Cell Phone third-party charges

By: Eileen Ambrose, The Baltimore Sun

Consumers also ought to review their cellphone bills each month for  unauthorized charges.

“Scam artists depend on hiding these small, vaguely worded charges among a  forest of fees on your cellphone,” Chilsen said. “It can be difficult to spot  them.”

If you notice one, contact the phone company immediately to dispute the  charge. Phone company policies differ, but consumers should offer to pay all of  their bill except the disputed charges.

Consumers also should file a complaint with the FTC or their state agency,  and let the phone company know they have done so.

To prevent further cramming, ask the phone company to block third-party  charges on your phone bill, a feature offered by many phone carriers

 

Compounding Pharmacy Regulations

By Scott Dance, The Baltimore Sun

Batches of sterile drugs from so-called compounding pharmacies will be subject to state review under the measure Gov. Martin  O’Malley signed this month. And pharmacists and doctors who perform compounding, in which drugs are somehow altered from their Food  and Drug Administration-approved form, will face an extra layer of permits  and inspections for drugs used in Maryland.

But “it’s not realistic for Maryland to set up national oversight,” said  Joshua M. Sharfstein, the state health secretary. 

The legislation is intended as a stopgap while the FDA seeks broader authority to inspect compounding centers that are neither state-regulated pharmacies nor federally regulated manufacturers. Much of the measure could become moot if Congress grants the FDA that authority — and state officials hope that it does, said Sharfstein, also a former FDA deputy commissioner.

A U.S.  Senate committee is set to review draft legislation addressing the  regulatory gap Thursday. Some Republicans in Congress argue that the FDA already has the power to regulate compounding operations, while the agency argues its legal authority is unclear.

The FDA and members of the pharmaceutical industry are expected to make their case in a hearing before the U.S. Senate Committee on Health, Education, Labor  and Pensions, which includes Sen. Barbara  A. Mikulski. Congress first considered legislation on compounding pharmacy regulation in November.

The new state law is one of several O’Malley signed to promote patient safety  — others tightened oversight of plastic surgery procedures and required health  care staffing agencies to be licensed.

The Maryland law, which takes effect July 1, seeks to promote safety in  sterile drugs coming from facilities both inside and outside the state. Drugs  require sterility if they are administered via injections into muscles,  underneath the skin or directly into the bloodstream.

For 110 Maryland-licensed pharmacies that have already told state regulators  they perform compounding of sterile drugs, the law will require an additional  permit and more thorough inspections. Out-of-state pharmacies that perform  sterile compounding will also face stricter oversight if they send drugs into Maryland.

Pharmacies pay $700 for a pharmacy permit and $600 to renew permits every two  years; regulators have not determined how much the new compounding permit will cost. Anyone  operating a sterile compounding facility in the state without the permit will face a fine of up to $1,000 and up to a one-year prison sentence upon conviction of the misdemeanor, as well as a civil fine of up to $50,000.

But other types of facilities besides pharmacies produce sterile medications.  Some come directly from manufacturers, which are FDA-regulated.

The law covers a separate, unregulated group, like the New England center —  facilities that produce large batches of sterile drugs, without a prescription  for a specific individual. Drugs from those facilities will no longer be  permitted in Maryland without a waiver granted by the state pharmacy board.

The law sets a high bar for the drug waivers, allowing them only with proof  of facility inspections and other safeguards and if health officials deem a  critical need for the medication. It also sets a two-year expiration for the  drug waivers. Information about the waivers will be posted on the pharmacy  board’s website.

State health officials said that they don’t know how many waiver applications  they expect to receive, but that the information could help federal regulators  understand the scope of the gap in oversight.

“FDA’s authority in that area is very confusing,” Sharfstein said. “They’re  seeking more explicit authority, and we support that.”

FDA Commissioner Dr.  Margaret Hamburg has said a confusing legal landscape, combined with  resistance from compounding pharmacies, had hampered her agency’s ability to act on complaints received about the New England center. In hearings held as recently as last month, Hamburg asked Congress to allow the FDA to require compounding pharmacies to register with the agency “so we know who they are and  what they do.”

The broader FDA oversight could “at least 90 percent eliminate the need for the waiver provision” in the state law, Naesea said.

 

Hospital billing variations

By: Maggie Fox, www.msnbc.com

The federal government, for the first time, has published the prices charged by thousands of different U.S. hospitals, and the numbers confirm what health reform advocates have been screaming about for years: the charges vary enormously, and for seemingly unclear reasons.

