The Affordable Care Act’s (ACA) health insurance review program has gone into effect, and this means that all insurers seeking to increase their health insurance rates by 10% or more must submit the proposed increase for review by state insurance experts. As part of the ACA’s emphasis on transparency and accountability, the rate review program allows state regulators to deny excessive rate increases and consumers will be able to see the reasons behind rate increases on a new Department of Health & Human Services website, HealthCare.gov. The ACA has also provided Health Insurance Premium Review Grants of $250 million over the next five years to the states, which will assist the states in improving their review of health insurance rates and their ability to hold insurance companies accountable for excessive premiums. For more information on the review program, see HHS’ website here.
Bundled Payments for Care Improvement Initiative Announced
On August 23, 2011, the U.S. Department of Health and Human Services announced the Bundled Payments for Care Improvement Initiative (“Initiative”). Developed by the Center for Medicare and Medicaid Innovation, the Initiative is designed to give providers “new incentives to coordinate care, improve the quality of care and save money for Medicare.” For providers participating in the Initiative, Medicare will bundle payments for a package of services provided during an episode of care instead of paying separately for each individual service provided. Four different models of bundled care are available. Providers can apply to participate in the program and will be able to choose which episodes of care and services will be bundled together. To apply, providers must submit a Letter of Intent by September 22, 2011 or November 4, 2011 and a completed application by October 21, 2011 or March 15, 2012, depending on which model of the Initiative they choose.
For more information please go to http://www.hhs.gov/news/press/2011pres/08/20110823a.html and http://www.innovations.cms.gov/areas-of-focus/patient-care-models/bundled-payments-for-care-improvement.html#.
Thoughts on Physician Employment and Corporate Bookkeeping
More thoughts on physician employment by hospitals
One of my clients, who was approached by a hospital for possible employment, proposed a trial period of 12 months. During that 12 months, she would be employed by the hospital and at the end of 12 months either party could walk away for any reason with no strings attached. No strings in this case meant no non compete and the hospital would pick up any tail insurance liability.
Since I always recommend an exit plan just in case hospital employment doesn’t work out, this trial period seems like a good idea. The hospital is seriously considering it and will let us know this week. Stay posted.
Continue reading “Thoughts on Physician Employment and Corporate Bookkeeping”
Eleventh Circuit Declares Individual Mandate Provision in Health Reform Law Unconstitutional
On Friday, August 12, 2011, the U.S. Court of Appeals for the Eleventh Circuit held that the individual mandate provision in the Patient Protection and Affordable Care Act (“Act”) is an unconstitutional exercise of Congress’ power under the Commerce Clause of the United States Constitution. However, the court refused to hold the entire Act unconstitutional, ruling instead that the individual mandate provision is severable from the rest of the Act. The decision creates a circuit split because it conflicts with the recent decision by the U.S. Court of Appeals for the Sixth Circuit, which rejected a challenge to the individual mandate provision’s constitutionality.
IRS Releases Proposed Rules on Health Insurance Premium Tax Credit
On August 12, 2011, the Internal Revenue Service (“IRS”) released proposed regulations regarding the health insurance premium tax credit available to certain individuals who enroll in insurance plans through the state-based Affordable Insurance Exchanges (“Exchanges”). The tax credit is designed to make health insurance purchased through the Exchanges more affordable. The proposed regulations outline eligibility for and calculation of the tax credit, providing several examples for explanation and clarification. The proposed regulations were published in the Federal Register on August 17, 2011. Comments are due October 31, 2011, and a public hearing is scheduled for November 17, 2011.
To read the text of the Proposed Rule, please go to http://www.gpo.gov/fdsys/pkg/FR-2011-08-17/pdf/2011-20728.pdf.
