June 1, 2014 Legislation





The California Senate has passed a bill allowing illegal immigrants to obtain a medical license in the state.  They have allowed the state boards to accept a federal taxpayer identification number in place of a Social Security number for a professional license application.  The state has already allowed illegals to become lawyers.  Individual tax identification numbers are available to illegals who need to pay income tax but do not have and can not get social security numbers.  The IRS is forbidden under law from sharing information about this to the Immigration Service.    Top


CMS has issued a final ruling that states physicians must be enrolled in Medicare to prescribe medications under Part D.  The physicians in concierge practices can apply for an exception.  The rule takes effect July 1, 2015.  The feds can deny prescribing authority to those whose DEA has been removed or if the state has relieved them of the ability to prescribe.  I wonder how much this will cost the physician who has an intermediate license to only volunteer practice.

CMS has reluctantly approved a transcatheter mitral valve repair.  There is only one currently approved.  The insurance companies are not happy campers about this as there is not any significant evidence for it being long term or have any advantages over surgical repair for mitral regurgitation. The OK comes with caveats.  A cardiac surgeon and cardiologist, each with mitral valve experience, must independently certify that surgery is too risky.

CMS states that it will use "other sources of funding" to bail out insurers who need a bailout due to Obamacare.  This has to do with HHS paying the insurers who lost too much with money that they received from insurers that did well.  If there is not enough money then other sources will be used to make the insurers whole.  This money would have to be approved by Congress.  Lots of luck on that.

CMS has issued a final rule asserting federal law over state law in the regulation of navigators.  They still allow background checks etc.  The rule also states that insurers who pay over $45,000 per enrollee per year will get reinsurance up to $250,000.

Obama has the IRS threatening employers with a fine of $100 per day or $36,500 per year per employee they move from their employer health insurance to the exchanges.  Under Obamacare large employers are required to offer health insurance to their full time employees or they may be subject to penalties.  This means employers may not give employees a lump sum of money to buy exchange insurance.  Employer paid health insurance is not deductible and neither is any money given to the employee to buy insurance.  The only way employers may give money to employees for health insurance is via higher wages on which both will pay taxes.  This will stop employers from providing money to employees for employer payment plans where out of pocket expenses are reimbursed.  

California has qualified a proposition for the November ballot championed by a distraught father whose two children were killed by a driver on alcohol and prescription drugs.  The woman driver had gone to several physicians who prescribed meds for her without knowing that others had done the same thing.  The proposition wants to rectify this type problem by having hospitals alcohol and drug testing once a year all their physicians.  Dumb.  The proposition also wants to rectify the problem by getting rid of the $250,000 cap on pain and suffering in med mal cases.  Equally dumb.  The proposition wants to rectify the problem by making mandatory physicians prior to prescribing the high power pain meds for a patient to check the Control Substance Utilization Review and Evaluation System (CURES).  They forgot in the proposition that the database is little used and not of date with no monies to update it.  Physician will then have to either not prescribe needed meds or query a bad database.  All in All a badly thought out law but in California and backed by the trial lawyers it may fly.

The administration has again toyed with Obamacare to the potential detriment of the population.  The newest wrinkle is to allow "reference pricing" for the high ticket items such as knee and hip prosthesis.  This means that they will only pay for example $30,000 for a knee replacement.  If you go to a hospital in your insurer's network that charges $35,000 for the replacement, the patient will pay the usual co-pays and deductible plus $5000.  To make matters worse for the individual, the extra money will not go toward the yearly deductible.  This means that the patient may have to go to a hospital miles away for the procedure instead of one nearby and in the network.

All should remember the medical device tax that both sides of the aisle want repealed.  Well it passed the House but Reid will not allow it to be used as an amendment to the stalled tax cut bill now before the Senate.

Hooray for Illinois.  I have been trying to get California to do this for years.  They passed a law making CPR and AED training mandatory in high school.  I would like to see this across America.

Kaiser Health News reports an interesting dilemma. In hearing before Congress regarding the two mid-night rule, the head of a auditing company said that by delaying the rule hospital claims will not be subject to review (auditing company will lose income).  The AHA said the $5 billion amount that is claimed Medicare overpaid the hospitals is too much (hospitals don't get overpaid).  The hospitals get more money from treating a patient as an inpatient than an outpatient and has to use the same amount of resources for either.  Since the two midnight rule was considered there was a surge of outpatient bills since hospitals did not want Medicare to come after a rebate later.  The CMS person testified that the rule was good since it decreased payments. One of the main problems is Medicare does not require hospitals to tell patients if they are inpatient or observation status.  The difference is dramatic to the patient.

Ohio is attempting to get rid of Medicaid money by declaring that vets on Medicaid may be eligible for "richer VA benefits".  This is already happening in 15 other states.  In Washington state about 7% of those on Medicaid are veterans.  Top


Pacifica Hospital of the Valley paid $500,000 to Los Angeles homeless service providers in an agreement for dumping a patient in downtown LA.  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.