April 1, 2009 Legislation

Hospitals

Stimulus

Physicians

Insurance

Hospitals

New Jersey has finally caught up to the rest of the country.  They have passed a law allowing physicians to refer to ASCs owned by the physicians.  The law is also effective retroactively.  The physician must refer and do the surgery.  The ASCs associated with a medical practice must now be accredited and registered with the state. 

CMS has warned the Univ. of Chicago that it may take away its accreditation.  The hospital let a man sit in a wheelchair without any triage for hours.  He died in the wheelchair without ever being seen.  The hospital says proper protocols were in place but they were not followed.  They should receive the civil med mal notification soon.      Top

Stimulus

The new stimulus package that isn't gives $10 Billion to the NIH for "comparative effectiveness" research.  The Congress thought it was going for comparisons but the NIH is planning on using the money for research on the process. 

The Congress also snuck in a one line notation in the bill that no one read stating the government would have ten years to pay for healthcare overhaul.  The healthcare bill was put on fast track so it only needs a simple majority in the Senate and can not be filibustered.           Top

Physicians

CMS has changed the rules for physicians who are applying to Medicare for billing status.  The old rule was one could bill for up to 27 months prior to receiving permission to bill.  The new rule negates this and states no billing until you get your Medicare number approval.  The same now holds true if a physician gets removed from Medicare.  He/she can only bill for 60 days for the services rendered prior to the removal, not the 27 months that was in effect prior.        Top

Insurance

CMS has announced new rules for Medicare Advantage plans.  Out of pocket costs must be capped at $3400 at the most.  They can not charge more than traditional Medicare charges for dialysis, home health and other services.  Also sick low income patients will not have to pay more than they would under traditional Medicare.

Illinois has passed a law that went into effect today to reduce hospital charges for the uninsured and cap how much can be collected.  The cost can not exceed the cost of the service plus 35% and caps the amount that can be collected at 25% of an annual family income.  The AG will be the enforcer.         Top

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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.