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.”
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.
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.
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.
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.