July 1, 2010 Legislation




Red Cross


Republicans attempted a repeal of the individual mandate in the Healthcare bill.  The Congress defeated the motion 187-230, with 21 Democrats favoring the bill.  This again gets the names of the Congresspeople up for election before the electorate.  

The White House is issuing rules to prevent business from cutting benefits or raising premiums.  Those that go against the rules will lose their existing health plans status.  In doing the above the White House acknowledged that people in small business may see a change in coverage which is against the Obama promises.  Plans will lose their status if they cancel coverage due to illness or impose any lifetime limits.  If plans go along with the White House they will not have to provide the "essential health benefits" as specified by the Feds.

More things in the healthcare bill are coming out.  All know that starting this year preventive screenings are a must as well as other services for no additional cost.  This included folic acid to prevent neural tube defects and counseling pregnant women to stop smoking.  Employers will be required to give lactating women a place (not a bathroom) to privately express their breast milk.  There will be some funding for ten years for housing, childcare and other needs.  This is a $25 million per year program.  Another program of $1.5 Billion over five years will go for home visiting to help to cope with the stress that inevitably come with being a parent.  

The US Senate is scaling back the amount of time of the "physician fix".  The time span has been shortened to November instead of the end of 2011 due to how much this would raise the national debt.  The Senate is not willing to cut other funding.  The new plan would add "only" $54 Billion to the debt.  The bill will probably also deny COBRA extension.  There is also doubt regarding the Medicaid money for the states.  The Republicans want to introduce a bill that would keep the Medicare status quo but not do a permanent fix until the end of 2012.  They would balance this by deleting the entire Medicaid package.  This also may not pass.  The Dems were 15 votes shy of the needed 60 on the first try.  They lost 54-45.  It is becoming obvious that the Senate Dems are afraid of losing at the polls in November to those who do not want to raise the deficit, no matter what Obama says.

Well, it has happened.  The Senate did not act and CMS will begin the 21% decrease in payments to physicians.  Will the medical profession take this or will they rebel by not taking any more Medicare patients.  Those who are on salary have no problems but those in private practice will be the ones to watch.  Along with the problem with physicians are the state Medicaid payments.  It will be interesting to see how many jobs are either furloughed or lost. The Senate will need to separate the multiple items in the bill and vote separately on each one.  The cumulative effect however can not increase the national debt.  There must be cuts in other places.

The day after the above was written the Senate did what it should have done prior, passed the Medicare delay for six months.  This was done as a stand alone bill and does not increase the debt.  It does not fix the problem but allows CMS to pay the physicians the amounts they are due.  The vote was a voice vote by acclamation.  The House still has to approve but refuses to do so unless the entire "Extender" bill is included.  The Senate is trying to pass the bill with less money for the states but still do not have the necessary votes.  In the meantime the physicians are getting the 21% pay cut.  Pelosi stated she would not allow a vote in the House on the physician pay unless the Senate also passed the Jobs Bill.  After she said that the House voted with one nay vote (Congressman Miller of Concord, California) to pass the delay.   I continue to hope that independent medical practitioners will cut back on Medicare patients since those employed from hospitals or insurance companies are contractually bound to take all that are sent to them.  CMS only knows that amount that have dropped out of Medicare is 3%.  They don't know how many have cut back or stopped taking new Medicare patients. To bolster my statement the amount that the payments will be reduced November 1 is 23% and 30% starting January, 2011.

The Senate has started to get smarter.  They are pulling the Jobs Bill apart and voting on each part individually.  This way the areas that do not increase the debt may pass and those which do increase the debt will fail or not be voted upon. The House could not pass the Jobs Bill on a 2/3 suspension of the rules vote.  They are now going back to a majority vote.  The Senate has a new Jobs Bill coming before it authored by new Senator Brown.  It will be paid for with cuts at other areas and using unspent stimulus money.  His plan includes some boost for Medicaid payments to the states.  Reid also put forth a new bill without any increase in Medicaid spending.

The Medicare physician delay bill does penalize hospitals by preventing hospitals from submitting separate claims for inpatient and outpatient therapeutic care provided within 72 hours of admission.

CMS has finally proposed visitation rules for hospitals that take fed money.  They allow the patient to control who the visitors are, not the hospitals.  

The new Patient Bill of Rights on insurance have the items in the healthcare reform bill.  

Colorado is delaying payments to those physicians that take Medicaid patients until July 9 after a new fiscal year has started.  The physicians should stop seeing the patients until then as well.

In the last edition of Medicalaw Updates I ran an article stating Vermont was going after the $250 CMS Part D rebates to those who were in the doughnut hole and whose payments were paid by the state.  This was appropriate.  However, these people are now getting a windfall in order to appease the Washington D. C. people.  Vermont has decided not to ask these people for their $250.  This was done after pressure by the state's Senators who voted for the reform and Sebelius who didn't seem to care that the state got screwed twice.   