“These rates can vary dramatically in ways that can’t be easily explained,” Health and Human Services Secretary Kathleen Sebelius told reporters in a telephone briefing. “Even within cities there can be massive variation in what consumers pay.”

What the Obama administration hopes is that publishing these prices will help force health care providers to be more consistent in their billing. It’s called transparency, and experts say a lack of price information is one of the single biggest forces that has driven up health care costs in the United States.

“Most perniciously, uninsured people are the ones who usually pay the highest prices for their hospital care. It is absurd – and, indeed, unconscionable – that the people least capable of paying for their hospital care bear the largest, and often unaffordable, cost burdens.”

The data uses billing information for the 100 most common hospital stays paid for by Medicare, from chronic obstructive pulmonary disease – mostly emphysema – to heart attacks, hip replacements and diabetes. The prices only cover Medicare, the federal health insurance plan for the elderly. Private insurers are often charged different prices, and people who pay cash are usually charged even more.

“Currently, consumers don’t know what a hospital is charging them or their insurance company for a given procedure, like a knee replacement, or how much of a price difference there is at different hospitals, even within the same city,” Sebelius said. “This data and new data centers will help fill that gap.”

“Making this available for free for the first time will save consumers money by arming them with information that can help them make better choices,” Sebelius said. But the prices aren’t those charged to patients upon walking in and the database does not easily allow consumers to compare the price of a procedure from one hospital to another.

And the prices don’t even reflect what Medicare actually pays. “We take out the variation that we see,” said Jonathan Blum, deputy administrator at the Centers for Medicare and Medicaid Services.

The data also does not include charges made by doctors — just the direct hospital charges. HHS officials said the hoped third parties would work to make the information more usable.

The nonprofit Robert Wood Johnson Foundation plans to publish a map based on the data, so people can choose where to be treated.

“Transformation of the health care delivery system cannot occur without greater price transparency,” says the group’s president, Dr. Risa Lavizzo-Mourey.  “While more work lies ahead, the release of these hospital price data will allow us to shine a light on the often vast variations in hospital charges.”

Hospitals said the data did not reflect their different costs. For instance, teaching hospitals said they have higher expenses. Other point out that some hospitals may bill separately for various items. But Blum said that does not explain some of the biggest variation in prices – sometimes 30-fold differences from one center to another.

“We cannot see any business reason why there is so much variation,” he told reporters.

 

Bill Emerson Good Samaritan Food Donation Act

Millions of pound of food and groceries go to waste each year. To encourage companies and organizations to donate healthy food that would otherwise go to waste, they are protected from criminal and civil liability under the Good Samaritan Food Donation Act.

The Federal Bill Emerson Good Samaritan Food Donation Act

On October 1, 1996, President Clinton signed this act to encourage donation of food and grocery products to non-profit organizations for distribution to  individuals in need. This law:

  * Protects you from liability when you donate to a non-profit organization;

  * Protects you from civil and criminal liability should the product donated in good faith later cause harm to the recipient;

  * Standardizes donor liability exposure. You or your legal counsel do not need to investigate liability laws in 50 states; and

  * Sets a floor of “gross negligence” or intentional misconduct for persons who donate grocery products. According to the new law, gross negligence is defined as “voluntary and conscious conduct by a person with knowledge (at the time of conduct) that the conductis likely to be harmful to the health or well-being of another person.”

The text of the bill itself follows:

  The Bill Emerson Food Donation Act

  One Hundred Fourth Congress of the United States of America

  At the Second Session

Begun and held at the City of Washington on Wednesday, the third day of January, one thousand nine hundred and ninety-six.

An Act

To encourage the donation of food and grocery products to nonprofit organizations for distribution to needy individuals by giving the Model Good Samaritan Food Donation Act the full force and effect of law.

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

Section 1. CONVERSION TO PERMANENT LAW OD MODEL GOOD SAMARITAN FOOD DONATION ACT AND TRANSFER OF THAT ACT TO CHILD NUTRITION ACT OF 1966.

  (a) Conversion to Permanent Law. — Title IV of the National and Community Service Act of 1990 is amended –

    1. by striking the title heading and sections 401 and 403 (42 U.S.C. 12671 and 12673); and

    2. in section 402 (42 U.S.C. 12672) –

  (A) in the section heading, by striking “model” and inserting “bill emerson”

  (B) in subsection (a), by striking “Good Samaritan” and inserting “Bill Emerson Good Samaritan:”

  (C) in subsection (b)(7), to read as follows:

  “(7) GROSS NEGLIGENCE. — The term ‘gross negligence’ means voluntary and conscious conduct (including a failure to act) by a person who, at the time of the conduct, knew that the conduct was likely to be harmful to the health or well-being of another person.”;

  (D) by striking subsection (c) and inserting the following:

  “(c) LIABILITY FOR DAMAGES FROM DONATED FOOD AND GROCERY PRODUCTS.

