Duane Morris Health Law

September 27, 2011September 10, 2014 by Duane Morris

Medicare Advantage Premiums Falling and Enrollment Up for 2012

HHS recently announced its expectation that Medicare Advantage premiums will fall approximately four percent in 2012, with enrollment expected to increase by 10 percent. This drop in premiums has been supported by the Affordable Care Act, which allowed CMS to prevent substantial cost increases or program cuts through elimination of co-pays and deductibles for Medicare-covered preventive services and additional discounts for Medicare beneficiaries that reach the prescription coverage “donut hole.” CMS is also offering high-quality performance incentives, including financial rewards and continuous marketing and enrollment to Five-Star Medicare Advantage and Part D plans.

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September 27, 2011September 10, 2014 by Duane Morris

CMS Asking Providers to Submit Letter of Intent to Participate in Bundled Payments for Care Improvement Initiative

Providers, including hospitals, physicians and non-physician practitioners still have time to contribute to the growing accountable care model by submitting to CMS a Letter of Intent to participate in the Bundled Payments for Care Improvement initiative to CMS. CMS is seeking applicants who are willing to participate in one of the four models for episode-based payment for acute and post-acute care created under the Bundled Payments for Care Improvement initiative. The initiative will start in 2012 and is geared toward aligning incentives between providers to improve coordination throughout episodes of care. The four models are described in detail here: http://innovations.cms.gov/documents/pdf/Fact-Sheet-Bundled-Payment-FINAL82311.pdf.

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September 15, 2011September 10, 2014 by Duane Morris

Accountable Care Act Funding Awarded to Community Health Centers

On September 15, 2011, HHS awarded $10 million in Accountable Care Act funds to 129 organizations seeking to become community health centers, which are geared toward meeting the primary health needs in economically distressed or other vulnerable areas. The funds were specifically directed toward organizations that seek to provide primary healthcare services, or to expand existing services, to vulnerable populations. Likewise, the development of the community health centers will boost local economic growth and support local job markets. For more information on the community health centers program, see http://bphc.hrsa.gov/about/index.html.

September 13, 2011September 10, 2014 by Duane Morris

Pennsylvania District Court Finds Individual Mandate Unconstitutional

On September 13, 2011, the United States District Court of the Middle District of Pennsylvania held that the Affordable Care Act’s individual mandate was unconstitutional as a violation of the Commerce Clause. In Goudy-Bachman v. U.S. Department of Health and Human Services, No. 1:10-CV-763 (M.D. Pa. Sept. 13, 2011), the court found, similar to its predecessors in other courts, that the federal government was one of limited enumerated powers and that “Congress [could not] invoke its Commerce Clause power to compel individuals to buy insurance as a condition of lawful citizenship or residency.” Thus, although the court recognized that “[t]he nation undoubtedly faces a health care crisis,” it severed the individual mandate, the guaranteed issue, and preexisting conditions reforms from the Affordable Care Act as unconstitutional. However, because the provisions found unconstitutional were severed from the Affordable Care Act, this decision allows the rest of the Act to stay intact and operative. The full decision is available at http://www.pamd.uscourts.gov/opinions/conner/10v763a.pdf.

September 13, 2011August 18, 2014 by Patricia S. Hofstra

On-Call Issues Persist

I have been asked to speak at the Orthopaedic Trauma Association’s 2011 meeting in San Antonio on October 15. The Association recently polled its members asking them to identify a topic for the plenary session and orthopaedic on-call compensation emerged as a common concern. In preparing for the presentation, I came across the OTA On-Call Position Statement posed on OTA’s web site.

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September 12, 2011September 10, 2014 by Duane Morris

Fourth Circuit Finds that Virginia Lacks Standing to Challenge ACA

In the latest scrimmage between states and the federal government on the constitutionality of the Affordable Care Act (ACA), the Fourth Circuit Court of Appeals found that the Commonwealth of Virginia lacked standing to challenge the constitutionality of the ACA’s individual mandate. Virginia brought suit against Kathleen Sebelius and the Department of Health & Human Services, challenging the individual mandate as unconstitutional and basing its standing on a conflict between the mandate and a new statute in Virginia, the Virginia Health Care Freedom Act. But the Fourth Circuit Court of Appeals found that Virginia lacked standing to challenge the mandate since the ACA’s mandate did not threaten the enforceability of the Virginia Health Care Freedom Act, especially where Virginia’s law simply tried to immunize Virginia citizens from the ACA individual mandate. Read the full opinion here.

September 1, 2011September 10, 2014 by Duane Morris

Double-Digit Hikes in Insurance Rates Must Now Be Reviewed

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.

August 23, 2011September 10, 2014 by Duane Morris

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#.

August 15, 2011August 18, 2014 by Patricia S. Hofstra

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.

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August 12, 2011September 10, 2014 by Duane Morris

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.

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