A final rule again revising Sec. 1557 of the Affordable Care Act protects gender identity, sexual orientation and pregnancy from sex discrimination and brings back notice and other requirements that were dropped from the 2020 version of the rule.^[1] The HHS Office for Civil Rights (OCR) and CMS, which released the rule April 26, also require covered entities to have a Sec. 1557 coordinator and grievance procedure and give patients a “notice of availability” about free language assistance and auxiliary aids, among other things. And there’s something brand new at the intersection of discrimination protections and artificial intelligence (AI).

To try to reduce the number of hospital discharge appeals, Kepro on May 1 added an informal process for patients who are troubled by their discharge planning, according to its website.^[1] The idea is to nip problems in the bud before moving on to a full-fledged appeal.

Kepro is one of two Beneficiary and Family-Centered Care-Quality Improvement Organizations (QIOs) with CMS contracts to decide appeals in real time from patients who disagree with the hospital’s decision to discharge them. There’s no word yet from the other QIO, Livanta, on whether it plans a similar process, although it now has an online appeal option.^[2]

Here’s a chart from the final Sec. 1557 rule,^[1] which was released by the HHS Office for Civil Rights and CMS on April 26 (see story, p. 1).^[2] It shows the various effective dates.

When a medical director was questioned about the veracity of his timesheet, he admitted to the hospital that it was only about 50% accurate. The hospital had a feeling it was paying more than fair market value for the physician’s administrative services because he spent most of the day performing surgeries and seeing patients at his private practice. But it was the physician’s explanation for exaggerating his medical-director hours that really raised eyebrows. He was including direct patient care services because he had convinced himself that “his mere presence in the hospital” counted toward his medical director hours, said attorney Bob Wade, with Nelson Mullins in Nashville, Tennessee, who did a compliance review of the medical director agreement.

New price transparency requirements take effect July 1 on the shoulders of other requirements that should have been met Jan. 1. With another deadline looming, hospitals may want to take advantage of CMS’s new online validator,^[1] which allows them to determine whether their machine-readable files (MRF) are in good shape. The stakes are high because CMS is taking enforcement seriously. It has already reviewed compliance with price transparency requirements at thousands of hospitals.

“No one is safe from being placed under the microscope,” said Martie Ross, a consulting principal with PYA, at its April 24 webinar.