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HCFA is gone. Secretary Thompson has made the bad old organization go away. It has been replaced by the much kinder Centers for Medicare and Medicaid Services (CMS). This new and more responsive organization will have three centers of service. The Center for Beneficiary Choices will be devoted to the Medicare+Choice program and the needs of the beneficiaries. The Center for Medicare Management will be for traditional Medicare and the Center for Medicaid and State Operation will obviously be devoted to those programs. The Administrator of this new organization Tom Scully stated that there will be a $35 million dollar campaign to tell people about their choices. Top
The State Senate has passed and sent to the Assembly a bill to send those that block access to churches or abortion clinics to jail for up to one year. They could also be fined up to $50,000. The chance for passage in the Assembly is good.
Other items up for votes are AB 289 which allows physicians to be employed by exempted narcotic treatment clinics provided the clinic does not interfere with, control, or otherwise direct a physician's judgment. AB 1311 would require a health care provider to give a free copy of the patient's medical record upon proof the records are needed to support a claim regarding eligibility for a public benefit program. SB 187 requires the DHS to establish a registry for the patients using medical marijuana under Proposition 215. Top
A study was released by the Congressional Budget Office showing that the Frist, Jeffords Bill would raise the median annual premium about 2.9%. The Kennedy, McClain Bill would raise the same median premium about 4.2%. The major difference is the ability to sue in state court. The Frist bill does not allow state suits, but only suits in federal court after an appeals process is exhausted. The maximum allowed damages would be $500,000. The Kennedy Bill allows suit against HMOs in state court for quality of care and denial of benefit issues. the cap on damages here would be the state imposed limit. The person could sue in federal court for non quality of care issues and the cap would be $ 5 million. Top
Florida has fined a surgeon $5000 for mixing up two patients. He did a mastectomy on a patient scheduled for a lumpectomy. The surgeon is also scheduled to pay $960 in costs and to deliver an hour lecture on wrong side surgery. I don't understand what happened to the usual checks and balances that are supposed to occur in the hospital system. It is not only the physician but the hospital system that must share the blame. See Recent News for more on this topic. This case happened at Moffitt Cancer Center, Florida's only NCI designated unit and by the program leader of the Comprehensive Breast Center. Top
Walgreen threatened to cut pharmacy hours in poor neighborhoods since Illinois was going to yank $22 million for Medicaid patient pharmacies. The State relented and Walgreen's is no longer going to cut hours. Top
Nevada has just passed a bill and sent it to the governor to allow medical marijuana. This is right after the US Supreme Court ruled that medical necessity is not a defense for the sale of marijuana. This vote passed after the people of Nevada voted twice to amend the State Constitution to allow medical use of marijuana. The other states that allow marijuana are Hawaii, Alaska, Arizona, California, Colorado, Maine and Oregon. This law allows patients to have up to seven plants for their own use, be registered with the state, and if caught with an ounce or less be only charged with a misdemeanor. It would not be a felony until after they were caught four times. Top
North Carolina is considering taxing HMOs and the Blues. The insurance companies have said they will pass the tax on to their customers, the payors. The HMOs believe they should not have to pay the tax since it will penalize people looking for the cheapest medical care. The commission after hearing the HMO arguments said they are only insurance companies and are subject to the same tax that the conventional insurance companies pay. Top
San Bernadino County wanted to ban emergency contraception in public clinics. California health officials denied that request. San Bernadino County has decided not to appeal the decision directly to the Bush administration (HHS) since they may be given to teen age girls. A very wise decision on the part of San Bernadino. Top
HealthSouth has settled their Medicare fraud charges by paying a fine of $7.9 million. They were charged in a whistleblower suit with overcharging programs for equipment purchased through a company owned by the HealthSouth CEO. Sounds like a potential conflict of interest. If it was any ordinary person the company may have been banned from Medicare. Top
JCAHO has decided to crack down. They have been criticized by the Feds for being soft on the hospitals, who get deemed status if they pass the inspection. Just because the crackdown happened in the same year as the HHS criticism is probably a coincidence. The percent of hospitals receiving a Type I has increased as has the absolute numbers of Type Is given. The average score has also gone from just over 92 to under 91. Northwestern Memorial Hospital in Chicago got a score of 88 and six Type I recommendations. In their last survey they had a 97 and no Type Is. JCAHO is also streamlining its standards as some may not be relevant. No Kidding. Top
In those cases brought before the Department of Managed Health Care for dispute resolution, HMOs have won 65%. Only a very small percent of the total HMO members have registered complaints that need the departments dispute resolution process. The total decided by a independent physician board so far is 195. Top
About 100 physician and dental groups have registered their displeasure of the requirement that they provide interpreters for non-English speaking patients. The Clinton administration interpreted the Civil Rights Act of 1964 to state that non-English speaking people seeing providers that receive federal funds, Medicare and Medicaid, are required to provide translators at their own expense. Family and friends are not permitted to be interpreters. One physician was recently fined $60,000 for failing to provide the necessary professional interpreter. The group stated that since most professionals will not pay the costs of up to $250 per translator when they get only $38 for the visit are going to refuse to see the patients. 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.