 Penalty for a hospital or responsible physician dumping patients needing emergency medical care, if the hospital has less than 100 beds 2019 54,833 55,800 1395mm(i)(6)(B)(i) 42 CFR 1003.410 OIG Penalty for a health maintenance organization (HMO) or competitive plan is such plan substantially fails to provide medically necessary, required items or services 2019 54,833 55,800 Penalty for HMOs/competitive medical plans that charge premiums in excess of permitted amounts 2019 54,833 55,800 Penalty for a HMO or competitive medical plan that expels or refuses to reenroll an individual per prescribed conditions 2019 54,833 55,800 Penalty for a HMO or competitive medical plan that implements practices to discourage enrollment of individuals needing services in future 2019 219,327 223,196 Penalty per individual not enrolled in a plan as a result of a HMO or competitive medical plan that implements practices to discourage enrollment of individuals needing services in the future 2019 31,558 32,115 Penalty for a HMO or competitive medical plan that misrepresents or falsifies information to the Secretary 2019 219,327 223,196 Penalty for a HMO or competitive medical plan that misrepresents or falsifies information to an individual or any other entity 2019 54,833 55,800 Penalty for failure by HMO or competitive medical plan to assure prompt payment of Medicare risk sharing contracts or incentive plan provisions 2019 54,833 55,800 Penalty for HMO that employs or contracts with excluded individual or entity 2019 50,334 51,222 1395nn(g)(3) 42 CFR 1003.310 OIG Penalty for submitting or causing to be submitted claims in violation of the Stark Law's restrictions on physician self-referrals 2019 25,372 25,820 1395nn(g)(4) 42 CFR 1003.310 OIG Penalty for circumventing Stark Law's restrictions on physician self-referrals 2019 169,153 172,137 1395ss(d)(1) 42 CFR 1003.1110 OIG Penalty for a material misrepresentation regarding Medigap compliance policies 2019 10,519 10,705 1395ss(d)(2) 42 CFR 1003.1110 OIG Penalty for selling Medigap policy under false pretense 2019 10,519 10,705 1395ss(d)(3)(A)(ii) 42 CFR 1003.1110 OIG Penalty for an issuer that sells health insurance policy that duplicates benefits 2019 47,357 48,192 Penalty for someone other than issuer that sells health insurance that duplicates benefits 2019 28,413 28,914 1395ss(d)(4)(A) 42 CFR 1003.1110 OIG Penalty for using mail to sell a non-approved Medigap insurance policy 2019 10,519 10,705 1396b(m)(5)(B)(i) 42 CFR 1003.410 OIG Penalty for a Medicaid MCO that substantially fails to provide medically necessary, required items or services 2019 52,596 53,524 Penalty for a Medicaid MCO that charges excessive premiums 2019 52,596 53,524 Penalty for a Medicaid MCO that improperly expels or refuses to reenroll a beneficiary 2019 210,386 214,097 Penalty per individual who does not enroll as a result of a Medicaid MCO's practice that would reasonably be expected to have the effect of denying or discouraging enrollment 2019 31,558 32,115 Penalty for a Medicaid MCO misrepresenting or falsifying information to the Secretary 2019 210,386 214,097 Penalty for a Medicaid MCO misrepresenting or falsifying information to an individual or another entity 2019 52,596 53,524 Penalty for a Medicaid MCO that fails to comply with contract requirements with respect to physician incentive plans 2019 47,357 48,192 1396r(b)(3)(B)(ii)(I) 42 CFR 1003.210(a)(11) OIG Penalty for willfully and knowingly certifying a material and false statement in a Skilled Nursing Facility resident assessment 2019 2,194 2,233 1396r(b)(3)(B)(ii)(II) 42 CFR 1003.210(a)(11) OIG Penalty for willfully and knowingly causing another individual to certify a material and false statement in a Skilled Nursing Facility resident assessment 2019 10,967 11,160 1396r(g)(2)(A)(i) 42 CFR 1003.1310 OIG Penalty for notifying or causing to be notified a Skilled Nursing Facility of the time or date on which a survey is to be conducted 2019 4,388 4,465 1396r-8(b)(3)(B) 42 CFR 1003.1210 OIG Penalty for the knowing provision of false information or refusing to provide information about charges or prices of a covered outpatient drug 2019 189,427 192,768 1396r-8(b)(3)(C)(i) 42 CFR 1003.1210 OIG Penalty per day for failure to timely provide information by drug manufacturer with rebate agreement 2019 18,943 19,277 1396r-8(b)(3)(C)(ii) 42 CFR 1003.1210 OIG Penalty for knowing provision of false information by drug manufacturer with rebate agreement 2019 189,427 192,768 