Those states that opted to do their own high risk pools were told they have one week to tell the feds how they intend to run the pools.  Those that were smart enough to let the feds do it are laughing.  The pools were to start now and run until the feds take over for all inl 2014 but now are starting enrollment on July 1 and begin coverage a month later.  Independent review now shows what all knew before that the amount of money the states are going to receive is not close to what is needed.

Michigan has decided to start their pool in October.  In order to enter the pool the individual must have paid out a minimum of $1000.  After that the new policies would have low co-pays.  The total out of pocket can not exceed about $6000 per year.  Stupidly the plan also allows cosmetic surgery.

Florida will start to enroll patients for their high risk insurance pool.  The patients must have had no insurance for the past six months and have a pre- existing medical condition.  They expect the allotted money to run out very soon.  They then will need to either close the program, cap enrollment or using state money.

The CBO has come out with a forecast that the high risk pool is grossly underfunded.  Those states that have agreed to administer the fund will soon be dipping into their own funds unless the Congress allocates more money.  This will be very difficult to get through the Senate.

The head of the CBO has written in his blog that the country is headed for a major disaster if more revenues are not done and if spending is not curtailed.  He stated the Bush tax cuts should be not renewed to get more revenue and that healthcare spending must be curtailed.  The Democrats agreed with the first part and the Republicans with the second along with getting rid of the ineffectual jobs bill.

The CMS has stated they will not reject physician claims automatically who do not have approved enrolment in PECOS by the July 6 deadline.  They will try to improve their processes and come up with a plan that written orders and certifications are only issued by eligible professionals.

The law of unintended circumstances has again raised its ugly head.  This time in Connecticut.  The legislature passed a law that if a discount prescription if offered to uninsured individuals it must be offered to Medicaid patients.  CVS said that it can not give away money and will shut down its program completely.  Now the government is thinking about suing to keep the program open even though it is a voluntary program.  They should have thought about this before.

New York has passed a bill on autism.  This will raise the price of insurance approximately 2% across the board.  Another example of legislative tinkering costing all.  There are no age limits nor any cap on the amounts to be paid.  Many believe the 2% is a very low figure.

HHS is spending $168 million on training new primary care physicians.  They want 500 new ones as soon as possible.  The new access problem will hit in 2014.  The feds will also spend $30 million to encourage 600 new nurses and an additional $32 million for 600 new Physician Assistants.  It sounds like they are willing to put the safety of the American people at risk. The new studies show a lack of 42,000 primary care doctors in 2020 and 47,000 by 2025.  One wonders how much the new law is responsible for the projected lack of providers.  

The People's Republic of Massachusetts has taken it on the chin.  The insurance appeals board has overruled the state on capping the amount of health insurance increase Pilgrim may charge.  They found the increase requested reasonable given what they must pay hospitals and physicians.  There are three other major cases before the board.  The Republic may appeal the ruling to the courts.  Governor Patrick wanted the caps to prevent "the little people" from paying more and so he can get elected.  

The Republic is really good to their municipal employees.  They get big health perks and the legislature has failed to rein them in.  There will be a vote next year by the residents of the Republic whether or not to continue to support the massive outlay of money the unions in the Republic are spending.  

The FDA has stopped its plan to require drug manufacturers of long acting pain relievers to register both the physicians writing the prescriptions and the patients who are receiving the meds.  They found that the list is untenable.        Top


The ABA has sent out a legislative alert that Congress is looking to regulate attorneys.  Wouldn't that be a shame?  The law is HR 4173 which would create a new federal entity that could regulate all providing financial products or services to consumers, including most attorneys.  Wouldn't it be good to have the attorneys on the physician side for a change.  If you support this bill write your representative.        Top


The California Board of Consumer Affairs has agreed with the California Optometry that Optometrists should be able to treat Glaucoma patients.  This was fought by the California Medical Assn.  The permission now goes to the Department of Finance to see if it will affect the budget and then to the Office of Administrative Law for final approval.  The legislature had previous passed a law so Optometrists could be trained to treat Glaucoma.   

In New York there is a bill to have less restrictions on Midwives.  The bill is a major threat to patients.  It would eliminate the requirement that midwives have a written agreement with either a hospital or an OB.

Interns will get more supervision where attendings will have to be at the hospital and not take call from home. They will also get shorter shifts from 24 hours to 16 hours.  If this happens it will not be until July 2011.  

The FTC agrees with physicians that they should not be subjected to the Red Flag Rules.  They first delayed the rule enforcement until the end of the year and then changed again to delay until the appeals court rules on the law suit by the attorneys.  That suit took the attorneys out of the Rules.   

CMS has changed some of the rules of PQRI by adding some new things physicians may report and by extending the payments to physicians to 2014 and not penalizing until 2015.  

Starting in 2011 the CMS will pay for a prevention physical once a year.      Top

Red Cross

The Red Cross must be one of the worst run organizations not only in medicine but in the country.  This time the FDA has fined them $16 million for their poor practices in collection and manufacturing of blood.  The current fines make the total $37 million paid for by the money they collect from hospitals and not from the public donations.          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.