November 15, 2016 Legislation



Now that The Donald is the 45th President what will happen to healthcare as we know it.  I believe that he will go slow with most things except Ocare. I do expect him to get rid of many of Obama's executive orders and many of the Obama administrative edicts.

Colorado has voted to allow right to die laws.  Two physicians must agree on a terminal illness, has 6 months or less to live and be competent.  A physician may then prescribe the secobarbitol for self administration.  Colorado is the sixth state to approve the law.   

On election night California, Massachusetts, Nevada and Maine, all Democratic states in the election, approved recreational Mary Jane.  The measure lost in Red State Arizona.  Florida, North Dakota and Arkansas approved medical Marijuana and Montana eased restrictions on the drug.  This seems to be the end for the feds war on the weed.

CMS has announced the new outpatient rules for hospital outpatient departments.  Off campus provider based departments that began billing under the Outpatient Prospective Payment System (OPPS) for services provided after 11/2/15 will be paid under a physician pay schedule unless an ED.  Those who billed prior to that date are proposed to be exempt from the site neutral provisions until and if they relocate.  CMS will increase the OPPS rates by 1.7%.  This is a copout to the hospital association.  All outpatient hospital services except ED should be at physician rates.  

CMS issued its final rule on physician fee payments for next year.  The rates will rise, wait for it, 0.24%.  Is MACRA worth it??  They are also adding new codes or more accurately identify cognitive services.  Get out if you can!!!

CMS published the final rule for national emergency preparedness that established national requirements for providers and suppliers to plan and coordinate with systems.  How much depends on the types based on needs and circumstances.  The rule becomes operational in November 2017 and all need to train and update their plan annually.  The plan must take in the safety of all workers for personal protection.  All must develop a risk assessment for an all-hazard approach within specific to the location and what is likely to occur in their area.  The plan should include strategies to address risks identified in the assessment including access to medical records, cybersecurity, succession planning and lines of authority.  Policies and procedures are to be developed based on the emergency plan and risk assessment.  These must include subsistence need, alternate energy sources, credentialing, HIPAA issues and screening along with procedures for evacuation or sheltering in place.  There must be a communication plan in place.  Training and testing the program is necessary at least annually.  Generator testing are necessary.  If providers are not in compliance when inspected they will lose their Participation rights in fed programs.

HHS has again issued a hospital appeal process for hospitals to receive two-thirds of their disputed reimbursement in exchange for a dismissal of appeals.  Providers must submit an expression of interest not later than January 31, 2107.

The USPSTF has given another pronouncement.  This one actually makes sense.  They believe that all people over 40 years of age should be screened to see if they are candidates for statin therapy.  They actually agree for  once with the physicians who actually treat patients.  The screening should be focused on lifestyle such as smoking, diabetes or hypertension and LDL measurements.  The group however hedges somewhat saying the groups with a 10% or greater risk of problems in the next decade should be on the statins.  The physicians say 7.5%.  They also are not keen on helping the geriatrics as they limit their response to those under 76 years old.  However, if already on them stay on them says the group.  

California Blue Shield is again being forced to repay consumers rebates due to not spending enough on medical care.  The amount is about $25 million.  The money is going to the employers of small companies who pay the money to the employees unless they pay the premiums for the employees and then they can keep the money.  They are also being sued for not paying enough in 2014. 

New Hampshire wanted to improve standards to prove citizenship to be eligible for Ocare and also wanted to make low income adults face a work requirement to get subsidies.  CMS turned both down.  The program will continue in the state without these requirements.  The decision comes the day prior to the election where the Dem Governor is running to unseat the GOP Senator.  CMS has also rejected similar work requirements in Ohio and Arizona.  CMS did approve a charge of $8 for the first unnecessary use of the emergency room and $25 for every time thereafter.          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.