News Tagged as Health Care Reform

From: DHCS Website – 4/4/12

News Release Excerpt:

SACRAMENTO – The California Department of Health Care Services (DHCS) today announced that Los Angeles, Orange, San Diego and San Mateo counties would be the initial participants in a proposed three-year demonstration project aimed at improving the coordination of care for low-income seniors and persons with disabilities who are dually eligible for Medicare and Medi-Cal. These are the first of up to 10 counties that could take part in the project in 2013.

“Currently, most dual eligible beneficiaries access services through a complex system of disconnected programs that often leads to beneficiary confusion, delayed care, poor care coordination, inappropriate utilization and unnecessary costs, issues we are addressing with this proposal,” said DHCS Director Toby Douglas. “The goal is to design a seamless system that helps dual eligible beneficiaries get the health care services they need and improve health outcomes in a more fiscally efficient manner.”

California has approximately 1.1 million people enrolled in both Medicare and Medi-Cal. They are among the state’s highest-need and highest-cost users of health care services, accounting for nearly 25 percent of Medi-Cal spending. The proposed three-year project would enroll a portion of California’s dual eligible beneficiaries into integrated care delivery models. An estimated $678.8 million in General Fund savings is expected in fiscal year (FY) 2012-13, increasing to $1 billion in 2013-14.

Read more…

DHCS Initial Selection of Counties for Dual Eligible Beneficiaries Enrollment into Managed Care Plans

Gov. Jerry Brown’s administration wants health care change, with or without federal law

From: The Sacramento Bee – 3/30/12

Aricle Excerpt:

Gov. Jerry Brown’s administration vowed Thursday to continue pushing forward elements of the federal health care overhaul in California, even if the U.S. Supreme Court strikes it down.

If the court does rule the federal law unconstitutional, state Health and Human Services Secretary Diana Dooley said California should at least consider enacting its own universal health care legislation, including requiring every Californian to buy insurance.

“I think that we should be committed to making this system more rational than it is today, and improving the health of the people of California,” Dooley said in an interview. “If we ask the insurance plans to take everybody and insure everybody with no screens or pre-existing conditions, then we have to have everybody buying some level of health insurance to meet their responsibility to the system.”

She said whether the administration sponsors such legislation would depend on “where we are and what the conditions are at that particular time.”

Dooley’s remarks came a day after the Supreme Court finished three days of oral arguments over President Barack Obama’s signature health care law.

Read more…

Supreme Court has a wide range of options in ruling on Obama’s health care overhaul law

From: Chicago Tribune – 3/30/12

Article Excerpt:

WASHINGTON (AP) — The arguments are done and the case has been submitted, as Chief Justice John Roberts says at the end of every Supreme Court argument. Now the justices will wrestle with what to do with President Barack Obama’s health care overhaul. They have a range of options, from upholding the law to striking it down in its entirety. The court also could avoid deciding the law’s constitutionality at all, although that prospect seems remote after this week’s arguments.

A look at six potential outcomes, from the simplest to the most complicated possible rulings:

Read more…

Legal Challenges to the Affordable Care Act

From: HFMA – March 2012

Publication Excerpt:

The Supreme Court has granted review of four issues from challenges to the Affordable Care Act that have been pursued in the federal courts since passage of the act in March 2010. The court originally set aside 5 1/2 hours for oral argument (arguments at the court are typically restricted to one hour, with each side granted a half-hour of argument), but has expanded the total argument time to 6 hours, spread over three days (March 26, 27, and 28, 2012). The four issues on which the court has granted review are:

• Whether the Anti-Injunction Act prevents challenges to the Affordable Care Act at this time (90 minutes of argument on March 26)
• The constitutionality of the individual mandate, requiring most Americans to purchase health insurance by 2014 (2 hours of argument on March 27)
• Whether the individual mandate is severable if it is found to be unconstitutional, or whether the entire Act would have to fail (90 minutes of argument on March 28)
• Whether the Affordable Care Act’s expansion of the Medicaid program is constitutional (1 hour of argument on March 28)

The issues of the constitutionality and severability of the individual mandate have attracted the most attention in the federal district and appellate courts. The possibility that the Anti-Injunction Act might bar challenges to the Affordable Care Act has also emerged as a significant issue, hinging on the question of whether the penalty for failure to observe the individual mandate functions as a tax.