Interim Final Rule Released Allowing HRSA to Exempt Religious Employers From Covering Contraception
Interim final regulations released on August 3, 2011 by the Department of Health and Human Services, the Department of the Treasury and the Department of Labor (DOL) give the Health Resources and Services Administration (HRSA) the discretion to exempt religious employers that offer insurance to their employees from the requirement to cover contraception. These regulations amended the previous interim final regulations addressing coverage of preventive services by new insurance plans. The Interim Final Rule sets forth a definition of “religious employer” based on the most commonly used definition in those states that exempt religious employers from state law requirements to cover contraception. HHS is accepting comments on this definition.
To read the Interim Final Rule, please go to: http://www.gpo.gov/fdsys/pkg/FR-2011-08-03/pdf/2011-19684.pdf.
New Guidelines Require New Insurance Plans to Provide Preventive Services to Women at No Additional Cost
On August 1, 2011, the U.S. Department of Health and Human Services (HHS) announced guidelines requiring new health insurance plans to provide certain preventive services to women without cost-sharing. The guidelines were developed by the Institute of Medicine. The preventive services that will no longer be subject to any co-payment, co-insurance or deductible include well-woman visits, screening for gestational diabetes, HPV testing for women 30 years of age and older, sexually-transmitted infection counseling, HIV screening and counseling, contraception and contraception counseling, breastfeeding support, and domestic violence screening and counseling. New health insurance plans must comply for plan years starting on or after August 1, 2012.
To read more about this announcement, please go to http://www.hhs.gov/news/press/2011pres/08/20110801b.html.
CMS and HHS Release Final Rules Affecting Payment to Inpatient Rehabilitation Facilities and Skilled Nursing Facilities
On August 1, 2011, the Centers for Medicare & Medicaid Services (CMS) and the U.S. Department of Health and Human Services (HHS) released a Final Rule updating the prospective payment rates for inpatient rehabilitation facilities (IRFs). The rule also establishes a program that reduces the annual increase factor by 2 percent for failure to report quality data to HHS starting in 2014. The Final Rule implements section 3004 of the Affordable Care Act and will become effective on October 1, 2011.
The Final Rule affecting IRFs was published in the Federal Register on August 5, 2011 and can be found here: http://www.gpo.gov/fdsys/pkg/FR-2011-08-05/pdf/2011-19516.pdf.
CMS Transmittal Clarifies that Critical Access Hospitals are Included in CMS Laboratory Demonstration Project
On July 29, 2011, CMS issued Transmittal 78 clarifying that critical access hospitals (CAH) are included in CMS’ laboratory demonstration project for certain complex diagnostic tests. Under standard rules, payment made for tests provided by a laboratory working under arrangement with a hospital or CAH would ordinarily be in the form of a bundled payment to the hospital or CAH, and not directly to the laboratory. However, the Affordable Care Act requires that CMS conduct a demonstration project that will allow laboratories to receive a separate, direct payment for certain complex tests. The demonstration project begins January 1, 2012 and continues for two years or until the $100 million in funding is exhausted. Transmittal 78 rescinds and replaces Transmittal 74 dated July 15, 2011.
To read Transmittal 78, please go to https://www.cms.gov/transmittals/downloads/R78DEMO.pdf.
$71.3 Million in Federal Funding to Expand Nursing Workforce
On July 29, 2011, the U.S. Department of Health and Human Services (HHS) announced that it would provide a total of $71.3 million in grant funding to expand the education and training of nurses and nursing diversity. The monies will be distributed among six types of awards: Nurse Education, Practice, Quality and Retention; Nursing Workforce Diversity; Nurse Faculty Loan Program; Advanced Nursing Education Program; Advanced Education Nursing Traineeships; Nurse Anesthetist Traineeships. Monies from these awards will support all levels of education from entry-level nursing to advanced traineeships, increase opportunities for individuals from disadvantaged backgrounds, and provide partial loan-forgiveness for nursing faculty.
To read more about this announcement and see details of each of the awards, please go to http://www.hhs.gov/news/press/2011pres/07/20110729a.html.