1396t(i)(3)(A) 42 CFR 1003.1310 OIG Penalty for notifying home and community-based providers or settings of survey 2019 3,788 3,855 11131(c) 42 CFR 1003.810 OIG Penalty for failing to report a medical malpractice claim to National Practitioner Data Bank 2019 22,927 23,331 11137(b)(2) 42 CFR 1003.810 OIG Penalty for breaching confidentiality of information reported to National Practitioner Data Bank 2019 22,927 23,331 299b-22(f)(1) 42 CFR 3.404 OCR Penalty for violation of confidentiality provision of the Patient Safety and Quality Improvement Act 2019 12,695 12,919 45 CFR 160.404(b)(1)(i), (ii) OCR Penalty for each pre-February 18, 2009 violation of the Health Insurance Portability and Accountability Act (HIPAA) administrative simplification provisions 2019 159 162 Calendar Year Cap 2019 39,936 40,640 1320(d)-5(a) 45 CFR 160.404(b)(2)(i)(A), (B) OCR Penalty for each February 18, 2009 or later violation of a HIPAA administrative simplification provision in which it is established that the covered entity or business associate did not know and by exercising reasonable diligence, would not have known that the covered entity or business associate violated such a provision: Minimum 2019 117 119 Maximum 2019 58,490 59,522 Calendar Year Cap 2019 1,754,698 1,785,651 45 CFR 160.404(b)(2)(ii)(A), (B) OCR Penalty for each February 18, 2009 or later violation of a HIPAA administrative simplification provision in which it is established that the violation was due to reasonable cause and not to willful neglect: Minimum 2019 1,170 1,191 Maximum 2019 58,490 59,522 Calendar Year Cap 2019 1,754,698 1,785,651 45 CFR 160.404(b)(2)(iii)(A), (B) OCR Penalty for each February 18, 2009 or later violation of a HIPAA administrative simplification provision in which it is established that the violation was due to willful neglect and was corrected during the 30-day period beginning on the first date the covered entity or business associate knew, or, by exercising reasonable diligence, would have known that the violation occurred: Minimum 2019 11,698 11,904 Maximum 2019 58,490 59,522 Calendar Year Cap 2019 1,754,698 1,785,651 45 CFR 160.404(b)(2)(iv)(A), (B) OCR Penalty for each February 18, 2009 or later violation of a HIPAA administrative simplification provision in which it is established that the violation was due to willful neglect and was not corrected during the 30-day period beginning on the first date the covered entity or business associate knew, or by exercising reasonable diligence, would have known that the violation occurred: Minimum 2019 58,490 59,522 Maximum 2019 1,754,698 1,785,651 Calendar Year Cap 2019 1,754,698 1,785,651 263a(h)(2)(B) & 1395w-2(b)(2)(A)(ii) 42 CFR 493.1834(d)(2)(i) CMS Penalty for a clinical laboratory's failure to meet participation and certification requirements and poses immediate jeopardy: Minimum 2019 6,417 6,530 Maximum 2019 21,039 21,410 42 CFR 493.1834(d)(2)(ii) CMS Penalty for a clinical laboratory's failure to meet participation and certification requirements and the failure does not pose immediate jeopardy: Minimum 2019 106 108 Maximum 2019 6,311 6,422 300gg-15(f) 45 CFR 147.200(e) CMS Failure to provide the Summary of Benefits and Coverage 2019 1,156 1,176 300gg-18 45 CFR 158.606 CMS Penalty for violations of regulations related to the medical loss ratio reporting and rebating 2019 116 118 1320a-7h(b)(1) 42 CFR 402.105(d)(5), 42 CFR 403.912(a) & (c) CMS Penalty for manufacturer or group purchasing organization failing to report information required under 42 U.S.C. 1320a-7h(a), relating to physician ownership or investment interests: Minimum 2019 1,156 1,176 Maximum 2019 11,562 11,766 Calendar Year Cap 2019 173,436 176,495 1320a-7h(b)(2) 42 CFR 402.105(h), 42 CFR 403.912(b) & (c) CMS Penalty for manufacturer or group purchasing organization knowingly failing to report information required under 42 U.S.C. 1320a-7h(a), relating to physician ownership or investment interests: Minimum 2019 11,562 11,766 Maximum 2019 115,624 117,664 Calendar Year Cap 2019 1,156,242 1,176,638 CMS Penalty for an administrator of a facility that fails to comply with notice requirements for the closure of a facility 2019 115,624 117,664 1320a-7j(h)(3)(A) 42 CFR 488.446(a)(1), (2), & (3) CMS Minimum penalty for the first offense of an administrator who fails to provide notice of facility closure 2019 578 588 Minimum penalty for the second offense of an administrator who fails to provide notice of facility closure 2019 1,735 1,766 