Providers, Insurers Partnering To Launch Narrow-Network Plans

Across the country, providers and insurers are partnering to launch narrow-network plans. In some cases, these healthcare systems and insurers will offer the narrow-network plans on state exchanges with monthly premiums in line with other exchange options. According to experts, the ACA is driving the shift toward these narrow-network products. Because the health law standardizes health plan benefits and sets caps on out-of-pocket costs, providers and insurers use the networks as a “differentiator.” Experts say it will take “unique and appealing plan benefits and participating providers to attract consumers who are accustomed to broader choices of hospitals and doctors.”

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Reference Chart Released for New Therapy-Related G-codes

CMS released a reference chart listing the new G-codes needed for outpatient therapy services claims under the Medicare fee-for-service program. These G-codes were mandated by the Middle Class Tax Relief and Jobs Creation Act of 2012 and meant to provide more detailed information about patients’ conditions. As of July 1st last month, claims that do not include the required codes would be returned of rejected.

Click here to access the reference chart

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Breaking Down ObamaCare Employer Mandate

Employers with 50+ full time employees who chose to opt out of providing Minimum Essential Coverage (MEC) face multiple tax penalties under the ACA employer mandate.  If the employer offers MEC plans, they avoid a yearly $2,000 tax per employee and the employee who enrolls satisfies the individual mandate.  Consequently, if the plan offered by the employer does not have Minimum Value (MV) the employer can still be subject to a tax of $3,000 for employees who decline the employers’ plan and shop at a state or federal exchange.  Minimum value plans must cover at least 60% of the costs of services covered under the plan and cost no more than 9.5% of the employees W-2 earnings.  If an employer wishes to avoid all potential penalties under ObamaCare, it may be in their best interest to offer both a MV plan and a MEC plan.

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2013 Legislative Session Healthcare Winners & Losers

The 2013 legislative session came to a close earlier this week. Below is a recap of this year’s healthcare winners and losers.

Winner: Community Health Centers: Community health centers got a rare increase in state funds. Under the budget, the state’s 14 health centers will get an extra $10 million a year through Medicaid.

Loser: Hospitals: The budget proposal cuts more than $500 million in funding from hospitals, slashing payments hospitals receive for treating uninsured and underinsured patients.

Click here for a full recap of 2013 legislative session winners and losers.

Obama Defends Health Law

President Barack Obama defended the Patient Protection & Affordable Care Act (PPACA) late last week, saying he was 110% committed to reform and felt the United States had a moral obligation to secure affordable health insurance for every American.

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ACOs Prosper Under Health Reform

Doctor-owned hospitals have emerged as among the biggest winners under two programs in the health law.  In fact, the number of physician-led accountable care organizations (ACOs) has recently surpassed the number led by hospitals, becoming the largest backers of the payment and delivery model.

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Top Healthcare Story Of 2012

By far, the number one health care news story of 2012 was the U.S. Supreme Court’s decision to uphold the individual mandate outlined by the Patient Protection & Affordable Care Act (PPACA).

In a split decision, with Chief Justice John G. Roberts Jr. casting the deciding vote, the U.S. Supreme Court upheld the cornerstone of President Obama’s healthcare reform law and signature domestic initiative. Roberts joined liberals on the court in upholding the mandate at the heart of the underlying law, saying the mandate could survive as a tax.

Following three days of oral arguments on the law’s constitutionality in March, insiders widely believed the individual mandate, and perhaps the entire healthcare law, was very much in jeopardy. However, the Justice Department argued the mandate does not force people to participate in the market for health insurance, but rather regulates participation in the market for healthcare services.

The high court rejected Medicaid expansion provisions in the new healthcare law. The court ruled that Congress overstepped its authority when it said states must go along with the Medicaid insurance program for low-income people, providing expanded coverage to about 17 million over the next decade.  Connecticut was the first state to participate in the provision which will be funded by the federal government beginning in 2014.

The HMS Blog posted two series on health reform: Understanding Health Reform  and The Impact of Federal Health Reform as well as a Post Election Guide to Health Reform to help sift through the confusion and clarify provisions of the PPACA.