| ITEM ONE: DJP Update 6-21-2010 “Grandfathered” Health Plans regulation issued by HHS
And now the regulations start! Be alert and monitor these regulations that implement the disaster in the details new law. We are moving in the direction of more government control of Medicine and lack of choice by patients of Free Enterprise alternatives. You can count on it. My CPA send me some information about “Grandfathered” health plans from a summary of the regulation at: http://www.sebsla.com/n-news/article.asp?id=40 and that link also gives the link to the Federal Website that has information of new regulation by HHS. The HHS press release of June 14, 2010 can be found at: http://www.hhs.gov/news/press/2010pres/06/20100614e.html Here is info from Federal Government Website that includes discussion of “Grandfathered” Health Plans and how that status can be lost. http://www.healthreform.gov/newsroom/keeping_the_health_plan_you_have.html Today, the Departments of Health and Human Services, Labor, and Treasury issued a new regulation for health coverage in place on March 23, 2010 that makes good on that promise by… Another excerpt: Plans will lose their grandfathered status if they choose to make significant changes that reduce benefits or increase costs to consumers. If a plan loses its grandfathered status, then consumers in these plans will gain additional new benefits including: Coverage of recommended prevention services with no cost sharing; and Patient protections such as guaranteed access to OB-GYNs and pediatricians. Under the Affordable Care Act, these requirements are applicable to all new plans, and existing plans that choose to make the following changes that would cause them to lose their grandfathered status. Compared to their polices in effect on March 23, 2010, grandfathered plans: Cannot Significantly Cut or Reduce Benefits. For example, if a plan decides to no longer cover care for people with diabetes, cystic fibrosis or HIV/AIDS. Cannot Raise Co-Insurance Charges. Typically, co-insurance requires a patient to pay a fixed percentage of a charge (for example, 20% of a hospital bill). Grandfathered plans cannot increase this percentage. Cannot Significantly Raise Co-Payment Charges. Frequently, plans require patients to pay a fixed-dollar amount for doctor’s office visits and other services. Compared with the copayments in effect on March 23, 2010, grandfathered plans will be able to increase those co-pays by no more than the greater of $5 (adjusted annually for medical inflation) or a percentage equal to medical inflation plus 15 percentage points. For example, if a plan raises its copayment from $30 to $50 over the next 2 years, it will lose its grandfathered status. Cannot Significantly Raise Deductibles. Many plans require patients to pay the first bills they receive each year (for example, the first $500, $1,000, or $1,500 a year). Compared with the deductible required as of March 23, 2010, grandfathered plans can only increase these deductibles by a percentage equal to medical inflation plus 15 percentage points. In recent years, medical costs have risen an average of 4-to-5% so this formula would allow deductibles to go up, for example, by 19-20% between 2010 and 2011, or by 23-25% between 2010 and 2012. For a family with a $1,000 annual deductible, this would mean if they had a hike of $190 or $200 from 2010 to 2011, their plan could then increase the deductible again by another $50 the following year. Cannot Significantly Lower Employer Contributions. Many employers pay a portion of their employees’ premium for insurance and this is usually deducted from their paychecks. Grandfathered plans cannot decrease the percent of premiums the employer pays by more than 5 percentage points (for example, decrease their own share and increase the workers’ share of premium from 15% to 25%). Cannot Add or Tighten an Annual Limit on What the Insurer Pays. Some insurers cap the amount that they will pay for covered services each year. If they want to retain their status as grandfathered plans, plans cannot tighten any annual dollar limit in place as of March 23, 2010. Moreover, plans that do not have an annual dollar limit cannot add a new one unless they are replacing a lifetime dollar limit with an annual dollar limit that is at least as high as the lifetime limit (which is more protective of high-cost enrollees). Cannot Change Insurance Companies. If an employer decides to buy insurance for its workers from a different insurance company, this new insurer will not be considered a grandfathered plan. This does not apply when employers that provide their own insurance to their workers switch plan administrators or to collective bargaining agreements. ———- ITEM TWO: An alert from AMA eVoice® Alert June 21, 2010 How will you get paid for your Medicare claims? You may have received conflicting reports about how Medicare claims for services provided on or after June 1, 2010, will be processed since Congress failed to send legislation to President Obama in time to avert implementation of the scheduled 21 percent payment cut. The AMA checked again today with senior officials at the Centers for Medicare and Medicaid Services, and physician claims submitted for services provided in June are in fact being processed under the reduced payment rate on a rolling, first in/first out basis. In other words, claims submitted earliest are now being paid at the reduced rate, while newer claims will continue to be held for a 10-day period until the president is able to sign legislation into law. The AMA still anticipates that whatever legislation is passed will apply retroactively to all services provided since June 1, and that claims that have already been processed will be adjusted automatically without physicians having to resubmit them. The AMA expects Congress to resolve the issue before the end of the week and will keep you updated on new developments. ———— DJP COMMENT: I had a dream that AMA advocated in the press for AMA policy of private contracting and balance-billing without penalty and ran large ads nationwide. But, alas, it was a dream! Help turn the AMA House of Delegates policy into reality. Write AMA and tell AMA to get moving on this issue. LAGNIAPPE: Just did a tweet about this new IPhone software for IPhone 4 that will work with some of the current models of IPhone: IPhone iOS 4 Software Update now available http://bit.ly/12tj1X & works with 3GS & 3G Stay well, Donald P.S. Stop by http://twitter.com/djpNEWS and sign up for DJPNEWS to get tweet alerts that may not make it into DJP Updates. Twitter is free and takes minutes to join. Put email in and pick password. Great source of breaking news and you don’t flood your email with it. You can get free app for BlackBerry or IPhone etc and you check on tweets when you want. Also, recent selected DJP Updates can be found at: http://www.donaldpalmisano.com/html/djp_update/ Donald J. Palmisano, MD, JD This DJP Update goes to 2260 leaders in Medicine representing all of the State Medical Associations and over 100 Specialty Societies plus some other friends. |