  “(1) LIABILITY OF PERSON OR GLEANER. — A person or gleaner shall not be subject to civil or criminal liability arising from the nature, age, packaging, or condition of apparently wholesome food or an apparently fit grocery product that the person or gleaner donates in good faith to a nonprofit organization for ultimate distribution to needy individuals.

  “(2) LIABILITY OF NONPROFIT ORGANIZATION. — A nonprofit organization shall not be subject to civil or criminal liability arising from the nature, age, packaging, or condition of apparently wholesome food or an apparently fit grocery product that the nonprofit organization received as a donation in good faith from a person or gleaner for ultimate distribution to needy individuals.

  “(3) EXCEPTION. — Paragraphs (1) and (2) shall not apply to an injury to or death of an ultimate user or recipient of the food or grocery product that results from an act or omission of the person, gleaner or nonprofit organization, as applicable, constituting gross negligence or intentional misconduct.”; and

  (E) in subsection (f), by adding at the end the following: “Nothing in this section shall be construed to supersede State or local health regulations.”.

  (b) TRANSFER TO CHILD NUTRITION ACT OF 1966. — Section 402 of the National and Community Service Act of 1990 (42 U.S.C. 12762) (as amended by subsection (a))

    1. is transferred from the National and Community Service Act of 1990 to the Child Nutrition Act of 1966;

    2. is redesignated as section 22 of the Child Nutrition Act of 1966; and

    3. is added at the end of such Act.

  (c) CONFORMING AMENDMENT. — The table of contents for the National and Community Service Act of 1990 is amended by striking the items relating to title IV.

Newt Gingrich Speaker of the House of Representatives

Strom Thurmond President of the Senate Pro Tempore

Approved 10/01/96

William J. Clinton President of the United States P.L. 104-210

Immigration Deportation policy

By: Corey Dade, www.Npr.org

Policy changes ordered by Obama to reduce the deportations of otherwise law-abiding illegal immigrants.

Priority cases include felons, repeat violators of immigration laws, people who have recently crossed U.S. borders illegally and those who pose a national security threat, the White House says.

In an announcement that appears to address the criticism, U.S. Immigration and Enforcement Director John Morton has ordered his agents to focus solely on “serious offenders.” Agents won’t pursue illegal immigrants convicted of one or two minor misdemeanors, such as traffic violations, he said.

The new directive limits the use of “detainers,” an enforcement tool that critics say has too often been used to nab people who pose no public safety or national security threat.

The biggest change under Obama has been his deferred deportation program, which gives qualified young people brought to the U.S. as children a renewable two-year reprieve. Since the program began in August, applications from more than 355,000 people have been accepted and nearly 103,000 have been approved, according to the latest government figures.

Obama’s 50 Accomplishments

http://www.washingtonmonthly.com/magazine/march_april_2012/features/obamas_top_50_accomplishments035755.php?page=1

MD – Veterans Full Employment Act

The Veterans Full  Employment Act makes it easier for veterans and spouses of  active-duty service members to receive professional licenses in MD.

The legislation would require an expedited process for veterans and spouses  of active-duty service members applying for licenses in more than 45  professions, including teachers, electricians, mechanics, doctors and real  estate agents. It would also require universities to better translate military  courses and experience into college credits and would grant veterans and some  spouses a temporary or “provisional” license until they met all of Maryland’s  licensing rules

Read more: http://www.baltimoresun.com/news/maryland/politics/blog/bal-first-lady-to-attend-veterans-bill-signing-20130415,0,1606414.story#ixzz2QZr22TS6

2013 Maryland Legislature Laws

By Erin Cox and Michael Dresser, The Baltimore Sun

Under the cellphone bill, drivers will be able to make a call at a stoplight but can be pulled over if chatting while in motion. The first ticket would come with a $75 fine that would increase with the next two offenses.  Lawmakers decided against penalizing drivers with points, which could be reported to insurance companies and used to raise rates.

Medical marijuana program: The legislation calls for doctors and nurses to distribute the drug through academic centers that also must study the program’s effects. The structure of the state’s plan is relatively conservative compared to states that allow private companies to set up dispensaries.

