CMS has published a notice extending the June 30 deadline for filing an ePrescribing hardship exemption to July 2 (included below). CMS appears to be doing this because there are some computer system updates underway for the Communication Support Page.
SFMS has also learned that some physicians with Apple computers are having challenges submitting their hardship exemptions. We are working with CMA and AMA to urge CMS to address this issue and also utilize this information to press CMS to further extend the deadline.
SFMS strongly recommends that any physician who remains unable to submit a hardship exemption request by the end of the day (11:59pm ET) on July 2 through the Communications Support and do the following:
Click here for more information on filing for a hardship from CMS.
Due to scheduled web maintenance, eligible professionals will be unable to access the Communication Support Page to submit requests for significant hardship exemptions to the 2013 Electronic Prescribing (eRx) Incentive Program payment adjustment beginning at 8:00 pm EST on Friday, June 29, 2012 until 11:59 pm EST on June 30, 2012.
Because this maintenance directly impacts the June 30, 2012 deadline, The Center for Medicare & Medicaid Services is extending the submission date for hardship exemptions until 11:59 pm EST on July 2, 2012.
Also, you may have experienced some unexpected challenges accessing the Communication Support Page recently, but the issue has been resolved. Moving forward, please use the link below to ensure you are accessing the secure Communication Support Page properly. CMS cannot be responsible for eligible professionals who access our site via a different link; we cannot guarantee that the data will be stored and saved in our database for processing. To be assured that we receive your hardship exemption request, use the link provided below by 11:59 pm EST on July 2, 2012 -- https://www.qualitynet.org/portal/server.pt/community/communications_support_system/234.
We would like to advise eligible professionals who experience difficulties accessing the Communication Support Page outside of the maintenance hours stated above to please contact the QualityNet Help Desk.
QualityNet Help Desk – Monday to Friday, 7:00 am to 7:00 pm CST; Phone (866) 288-8912; Email Qnetsupport@sdps.org
The Supreme Court in a 5-4 ruling upheld the federal health reform law’s individual mandate, reaffirming the law's requirement that most U.S. residents must purchase health insurance.
The justices said that the individual mandate—the requirement that most Americans buy health insurance or pay a fine—is constitutional as a tax.
Chief Justice John Roberts—a conservative appointed by President George W. Bush—provided the key vote to preserve the landmark health care law.
The government had argued that Congress had the authority to pass the individual mandate as part of its power to regulate interstate commerce; the court disagreed with that analysis, but preserved the mandate because the fine amounts to a tax that is within Congress’ constitutional taxing powers.
The announcement will have a major impact on the nation’s health care system, the actions of both federal and state governments, and the course of the November presidential and congressional elections.
While the individual mandate remained 18 months away from implementation, many other provisions already have gone into effect, such as free wellness exams for seniors and allowing children up to age 26 to remain on their parents’ health insurance policies.
Throughout the health care reform debate, SFMS/CMA has strongly advocated for affordable access to care for California’s uninsured and for expansion of health insurance coverage. The physician organization has also supported eliminating egregious health plan rescission practices, pre-existing condition bans, and ending excessive insurer profit and administrative costs. SFMS/CMA was also instrumental in arguing for state based health insurance exchanges, rather than one national exchange of private health plan choices and urged reinvestments in primary care, public health and the physician workforce.
Under the reform law, California could receive as much as $9 billion annually to expand Medi-Cal, the state’s Medicaid program. According to calculations from the Urban Institute, the state could receive an additional $6 billion annually for low- and middle-income residents who buy subsidized insurance through the state health insurance exchange. In addition, California physicians could receive an additional $700 million annually in increased reimbursements under the law for treating patients who obtain coverage under the Medi-Cal expansion.
Following the Supreme Court ruling, House Minority Leader Nancy Pelosi (D-Calif.) in a statement said, “This decision is a victory for the American people. With this ruling, Americans will benefit from critical patient protections, lower costs for the middle class, more coverage for families, and greater accountability for the insurance industry."
Physicians have until July 6 to comment on standards for specialty practices wanting to become part of a patient-centered medical home “neighborhood.”
The National Committee for Quality Assurance is seeking comments on proposed Specialty Practice Recognition (SPR) 2013 standards. The program will recognize specialty practices that work with primary care medical homes to coordinate care, provide timely access, use information technology to reduce test duplication and work toward continuous quality improvement.
