Health Care Reform

HEALTH CARE REFORM INFORMATION
NAIC Moves Forward With Medical Loss Ratio Rules The National Association of Insurance Commissioners (NAIC) approved a proposed financial template, called a "blank," specifying the types of spending that health insurers may be able to count as medical expenses under the new medical loss ratio requirements set by the Patient Protection and Affordable Care Act. The commissioners moved forward with 10 of 11 proposed amendments that further narrowed the types of expenses and fees that insurers would be allowed to count toward MLR calculations. Begining in 2011 insurers operating in the large group market must spend at least 85 percent of premium revenue on medical care for subscribers, rather than on administrative costs or profits. The MLR for individual and small-group health plans must be at least 80 percent. Regulators will review the blank forms and calculate where the insurers stand in relation to those requirements, and if they fall short, the insurer must rebate the excess profits back to their customers. AMA comments on Final Rules of Meaningful Use A memo to the board of trustees says the requirements are improved but still ask too much of doctors. CMS Reviews PECOS Enrollment (June 30, 2010) The Centers for Medicare and Medicaid Services (CMS) is working with providers to address concerns about enrollment in the Provider Enrollment, Chain and Ownership System (PECOS). (more) Medicare Payment Fix Passed (June 25, 2010) President Obama signed into law the “Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010.” This law establishes a 2.2 percent update to the Medicare Physician Fee Schedule (MPFS) payment rates retroactive from June 1 through November 30, 2010. The Centers for Medicare & Medicaid Services (CMS) has directed Medicare claims administration contractors to discontinue processing claims at the negative update rates and to temporarily hold all claims for services rendered June 1, 2010, and later, until the new 2.2 percent update rates are tested and loaded into the Medicare contractors’ claims processing systems. Effective testing of the new 2.2 percent update will ensure that claims are correctly paid at the new rates. CMS says it expects to begin processing claims at the new rates no later than July 1, 2010. Claims for services rendered prior to June 1, 2010, will continue to be processed and paid as usual. Claims containing June 2010 dates of service which have been paid at the negative update rates will be reprocessed as soon as possible. Under current law, Medicare payments to physicians and other providers paid under the MPFS are based upon the lesser of the submitted charge on the claim or the MPFS amount. Claims containing June dates of service that were submitted with charges greater than or equal to the new 2.2 percent update rates will be automatically reprocessed. Affected physicians/providers who submitted claims containing June dates of service with charges less than the 2.2 percent update amount will need to contact their local Medicare contractor to request an adjustment. Submitted charges on claims cannot be altered without a request from the physician/provider. Physicians/providers should not resubmit claims already submitted to their Medicare contractor. Temporary Medicaid Fix Passes House, Senate (June 24, 2010) Shortly after 7:00 Eastern time Thursday evening, the House passed H.R. 3962, which provides a 2.2 percent Medicare fee schedule update for physician services through November 2010. The bill passed by a bipartisan vote of 417 to 1. Since the same legislation passed the Senate last week, the bill will be sent promptly to President Obama’s desk to be signed into law. The 2.2 percent update provided by H.R. 3962 would replace the 21 percent Medicare cut currently in effect, and be applied retroactively to claims for services provided on or after June 1. On June 18, the Senate passed an amended version of H.R. 3962, now called the “Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010,” by unanimous consent. Patient Protection and Affordable Care Act and the subsequent reconciliation bill (more) SUMMARY from MSSNY: WHAT HCR PASSAGE MEANS FOR NYS PHYSICIANS The House of Representatives on Sunday night in separate votes approved the Senate health reform bill (HR 3590) which now proceeds to President Obama to be signed into law, and the so-called "corrections" bill (HR 4872) which contains a series of changes favored by the House. Many provisions in the bill will positively benefit physicians as well as their patients. However, there are other issues which MSSNY has serious concerns and will continue to work aggressively with the AMA and the New York Congressional delegation to address. The American College of Physicians, the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Cardiology, the American Osteopathic Association, the National Medical Association and the National Hispanic Medical Association each announced support for the bill. The American Medical Association, while noting that the bills are imperfect, announced its qualified support for the measure. Analysis of these enormous bills is underway. Click here for an interim summary of some of the positive and negative aspects of these bills. The President's proposal puts American families and small business owners in control of their own healthcare, click here. The Patient Protection and Affordable Care Act Implementation Time Line SRG Announcement (April 16, 2010)

HEALTH CARE REFORM INFORMATION

NAIC Moves Forward With Medical Loss Ratio Rules
The National Association of Insurance Commissioners (NAIC) approved a proposed financial template, called a "blank," specifying the types of spending that health insurers may be able to count as medical expenses under the new medical loss ratio requirements set by the Patient Protection and Affordable Care Act. The commissioners moved forward with 10 of 11 proposed amendments that further narrowed the types of expenses and fees that insurers would be allowed to count toward MLR calculations. Begining in 2011 insurers operating in the large group market must spend at least 85 percent of premium revenue on medical care for subscribers, rather than on administrative costs or profits. The MLR for individual and small-group health plans must be at least 80 percent. Regulators will review the blank forms and calculate where the insurers stand in relation to those requirements, and if they fall short, the insurer must rebate the excess profits back to their customers.

AMA comments on Final Rules of Meaningful Use
A memo to the board of trustees says the requirements are improved but still ask too much of doctors.

