Security Breach at Indiana State Department of Health
Posted by: Robert Markette
March 15, 2007

According to an announcement from ISDH today, its website was hacked. The hackers were able to obtain a information on home health aides and certified nursing assistants who were in the state?s system in July 2005. The number of individuals affected is in the thousands. The information obtained by the hackers included names, addresses, and social security numbers.

Like many providers who have had recent security incidents, ISDH is sending out notice to all persons who may be impacted by this security breach. They have also taken action to fix the technical failure that allowed the security breach. Indiana is one of a growing number of states that requires notification to individuals when there is a breach that results in disclosure of their personal information.

ISDH?s letter to the Home Health Aides is another example of how to notify affected individuals of a security breach. (I received a copy from the IAHHC list serve. I am attaching it to this post, because I know some providers have wondered how to put this kind of letter together. It has been widely distributed by the state and various Indiana trade associations.) It does not explain in great detail how the breach occurred, but it tells the reader there was a breach and what information was involved. It then immediately expresses ISDH?s apology for the inconvenience and concern that has resulted.

Then recommends monitoring your credit and placing a fraud alert on your credit report. The fraud alert tells creditors to take extra steps when opening credit and other accounts. The letter provides the reader with information on obtaining a credit report and how to place a fraud alert. It also includes the names of the major credit reporting bureaus. It is a good idea to include this information in the letter, to make it as easy as possible for your patients to take action.

ISDH also opened a hotline for people with questions. The need to open a dedicate hotline is a separate question. For many home health providers you may not have a sufficient number of patients to justify a dedicated hotline. Hotlines can be expensive to operate, due to phone line costs, equipment costs, and the need for additional personnel. Many providers may be able to handle the calls resulting from a notification letter by simply having the privacy officer or another designated individual handle the calls.

The notice letter by ISDH is a pretty standard letter and is a good model to use if you ever have to notify patients of a security breach and are not sure where to start. The apology is a good idea as well. You would be surprised at how many lawsuits are averted by a simple apology.

In the majority of states, if you have EPHI disclosed as the result of a security breach, you will need to notify the patients whose information was involved. Of course, before you send a letter like this out after a security incident, you should discuss it with your lawyer. If you get sued, the letter may become evidence against you, but the letter may also lessen the likelihood of a lawsuit, if it leaves your patients feeling like you are doing everything you can and regret the unfortunate incident.

Attachments:
INCNAnotificationletterFINAL031207.doc

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Indiana proposes rule to reimburse for telemedicine
Posted by: Robert Markette
June 01, 2006

Indiana?s Family and Social Services Administration (?FSSA?) has published a proposed rule in the Indiana Register that would allow for telemedicine to be reimbursed by Medicaid. A copy of the rule is attached to this post.  In the comments, FSSA recognizes that reimbursing for telemedicine services would save the state money and make specialty medical care available to individuals in rural settings.

Unfortunately, the proposed rule allows for reimbursement of telemedicine services in a very narrow set of circumstances.The definition of telemedicine does not create any new ?services? that are reimbursable, but simply allows for the reimbursement of services when provided via video teleconference. Of course, this may rule out a number of telemedicine technologies that can improve the quality of home care for patients, but that do not involve video teleconferencing.

For home care, this would not necessarily be fatal, because most home computers can now handle video teleconferencing. However, the rule includes a list of services that are not reimbursable as telemedicine services. This list includes home health services and waiver services.

Although most home health and waiver services are ?hands on? and would not lend themselves to remote delivery, there is a growing trend to use telehealth in home health care. This is a trend encouraged by the Centers for Medicare and Medicaid Services. FSSA has overlooked the ways that telemedicine can improve home care and save the state money as well.For those of you who were hoping Indiana was going to start reimbursing for telemedicine, it appears Indiana is finally recognizing the growing trend. However, FSSA needs to be made aware of the uses of telemedicine in home care, so that they might consider a more detailed rule that would allow for telemedicine?s use in home care.

The public hearing for this rule is set for June 22, 2006, at the Indiana Government Center-South, 402 West Washington Street, Conference Center Room 2, Indianapolis, Indiana. That is the home care provider community?s chance to enlighten FSSA as to the uses of telemedicine in home care and try to convince FSSA to specifically address the use of telemedicine in home care.

Attachments:
08P405060029.PDF

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Nurse Shortage Even Impacting Schools
Posted by: Robert Markette
December 15, 2005

I read an interesting article in yesterday's USA Today, "Nurse Shortage Puts School Kids at Risk", December 14, 2005.  The article does not have anything to do with home or hospice care, but it does show that the nursing shortage has a much wider reach.  It describes how the nursing shortage is even causing problems for schools.  According to the article, schools cannot find enough nurses to fill all the school nurse positions.  The story recounts the number of incidents and even deaths that have resulted from the lack of school nurses.  In some cases, a school nurse serves two or three schools and may actually be at one school when an issue arises at another.

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