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The Politics of Healthcare

How Obamacare Is Shaping the Immigration Debate
June 18, 2013 11:56 AM by Lisa Brzezicki

(Editor's Note: This guest blog was written by Michael LaMagna, a Partner at Helwig, Henderson, Ryan, LaMagna and Spinola, LLP.)

When people ask me why I enjoy healthcare law and all of its related fields, I always answer that healthcare relates to everything. At first glance, the immigration debates seem very separate from the Affordable Care Act (ACA) and it is not apparent how they are interrelated. However, it is very possible that the entire Immigration Reform Bill will pass or fail, because of ACA.

As I am writing this there is hot debate on whether the Immigration Reform Bill will pass Congress; however, the latest sticking point is when or even if immigrants who are granted permanent status would be granted health benefits. Senate Republicans are advocating that immigrants would be ineligible for federal health subsidies for five years after they become legal residents and House Republicans are advocating that they be required to purchase private health insurance, without access to Federal money. At the same time, many border-state governors are rejecting the implementation of ACA altogether, the effects of which remain uncertain. One thing that is clear is that neither the Senate nor House Immigration Bill will help the uninsured illegal immigrants get health insurance.

Another related Immigration Bill concern is the usage of a National Identification Card, which can be used for identification, medical records retrieval, healthcare monitoring and is tied to the Department of Homeland Security nationwide computer. This is causing both sides to discuss not only the security issue, but the privacy of healthcare information and who will have access. I am not sure if we are quite prepared to turn over our private healthcare information to the government, who will be monitoring our healthcare, could very well be a conflict.

Once again, I say to all of you out there, healthcare certainly affects every part of our life and shapes the national debates in one way or another.

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such. Michael LaMagna is a Partner at Helwig, Henderson, Ryan, LaMagna and Spinola, LLP, practicing Elder Law/Probate/Disability/Wills, Trusts and Estates, Health Care Regulatory, Medicare Appeals, Social Security and General Legal practice in both New York and Connecticut. Email him at Mlamagna@hhrls.com, call him at 914-437-5955 or visit Attorney LaMagna's website at www.HHRLS.com for more information.

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Medicare Remains Solvent, at Least Until 2026
June 10, 2013 1:51 PM by Lisa Brzezicki

(Editor's Note: This guest blog was written by Michael LaMagna.)

In what certainly can be touted as good news, the Medicare Trustees reported in their annual report that the Medicare Trust Fund, which holds all of our payroll deductions, is scheduled to remain solvent until the year 2026. This is two years greater than reported last year. The main considerations for the brief extension were the improving economy and slowing healthcare costs.

The slowing healthcare costs can be attributed, at least in part to, the Affordable Care Act, new policy limitations on the Medicare Part C or Medicare Managed Care Plans, reduced hospital re-admissions and payment changes to healthcare facilities. What impact the Affordable Care Act, which goes into full swing on Jan. 1, 2014, remains to be seen.

Although, this was certainly good news, the Trustees cautioned there is still significant work to be done with respect to Medicare and Social Security, the federally funded programs. It is well known that the programs are not sustainable in their current forms, especially since there are approximately 10,000 people retiring each day. In even more alarming developments, the Social Security Disability Trust Fund is scheduled to become depleted in 2016. 

If the retirement fund become depleted, it is not likely that benefits will stop completely; Medicare will pay less and less of the projected benefit, based on what is contributed. To fix the Medicare and Social Security Disability solvency issues would include raising the payroll tax or decreasing benefits, two very unpopular political moves that all sides appear reluctant to promote.

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such.  Michael LaMagna is a Partner at Helwig, Henderson, Ryan, LaMagna and Spinola, LLP, practicing elder law/probate/disability/wills, trusts and estates, healthcare regulatory, Medicare sppeals, Social Security and general legal practice in both New York and Connecticut.  Email: Mlamagna@hhrls.com, phone: 914-437-5955 www.HHRLS.com for more information.     

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Coming to a TV Screen Near You: Obamacare Campaign
May 30, 2013 5:17 PM by Lisa Brzezicki

(Editor's Note: This guest blog was written by Michael LaMagna.)

We usually associate summer with BBQs, pool parties and the like, but brace yourself because this summer we will be barraged with Obamacare commercials. The White House is just starting their campaign throughout the U.S. urging people to buy health insurance when it becomes available Oct. 1, 2013 (just four months away). In fact, the goal is to sign up at least 7 million people in the first year.

What we can expect is TV ads, door-to-door interaction and newspaper advertisements touting the benefits of signing up for the mostly unknown benefits and with healthcare exchanges, which are mostly unknown as well. This can be especially challenging as more than 4 in 10 Americans do not even recognize the law as surviving the Supreme Court. In addition, the success of the program depends on at least 7 million people signing up in the first year, with a majority of those people being younger and well. If more chronically ill people sign up, there can be enormous fiscal implications.

Even more troubling is the impact of the states that haven't fully accepted the law and those ill-equipped to implement. Will people migrate from state to state to obtain insurance, and what would be the eligibility requirements, much like Medicaid eligibility requirements are state based. The good news is that we have the summer to answer some of our questions and come up with a few more.

I would like to know what you think about the advertisement blitz and its effectiveness and your thoughts about people calling and visiting your homes.

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such. Michael LaMagna is a Partner at Helwig, Henderson, Ryan, LaMagna and Spinola, practicing elder law/probate/disability/wills, trusts and estates, health care regulatory, Medicare appeals, Social Security and general legal practice in New York and Connecticut. Contact him at Mlamagna@hhrls.com; 914-437-5955; www.HHRLS.com.

