Health Care Law Blog
On June 29, 2011, the 6th Circuit Court of Appeals issued the first appellate decision with regard to the constitutionality of the Patient Protection and Affordable Care Act ("PPACA"). In a split decision (2-1), the court upheld the minimum coverage provision of PPACA (also know as the 'individual mandate') as constitutional. The individual mandate essentially fines non-exempt persons for not securing minimum essential health insurance coverage. The court noted that this provision was effectively a regulation on the practice of self-insuring (an individual's actions in arranging his or her own financial affairs to compensate for future health care needs).
According to the Centers for Medicare & Medicaid Services ("CMS"), CMS has already paid $75 million to health care providers for meaningful use of electronic health records ("EHR") since the first incentive payments began in mid-May, 2011. This number is only expected to rise as physicians and hospitals have until the end of 2012 to attest to "meaningful use" of EHR and become entitled to receive the maximum amounts over a five-year period.
On June 1, 2011, the Centers for Medicare & Medicaid Services ("CMS") issued a proposed rule that would allow certain physicians to avoid having to use electronic prescribing ("eRx") by the required June 30, 2011 date.
Currently, CMS requires that providers complete at least 10 drug orders using an eRx system between January 1 and June 30, 2011 in order to avoid a one percent decrease in Medicare payments in 2012. Prior to the June 1, 2011 proposed rule, only rural providers with limited internet access or providers in an area with limited pharmacies for eRx could claim a hardship waiver to avoid the penalties for failing to make the 10 eRx orders.
The Office of the National Coordinator for Health Information Technology ("ONC") announced that the first electronic health record ("EHR") incentive payments were going to be made in mid-May to providers who had successfully attested to having met "meaningful use" and all of the other program requirements. The maximum payment that a Medicare provider in the EHR program can receive in 2011 for his or her first year of participation is $18,000. Incentive payments for eligible hospitals begin at $2 million.
The Centers for Medicare and Medicaid Services ("CMS"), like other federal agencies, generally has 20 days (plus a 10 day extension) to respond to requests for information under the Freedom of Information Act ("FOIA"). However, CMS responses seem to take quite a bit longer.
Last week, I received a response to a FOIA request that I filed with CMS in March of 2010. That's right: 2010. In its response, CMS explained that when it is busy, it utilizes a "first-in, first-out" approach when responding to requests.
Small employers may soon expect to see provisions in their health plan policies requiring them to make minimum contributions to their employees' premiums as a result of a recent Michigan Supreme Court decision. On May 17, 2011, the Supreme Court of Michigan rendered a decision interpreting a provision in the Small Group Health Coverage Act (the "Act"), a law that requires every insurance carrier wishing to provide health care benefits to small employers in Michigan to offer all of its small-employer health plans to all small employers. MCL 500.3701 et. seq.
On May 17, 2011, the Center for Medicare and Medicaid Innovation, a part of the Centers for Medicare & Medicaid Services ("CMS"), announced a "Pioneer ACO Model" designed for providers that are already experienced in coordinating care for patients across care settings.
The Pioneer ACO program provides higher risks and greater rewards in the first two years of the program than those available to non-Pioneer Accountable Care Organizations ("ACOs"). Specifically, non-Pioneer ACOs can choose from two tracks that vary on risk and reward under the CMS proposed ACO regulations. Track One ACOs are those involved in a “one-sided model” that begins as a no-risk shared-savings payment system for the first two years and converts to a risk-sharing payment system in the third year. Track Two ACOs are those that are involved in a "two-sided model,” with risk-sharing (of both savings and losses) beginning in year one. Pioneer ACOs also participate in two-sided risk sharing from year one.
The 2010 health reform act, the Patient Protection and Affordable Care Act ("PPACA"), provides for the creation of health insurance "exchanges." Exchanges are programs designed to make it easier for eligible consumers and small businesses to compare and purchase health insurance coverage in a one-stop shopping format. An Exchange is essentially a set of state regulated and standardized private health care plans, from which individuals may purchase health insurance that is eligible for federal subsidies. States choosing to create Exchanges are required to have them up and running by 2014.
The Medicare Data Access for Transparency and Accountability Act ("DATA Act") was introduced in the United States Senate on April 7, 2011. The DATA Act seeks to make public the Department of Health and Human Services' claims and payment data, which would include data on payments made to medical providers pursuant to the Social Security Act (i.e., Medicare). Specifically, the data made available to the public would include the following:
While most of the media attention related to medical marihuana has been focused on employment issues and the location of marihuana dispensaries, a Michigan physician is also receiving some press because of criminal charges recently filed against her.
On April 15, 2011, as part of a Drug Enforcement Agency ("DEA") investigation into Dr. Ruth A. Buck's potential prescription drug crimes, the DEA also charged Dr. Buck criminally with aiding and abetting the distribution of marihuana.
