Category:

Health Insurance

CMS Launched Pilot Project to Offer Individual Market Wellness Programs

Workplace wellness programs — efforts to get workers to lose weight, eat better, stress less and sleep more — are an $8 billion industry in the U.S. Recently, Centers for Medicare and Medicaid Services (CMS) launched a pilot project for states to implement health-contingent wellness programs in the individual market. The project is part of a mandate under the Affordable Care Act that added a provision to the Public Health Service Act calling for health-contingent wellness programs to be tested in the individual market through a pilot project operated by HHS, the Department of Labor and the Treasury Department.

CMS Issues New Rule to Tighten Provider Enrollment

On September 5, 2019, the Centers for Medicare and Medicaid Services (“CMS”) released its final rule with comments on Program Integrity Enhancements to the Provider Enrollment Process (“ The Program Integrity Enhancements”).  The final rule gives CMS the power to revoke Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) enrollments of providers or suppliers who have an “affiliation” with previously sanctioned entities, even if those providers and suppliers aren’t directly violating any existing rules themselves. CMS says that this new authority will help to “stop fraud before it happens.”

Removing “Incident to” Billing: Recommendations from Policy Experts

Earlier this year, the Medicare Payment Advisory Commission (MedPAC) uninamously voted to recommend removing “incident to” Medicare billing for advanced practice registered nurses (APRNs) and physician assistants (PAs). MedPAC serves as an independent congressional agency that advises Congress on Medicare-related issues by analyzing access and quality of care. If this recommendation is adopted, APRNs and PAs would only be able to bill Medicare directly, thus reducing the amount paid by Medicare from 100% under services billed “incident to” to 85% directly. This recommendation could potentially save the Medicare program up to $250 million annually and would allow for better data collection into the amount of services performed by APRNs and PAs, whose services are often masked under “incident to” billing reports. Though there is still some debate on whether the financial loss of losing this option is too high for primary physicians who may hire APRNs and PAs for their practice, the benefits of billing directly likely outweigh the losses.

Protecting PHI as the Health Care Industry Promotes Shift to TeleMedicine

In a time where much of the healthcare industry has shifted to incorporate telehealth and telemedicine, health care organizations and providers are faced with the upkeep of the growing influx of patient data and the challenges associated with their obligation to maintain patient privacy. These challenges increasingly more burdensome as providers strive to keep up to date with the advancement of technology. Healthcare organizations must maintain patient privacythrough close monitoring of clouds, employee use of mobile devices, patient access to medical information and scheduling, and access to the provider networks through non-organizational devices. Maintaining the multiple platforms is costly and the industry remains at risk due to the rising volumes of cybersecurity attacks and breaches. UConn Health recently experienced a data breachthat necessitated notifying 326,000 people of potential impact to their protected health information (PHI) including names, dates of birth, address, billing information, and even social security numbers due to potential access by an unauthorized person.

Injunctions Halt Trump Administration’s Attempt to Expand Religious Exemption for Obamacare Contraceptive Mandate

A pair of injunctions in the Northern District of California on January 13, and the Eastern District of Pennsylvania on January 14, halted the implementation of amendments to a religious exemption to the so-called contraception “mandate” of the Affordable Care Act, also known as Obamacare. The “mandate” requires most employers to include contraception coverage in the insurance plans they offer to employees. While Obama administrative agencies contemplated religious exemptions early on, contentious litigation and political transition expanded the scope of the exemption until these latest developments.

Illinois Law Makers Seeking to Curb E-Cigarette Use Among Teens and Children

In the wake of rising e-cigarette use among teens and children, Illinois lawmakers seek a legal solution to protect Illinois youths from smoking-related illnesses and pre-mature death. Illinois’s Congress introduced Tobacco 21, a bill designed to raise the legal age to purchase tobacco products like e-cigarettes to 21 years of age. Despite a lack of support from Governor Bruce Rauner, Illinois politicians continue to fight to save the bill, and with good reason. The United States Food and Drug Administration (FDA) recently announced its Youth Tobacco Prevention Plan, which addresses the rising e-cigarette use among adolescents. The FDA’s plan is two-fold: (1) crack down on the sale and marketing of e-cigarettes and (2) educate teens and children about the dangers of using e-cigarettes. Tobacco 21 provides support for the FDA’s Plan.

Proposed Public Charge Intended for Immigrants but will Impose on Health Care

Every time we turn on the news, someone is either talking about immigration reform or health care reform. Health care and immigration are two major areas that President Trump promised to address and is attempting to tackle within his first two years in office. Although most would not consider that these two issues would overlap, in today’s American health care system, Americans need immigrants. Immigrants contribute a great deal to our medical research, make up a large percentage of our health care providers, and subsidize health insurance premiums.

Is the ACA Unconstitutional (Again)?

Before the Affordable Care Act (“ACA”) was passed, critics exclaimed that the government had no right to interfere in a citizen’s healthcare. When it was passed, the requirement that every American purchase health insurance caused America to scramble to comply. However, in a year all the critics might be silenced. Recently, Congress repealed the individual mandate’s tax penalty. How will Americans comply with the new act?

Can Congress Regulate Big Pharma?

Drug companies need to fund the research and development necessary to create better products. This means that pharmaceutical companies have fought for years to maintain control over the prices of said drugs. But this standard is being challenged with a new bill that was introduced to the House of Representatives on June 25, 2018.

Market Giants Move to Redesign Healthcare

In January 2018, Warren Buffet, Jamie Dimon, and Jeff Bezos announced that Berkshire Hathaway, JP Morgan Chase, and Amazon would partner together to form a non-profit company aimed at improving the United State healthcare system and combating ever-increasing costs. The idea for the project came about from the ongoing discussion between the three CEOs regarding providing healthcare for their, collectively, approximately 840,000 employees. Even though details are scarce, given the importance of the issue and the prominent names attached to this project, the press, the public, and the market have reacted accordingly. In other words, people are scrambling to figure out what this might mean for their companies and our healthcare system as a whole.