Minimum penalty for the third and subsequent offenses of an administrator who fails to provide notice of facility closure 2019 3,468 3,529 1320a-8(a)(1) CMS Penalty for an entity knowingly making a false statement or representation of material fact in the determination of the amount of benefits or payments related to old-age, survivors, and disability insurance benefits, special benefits for certain World War II veterans, or supplemental security income for the aged, blind, and disabled 2019 8,457 8,606 Penalty for violation of 42 U.S.C. 1320a-8(a)(1) if the violator is a person who receives a fee or other income for services performed in connection with determination of the benefit amount or the person is a physician or other health care provider who submits evidence in connection with such a determination 2019 7,975 8,116 1320a-8(a)(3) CMS Penalty for a representative payee (under 42 U.S.C. 405(j), 1007, or 1383(a)(2)) converting any part of a received payment from the benefit programs described in the previous civil monetary penalty to a use other than for the benefit of the beneficiary 2019 6,623 6,740 1320b-25(c)(1)(A) CMS Penalty for failure of covered individuals to report to the Secretary and 1 or more law enforcement officials any reasonable suspicion of a crime against a resident, or individual receiving care, from a long-term care facility 2019 231,249 235,328 1320b-25(c)(2)(A) CMS Penalty for failure of covered individuals to report to the Secretary and 1 or more law enforcement officials any reasonable suspicion of a crime against a resident, or individual receiving care, from a long-term care facility if such failure exacerbates the harm to the victim of the crime or results in the harm to another individual 2019 346,872 352,991 1320b-25(d)(2) CMS Penalty for a long-term care facility that retaliates against any employee because of lawful acts done by the employee, or files a complaint or report with the State professional disciplinary agency against an employee or nurse for lawful acts done by the employee or nurse 2019 231,249 235,328 1395b-7(b)(2)(B) 42 CFR 402.105(g) CMS Penalty for any person who knowingly and willfully fails to furnish a beneficiary with an itemized statement of items or services within 30 days of the beneficiary's request 2019 156 159 1395i-3(h)(2)(B)(ii)(I) 42 CFR 488.408(d)(1)(iii) CMS Penalty per day for a Skilled Nursing Facility that has a Category 2 violation of certification requirements: Minimum 2019 110 112 Maximum 2019 6,579 6,695 42 CFR 488.408(d)(1)(iv) CMS Penalty per instance of Category 2 noncompliance by a Skilled Nursing Facility: Minimum 2019 2,194 2,233 Maximum 2019 21,933 22,320 42 CFR 488.408(e)(1)(iii) CMS Penalty per day for a Skilled Nursing Facility that has a Category 3 violation of certification requirements: Minimum 2019 6,690 6,808 Maximum 2019 21,933 22,320 42 CFR 488.408(e)(1)(iv) CMS Penalty per instance of Category 3 noncompliance by a Skilled Nursing Facility: Minimum 2019 2,194 2,233 Maximum 2019 21,933 22,320 42 CFR 488.408(e)(2)(ii) CMS Penalty per day and per instance for a Skilled Nursing Facility that has Category 3 noncompliance with Immediate Jeopardy: Per Day (Minimum) 2019 6,690 6,808 Per Day (Maximum) 2019 21,933 22,320 Per Instance (Minimum) 2019 2,194 2,233 Per Instance (Maximum) 2019 21,933 22,320 42 CFR 488.438(a)(1)(i) CMS Penalty per day of a Skilled Nursing Facility that fails to meet certification requirements.

411. 
     
412. The Kennedy Forum @kennedyforum American Psychological Association @APA (APA) advances psychological science to promote health, education and human welfare.
413. Dr.Vivek Murthy, U.S. Surgeon General @Surgeon_General 19th & 21st U.S. Surgeon General.
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429. This is an archive of an Obama Administration account maintained by the National Archives and Records Administration (NARA)udge Jackson appointed the Southern Poverty Law Center, National Health Law Program, National Center for Law and Economic Justice, Disability Rights Louisiana, and O'Melveny & Myers, LLP as legal counsel for the class.
430. The class counsel would like to hear from you if you believe you are a class member or you are impacted by this lawsuit.
431. If you or a child in your care is a Medicaid recipient under age 21 who has been unable to get Medicaid home or community-based mental health or behavioral health services, please contact the Southern Poverty Law Center at: or 1-800-358-2337.