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McBrayer Blogs
Showing 48 posts in Affordable Care Act.
Get Ready to Negotiate: OIG Authorizes Hospitals to Pay Physicians for Call Coverage
Since the enactment of EMTALA in 1986, hospitals have struggled with providing sufficient call coverage to meet federal requirements as physicians have been increasingly hesitant to take on the added responsibility, cost, and risk of responding to emergency department requests for consultation. With patients often presenting in increasingly acute conditions with no health insurance coverage, physicians understandably find themselves between a rock and a hard place as utilization of hospital emergency departments has skyrocketed, particularly in Eastern Kentucky. And, it is becoming increasingly difficult to see these patients in the hospital emergency departments without also seeing the patients for follow-up in private physician offices often without payment. Thus, the movement for hospitals to pay for physician call services started amid a tangled web of intricate financial relationships, power struggles between hospitals and medical staff, and a statutory and regulatory maze of the Stark Law and Anti-kickback Statutes. Finally, good news is on the horizon as a result of a series of recent Department of Health and Human Services Office of Inspector General’s Advisory Opinions, which essentially give the okay for a hospital to pay a per diem fee to specialists providing unrestricted on-call coverage for hospital emergency departments within certain parameters. For physicians, these OIG Opinions give clear guidance and should be a tool to negotiate payment for call within the parameters of fair market value. More >
Kentucky Health Cooperative One Step Closer
The Kentucky Department of Insurance just approved Kentucky Health Cooperative’s (“KYHC”) entry into the Commonwealth of Kentucky’s HMO insurance market. With this endorsement, KYHC will now be allowed to offer health plans to hundreds of thousands of Kentuckians beginning in October 2013. Benefits are set to begin in January 2014—the deadline for when most citizens will be required to have health insurance under the laws of the Affordable Care Act (“ACA”). More >
Medicaid Expansion in Kentucky
The Supreme Court upheld much of President Obama’s Patient Protection and Affordable Care Act (“PPACA”) in National Federation of Independent Business et al v. Sebelius, but overturned a key element of PPACA’s Medicaid expansion provisions. Originally, PPACA required states to expand Medicaid coverage to individuals at or below 133 percent of the federal poverty level or risk forfeiting existing federal funding for the state’s Medicaid program. In National Federation, the Supreme Court held that PPACA could not withdraw existing Medicaid funding from states choosing not to expand their programs. This change presents each state with a meaningful choice to opt in or out of PPACA’s Medicaid expansion. More >
State Legislation, the ACA, and Autism: New Laws Bring in Waves of Change
In recent years, state legislators across the country have closely focused on a specific health problem that can affect mental capacity: autism. Autism and autism spectrum disorders (ASD’s) cause developmental disabilities and numerous social, behavioral, and physical challenges. The tragedy at Sandy Hook Elementary School renewed intense public debate about this particular diagnosis and treatment of other mental health issues. More >
The Kentucky Health Benefit Exchange: How Obamacare is Changing the Health Insurance Marketplace
Now that the President has been re-elected and the Supreme Court has upheld most of the Accountable Care Act (“ACA”), Obamacare will not be repealed. So, what does that mean for Kentuckians? Several things including an individual mandate to buy health insurance and a health benefit exchange where Kentuckians can buy insurance. More >
THE KENTUCKY HEALTH BENEFIT EXCHANGE: LITTLE GNOME FACTS
“Like Travelocity but for health insurance” is how Executive Director Carrie Banahan and Deputy Director Bill Nold of the Office of Kentucky Health Benefit Exchange describe the developing Kentucky Exchange. More >
Here Comes the Sun, Are you Prepared? – Tips for Navigating the New Sunshine Provisions
The Sunshine Act was legislated as part of the Patient Protection and Affordable Care Act (the “ACA”) to reduce the risk of inappropriate financial incentives interfering with medical judgment and patient care by enhancing the transparency of financial relationships between certain health care providers (i.e. physicians and teaching hospitals) and manufacturers of covered drugs and devices. Because these relationships are being scrutinized now more than ever, those involved in clinical research with manufacturers of drug and device companies may find the following these general guidelines helpful in avoiding risks of non-compliance and legal complications: . More >
Compliance Plan – A Provider’s Defense
The Office of the Inspector General (“OIG”) has always encouraged Medicare and Medicaid providers to implement a compliance program. For 14 years, as a matter of fact, OIG has provided compliance guidance in 11 healthcare sectors (including: hospitals, nursing facilities, home healthcare, hospice and third-party billers). With the passing of the Patient Protection and Affordable Care Act (“PPACA”), compliance plans and programs are now mandatory for any provider enrolled in a Federal health care program, including Medicare. More >
Kentucky Health Cooperative Insurance, Available in 2014
The Supreme Court Decision of June 28, 2012 upholding the Patient Protection and Affordable Care Act (“PPACA”) in National Federation of Independent Business, et al., v. Sebelius , Secretary of Health and Human Services, et al., reignited the creation and implementation of Consumer Operated and Oriented Plan programs (“CO-OPS”). CO-OPs are aimed at offering small businesses and individuals more affordable health insurance options, especially in states where there are a few insurance carriers capitalizing the market with plans that are not economically targeted at the smaller insurance market. More >
Fraud, Waste and Abuse Controls Under The Affordable Care Act
The Affordable Care Act (“ACA”) strives to improve our health care system in three main areas; by expanding consumer protections, strengthening Medicare and reducing health care costs. One key way the government hopes to achieve these goals is through tougher fraud and waste controls. Given the focus on prevention, penalty and recovery, compliance plans are of the utmost importance for all health care providers. First we examine all of the elements incorporated in the ACA that pertain to fraud, abuse and waste before we can begin to develop a compliance plan for our facilities. The new law contains a host of tools aimed at enforcing fraud and waste prevention. Let’s review: More >
