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The GAO has reported that the joint has finally made some progress in their under the table relations with their for profit arm. They were sharing facility specific information which is not allowed but may be lucrative. Congress has asked for an investigation of the joint and potential for conflict of interest with its for profit arm.
The Federation of American Hospitals has criticized the joint for their selection of three of the six proposed 2008 patient safety goals. The reason are these are different than the goals set up by NQF. This makes more work for the hospitals. Top
TennCare is putting into place a new rule that requires medical necessity to be the least costly treatment that is adequate for the patients. What that is is defined by the health plans involved with the program. Does anyone truly believe that the insurance companies will not use this to delay and deny treatments for the people. Of course, they do this all the time for the non-TennCare patients. On April 1, the care will be switched to the guardians of great medical care, the HMOs. This means going back to the high school drop-out and asking mother may I for the expensive tests. The automatic answer by the morons is no. If this doesn't get the physicians to drop out of the program they deserve what they get. Top
CMS has stated that they will enforce the rules as to who is a State Medicaid provider (hospital). They will also only pay on a cost basis. The rule was published in the January 18 Federal Register under 72 Fed. Reg. 2236.
Another new rule under Section 6032 of the Deficit Reduction Act (DRA), is that entities that get more than $5 million from Medicaid must implement policies about state and federal false claims, false statements and whistleblower protections as well as their own policies. The CMS in a call stated that the entities do not need to provide actual teaching to its contractors, employees and agents but they must amend their employee handbooks to comply with state law that needs to be enacted. In other words, even though the law is now in effect, nothing is required since no state has enacted any rules. Medical staffs are not considered employees unless they hold a contract as a medical director. All enforcement will be by the state and not CMS. Basically the CMS does not have a handle on the new law and will give out new regs at some time in the future. Top
The new People's Republic of Massachusetts' health plan is running into some problems. The Republic received its first bids by the insurance companies for the premiums for the basic coverage. It will run about $380 per month. This is about double what they thought it would cost. The Republic has asked for new bids and if still high may have to rethink the amount of coverage.
On the Left Coast, San Francisco's sick leave plan goes into effect on February 5. The plan requires all businesses to provide sick leave, no matter the number of employees or their status. This will 9increase the sick leave by about 115,000 workers who do not get the perk. They get one hour of sick leave time for every 30 hours worked. There is a cap on the number of hours at 40 for those businesses with less than 10 employees and another cap at 72 hours for those businesses with ten or more employees. This law goes with the new $9.14 per hour minimum wage and a 1.5% tax on businesses with payrolls over $166,667. Another new law in the city is that companies with 20 or more employees pay an additional $1.11 per hour for health coverage for the employees.
Congress has a balanced budget law for physician payments. They never keep it and never reduce the amount they are supposed to pay the physicians. In 2008 the reduction is to be 10%. Now the Medicare Advisory Panel has recommended the repeal of the law or at least increase the payment again. This time by 1.7%. 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.