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McBrayer Blogs
Showing 22 posts in Patient Protection and Affordable Care Act (“ACA”).
The Pioneer Program Report Card
In 2012, thirty-two organizations were selected to participate as “Pioneers” in a pilot Accountable Care Organization (“ACO”) program created through the Affordable Care Act (“ACA”). The program’s goals were to revolutionize the health system and reduce medical costs by basing physician and hospital pay on quality rather than quantity. More >
CMS Proposes to Change Physician Requirements for RHC's and FQHC's
Since the passage of the Patient Protection and Affordable Care Act of 2010 (“PPACA”), many providers, suppliers and physicians that were enrolled in Medicare and Medicaid were mandated to create compliance programs for their healthcare facilities. Since that time, small and rural providers have been scrambling to adopt and implement programs that can adequately withstand regulatory and law enforcement scrutiny. Larger providers, such as multi-state hospitals, were already equipped with a compliance program. It is the small and rural providers, limited by staff and financial resources, which have had their hands full complying with the new regulatory requirements. More >
The Kentucky Health Benefit Exchange: How Obamacare is Changing the Health Insurance Marketplace
Now that the President has been re-elected and the Supreme Court has upheld most of the Accountable Care Act (“ACA”), Obamacare will not be repealed. So, what does that mean for Kentuckians? Several things including an individual mandate to buy health insurance and a health benefit exchange where Kentuckians can buy insurance. More >
THE KENTUCKY HEALTH BENEFIT EXCHANGE: LITTLE GNOME FACTS
“Like Travelocity but for health insurance” is how Executive Director Carrie Banahan and Deputy Director Bill Nold of the Office of Kentucky Health Benefit Exchange describe the developing Kentucky Exchange. More >
Here Comes the Sun, Are you Prepared? – Tips for Navigating the New Sunshine Provisions
The Sunshine Act was legislated as part of the Patient Protection and Affordable Care Act (the “ACA”) to reduce the risk of inappropriate financial incentives interfering with medical judgment and patient care by enhancing the transparency of financial relationships between certain health care providers (i.e. physicians and teaching hospitals) and manufacturers of covered drugs and devices. Because these relationships are being scrutinized now more than ever, those involved in clinical research with manufacturers of drug and device companies may find the following these general guidelines helpful in avoiding risks of non-compliance and legal complications: . More >
Guess Who’s Coming to Visit? Long-Term Care Facility Inspections
Compliance and preparedness are two very real, everyday concerns for long-term care facilities. Not only are these important aspects of daily operations for the safety of the employees and patients, they are paramount because any day a visitor from the Office of the Inspector General (OIG”) or Occupational Safety and Health Administration (“OSHA”) could show up for an inspection. Is your facility prepared? More >
Compliance Plan – A Provider’s Defense
The Office of the Inspector General (“OIG”) has always encouraged Medicare and Medicaid providers to implement a compliance program. For 14 years, as a matter of fact, OIG has provided compliance guidance in 11 healthcare sectors (including: hospitals, nursing facilities, home healthcare, hospice and third-party billers). With the passing of the Patient Protection and Affordable Care Act (“PPACA”), compliance plans and programs are now mandatory for any provider enrolled in a Federal health care program, including Medicare. More >
Kentucky Health Cooperative Insurance, Available in 2014
The Supreme Court Decision of June 28, 2012 upholding the Patient Protection and Affordable Care Act (“PPACA”) in National Federation of Independent Business, et al., v. Sebelius , Secretary of Health and Human Services, et al., reignited the creation and implementation of Consumer Operated and Oriented Plan programs (“CO-OPS”). CO-OPs are aimed at offering small businesses and individuals more affordable health insurance options, especially in states where there are a few insurance carriers capitalizing the market with plans that are not economically targeted at the smaller insurance market. More >
Supreme Court Decision Legitimizes Accountable Care Organizations
With its decision upholding the Affordable Care Act, the Supreme Court has authorized the use of Accountable Care Organizations (“ACO”) as one of the principal tools for addressing health care costs and improving care. When an ACO succeeds in both delivering high-quality care and spending health care dollars more wisely by reducing the rate of growth in the cost of health care, the ACO will share in the savings it achieves for the Medicare program. The Centers for Medicare and Medicaid Services (“CMS”) announced the selection of 88 ACOs to participate in the first round of the Medicare Shared Savings Program. These ACOs will take responsibility for coordinating care for nearly 1.2 million Medicare beneficiaries in 40 states. Three ACOs have been approved for Kentucky and include Quality Independent Physicians (Louisville), Southern Kentucky Health Care Alliance (Smithsgrove), and Deaconess Care Integration (Serving Indiana and Kentucky). In late July, CMS announced 15 new ACOs to participate in the Advance Payment ACO Model Program including Jackson Purchase Medical Association PSC, which is an ACO that includes 6 physician practices in Paducah and Ballard County Kentucky that covers 6000 Medicare beneficiaries. This brings the total participation in the program to 20. With the 32 systems approved to participate in the Pioneer ACOs Program in February 2012, CMS announced there are now 153 organizations participating in Medicare Shared Savings initiatives, serving over 2.4 million beneficiaries. More >
Federal Medicaid Opt-Out Effect on Hospitals
The mandatory expansion of Medicaid was an important element of the Affordable Care Act as providing health care benefits to uninsured was intended to achieve equity. The expansion of Medicaid rolls was also intended to reduce the cost of providing care for the uninsured and the need for disproportionate share hospital funding, which is an adjustment to account for the needs of hospitals serving a large number of low-income patients. With the ability to opt out of the Affordable Care Act’s expansion of Medicaid eligibility (read more: The Federal Medicaid Apple: Poison or the Cure?), the opt-out states may create financial problems for hospitals that depend on disproportionate share payments to cover part of their costs for providing non-reimbursed services to the indigent and uninsured. The Affordable Care Act’s decrease in disproportionate share payments to hospitals is not changed by the Supreme Court’s ruling. More >