The argument that the act’s expansion of Medicaid is unconstitutional has not been successful in lower court challenges. This argument asserts that the act violates the Constitution’s Spending Clause (Article I, Sec. 8, Clause 1), based largely on speculation in preexisting Supreme Court case law that financial inducements offered by Congress to encourage state action could at some point pass a threshold and become coercive.

The discussion below summarizes district court rulings on the challenges to the Affordable Care Act, followed by a summary of reviews of the district courts’ rulings in the federal appellate courts.

Read more…

Could the health-care law work without the individual mandate?

From: Washington Post – 3/27/12

Article Excerpt:

If the Supreme Court were to invalidate the 2010 health-care law’s requirement that virtually all Americans obtain insurance, would the rest of the law become unworkable?

Even among supporters of the statute, opinions vary widely about the practical impact of a decision to strike down the mandate but leave everything else intact — one of several options available to the court.

“It’s probably the biggest area of uncertainty around all estimates about the law,” said Larry Levitt, a health insurance expert with the Kaiser Family Foundation.   The Obama administration argues that requiring individuals to get coverage is essential to the success of two of the most important — and popular — regulations that the law will impose starting in 2014: a rule that insurers can’t discriminate against people with preexisting conditions, and limitations on how much they can vary rates among customers.

Many of the law’s supporters insist that without the mandate, these rules would impose an unsustainable burden on insurers, ultimately causing the market to implode.

Read more…

Two Years In, A Consumer Guide to Health Reform Law

From: Kaiser Health News – 3/21/12

Article Excerpt:

Friday marks the two-year anniversary of the 2010 health care overhaul law, and despite an upcoming challenge in the Supreme Court, it has already begun to be implemented.  While some of the key features don’t kick in until 2014, the still-controversial law has already altered the health care industry and established a number of consumer benefits.

Here’s an FAQ about some of the law’s provisions that are already in place as well as major features of what’s to come, if the law stays in place.

Read more...

Health Reform Law Provides Coverage for Nearly 50K Americans with Pre-Existing Conditions

From: HHS News Release – 2/23/12

News Release Excerpt:

Health and Human Services Secretary Kathleen Sebelius today announced that the new health care law’s Pre-Existing Condition Insurance Plan (PCIP) program is providing insurance to nearly 50,000 people with high-risk pre-existing conditions nationwide. The Department released a new report demonstrating how PCIP is helping to fill a void in the insurance market for consumers with pre-existing conditions who are denied insurance coverage and are ineligible for Medicare or Medicaid coverage.

“For too long, Americans with pre-existing conditions were locked out of the health care system and their health suffered,” said HHS Secretary Kathleen Sebelius. “Thanks to health reform, our most vulnerable Americans across the country have the care they need.”

Under the Affordable Care Act, in 2014, insurers will be prohibited from denying coverage to any American with a pre-existing condition. Until then, the PCIP program will continue to provide enrollees with affordable insurance coverage.

Read more…

ACOs: What Providers Need to Know

MLN – October 2011

Fact Sheet Summary

This fact sheet is designed to provide education on Accountable Care Organizations (ACOs) under the Medicare Shared Savings Program. It includes a definition of an ACO, and information on how to participate in an ACO, how shared savings will work, how this program is aligned with other quality initiatives and how ACOs help doctors coordinate care.

Appeals Court in D.C Upholds Healthcare Law

From: HFMA Financial News – 11/08/11

HFMA Article:

The District of Columbia Circuit Court of Appeals on Tuesday upheld the Affordable Care Act’s requirement that nearly all Americans must purchase health insurance, the latest appeals court ruling in advance of the Supreme Court’s likely decision to take up the issue in the spring.

In a 2-to-1 opinion to uphold the law, Judge Laurence Silberman wrote for the majority that the commerce clause of the Constitution allows Congress to regulate decisions that affect interstate commerce.

“Congress, which would, in our minds, clearly have the power to impose insurance purchase conditions on persons who appeared at a hospital for medical services – as rather useless as that would be – is merely imposing the mandate in reasonable anticipation of virtually inevitable future transactions in interstate commerce,” Silberman wrote.

The suit in Washington was brought by the American Center for Law and Justice, which claimed that the insurance mandate is unconstitutional because it forces Americans to buy a product for the rest of their lives and that it violates the religious freedom of those who choose not to have insurance because they rely on God to protect them from harm.

The link provided will take you to the Court decision.

Interim Final Rule – Final Waivers in Connection with the Shared Savings Program

CMS-1439-IFC – 11/2/11

The interim final rules applicable to establishing certain waivers associated with ACOs was published in the federal register on 11/2/11.