March 1, 2011 Legislation





Obama is hearing the voice of the people.  He has now declared that the dreaded and potentially illegal tax on those not purchasing insurance can be dropped by the states in 2014 (two years past the next election).  This is the year the tax is supposed to start along with the exchanges and the mandate to large employers to offer insurance or pay a penalty.  Obama has unilaterally changed the date of dropping the three things from 2017 to 2014.  The problem is that Congress created the dates and only Congress can change them.  There is a bipartisan bill in Congress to make the changes.

Governor Sean Parnell of Alaska has stated that he will not enact what he considers to be the illegal Obamacare law.  He bases his decision on the Florida case where the judge threw out the entire law since it had no severability clause.  

Arizona is considering forcing hospital personnel to become de facto immigration agents.  A law up for a vote would require hospitals to check the immigration status of all emergency patients and after treatment in the ED or hospital report them to immigration.  The same would be true for non emergency patients but hospitals would have latitude as to whether or not to treat them. 

Arizona has been told they do not need federal permission to shed adults without children from the Medicaid rolls.  The law expires September 30 and Arizona need not re-apply for an extension to the demonstration project.

Arizona has taken the government's recommendation to heart and is cutting Medicaid to a shell of its former self.  The new program will service about 100,000 instead of the over 1.3 million currently enrolled.  It is expected that most rural hospitals will close due to uncompensated care.

South Carolina is planning to cut $125 million from the pay of hospitals and physicians who see Medicaid patients.  This means less access to care and potential hospital job losses.

New York is proposing a cap on yearly increases in Medicaid that would mean across the board spending cuts to providers.  The interesting twist is that the proposed law would allow each to find their own way to reduce costs.  There will be also a 2% across the board reduction in pay this year.

New Jersey is planning to cut $450 million from Medicaid by putting all recipients into HMOs and cutting payments to nursing homes.

Georgia is planning a 1% decrease in pay to Medicaid providers. They are also considering getting rid of public health labs, dental care, podiatry and vision benefits.

Four more states have received waivers to allow less generous benefits in their states than mandated by Obamacare.  Florida, New Jersey, Tennessee and Ohio are now allowed to operate small plans of less than $750,000.   

Governor Patrick of The People's Republic of Massachusetts has announced that he wants the state employees, Medicaid recipients and other state supported people put into ACOs with bundled payments by 2014.  He believes this will save the cash starved Republic millions of dollars.  

The government has put out a booklet, slides and other information on health care fraud.  It is free and they want it used for information for physicians.  The site for the information is

The House has approved the medical liability bill modeled after California with a $250,000 cap on non economic damages.  Each party would only be liable for their portion of the incident.  

The Republicans have been rebuffed in their attempt to repeal the entire Obamacare but are planning to kill it in slices.  They have introduced a bill that would forbid the IRS from using money for enforcing Obamacare's rule that all purchase insurance.

The CBO has come out with a statement that repealing Obamacare would cost $210 Billion over the next decade. In a slightly different decade the plan was supposed to save $110 Billion. 

Believe it or not the Federal Office of Contract Compliance Programs (OFCCP) is planning more regulation for those providers who they consider should be doing affirmative action programs.  It believes it has jurisdiction over healthcare providers with contracts under Medicare Part C and D.  They have two cases currently under appeal and have won both in the lower courts.  If they win in the courts of appeal it would require those covered to have nondiscrimination in their employment practices and prepare and maintain written affirmative action plans in accordance with complicated regs.  The OFCCP believes that it has jurisdiction over providers that work with FEHBP and TMA.  (See OFCCP v UPMC Braddock and OFCCP v Florida Hospital of Orlando).  The provider would need a fed contract worth over $50,000 and 50 employees.  If you are found to be under their jurisdiction you are subject to compliance audits which may take years to finish. A word to the wise consider canceling your federal TRICARE contracts and continue as a non network provider.  

Obama has revised the Bush rule that granted protections for opposed abortion and sterilization on religious or moral grounds.  However, the federal law still states that health care providers cannot be compelled to perform or assist in an abortion.  The same is not true for filling prescriptions for contraceptives.  Obama has said that Catholic hospitals will continue to have the same statutory protections they have had for decades.

TJC has a new standard stating that institutions must be able to communicate with it's patients in a language the patient understands.  This has been the law of the land for years.  TJC now requires written policies for the same.  As one who just came out of a hospital in a foreign nation where few spoke English, I like the law but I was able to make myself understood as were they by using hand signals.  My case required no informed consent.  

CMS has rescinded the rule that physicians must sign all requisitions for lab tests. It actually went into effect January 1 but was never enforced.         Top


For the first time OCR has fined an organization for significant HIPAA violations.  Cignet Health of St. George's County, Maryland, has been fined $4.3 million.  The organization violated 41 people's access to their health information.  This was $1.3 million of the fine.  Cignet failed to cooperate with the investigation and forced a court judgment to produce the records.  The failure to cooperate cost the additional $3 million.  Hopefully there will be no more stupid organizations like Cignet in the future.   

The OCR did it a second time.  They fined Massachusetts General Hospital $1 million.  They had lost the records on 192 infectious disease patients when an employee left the laptop on a train and it was never recovered.Top


The Montana House has passed a bill giving protections to providers in a med mal lawsuit.  They are immune from suit if they have a documented rationale for omitting a level of care.  They hope that this will cut out defensive medicine and lower the risk of law suits.  If there is malpractice the law will not protect providers and there are no caps.  

North Carolina is pushing a bill to limit non economic damages to $250,000 as well as making ED physicians immune from suit unless they do "gross malpractice."  The legislature hopes to lure physicians to the state with this bill.  They already have enough lawyers.        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.