For the second time in a week, the federal government has extended deadlines relating to state insurance exchanges. Today was originally the deadline for each state to submit an application to the federal government if the state would be running its own insurance exchange. For any state that does not set up its own exchange, the federal government… Continue Reading
Category Archives: Payer/Insurance Reform
Subscribe to Payer/Insurance Reform RSS FeedRivell v. PHCS: Network Provider Contracts’ Unintentional Limits on Network Rentals and Provider Marketing
Posted in Payer/Insurance ReformOn August 13, 2012, in Rivell v. Private Health Care Systems Inc., the U.S. District Court for the Southern District of Georgia dismissed the plaintiffs’ claims arising from the rental of a health care provider network by a preferred provider organization (“PPO”) to a discount medical plan (“DMP”) as time barred for two plaintiffs and… Continue Reading
David Moore v. John Deere Health Care Plan Inc.: The Mostly Right Way for Managed Care Organizations to Terminate an Incompetent Network Provider
Posted in Payer/Insurance Reform, PPACAWhen facing an incompetent network health care provider and angry members, a managed care organization (MCO), such as a health maintenance organization (HMO), a preferred provider organization, or a physician-hospital organization, must take action to protect its members. How can the MCO terminate the provider’s contract without becoming liable to that provider for damages? In… Continue Reading
CMS to Increase Payments to Primary Care Physicians in CY 2013
Posted in Payer/Insurance ReformThe Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that will increase Medicare payments to primary care physicians by 7 percent and other practitioners providing primary care services between 3 and 5 percent. This proposed payment increase is part of the Medicare Physician Fee Schedule (MPFS) for calendar year (CY) 2013 and… Continue Reading
Insurers Promise Some Continued Benefits, Regardless of Supreme Court Decision on PPACA
Posted in Payer/Insurance Reform, PPACAAs we get closer to receiving a decision from the U.S. Supreme Court on the constitutionality of PPACA and its individual insurance mandate, three major insurers have committed to continue some benefits that were required by PPACA. These announcements address some of the uncertainty being experienced by insureds who don’t know what will happen or how quickly changes… Continue Reading
Affordable Care Act Grants Improve Consumer Health Awareness
Posted in Community Benefit, Payer/Insurance Reform, PPACAThe Affordable Care Act provides for nearly $30 million in grant funding for states to establish and strengthen Consumer Assistance Programs. States must apply for the grants and articulate how they will use the funding to assist their residents with problems and related questions regarding health insurance coverage. Consumer Assistance Programs provide assistance to state… Continue Reading
Comprehensive Primary Care Initiative
Posted in Payer/Insurance ReformYesterday, 45 commercial, federal and State insurers in seven markets today pledged to work with the Centers for Medicare & Medicaid Services (CMS) to improve access to quality health care at lower cost. Under the Comprehensive Primary Care initiative, CMS will pay primary care practices a care management fee, initially set at an average of… Continue Reading
More Constitutional Decisions on PPACA
Posted in Payer/Insurance Reform, PPACAThe constitutional challenges to PPACA keep coming in. So far, the tally is two decisions for and two against. Two decisions are currently on appeal, and the most recent decision will likely be headed to the appellate courts soon. The decisions in favor of PPACA: As reported earlier here and at SSD’s Sixth Circuit blog, in… Continue Reading
Constitutional Decisions on PPACA Begin
Posted in Payer/Insurance Reform, PPACAWe are beginning to see action (and divergent results) on the various court challenges to PPACA, starting with two recent decisions. As explained in SSD’s Sixth Circuit Blog, the federal court for the Western District of Michigan dismissed the case of Thomas More Law Center, et al. v. Obama (E.D. Mich., Case No. 10-CV-11156) (PDF) that challenged whether Congress has authority… Continue Reading
NAIC Releases Draft Regulation on Medical Loss Ratios; Expresses Concerns Over Implementation [UPDATED]
Posted in Payer/Insurance Reform, PPACAOn October 14, 2010, the National Association of Insurance Commissioners (NAIC) Health Insurance and Managed Care Committee approved model regulations relating to insurer calculation of medical loss ratio (MLR) for health coverages as required under the Patient Protection and Affordable Care Act (PPACA). [UPDATE: On October 21, Executive and Plenary committees of the National Association… Continue Reading