The standards, which should be finalized by early 2013, will align with those for meaningful use bonuses for electronic health records. Primary care practices that have earned medical home recognition from NCQA have been paid additional money from some third-party payers. NCQA expects this also to be possible for specialty practices that become part of the medical home neighborhood.
NCQA’s primary care medical home program has recognized at least 4,220 practices. A small number of specialty practices participated. However, interest developed for a framework for non-primary care practices to participate in the model if being the actual medical home was not a good fit.
The Washington Post compiled a refresher on some of the health care reform law’s most significant policies and consequences:
By 2022, the Congressional Budget Office estimates the Affordable Care Act will have extended coverage to 33 million Americans who would otherwise be uninsured. Here’s the graph:
Families making less than 133% of the poverty line—that’s about $29,000 for a family of four—will be covered through Medicaid. Between 133% and 400% of the poverty line—$88,000 for a family of four—families will get tax credits on a sliding scale to help pay for private insurance.
For families making less than 400% of the poverty line, premiums are capped.
When the individual mandate is fully phased-in, those who can afford coverage—which is defined as insurance costing less than 8% of their annual income—but choose to forgo it will have to pay either $695 or 2.5% of the annual income, whichever is greater.
Small businesses that have fewer than 10 employees, average wages beneath $25,000, and that provide insurance for their workers will get a 50% tax credit on their contribution. The tax credit reaches up to small businesses with up to 50 employees and average wages of $50,000, though it gets smaller as the business get bigger and richer. The credit lasts for two years, though many think Congress will be pressured to extend it, which would raise the long-term cost of the legislation.
Insurance companies are not allowed to discriminate based on preexisting conditions. They are allowed to discriminate based “on age (limited to 3 to 1 ratio), premium rating area, family composition, and tobacco use (limited to 1.5. to 1 ratio).”
Starting in 2018, the law imposes a 35% tax on employer-provided health plans that exceed $10,200 for individual coverage and $27,500 for family coverage. The idea is a kind of roundabout second-best to capping the tax code’s (currently unlimited) deduction for employer-provided heath insurance. The policy idea is to give employers that much more reason to avoid expensive insurance policies and thus give insurers that much more reason to hold costs down.
The law requires insurers to spend between 80 and 85 percent of every premium dollar on medical care (as opposed to administration, advertising, etc). If insurers exceed this threshold, they have to rebate the excess to their customers. This policy is already in effect, and insurers are expected to rebate $1.1 billion this year.
The law is expected to spend a bit over $1 trillion in the next 10 years. The law’s spending cuts—many of which fall on Medicare—and tax increases are expected to either save or raise a bit more than that, which is why the Congressional Budget Office estimates that it will slightly reduce the deficit. As time goes on, the savings are projected to grow more quickly than the spending, and CBO expects that the law will cut the deficit by around a trillion dollars in its second decade.
In recent years, health-care costs have slowed dramatically. Much of this is likely due to the recession. Some of it may just be chance. But there’s also evidence that the law has accelerated changes in the way the medical system delivers care, as providers prepare for the law’s efforts to move from fee-for-service to quality-based payments.
Source: Erza Klein WonkBlog post, The Washington Post, June 2, 2012.
Governor Brown’s announcement that a budget agreement to eliminate the Healthy Families Program has been reached, could have an enormously negative impact on 880,000 children that rely on the Healthy Families Program for health care coverage. Disrupting the care of these children could result in mass confusion for families and disruption in care for children. The agreement would move all of the children and teenagers from the Healthy Families Program to Medi-Cal. Healthy Families has been a successful program providing health, dental and vision coverage to lower income children.
“The move to eliminate the Healthy Families Program would be devastating for children and teenagers throughout California that depend on the program for medical care,” said CMA President James T. Hay, MD. “What the governor has proposed will undoubtedly ensure that those kids now have a harder time getting access to care.”
SFMS/CMA has joined together with over 40 organizations in opposition of the proposal because of the ramifications it would have on California’s most vulnerable children.
SFMS/CMA, along with other provider and children’s groups has proposed a compromise effort to restructure Healthy Families by moving only the ‘bright line’ children—those whose parents earn between 101 and 138% of the Federal Poverty Level (FPL) into Medi-Cal. The state is required to transition these children due to federal health reform.
The proposal to start with the ‘bright line’ children is supported by analyses recently released by both the Legislative Analyst’s Office (LAO) and the Urban Institute.