May 1, 2016 Legislation





CMS has announced the delay in its star rating program for hospitals.  It heard many concerns about the program from hospitals.  

CMS has dropped its imposition of inpatient payment cuts under the two midnight rule.  They were faced with a lawsuit if they continued with the program.  Hospitals will get a 0.6% increase in inpatient payments in 2017 to make up for the 0.2% decrease of the program in the last three years.  

CMS will continue to attempt to recoup 0.8%  in unlawful billings by hospitals that used the new MS-DRG to get higher payments.  They will do this by an across the board cut of 1.5%.  The hospitals are not pleased about this.

CMS is starting to a new initiative in 20 regions affecting 5000 primary care practices and 20,000 physicians.  They will be paid a monthly fee to do provide specific services in addition to the usual fee for service fee.  In another potential track their EM fee would be reduced and they would receive an up front payment.    This is all preliminary at this time but will be started shortly.

HHS is making problems for consumers.  In the guise of trying to help with no surprise out of network billings they have made it possible for providers to not contract with health plans to get out of network rates.  The insurers will need to just give a form to the consumer and the insurer is off the hook.  Bad legislation by the administration.  This starts in 2018.

CMS issued its Medicaid Managed Care rule.  This is the first change in over a decade.  There is a 85% medical loss ration for contracts that start after July 1, 2017.  The remainder of the 1400 page document will take place over many years.  

California will start on May 1 to put illegal children on Medicaid.  This is exclusively funded by the state as it is illegal for the feds to fund the program. 

Covered California will attempt to reduce the C-Section rates by the threat of exclusion from its approved provider networks if providers do not meet the fed 2020 target rate or explain why.

Covered California is at least doing one good thing.  They are acting to make sure that all who join PPOs will have a primary care physician.  They have also proposed that providers will be rewarded or penalized based on quality of care standards, whatever they are.  This usually means cheap medicine.  

The California AG, who is also running for the Senate, has approved the sale of the Daughters of Charity hospitals to Blue Mountain Capital Management.  The hospitals must stay open and provide Medicaid care for at least ten years.  

Florida has a new law that says providers must post prices and out of network charges that could be incurred by procedures.  Insurers will also be forced to cover speech, physical and occupational therapy for patients with Down Syndrome.  

New York Governor Cuomo has reminded insurers that they will have to provide maternal and postpartum depression screening.  This is to be considered preventative health services and can not be charged for.  This means the overall cost of insurance will again climb.  Free services are not free.

Canada will look at assisted suicide for those who are "suffering intolerably".  The new Trudeau government is introducing the subject in the Parliament.         Top


Maine has joined New York and Minnesota in requiring physicians to use e-prescribing but only for opioid prescriptions.  The governor signed the bill into law.  Prescribers will now have to check a data bank before prescribing the drugs.  The law limits the daily strength of the drugs to 100 milligram equivalents.  They can only prescribe for 7 days for acute pain and 30 days for chronic pain.  Providers also have to attend a 3 hour class on addiction.  The law goes into effect in 2017.

Oklahoma has passed a law that says it is now illegal for to not give a license, reimbursement, employment or admitting privileges to a physician because he/she does not take or pass a MOC program.  This puts into law what the ABMS has always said, that the test is voluntary.  Kentucky has a law that prohibits MOC from being a condition of state licensing.  Michigan and Missouri have bills in the hopper at present.  Keep the momentum going.

Oklahoma has passed a bill that is awaiting a signature of the governor to revoke the medical licenses of physicians that perform abortions.  There is an exception for those who do it to protect the mother or for a miscarried fetus.

HHS OCR has fined the Raleigh, North Carolina, Orthopaedic Clinic $750,000 for not having a business associate agreement in place.  A vendor screwed up some x-rays they were harvesting for silver.        Top


Washington state is investigating Seattle's Northwest Hospital for how it dealt with Rocky Allen.  Mr. Allen is under indictment in Colorado for diverting drugs and potentially giving patients hepatitis.  the state wants to know if the hospital followed state law as they never told the state of any problems with the dismissal as required by law.  

OSHA has fine New Jersey's Cooper University Hospital $55,000 for allowing employees to be exposed to needle stick injuries.  They also had problems with their carpentry department handling toxic chemicals.

Good Samaritan Hospital has agreed to pay a fine of $450,000 to settle claims it patient dumped patients on the streets of Los Angeles.  The money will go to help the homeless.        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.