CMS Reviews PECOS Enrollment
(June 30, 2010) The Centers for Medicare and Medicaid Services (CMS) is working with providers to address concerns about enrollment in the Provider Enrollment, Chain and Ownership System (PECOS). (more)

Medicare Payment Fix Passed
(June 25, 2010) President Obama signed into law the “Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010.” This law establishes a 2.2 percent update to the Medicare Physician Fee Schedule (MPFS) payment rates retroactive from June 1 through November 30, 2010. The Centers for Medicare & Medicaid Services (CMS) has directed Medicare claims administration contractors to discontinue processing claims at the negative update rates and to temporarily hold all claims for services rendered June 1, 2010, and later, until the new 2.2 percent update rates are tested and loaded into the Medicare contractors’ claims processing systems. Effective testing of the new 2.2 percent update will ensure that claims are correctly paid at the new rates. CMS says it expects to begin processing claims at the new rates no later than July 1, 2010. Claims for services rendered prior to June 1, 2010, will continue to be processed and paid as usual.

Claims containing June 2010 dates of service which have been paid at the negative update rates will be reprocessed as soon as possible. Under current law, Medicare payments to physicians and other providers paid under the MPFS are based upon the lesser of the submitted charge on the claim or the MPFS amount. Claims containing June dates of service that were submitted with charges greater than or equal to the new 2.2 percent update rates will be automatically reprocessed. Affected physicians/providers who submitted claims containing June dates of service with charges less than the 2.2 percent update amount will need to contact their local Medicare contractor to request an adjustment. Submitted charges on claims cannot be altered without a request from the physician/provider. Physicians/providers should not resubmit claims already submitted to their Medicare contractor.

Temporary Medicaid Fix Passes House, Senate

(June 24, 2010) Shortly after 7:00 Eastern time Thursday evening, the House passed H.R. 3962, which provides a 2.2 percent Medicare fee schedule update for physician services through November 2010. The bill passed by a bipartisan vote of 417 to 1. Since the same legislation passed the Senate last week, the bill will be sent promptly to President Obama’s desk to be signed into law.

The 2.2 percent update provided by H.R. 3962 would replace the 21 percent Medicare cut currently in effect, and be applied retroactively to claims for services provided on or after June 1.

On June 18, the Senate passed an amended version of H.R. 3962, now called the “Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010,” by unanimous consent.

Patient Protection and Affordable Care Act and the subsequent reconciliation bill (more)

SUMMARY from MSSNY: WHAT HCR PASSAGE MEANS FOR NYS PHYSICIANS
The House of Representatives on Sunday night in separate votes approved the Senate health reform bill (HR 3590) which now proceeds to President Obama to be signed into law, and the so-called "corrections" bill (HR 4872) which contains a series of changes favored by the House. Many provisions in the bill will positively benefit physicians as well as their patients. However, there are other issues which MSSNY has serious concerns and will continue to work aggressively with the AMA and the New York Congressional delegation to address. The American College of Physicians, the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Cardiology, the American Osteopathic Association, the National Medical Association and the National Hispanic Medical Association each announced support for the bill. The American Medical Association, while noting that the bills are imperfect, announced its qualified support for the measure. Analysis of these enormous bills is underway. Click here for an interim summary of some of the positive and negative aspects of these bills.

The President's proposal puts American families and small business owners in control of their own healthcare, click here.

The Patient Protection and Affordable Care Act Implementation Time Line

SRG Announcement (April 16, 2010)

Healthcare Reform Resources

Patient Protection and Affordable Care Act and the subsequent reconciliation bill. (more)

Medicare Payment Cuts Postponed for 31 days
Congress fails to address 21% Medicare SGR Cut but action promised next week. Read the statement issued by MSSNY President David Hannan, MD (more)

NYS Dependant Coverage Legislation effective Sept. 1, 2009
Extends dependent coverage under parents' policy through age 29

America’s Affordable Health Care Choices Act-Section Analysis, July 14, 2009
http://waysandmeans.house.gov/
media/pdf/111/sbys3200.pdf

Westchester County Medical Society opposes AMA support of HR 3962
Read official statement issued by John J. Stangel, MD, president, WCMS

Medical Association of Alabama
opposition to HR 3200 - http://www.masalink.org/news.
aspx?id=2225

Texas Medical Association - http://www.texmed.org/
Template.aspx?id=7899

Statement andCommentary

AMA Letter to Honorable Harry Reid

AMA HSR Comparison Chart

Physician Views on the Public Health Insurance Option and Medicare Expansions

Majority of Physicians Support Health Reform that Includes both Public & Private Insurance Options

The Economic Effects of Health Care Reform on Small Businesses and their Employees

Focus on Healthcare Reform-Side by Side Comparison of Major Healthcare Reform Proposals

Update from the AMA

(01/26/2010) Implementation Timeline

(01/26/2010) Letter from AMA to President Obama

The AMA sent a letter today to Speaker Pelosi and House and Senate leadership expressing AMA's opposition to the Independent Payment Advisory Board (IPAB) provision in HR 3590.
AMA letter to Speaker Pelosi

The American Medical Association continues to work with lawmakers in reforming health care in a way that provides quality, affordable health care for all. On Dec. 1, the AMA wrote a letter to Senate Majority Leader Harry Reid (D-Nev.) concerning the Senate's proposed health system reform bill.AMA letter to Senate Majority Leader Harry Reid

View additional AMA comments on H.R. 3590, the “Patient Protection and Affordable Care Act.”

View the H.R. 3962 and H.R. 3590 Legislative Summary Chart of Major Provisions

Physicians comment on reform
William Dolan, MD, says many private and specialty doctors and their patients will be affected by proposed Medicare reimbursement cuts more

Letter from J. James Rohack, MD, president American Medical Association

Links for More Information

American Medical Association-
http://www.ama-assn.org

American College of Physicians
http://www.acponline.org/
pressroom/affordable
care.htm?hp

Medical Society of the State of New Yorkhttp://www.mssny.org/mssnycfm/mssny
editor/File/2009/
In_the_News/072409/MSSNY_
letter_of_support.pdf

US House of Representatives - http://www.house.gov

US Senate - http://www.senate.gov