October 1, 2013 Legislation





New York passed a law requiring all personnel in the state's hospitals either wear a mask or get a flu shot.  This includes all healthcare agencies.  The rate of immunization is about 48%.  Therefore, expect to see a lot of masks.  The requirement starts when the flu season is the most prevalent.  The rule does not cover visitors and carries no penalties for not doing it.  The CDC states that just under twenty states have laws regarding flu shots.  Most of the laws require the hospital give flu shots for free.      Top


Obamacare is not going well.  Several days prior to the start of the sign-ups the government decided that not only do large companies get a one year reprieve but now small companies  have longer to sign up as there are "glitches".  The Latino individuals also can not sign up using the Spanish sign-up for another month since it also is not ready.

The administration has rebuffed labor's request to get tax credits for their member's health insurance.  The credits are available for low income people who use exchanges.  The administration states rightly that the law does not allow what the unions want.  This has lead to the AFL-CIO to call for the repeal of Obamacare if it hurts their current health benefits.  This is inevitable as more large employers are switching their employees to exchanges (Sears, IBM, Walgreens).  The unions also are not happy that they like the other insurers will have to pay the $63 per member tax.  They also do not like that full time now means 30 hours a week instead of forty and that business will create 29.5 hour jobs.

Did you know there is a program under Obamacare that is not an exchange or Medicaid?  There is something called "Basic Health Program" that is for those who can not afford the exchanges and do not qualify for Medicaid.  It is lower cost than the exchanges and has the same things as the exchanges.  Why would anyone buy an exchange when the same thing can be obtained for less?  This will not be available until 2015.

There is a new glitch in Obamacare that cost some families thousands of dollars and leave many children without health insurance.  The glitch is that "affordable" is defined as 9.5% or less of an employee's household income.  So if an employed person is not offered insurance for the family, the family can not get subsidized insurance via an exchange.  They will not have insurance and will not be penalized for not having it.  

In a major attempt to get people behind Obamacare the fed announced the average prices of plans in the 36 states that they will handle the exchanges.  The average price of course is meaningless as the prices for the same coverage may vary over $300 between states as well as significant differences within the same state.  The feds were silent on the insurers and the polices that will cost more to get an average.

The LA Times has an article regarding California exchanges limiting which hospitals and physicians may participate with them. The reason is to keep the premium as cheap as possible. This will lead to significant changes of the patient physician relationship which Obama promised would not occur.  He, of course, lied or was just ignorant.  Neither is good for the leader of the free world.

The Department of Labor has mandated that caregivers be paid overtime.  This will increase the cost of care of the disabled and elderly.  The rule starts in January, 2015.  Since most of these individuals are state paid it is estimated that the rule will cost California an additional $150 million per year.  It is possible that the states will not allow overtime and hire additional part time employees instead.

The OCR has decreed that labs do not have to comply with the new HIPAA laws yet.  They can wait until the new CLIA notices are devised.  Also pharmaceutical manufacturers can pay providers only the amount they put out without profit on renewal notices to patients.  If they pay BAs who put out the reminders the payment is fair market value.

CMS has directed their auditors to delay enforcement of the "two-midnight" rule.  This rule which states hospital stays of less than one day can have the medical necessity scrutinized has been under fire by the AHA.  Under the new edict stays of one day that occur between October 1 and December 31 will not be scrutinized for medical necessity.  This is to allow hospitals to get used to the rule.  The old rule still applies that allows auditors to use a 25 patient sample of short stays and if a stay is found that is not medically necessary they can be denied and educate the hospital.  CMS did this so that people in the hospital under observation for three or more nights would be considered inpatients and not observation.        Top


The CBO has stated that the House committee solution to the ridiculous SGR would cost about $175 Billion over 10 years.  If passed it would change the methodology of physician payment.  If not passed physicians will be docked 24% of the Medicare pay starting the first of the year unless Congress does what it has always done extend the status quo with a slight increase.

Oklahoma has disciplined a physician, Dr. Trow or far eastern Oklahoma, for using Skype to treat patients.  He was accused of prescribing dangerous medications without a face to face initial interview.  Oklahoma does not consider Skype to be an approved method of telecommunications.  The physician was given a two year probation and ordered to take a course on prescribing.  He is not allowed to prescribe narcotics until the completion of the course.  He used Skype due to his own failing health with back and hip problems which kept him home.        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.