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McBrayer Blogs
Showing 48 posts in Affordable Care Act.
Time to “Face” The Risks
In 2011, the U.S. Centers for Medicare and Medicaid Services (“CMS”), as part of the reform instituted by the Affordable Care Act, required that home health agencies and hospice patients receive a face-to-face visit (at specified time periods) by a physician or nurse practitioner to ensure that they continue to meet Medicare and Medicaid eligibility criteria. More >
Should Kentucky Physicians Follow California Physicians’ Lead In Challenging Medicaid Rates?
In recent years, Kentucky physicians have dealt with the state’s prescription drug abuse problem head-on – by adding substance disorder recovery services to their practices or establishing separate addiction recovery clinics. This trend has undoubtedly played a role in the 2013 decline of Kentucky deaths from overdoses of controlled substances – the first in many years. More >
New Enrollment and Re-Validation Requirements for Providers/Suppliers for Participation in Medicare and Medicaid: Watch Your Mail! Part I
Even though the Centers for Medicare and Medicaid Services (“CMS”) published final regulations to implement provisions to the Affordable Care Act (“ACA”) on February 2, 2011, it is likely that many Kentucky health care providers, including physicians, are not aware of the importance of the new requirements for revalidation of Medicare and Medicaid enrollment or the new and more burdensome requirements for initial enrollment. The requirements are aimed at strengthening provider and supplier screening procedures to reduce fraud, waste, and abuse in federal health care programs. Because CMS contractors and KY Medicaid have been slow to comply with these new requirements, it is likely that many providers have not noticed the enrollment/screening changes unless they have been asked to revalidate or have applied for new or additional provider/supplier numbers. More >
"Essential Benefits" Will Lead to More Patients for Some Providers
In a 2009 speech to the American Medical Association, President Obama promised, “If you like your health-care plan, you’ll be able to keep your health-care plan, period. No one will take it away, no matter what.” This declaration came as the health care law was being written and similar statements were repeated by the President after the bill became law. More >
The ACA’s Effect on Nonprofit Hospitals
By considering the promotion of health a charitable endeavor, the IRS has long granted nonprofit hospitals tax-exempt status under 501(c)(3), the charitable organization exemption. To maintain their status, nonprofit hospitals have always been required to meet specific requirements, such as having an independent board of trustees or offering preventive health outreach programs in their communities. More >
The Young and the Restless
HealthCare.gov’s technical woes are expected to be fixed by November 30th. But, those fixes might come too late for a certain subset of needed enrollees – the young and healthy. The purpose behind the Affordable Care Act’s individual health insurance mandate was to ensure that private insurers would get enough young, healthy people in the system who could offset the costs of covering older and sicker, Medicaid-eligible patients. More >
How Kentucky Got Lucky: The Success of kynect.gov
It is no secret that the federal HealthCare.gov has received less than rave reviews since its October 1st roll-out. The states who have relied on the federal government to run their marketplaces have encountered numerous problems, from glitches to process delays to complete inaccessibility. Kentucky (the only southern state which opted to run its own health insurance marketplace and expand Medicaid), however, has shone like a beacon in the turbulent exchange introduction period. It is quite surprising that Kentucky, consistently near the bottom in health rankings and with approximately 625,000 uninsured citizens, would be the model for anything health care-related. Here is how Kentucky is leading the nation with its exchange site: More >
The Kentucky Office of Health Policy Wants Your Comments
On October 1, 2013, the Kentucky Office of Health Policy issued a Special Notice stating that the Cabinet for Health and Family Services is accepting written comments in preparation of the filing of the 2014 update to the 2013-2015 State Health Plan. According to the Special Notice, the Cabinet is particularly interested in comments regarding revisions to the State Health Plan in order for it to comply with the Affordable Care Act. Although the State Health Plan is only prepared triennially, it is updated and signed by the Governor annually. More >
An Unlikely Consequence, cont.
On Tuesday, I discussed the recent trend of hospital layoffs of staff, administrative and professional alike, in order to reduce costs despite expectations of an unprecedented number of individuals seeking health care services under the ACA. More >
An Unlikely Consequence
The Affordable Care Act (“ACA”) took a big leap forward this month with the opening of the federally-facilitated and state-operated Exchanges. Here in Kentucky, 70,467 people reportedly participated in pre-screenings to determine qualifications for subsidies, discounts, or programs like Medicaid on the Health Insurance Exchange’s first enrollment day, October 1, 2013. The ACA is eventually expected to provide health coverage to as many as 30 million additional Americans. So, why are hospitals across the nation slashing jobs? More >
