As has been reported insurers are not going along with Obama's begging them to allow consumers to keep their own plans even if they do not have all the benefits needed by Obamacare. The administration is now wanting to pay the insurers for any losses they incur for the next three years if they go along with Obama. This is of questionable legality. The law as announced in the Federal Register would also exempt the union plans that Obama previously said would not be exempted. His lies and rule by fiat continue. The latest to not follow the Obama request is Aetna.
Sebelius has decreed that the federal pre-existing condition plan is to be extended by one month. She also begged the insurers to allow the payment for the first month insurance to be delayed until January 8 and to accept partial payments. She went on to beg the insurers to accept people for insurance retroactively and to allow those who had problems with the terrible website more time to sign up. She realizes the problems that patients are having and again pleads with the insurers to allow continuing coverage for consumers with their physicians even if they are out of the plan and allowing prescription to be filled after January 1 even if they are not on the approved formulary of the new exchanges. This begging and pleading are questionable as CMS stated that the insurers response would be considered in whether or not to allow them to participate in the exchanges in 2015.
I don't know how they can do this but South Carolina is voting on ending Obamacare in their state. They believe that the US Supreme Court decision in Printz v US gives them the right along with the 10th Amendment.
The Meaningful Use 3 has been delayed for one year. It will now start in 2007 and Stage 2 will be in force until then. Top
The SEIU, the nation's largest healthcare union, is attempting to get via thuggery, if there is such a word, what they can not get on their own, more members. They have filed for an initiative in California and Oregon that would limit hospital CEO salaries, actually not a bad idea, and limit how much hospitals can charge patients, also not a bad idea. However, they are willing to not spend the money to get the propositions on the ballot providing the hospitals in the states agree to "work with the union". The California Hospital Assn. is talking to the union but stated they are ready to spend money to go against the proposition if it makes it to the ballot. This smells like the neutrality agreement that the US Supreme Court ruled on this week. They ruled the issue was moot and should not have been granted certiorari. Three liberal justices dissented. The case was Unite Here Local 355 v Martin Mulhall et al. Top
CMS has issued a 1,369 page tome detailing the 2014 Medicare Physician Payment Schedule. This included a 20.1% decrease in the RVS conversion factor which hopefully will be changed by Congress. Also they stated they would pay for non face to face complex chronic care management services for those with two or more chronic conditions. The physician has to use what is known as a "G" code. This is limited to 20 minutes per month or about $30 and come with some string attached. There are many other payment issues as well but some that need to be made public are the PQRS adding 56 more measures and making an upward adjustment for the Value Based Payment Modifier for groups between 10 and 99 eligible professionals.
The SGR bill continues to work its way thru Congress but since it will pass other bills are attempting to be amended to it. There seems to be this imperative not to pass clean bills. To the consternation of thinking physicians this bill has attached a rider that allows the Secretary of HHS to look at the advanced radiology requisitions with a jaundiced eye. The criteria for what is acceptable will have some input from the College of Radiology. How much is to be determined. There is a one liner (there always is) that allows the Secretary to enlarge this oversight to all outpatient physician services. If by 2020 any physicians that are not playing nice will have to get pre-authorization from the Secretary for ordering various tests.
The again temporary demise of the SGR was attached to the House Budget Bill. This is a 3 month kicking of the can. The physicians will get a whopping 0.5% raise over the next three year period. The problem with this is the budget mandates a 2% cut yearly in Medicare spending. This means physicians will get 20% less over 10 years. This is the SGR in other clothes. As this was passing the House and Senate were both in line for a permanent fix. The Senate bill has a rider for Mental Health extension countrywide. The bill would replace the SGR with payments based on quality.
Louisiana put in an emergency rule targeting physicians who steer patients to particular Medicaid plans. If a physician is caught he/she may be ousted from the program or asked to return payments for services provided and face up to a $5000 fine. Specifically, the physician is prohibited from allowing a patient to use an office fax machine or telephone to sign up for a particular Medicaid plan. They also may not offer any incentive to join a plan. Top
DISCLAIMER: Although this
article is updated periodically, it reflects the author's point of view at the
time of publication. Nothing in this article constitutes legal advice. Readers
should consult with their own legal counsel before acting on any of the