January 13, 2011 Legislation



Physicians need to reminded that the new Stark rules went into effect the beginning of the year.  If they have in-house MRI, CT or PET they must give the names of five other units in the area or if there are not five then all the other units in the area.  They must be told in writing that they may go to any unit.  There is no requirement that any signature of the patient on a form be kept in the chart.

On the new year the first part of Obamacare started.  The doughnut hole will start to be closed this year.  Preventative care will be offered. The insurance rules as to medical spending goes into effect with the changes as allowed by the Secretary.  The controversial legal changes do not go into effect until 2014.  

A new Medicare website has started.  It gives information on providers who participate in Medicare.  It will let consumers know which physicians have agreed to share quality information with the feds.   

An old administration committee is disbanding.  The White House Office of Health Reform is winding down.  Nancy Ann DeParle, the former head of the activist nurse union is applying for the position of the White House assistant chief of staff.  Her deputy has moved to HHS.  I guess they believe that health care reform is over.

It is hard to fathom this administration.  Several days after stating that CMS will pay for end of life discussions they did a U- turn and stated this will not be a covered service.  They caved to the new Republican force in the House and their bid to overturn Obamacare.  This had already been published in the Federal Register in November.  The end of life planning was specifically excluded from the original bill and CMS tried to get it in via a back door.

A bill has been introduced into Congress to get rid of the onerous 1099 requirement that all businesses give 1099s to any one business they did over $600 worth of business with.  This was supposed to raise $19 Billion for Obamacare and last year was defeated in the Senate since there was no offset.  There still is no offset but it has much more bipartisan support.

Obama is reorganizing and expanding its HHS infrastructure.  They are doing this to make it harder for the Republicans to stop funding for some of the programs.  

The independent CBO has stated that the repeal of Obamacare would cost many millions of people to be uninsured and to increase the deficit by $230 Billion in the next decade.  That should be enough to dissuade complete removal of Obamacare and only remove those parts that are onerous or blatantly illegal.

CBO also stated in it's report that most of the funding for Obamacare subsidies are in the law and can not be not funded unless the law is repealed.  The GOP could not fund the continuation of existing activities.  That would save money but hurt the Indian Health and other similar organizations.  The insurance mandate and Medicaid funding can not be not funded on their own.  The major thing to be defunded is the CMS slush fund of $10 Billion for innovative payment and service delivery models.

This next week the CMS is to begin the process of deciding what will be in the benefit package for those who buy insurance as individuals or via small group plans and purchased via the 2014 state insurance exchanges.

California passed a rule that HMO patients would be seen within certain time spans.  There are some HMOs that use poorly run IPAs such as the John Muir IPA that can not meet these mandates.  If the HMOs do not need the mandates they will face fines.  I hope they pay them and then get rid of the poorly run IPAs that are costing them the fines.  

The governor of the People's Republic of Massachusetts used a lame duck session to push through a large amount of money to be spent on new Medicaid patients.  The new legislature with a heavy influx of Republicans would not have passed it or at least modified it.  The Republic continues to increase its spending on its universal health coverage.  This should be a lesson for Obamacare but I doubt it.       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 information presented.