Medicare/Medicaid Exclusion

I posted this today but it showed up when I first began writing it, so I wanted to put a post today so that those of you that look for new entries would see it.

Basic Information about Nursing Boards

Be sure to check out my new article "The Nurse Police". I explain the role of Nursing Boards and some basic steps nurses can take to protect themselves.

Medicare/Medicaid Exclusion

You decided that you can't fight the Nursing Board any longer or something has come up that affects your ability to fight the Nursing Board, so you decide to voluntarily surrender your nursing license or perhaps the Board suspends or revokes your license, so you decide that you will work as a nurse's aide or maybe a tech in a hospital or clinic. However, if the cause of the suspension or revocation is one designated by the Social Security Act as a practice violation that merits action, you may find yourself unable to even work as an aide or tech.

The specific law is: Pursuant to section 1128(b)(4) of the Social Security Act, the Office of the Inspector General may exclude an individual or entity-

(A) whose license to provide health care has been revoked or suspended by any State licensing authority, or who otherwise lost such a license or the right to apply for or renew such a license, for reasons bearing on the individual's or entity's professional competence, professional performance, or financial integrity, or

(B) who surrendered such a license while a formal disciplinary proceeding was pending before such an authority and the proceeding concerned the individual's or entity's professional competence, professional performance, or financial integrity.

Pursuant to section 1128(c)(3)(E) of the Act, the length of an exclusion under section 1128(b)(4) -

shall not be less than the period during which the individual's or entity's license to provide health care is revoked, suspended, or surrendered, or the individual or entity is excluded or suspended from a Federal or State health care program.

So, what this means is that you are not allowed to work for any entity, no matter what your role, that receives Medicare/Medicaid funding. Also, when the exclusion period is over, you have to make a formal request to be removed from the excluded list; your name is not automatically removed when the time is up. There are many more caveats to this law, but this is just a quick glance in order to warn nurses that may be looking at voluntary surrender.

Administrative Hearings- What are Those?

Having spoken with several nurses recently, it is obvious that an Administrative Hearing is not well understood. A hearing in Administrative Law is comparable to a trial in criminal or civil courts. The main exception is that there is no jury in Administrative Law and some of the evidence rules are different. But, an Administrative Hearing is just as serious as a criminal case or a civil lawsuit.

The Texas Board of Nursing does not usually go to a hearing at the State Office of Administrative Hearings (SOAH)with a nurse unless the allegations are serious or the Board has not been able to obtain a response from the nurse or the parties have not been able to resolve the case through negotiations. The case may not be negotiated either because the nurse does not believe she/he did anything wrong, or they do not agree with the severity of the proposed restrictions by the Board.

Hearings are very expensive and time consuming and there is little control over the outcome, which are the reasons I try to avoid hearings. The Board is usually reasonable and a negotiated agreement that the nurse is content with and that protects the public can usually be reached by the parties. However, this is not always true and at times the only solution is to proceed to a hearing in order to protect one's rights.

The key hint to nurses is to NOT ignore the correspondence sent by the Board and to be sure and seek appropriate legal advice when that correspondence is received.

Help for Nurses Accused of Impairment

The Texas Board of Nursing and TPAPN have developed a program called the Extended Evaluation Program (EEP) that promises to be a big help to those nurses accused of substance abuse, that have a positive drug screen, but that have been evaluated as having a low probability of substance abuse. Think about a situation where a nurse took a pain pill and then was screened at work and came up positive. The nurse is adamant that he/she does not have a problem with drugs and is not a candidate for traditional TPAPN. The Board wants to monitor the nurse to assure that the nurse does not have an issue with drugs or alcohol. EEP seems to be the answer.

EEP allows TPAPN to screen the nurse for drugs and alcohol for a year. Participation in EEP is confidential and if after one year, the nurse remained compliant with the program, the matter is dismissed. Because the program is so new, I have not heard of any issues or problems.