March 15, 2009 Legislation




If people want to know a reason healthcare costs so much they only have to go to their own legislatures.  In Missouri, a House subcommittee has given the go ahead to mandate autism coverage for insurance companies doing business in the state.  The mandate for group health plans would be $72,000 yearly for autism services for those people under 11 and $36,000 for those between 11 and 21 years of age.  A Senate committee had already endorsed a very broad array of services.  This will increase the cost of insurance for all with group health coverage.  The autism group estimates that this will raise premiums about 1% and the insurance people say 3%.

California also will require HMOs to cover speech, physical and occupational therapy for autism.  They will not have to cover behavioral therapy.  This decision will let appeal law suits continue and raise premiums, a lose lose scenario.  

Socialist California State Senator Leno is again pushing a state run single payor medical system.  It was vetoed last year and will be again this year.  The Senator's term limits will never come soon enough. 

To no ones surprise, the Congressional Democrats who love the money paid to them by trial attorneys, introduced a bill to overturn the US Supreme Court decision to disallow state claims against device makers.

CMS is embarrassed that no one is using their online system for initial enrollment or to change information.  All are using paper.  CMS has finally figured out that since they only allowed physicians to use the online system, nothing happened since all forms are filled out by non physicians.  CMS has changed PECOS to allow non physicians to enter information on line.  It do take the government a little time to find out what is happening in the real world.  

There is a new rule regarding physician owned hospitals.  The physician must tell the patient that they own part of the hospital. If the physician does not disclose they may be forced to give up their hospital privileges.  The hospital must tell the patient all the physician owners of the hospital. If they don't they will not be paid. This begins June 8, 2009. 

MedPac is calling for a 1.1% increase in fees to physicians instead of the now in place 21% decrease for 2010.  They also state that the system is flawed and needs to be changed.  The increase would give more money to primary care and take it away from the specialists.  

The People's Republic of Massachusetts has finally passed the law to ban medical device  and pharmaceutical companies from gifting physicians and having to report any payment of over $50 for consulting or speaking engagement.  This has already cost the Republic one major medical convention and will probably decrease other medical conventions in the state as well.   Top   


The feds have finally made the new EMTALA rules final.  This includes the rules that allow hospitals to enter into contracts with other hospitals to form community call plans.  The community call plan calls for a physician call list which may be physicians with privileges or from another hospital in the plan.  The hospital must have policies and procedures to tell what happens when the on call physician is not available because of circumstances beyond the physician's control.  The hospital and physicians have leeway in determining how call is to be handled as well as the reasonable time to appear in the ED.  If the physician does not appear in a reasonable time the physician and the hospital are liable.  If the physician routinely transfers the patient then the physician and the hospital may be liable as well.

The new rules specify that patients who are held in observation are outpatients and still subject to EMTALA, whereas those admitted have had their EMTALA obligation satisfied.

The new rules also discuss the recipient hospital and the ability to transfer patients as well as what happens in a weather emergency (flood or hurricane).         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.