Lawmakers also passed an O’Malley bill to expand early voting that also allows for same-day registration and voting — though it will only be allowed during the early voting period.

Another O’Malley bill will create an expedited professional-licensing process for veterans in transition to the civilian workforce and award college credits for certain military experience.

Legislation that would have tightened the state’s speed camera program in the wake of an investigation by The Baltimore Sun, which found erroneous tickets and other problems, failed in the Senate.

A late-developing proposal to delay a new stormwater fee program was approved by the Senate but died in the House. It would have put off for two years the collection of money from residents and businesses to pay for treatment of polluted runoff. A last-minute bill approved by both chambers will put a constitutional amendment before voters in the next general election. It calls for a “lock box” to prevent money from the Transportation Trust Fund from being used to fund other parts of the budget.

Lawmakers overcame disagreement to pass a major campaign finance bill. If signed by O’Malley, the legislation would close a loophole that has allowed certain campaign contributors to far exceed the state’s limits by giving through multiple limited-liability corporations or partnerships.

The measure would also raise the state’s maximum allowed campaign contributions for the first time since the early 1990s. It would increase the amount an individual or company can give to one candidate from $4,000 in an election cycle to $6,000. It also would impose new reporting requirements for candidates.

Other bills passed Monday would create term limits for the Morgan State University Board of Regents and reform the state’s eviction law so that people cannot be locked out of their homes without a court order.

Several hundred bills died Monday night without a final vote. A bill that would have spelled out the rights of some surrogate mothers, the people who contract with them and the children born from the arrangements died without a vote in the House Judiciary Committee.

A measure to designate the soft-shell crab sandwich as the state sandwich also died.

Filial support law in Maryland

By Eileen Ambrose, The Baltimore Sun

The filial support law requires adult children to be responsible for the care of indigent parents. Twenty-nine states, including Maryland, have such laws, although they vary and can be overridden by other statutes. Maryland, for instance, bars nursing homes from saddling children with their parents’ bills, but the filial support law can apply under other circumstances.

Though the laws have mostly been ignored in many states, there are new reasons courts might be asked to start enforcing them, Pearson said. Baby boomers are getting up in years and approaching a time when many of them will need expensive long-term care, she said. That care will have to be paid somehow.

Filial support laws go back centuries, and nearly all states had them at one time, Pearson said. States began repealing the laws after the creation of Medicare and Medicaid in the 1960s, the latter of which pays for long-term care for the poor.

The laws have been used in recent years to rescue destitute parents whose assets have been diverted to an adult child, Pearson said. This can happen when a parent transfers a house or other assets to an offspring, who promises to provide care and then reneges. The filial support law is a tool to help recover the parent’s assets, she said.

Generally, though, filial support laws are rarely enforced, and most families are unaware of them.

 Another Maryland statute prohibits nursing homes from going after an adult child to pay a parent’s unpaid bill, unless the offspring agreed in writing to be financially responsible.

A Maryland nursing home, though, can ask the court to force a child acting on behalf of a parent to file an application for Medicaid, Frank said. The child faces up to a $10,000 civil fine for not doing so.

Maryland’s filial support law comes into play when a parent is under the care of a state psychiatric hospital, Frank said. If the parent is under age 65, the state can use the law to get children to reimburse the state for the parent’s care,.

E-cigarettes

By: Andrew M. Seaman, The Baltimore Sun

E-cigarettes were first introduced in China in 2004. The battery-powered devices let users inhale nicotine-infused vapors, which don’t contain the harmful tar and carbon monoxide in tobacco smoke.

percent) and to get around smoking restrictions (3 percent).

Some 86 percent said they had either not smoked cigarettes for several weeks or months since using the e-cigarette or that the amount they smoked had decreased dramatically.

More research is needed on the long-term effects of e-cigarettes.

Siegel said there’s no question that e-cigarettes are safer than smoking, but there are concerns over some of the vapors’ ingredients – including propylene glycol, which irritates airways, and formaldehyde, which is known to raise lung and nasal cancer risk when it’s inhaled.

Despite the survey participants’ feeling that their breathing eased with e-cigarettes, past research suggests the vapor has at least temporary negative effects on airways.

Researchers said testing found signs of airway constriction and inflammation within five minutes of people inhaling vapors from e-cigarettes. But that study only included a small group of people and the researchers couldn’t say if those reactions actually lead to health problems (see Reuters Health story of January 5, 2012 here: http://reut.rs/10BNlAA.)