July 1, 2017 Legislation




CMS has just announced even more small practices will be exempt from MACRA.  Those with under $90,000 in Medicare revenue or under 200 Medicare individual patients per year are exempt.  Prior it was under 10 patients and under $30,000 in Medicare receipts.

The administration has started on their promise to reduce the cost of medicines.  The FDA is starting to focus on encouraging the development of generic drugs.  This will do nothing to the cost of mew meds that are very high priced.  They really can not do much about pricing but can get rid of the roadblocks to the generic development of drugs.  The administration is also considering value pricing that determines price on how well the drug works.  

The powerful OB/GYN college has announced their mammogram recommendations.  Theirs is different from the American Cancer Society and the dreaded USPSTF.  The college recommends offering screening at age 40 and have full screening at age 50.  The ACS recommends offering age age 40 but annual at 45 and go to every other year at age 55.  The feds want screening every other year starting at 50 but offering it at age 40.

The Nevada Governor has vetoed a bill that would give the state Medicaid for all.  He had too many questions as to how the program would work.  The insurance would be on the state exchange but work within Medicaid, not not be Medicaid as there are strict financial conditions for that.

California still thinks they have unlimited money.  They don't.  The treasurer is giving $20 million to clinics to treat low income people.  He feels this is an emergency because of the POSSIBLE cuts from Washington. The money would go to the clinics that is small or a rural non profit if they get cut in Medicaid payments.  This would include Planned Parenthood.  It should be known that he is going to be running for Governor in the progressive state and needs some publicity.   

The English NHS has finally approved Kadcyla for breast cancer but only for 1200 women.  If you are 1201 you die.  In order to obtain the drug the woman must have Her2+ breast cancer metastatic and have failed Herceptin.  This only occurred when Roche agreed to lower the price of the drug for the NHS.  It usually is about 90,000 Pounds per year per patient.  The good people at the NHS are now thinking about getting rid of the first line drug Perjeta.        Top


A Miami man, Adrian Ambramovich, has been accused of robocalling hospitals clogging up their emergency phone lines.  The FCC is proposing to fine him $120 million.  

California has a new law in place and now active that protects against balance billing.  It says if you visit an in network facility you will be responsible for only the in network share of cost, even if seen by a non-participating person.  This covers managed health plans and PPO plans for non-emergency services.  It does not cover employer sponsored plans regulated by the US Department of Labor.  There is a kicker.  If one wants to be seen by an out of network provider and pay out of pocket, they may.  They must sign a paper allowing this at last 24 hours in advance of any generated charges.      

Kaiser is making money had over fist so they do not mind being continually fined for their terrible mental health services.  They continue to not give access in a timely manner to mental health needs.  The state is looking to possibly fine them again.  Kaiser has already been fined $4 million for their terrible service.          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.