CMS Issued Stark Self-Disclosure Protocol

On September 23, 2010, the Center for Medicare and Medicaid Services (CMS) announced a disclosure protocol pertaining to Stark Law self-referrals in accordance with Section 6409 of the Patient Protection and Affordable Care Act (PPACA). The purpose of the Medicare self-referral disclosure protocol (SRDP) is to create a mechanism that affords both health care providers and suppliers the opportunity to disclose either real or potential violations of the Stark law. In the event of a violation, a provider’s or supplier’s submission of this information to CMS may potentially result in a reduction in the amount due for the self-referral violations. For additional information regarding the SRDP, please go to the following website: http://www.cms.gov/PhysicianSelfReferral/65_Self_Referral_Disclosure_Protocol.asp

Correction of Final IPPS for ACHs (Acute Care Hospitals) and LTCH (Long-Term Care Hospital) PPS and FY 2011 Rates

This regulation was adopted in order to correct technical and typographical errors that were found in the preamble and addendum of two documents regarding hospital inpatient prospective payment: a final rule and the interim final rule. The final rule and interim final rule documents containing the errors are titled “Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System Changes and FY 2011 Rates; Provider Agreements and Supplier Approvals; and Hospital Conditions of Participation for Rehabilitation and Respiratory Care Services; Medicaid Program: Accreditation for Providers of Inpatient Psychiatric Services.” The regulation provides a summary of the errors and their corresponding corrections, which were effective beginning October 1, 2010.

Alert: CMS’s Stark Law Self-Referral Disclosure Protocol Raises Tough Decisions for Healthcare Providers

On September 23, 2010, the Center for Medicare and Medicaid Services (CMS) announced a disclosure protocol pertaining to Stark Law self-referrals in accordance with Section 6409 of the Patient Protection and Affordable Care Act (PPACA). The purpose of the Medicare self-referral disclosure protocol (SRDP) is to create a mechanism that affords both health care providers and suppliers the opportunity to disclose either real or potential violations of the Stark law. In the event of a violation, a provider’s or supplier’s submission of this information to CMS may potentially result in a reduction in the amount due for the self-referral violations. For additional information regarding the SRDP, please go to the following website: http://www.cms.gov/PhysicianSelfReferral/65_Self_Referral_Disclosure_Protocol.asp

Changes to the Hospital Outpatient Prospective Payment System (OPPS) and CY 2010 Payment Rates

Summary: This regulation was adopted in order to correct technical errors that were identified in two documents regarding hospital outpatient prospective payment: a final rule and its subsequent correction document. The final rule containing errors is titled “Medicare Program: Changes to the Hospital Outpatient Prospective Payment System and CY 2010 Payment Rates; Changes to the Ambulatory Surgical Center Payment System and CY 2010 Payment Rates.” The subsequent correction document also containing errors is titled “Medicare Program: Changes to the Hospital Outpatient Prospective Payment System and CY 2010 Payment Rates; Changes to the Ambulatory Surgical Center Payment System and CY 2010 Payment Rates” Continue reading “Changes to the Hospital Outpatient Prospective Payment System (OPPS) and CY 2010 Payment Rates”

Interim Final Rules for Group Health Plans and Health Insurance Issuers Relating to Internal Claims and Appeals and External Review Processes Under the PPACA

This regulation outlines the requirements for the following processes of group health plans and health insurance coverage in the group and individual market: (1) internal claims and appeals, and (2) the external review processes. These updated processes become effective for plan years (policy years in the individual market) beginning on or after September 23, 2010. Key provisions of this regulation include: how insurers can comply with the new internal claims and appeals process, guidance for external review processes and whether insurers must follow state or federal procedures, and notice requirements for appeals processes. This regulation is not applicable to grandfathered group health plans.

Group Health Plans and Health Insurance Issuers Relating to Coverage of Preventive Services under PPACA

This regulation outlines requirements for group health plans and health insurance coverage in the group and individual markets for two areas: (1) expansion of coverage of recommended preventive services, and (2) restrictions on or prohibition of the implementation of cost-sharing mechanisms by the insurers (i.e. coinsurance, deductibles and copayments). These requirements generally become effective for plan years (policy years in the individual market) beginning on or after September 23, 2010. A list of recommendations and guidelines for insurers with respect to preventative services is available at: http://www.HealthCare.gov/center/regulations/prevention.html

Group Health Plans and Health Insurance Issuers Relating to Dependent Coverage of Children to Age 26 Under the PPACA; Interim Final Rule and Proposed Rule

This regulation outlines the requirements for dependent coverage of children until the attainment of 26 years of age by their parents’ group health plans and health insurance issuers in the group and individual markets. This regulation also contains information regarding whether this provision preempts existing state laws that have different age limitations. Eligible dependents may be enrolled no earlier than the first day of the first plan year (policy years in the individual market) beginning on or after September 23, 2010.

Health Care Reform Insurance Web Portal Requirements

This regulation outlines the requirements for state insurance websites (“Web Portals”) that must be made public by July 1, 2010 to individuals and small business in all 50 states and the District of Columbia. Currently, each web portal at minimum must contain the following information (to the extent practicable):

  • Health insurance coverage offered by health insurance issuers
  • Medicaid coverage
  • Children’s Health Insurance Program (CHIP) coverage
  • State health benefits high risk pool coverage
  • Coverage under the high risk pool
  • Coverage for small businesses and their employees (small group market)

Continue reading “Health Care Reform Insurance Web Portal Requirements”

Early Retiree Reinsurance Program

This regulation was adopted to offset the inadequate employer insurance coverage of employees in the early retiree age group (and their eligible spouses, surviving spouses and dependents of the retirees). Five billion dollars ($5,000,000,000) of federal funding was set aside for this temporary reinsurance program to help cover a portion of the insurance costs to participating employers that provide employment-based health insurance to employees in this retiree group. Reimbursement is available for claims between $15,000 and $90,000 (the amounts are “indexed for plan years starting on or after October 1, 2011”). Funds are awarded on a first come, first served basis, and nearly 3,000 employers and other sponsors have already been approved for participation. This program began no later than 90 days after the enactment of the statute, which was June 21, 2010 and will end by January 1, 2014. Additional information regarding this provision is available at: http://www.errp.gov/