December 15, 2014 Legislation





It is amazing the hubris of hospitals.  The Connecticut hospitals testified before the state that they need the facility fees to pay for the free and reduced payments they get from Medicaid and Medicare.  The Yale administrator testified that his hospital has a 25% Medicaid population and is being paid $.59 per $1 cost.  He then bashed Obamacare saying they were only getting $.90 on the dollar.  The administrator of Hartford Healthcare stated that facility fees were only for complex cases such as cancer and transplant.  He states that contracts with insurers allow the fees.  Really!        Top


The administration realizes that ACO's are not doing well as more hospitals and systems leave the program.  They have now proposed changes to the program that make it less risky for the providers.  They propose extending the three year penalty to six years.  However, ACOs that fail to slow spending in their first two years will still be penalized.  They want ACOs in the risky track and so are decreasing the safe track bonuses from 50% to 40%.  They also want to now add a third track, a hybrid.  This would have identified patients at the beginning of the year.  

Medicare is also tightening ambulance non-emergency rules.  In Pennsylvania, South Carolina and New Jersey seniors will need pre-approval to take an ambulance to things like cancer or dialysis treatments.  This is due to perceived high fraud in these states.  Medicare does not cover nonmedical transportation at all.

CMS has extended the deadline for Meaningful Use attestation until December 31.  This is for hospitals.  

The DOJ has announced that for the 2014 fiscal year that ended on September 30, they had for the first time collected over $5 Billion in False Claims Act settlements.  Of this total $2.3 were about healthcare and the rest was for banks and financial institutions.  

The new budget has some medical aspects.  Again, the budget blocks federal funding for abortions for federal prisoners but this time the HHS Secretary must also direct consumers shopping for health care coverage on the federal exchange whether or not the plan covers abortion services.  The budget also funded Obamacare but would cut the budget for the IPAB by $10 million and would allocate no new funds for the project.  

The House passed the Clay Hunt Suicide Prevention Bill which allocates $22 million for VA oversight of mental health programs.

HHS has issued a declaration stating the United States can not be sued in the United States for any part of the making of three Ebola drugs.

Connecticut Medical Spas now must employ either on staff or by contract a MD, PA or Advanced Practitioner Nurse to do a H and P on all patients prior to any procedure.  The new law also stops home Botox parties.

Governor Moonbeam of California is back to his spending Democratic roots.  He is now considering expanding Medicaid to undocumented aliens.  This illegal move is based on Obama's executive action on immigration.  The program is now running in the red and will sink lower with another 1 million illegals.        Top


Massachusetts screwed up.  The Board of Pharmacy, Dentistry, Physician Assistants and Perfusionists met almost 36 times with not enough members for a quorum.. That makes all actions in those meetings illegal and unenforceable.  They did new applications and discipline.  All these poorly run Boards are under the Department of Public Health.

The Boston Globe reports that the large Atrius medical group will be much smaller.  The new group will still have 750 physicians and 650,000 patients.  Three other groups that were in Atrius were almost 400 physicians.  Atrius is not hospital owned but they do have affiliations.        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.