Supreme Court to hear ACA subsidy case Last Friday, the U.S. Supreme Court unexpectedly said it will hear King v. Burwell—a case that questions whether premium subsidies can be provided under the Affordable Care Act (ACA) to individuals purchasing health insurance coverage on exchanges run by the federal government. The lawsuit has the potential to affect 36 states that use the federal health care exchange, but would not change the subsidies in states like California that run their own exchanges. The decision to hear the case comes just one week before the second exchange open enrollment ... November 14, 2014 General Affordable Care Act, Health Insurance Exchange, United States Supreme Court, ACA 0 0 Comment Read More »
Medi-Cal UCR web app for CHDP primary care rate increases now available; deadline to submit is Nov. 28 The California Department of Health Care Services (DHCS) has taken steps to correct a problem with the Affordable Care Act primary care rate increase unique to Child Health and Disability Prevention Program Services (CHDP) providers. Before the rate increases were implemented, some practices were previously instructed by DHCS to bill at their Medi-Cal rates. This caused concern—based on DHCS's pricing logic of paying the lesser of Medicare’s rate or the billed charges—that some practices would not qualify for the retroactive increases once the systems were updated to process claims at ... November 14, 2014 General, Medi-Cal Child Health and Disability Prevention Program, DHCS, Medi-Cal, Affordable Care Act 0 0 Comment Read More »
Supreme Court delays hearing ACA subsidy case The U.S. Supreme Court has declined to hear King v. Burwell—a case the questions whether premium subsidies can be provided under the Affordable Care Act (ACA) to individuals purchasing health insurance coverage on exchanges run by the federal government. The lawsuit has the potential to affect states that use the Federal health care exchange, but would not change the subsidies in states like California that run their own exchanges. The question asked in King v. Burwell is whether the language of the ACA law allows consumers to receive premium tax ... November 6, 2014 General Affordable Care Act, Health Insurance Exchange, ACA 0 0 Comment Read More »
DHCS releases Medi-Cal concept paper that proposes risk-based health home models and malpractice subsidies The California Department of Health Care Services (DHCS) has released a proposal in the form of a concept paper for the state’s next 1115 Section Medicaid Waiver for public for comment. California is currently in the fourth year of its current Section 1115 waiver that was approved by the federal government so California could expand Medi-Cal coverage in accordance with the Affordable Care Act in 2010 and implement a variety of delivery reform projects like the duals demonstration project. The concept paper outlines new ideas to modify provider payments and save ... September 4, 2014 Medi-Cal DHCS, Medi-Cal, Affordable Care Act 0 0 Comment Read More »
Feds propose compromise to ACA birth control rule to accommodate religious groups Last week, the Obama administration proposed a compromise to provide contraceptive coverage under the Affordable Care Act (ACA) to employees of whose employers object on religious grounds to providing contraceptives to their employees. The administration is hoping to quell the controversy around the ACA contractive coverage that has yielded dozens of lawsuits, while ensuring that all women are able to get coverage of recommended preventive services without cost sharing, as intended under the health care law. “Women across the country deserve access to recommended preventive services that are important to ... September 3, 2014 General ACA, Contraception, Affordable Care Act 0 0 Comment Read More »
Two federal courts issue conflicting rulings on ACA premium subsidies Two federal appeals courts issued conflicting rulings last week on whether premium subsidies can be provided under the Affordable Care Act (ACA) to individuals purchasing health insurance coverage on exchanges run by the federal government. The rulings will not, however, impact states like California that run their own exchanges. The U.S. Court of Appeals for the District of Columbia Circuit, in a 2 to 1 vote, majority opinion said that the ACA’s language unambiguously restricts premium subsidies to insurance purchased on exchanges “established by the State,” and that the IRS’ ... August 4, 2014 General Affordable Care Act, Health Insurance Exchange, ACA 0 0 Comment Read More »
Medicare's financial outlook improves Trustees overseeing Medicare’s Hospital Insurance Trust Fund, which finances about half the health program for seniors, said Monday in a report that the program won’t run out of money until 2030 – that’s four years later than projected last year and 13 years later than projected at the passage of the Affordable Care Act (ACA). The outlook for Medicare improved largely because of lower-than-expected hospital spending and savings resulting from the ACA. The effect of the new law encouraged providers and Medicare Advantage insurers to deliver care more cost-effectively and ... August 4, 2014 Medicare Affordable Care Act, Medicare, ACA 0 0 Comment Read More »
CMS proposes to end Sunshine Act CME exclusion The Centers for Medicare & Medicaid Services (CMS) has decided to eliminate the continuing medical education (CME) exclusion for the Physician Payments Sunshine Act. The news was included in the 2015 Medicare Physician Fee Schedule proposed rule. The Sunshine Act stems from a provision of the Patient Protection and Affordable Care Act. Under the Sunshine Act, drug and medical device manufacturers are required to report their financial interactions with licensed physicians – including consulting fees, travel reimbursements, research grants and other gifts. Any payments, ownership interests and other “transfers of ... July 15, 2014 General Health Care Reform, Physician Payment Sunshine Act, Affordable Care Act 0 0 Comment Read More »
Legislation introduced to restore Medi-Cal funding Today Assembly Budget Chair Nancy Skinner and Assembly Health Chair Richard Pan, M.D., introduced two bills, one that would restore the 10 percent Medi-Cal physician payment cut that went into effect this year and another that would extend the temporary Medi-Cal primary care rate increases called for under the Affordable Care Act (ACA). “I have sought to make the Medi-Cal program more cost-effective, transparent and accountable,” said Dr. Pan. “The legislation that we are introducing today continues this effort.” Medicaid rates in California are the lowest in the nation, while the ... February 20, 2014 Medi-Cal ACA, Insurance/Reimbursement, Medi-Cal, Medi-Cal Cuts, State Legislative Advocacy, Affordable Care Act, We Care for California 0 0 Comment Read More »
DHCS pays over $100 million to primary care physicians in initial retroactive Medi-Cal rate increase payment The Department of Health Care Services (DHCS) has now made several retroactive interim payments to primary care physicians who have attested to their eligibility for the rate increases called for under the Affordable Care Act (ACA). These primary care payment increases have been put in place by the federal government in an effort to recruit more primary care physicians to treat low-income patients who will be newly eligible for health coverage in 2014. Although under the ACA the rate increases took effect on January 1, 2013, DHCS had been waiting ... February 7, 2014 Medi-Cal Affordable Care Act, Insurance/Reimbursement, Medi-Cal, ACA 0 0 Comment Read More »
