This regulation, issued on November 15, 2010, amends an earlier regulation published in June that outlined rules governing whether group health plans and health insurance coverage in both the individual and group markets can maintain “grandfathered” health plan status. The grandfathered status allows plans to retain an exemption from some new requirements under the Patient Protection and Affordable Care Act. Under the amended regulation, a group health plan may now switch insurance companies and maintain its grandfathered plan status as long as it adheres to other requirements outlined in this and the original regulation. This amendment affords employers more flexibility in shopping for health plans that offer coverage at a lower cost. Additional information regarding this provision is available at: http://www.hhs.gov/news/press/2010pres/06/20100614e.html.
New Regulation Outlining Changes to Medicare Program
This regulation, issued on November 24, 2010, outlines several changes to the Medicare program regarding the following: (1) the hospital outpatient prospective payment system, (2) the ambulatory surgical center payment system, (3) payments to hospitals for graduate medical education (GME) costs and indirect medical education (IME) costs, (4) rules governing physician self-referrals and related provider agreements in hospitals where physicians have investment interests or in hospitals owned by physicians, and (4) payments for certified registered nurse anesthetist services in rural and critical access areas. Changes to the hospital and ambulatory surgical centers payments systems will be to the amounts and factors used to determine payment rates. For both GME and IME hospital payments this regulation implements new provisions under the Patient Protection and Affordable Care Act. With respect to physician self-referrals, this regulation introduces new limitations. And as to anesthesia services there will be changes to the effective date of when hospitals can begin receiving reasonable cost payments for these services.
Labor Department Releases Set of FAQs On Grandfather Requirements Under PPACA
On October 29, the Labor Department released a set of frequently asked questions (FAQs) regarding the grandfather requirements under the ACA.
New Affordable Care Act Grants to Help Put Patients in Control of Their Healthcare
The U.S. Department of Health and Human Services (HHS) today announced new Consumer Assistance Grants program awards of nearly $30 million to help states and territories put patients in charge of their health care. These grants will support states’ efforts to establish or strengthen consumer assistance programs that provide direct services to consumers with questions or concerns regarding their health insurance.
HHS Announces the Availability of Up to $335 Million to Boost Access to Primary Health Care
On October 26, 2010, HHS announced that there is up to $335 million in available funding for existing community centers throughout the United States. The purpose of the additional funding is to increase access to preventative and primary care services. Health centers interested in obtaining federal funds must submit an application in which they have to explain how they intend to expand their medical capacity and services to underserved populations. The applications must be submitted by January 6, 2011, and they are available at bphc.hrsa.gov/es/. For additional information regarding this news release, please go to the following website: http://www.hhs.gov/news/press/2010pres/10/20101026a.html.
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.