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U.S. Supreme Court Upholds Individual Mandate, Most of PPACA
The United States Supreme Court, by a 5-4 decision on Thursday, let stand almost all of the Patient Protection and Affordable Care Act (PPACA) enacted by Congress in 2010. A provision of the law that would have permitted the federal government to impose financial penalties on states that do not comply with the Medicaid coverage expansion authorized in PPACA was ruled unconstitutional.
The majority opinion in National Federation of Independent Business v. Sebelius written by Chief Justice John Roberts, upheld the requirement for every person to obtain health insurance coverage starting in 2014, or face a penalty if they fail to do so. While Justice Roberts’ opinion noted that the coverage mandate could not be sustained as acceptable under either the Commerce clause or the Necessary and Proper clause of the U.S. Constitution, it was acceptable within Congress’ constitutional power to “lay and collect Taxes.” This provision was upheld thereby rendering moot the question of throwing out the entire law had the coverage mandate been found to be unconstitutional.
Medicaid Issue
With regard to the provision of PPACA expanding Medicaid eligibility to 133% of the Federal Poverty Level, Justice Roberts noted that changes to the Medicaid program were “a shift in kind, not merely degree. A State could hardly anticipate that Congress’ reservation of the right to “alter” or “amend” the Medicaid program included the power to transform it so dramatically. The Medicaid expansion thus violates the Constitution by threatening States with the loss of their existing Medicaid funding if they decline to comply with the expansion.” However, the majority opinion concluded that the unconstitutionality of this provision should not invalidate the rest of the law.
Dr. Hughes’ Comments
MSSNY President Dr. Robert Hughes issued a statement following the court’s decision urging Congress and President Obama to work together to address the shortcomings of the health care reform law:
“Now that the decision has been reached by the Supreme Court, it is time for Congress and the President to put aside partisan differences to work together to fix the many flaws of the PPACA law that have been identified by the many physicians who opposed the law as well as the many physicians who supported many of its provisions, to better assure that the goal of law is met – assuring patients can receive timely quality health care from the physician of their choice. Some of these essential reforms include:
o enactment of comprehensive lawsuit abuse reform;
o preservation of Medicare access for seniors including long term Medicare physician payment stability and permitting patients to privately contract with physicians not participating in the Medicare program;
o repeal of the Independent Payment Advisory Board (IPAB) to prevent rationing of care;
o enactment of antitrust reform to permit independently practicing physicians to collectively negotiate with health insurance companies so as to preserve the right of physicians to advocate for their patients against market-dominant insurers; and
o expanding the use of health savings accounts as a means to provide health insurance coverage.”
The Medical Society of the State of New York pledges to work with all interested parties toward achieving these goals. For more information regarding health care reform, MSSNY members can go to a special section on MSSNY’s website.
HHS Publish HIPAA Privacy and Security Rules
The U.S. Department of Health and Human Services has published on its website the Office of Civil Rights Audit Protocol to assess compliance with the HIPAA Privacy and Security rules. Physicians in NY have been included among the covered entities to be audited.
Click here.
For more information about HIPAA Privacy and security issues, please refer to the following website:http://www.mssny.org/mssnyip.cfm?c=s&nm=HIPAA/NPI
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MSSNY Speaks at the AMA Meeting
AMA Reference Committee Chairs Drs. Tom Madejski (Medical Service) and Jerry Cohen Constitution and Bylaws) at the Annual AMA Meeting in Chicago.
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CDC Updates Recommendations on Use of Tdap in Older Adults
"Providers should not miss an opportunity" to immunize adults aged 65 and older with the tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine, according to updated recommendations from the CDC's Advisory Committee on Immunization Practices, published in MMWR.
ACIP says it supports "the conclusion that the actual burden of pertussis" in this age group "is at least 100 times greater than that reported." While the Boostrix vaccine is preferred for these patients, Adacel may also be used. Both are immunogenic and offer protection, and adverse events are no more common in older patients than in younger ones. MMWR article
Exemptions for Hardship for E-Prescribing
CMS may exempt individual eligible professionals and group practices participating in eRx GPRO from the 2013 eRx payment adjustment if it is determined that compliance with the requirements for becoming a successful electronic prescriber would result in a significant hardship.
Significant Hardships
The significant hardship categories are as follows:
- The eligible professional is unable to electronically prescribe due to local, state, or federal law, or regulation
- The eligible professional has or will prescribe fewer than 100 prescriptions during a 6-month reporting period (January 1 through June 30, 2012)
- The eligible professional practices in a rural area without sufficient high-speed Internet access (G8642)
- The eligible professional practices in an area without sufficient available pharmacies for electronic prescribing (G8643)
Submitting a Significant Hardship Code or Request
To request a significant hardship, individual eligible professionals and group practices participating in GPRO must submit their significant hardship exemption requests through the Quality Reporting Communication Support Page (Communication Support Page) on or between March 1 and June 30, 2012. Please remember that CMS will review these requests on a case-by-case basis. All decisions on significant hardship exemption requests will be final.
For more information on how to navigate the Communication Support Page, please reference the following documents:
Quality Reporting Communication Support Page User Guide
Tips for Using the Quality Reporting Communication Support Page
For additional information and resources, please visit the E-Prescribing Incentive Program web page. If you have questions regarding the eRx Incentive Program, eRx payment adjustments, or need assistance submitting a hardship exemption request, please contact the QualityNet Help Desk at 866-288-8912 (TTY 877-715-6222) or via qnetsupport@sdps.org. They are available Monday through Friday from 7am to 7pm CST.
Aetna Policy Change
In a letter dated March 23, 2012, AEtna informed its healthcare professionals that CLIA and CAP certification would be required for payment of surgical pathology. The Aetna policy change applies to the professional component billed in the AMA-CPT code range of 88300-88314 and 88342. In response to our concerns, Aetna is moving back the effective date to January 1, 2013. In addition, Aetna will also accept the New York State Department of Health certification as indicated on the following website.
The Aetna revised letter is attached for your reference.
Drug Shortage List June 22, 2012
· Drug Shortages: Current Drug Shortages: Bumetanide Injection
Rochester Volunteer: Opportunity to Work with Children with Diabetes
WHAT: Rochester Residential American Diabetes Association Camp in Urgent need of a Medical Coordinator July 8 – 13. WHO: ¨ Nurse Practitioner/Registered Nurse, Certified Diabetes Educator/Certified Pump Trainer Or Pediatric Endocrinologist.
Contact Danielle Humphreys if interested 585-458-3040 x3472 or dhumphreys@diabetes.org
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