December 15, 2011 Legislation




Connecticut has a rule that drugs for Medicaid patients must be on an approved list to be used without prior authorization.  The drugs that did not make the list were the expensive oncology drugs.  A drug not even approved in the US was put on the list.  This means waits while the red tape unfolds and puts patients at risk.  The state DDS spokesperson tells how they think of people by stating that the authorization of the "clients" must be within two hours.  Lots of luck on that one.  It is a shame that those on Medicaid are not people or patients.

England's NICE has not allowed Fingolimod, a drug that is the first oral med for MS.  It is allowed and on the formulary in the US and Europe.  NICE is disallowing the drug strictly on cost.  They state that the IM interferon is as good and much cheaper.  Can't wait until the new Obamacare Committee is set up so we can get no drugs here either.

House Republicans have blocked the 2% decrease in Social Security for multiple reasons.  The first is how it is to be paid for.  The Democrats want it paid for by a surtax on those making over $1 million per year.  The Republicans want it paid for by charging these millionaires full price for Medicare and not allowing them to get government assistance.  They also want a freeze on federal pay which has been supported by Obama.  The Democrats do not want to cut any government program.

Obama has decided to bypass Congress and relax some healthcare regs to create jobs.  The main change as announced by CMS is to give more time for physicians and others to meet the EMS standards.  If they didn't employees of the hospitals and the physicians would be let go to keep the bottom line in the black.

CMS has given out almost $2 Billion to hospitals and physicians for meeting meaningful use EHRs.

CMS has announced the start up application dates for the advanced pay ACOs.  These are limited to non hospital organizations with under $50 million in annual revenue and critical care or rural hospitals with under the $50 million limit.

As all know and are not surprised by the failure of the "super committee" the automatic decreases in the Medicare and Defense arenas are to take place starting in 2013.  The GOP wants to exempt the defense and the Dems want to exempt Medicare.  Any surprise there?  Obama wants the cuts to take place as passed.

The IOM sent to CMS a list of what must be covered in exchanges under Obamacare.  Now 2400 organizations and providers have sent a letter to CMS objecting to the scope of the IOM letter recommendations. 

For the first time in history, CMS has overruled the FDA on a drug usage.  They have that right but have never used it.  The FDA said that the Plan B pill was safe enough to be given without a prescription to girls 11 and above.  The CMS said that it would require a prescription for those females under the age of 17.  This seems to be a strictly political decision with an attempt to rationalize it by science.  After CMS did it's thing, Obama stated he had not participated in any discussion in the action but agreed with it.  Sebelius, when confronted by Mayor Bloomberg about her decision, said it was not about politics but science.  

As I reported in the last edition, CMS went after little Everence Insurance who raised their rates 11%.  The insurance company run by the Mennonite Church said too bad to the mean old CMS and will continue to charge what they think is reasonable.  The feds have no ability to force any change of rates.

Congressional Republicans are planning to put into action a SGR block for two years with a 1% raise.  This would be part of a year end legislation with multiple tax provisions.  The GOP will not back a permanent SGR removal.  This is hoped to be paid for by means testing and an increase in the Medicare tax on the wealthy.  Yes, this is coming from the Republicans.  The AHA and its lackey organizations sent letters pleading that the physician SGR fix would not come from the hospital sector, but the House bill does take money from the hospitals by reducing the EM code payments for outpatients .  Even harder for the hospitals to swallow is that it relaxes physician referrals to physician owned hospitals.  It would allow physician owned hospitals to expand if they were already in existence when the law went into effect.  Also, it would allow the finishing of construction of those physician owned hospitals that were under construction.  It also extends the non hospital cap on physical therapy to hospitals. The bill will die in the Senate due to conservative add-ons which the Democrats will not allow.

MedPAC believes the 2% reduction for physicians and hospitals from the failure of the super committee to come to any agreement will just mean that physicians will be paid more of what they are worth (2% less) and hospitals will become more efficient.  They do not take into account the other laws that reduce payments for not using appropriate EHR or prescribing.  It also doesn't take into consideration the 27$ cut that is now on the books for the SGR.  

Gee!  The HHS has stated that rebates of the patient's own money from health insurers who do not meet the 80% test will not be taxable.  How refreshing to get your own money back without getting taxed on it.      

The feds will allow Medicare claims database to be used for public information such as how many times a person has done a particular operation.  Of course they have no idea regarding non Medicare patient work.  The physicians will be identified but the patients will not.  Any bet on how few times this will be used.

Kansas has a massive hole in its overseeing of the nursing profession.  There is no law mandating long term care facilities to do background checks and the state only does them on new licesenees.

England's NHS has decided that all medical records will be on line and patients will have access to all their records in the next year.  The NHS also wants the information for their own use.         Top 


California has fined 14 hospitals for safety violations.  The hospitals are: Fresno Surgical for a retained foreign body-$50,000; Henry Mayo Newhall in Valencia for unsafe administration of medicine-$50,000; Kaiser South San Francisco (one of "the best hospitals in the country") for unsafe administration of medicine-$50,000; USC Medical Center for retained foreign body- $25,000; Lucile Packard Children's Hospital at Stanford (another "Best Hospital") for unsafe administration of medicine-$50,000; Mission Hospital in Mission Viejo for a retained foreign body- $100,000 (4th penalty for the hospital); San Francisco General for not following its own surgical procedures-$50,000; Santa Barbara Cottage Hospital for failure to implement and develop safety measures for the protections of the patients.  They let a baby abductor get off the grounds-$50,000; Scripps La Jolla for retained foreign body-$100,000; St. Jude in Fullerton for unsafe administration of medicine-$75,000; Sutter Solano in Vallejo for retained foreign body-$50,000; Torrence Medical Hospital for retained foreign body-$75,000; UCSF Hospital for failure to follow its surgical procedures-$75,000 (6th fine for the hospital); Ventura County Hospital for a retained foreign body-$50,000.          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.