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Health Insurance for Young Adults: What You Need to Know
May 28, 2013 4:03 PM by Lisa Brzezicki

(Editor's Note: This guest blog was written by Michael LaMagna.)

If there is one thing that many of us are guilty of, it's neglecting our own health and focusing on our children and their needs. I am sure that most of us are aware that our health plans are now required to keep young adult children on their parent's health plans until they reach age 26, but many people, including the plan participants, do not know what is covered and what is not. 

Currently, there are more than 3 million young adults covered under their parent's plans.  Although this group may be covered for comprehensive medical needs, young adults who are covered under their parent's plans find themselves not covered for mental health issues, substance abuse and maternity care, which are common healthcare occurrences in the 26 and under crowd. There may be some hope starting in 2014, health plans will no longer be able to turn people down because they have preexisting medical conditions and with the advent of healthcare exchanges, young people will be free to shop around for individual plans if they don't want to stay on their parent's plan. All non-grandfathered healthcare plans will cover 10 essential health occurrences, including maternity and newborn care, mental health and substance abuse services.

In addition to the comprehensive plans available on the exchanges, young people up to age 30 will have the option of choose a catastrophic plan, which will cover preventive services without any cost sharing and three physician visits after a $6,350 deductible is met.

Of course there are exceptions called grandfathered plans, which you should be aware. Large-group employers are exempt from covering the 10 essential health benefits, which may exempt young people from mental health, substance abuse and maternity care. While Medicaid can be an option for specific care, there are strict income and asset guidelines that must be adhered to, which will make it impossible for most non-disabled working people to qualify.

Even still, many mental health professionals and counselors who provide outpatient services may not take many of the health plans or accept Medicaid. It is vital that you become very familiar with your health plans and know your rights regarding coverage and the appeals process in case you or your children get denied coverage. It is common for bills for these services to be in the tens of thousands of dollars, which many people do not have to pay the hospital bills, especially those 26 and under and their parents.  

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such.  Plan to attend Attorney LaMagna's free seminar, "Talking Dollars and Sense," at the Kensington Assisted Living, White Plains, NY on May 16, 2013 from 6:00-7:30pm. RSVP by calling The Kensington at 914-220-4259.  Michael LaMagna is a Partner at Helwig, Henderson, Ryan, LaMagna and Spinola, practicing Elder Law/Probate/Disability/Wills, Trusts and Estates, Health Care Regulatory, Medicare Appeals, Social Security and General Legal practice in both New York and Connecticut.    Email him at Mlamagna@hhrls.com, call him at 914-437-5955 or visit Attorney LaMagna's website at www.HHRLS.com for more information. 

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Death With Dignity
May 15, 2013 6:48 AM by Lisa Brzezicki

Earlier this week, Vermont legislature became the first legislative body in the nation to approve death-with-dignity legislation, with Gov. Peter Shumlin vowing to sign the bill into law.

In a press release issued by end-of-life choice advocacy group Compassion & Choices, President Barbara Coombs Lee, PA, FNP, JD, said, "This historic legislative victory proves that the aid-in-dying issue is no longer the third rail of politics. In fact, it’s a winning issue on which Gov. Shumlin campaigned. We congratulate Patient Choices Vermont for its leadership of this multi-year campaign. Their success shows aid in dying has become a legislative winner.

"Legislators now are embracing the high margin of public support for end-of-life choices nationwide," continued Coombs Lee, who co-authored the nation’s first Death-with-Dignity law in Oregon and was a senior advisor for the nation’s second Death-with-Dignity law in Washington state, both approved by ballot initiatives. "This bill’s passage should enable legislatures in Massachusetts, New Jersey and other states that are considering aid-in-dying bills to approve them."

The Vermont bill provides criminal, civil and professional protections for physicians who prescribe medication to mentally competent, terminally ill patients that they can ingest to achieve a peaceful death. It has requirements similar to the Oregon and Washington laws, but the Vermont requirements would expire after a three-year period and then professional practice standards would govern the practice of aid in dying.

Share your thoughts on the Death-with-Dignity law.

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Six Ways the 2014 Fiscal Budget May Change Healthcare
April 30, 2013 2:19 PM by Lisa Brzezicki

(Editor's Note: This guest blog was written by Michael LaMagna.)

With all of the talk regarding the sequester and budget cuts, I decided to focus on what the fiscal 2014 budget would mean to the 54 million+ Medicare beneficiaries, if the budget was passed in its current state. Currently, the 2014 proposed fiscal budget contains $4 trillion in cost savings, with almost $400 billion in Medicare spending reductions over the next decade. The cost-saving provisions are spread amongst all beneficiaries and providers of care. I highlighted the six provisions that would directly affect Medicare beneficiaries and their providers of care:

  1. Higher Part B deductibles:  Medicare Part B, which pays for physician and ancillary services, will have an increase of approximately $75, which is a significant increase over the $147 current deductible. This is true despite more than half of Medicare beneficiaries having an annual income of less than $22,500 in 2012;  
  2. Home Health Care Visits:  Starting in 2017, new Medicare beneficiaries would be expected to pay $100 for five or more home healthcare visits paid by Medicare if the care was not provided after a hospital or rehabilitation visit;
  3. Surcharge for Medigap premiums:  Also starting in 2017, new beneficiaries who purchase the often critical supplemental or Medigap policy, will have a 15% surcharge to discourage over usage;
  4. Medicare Part B and Part D premiums to increase for wealthier individuals: Although individuals with incomes above $80,000 and couples who have incomes over $170,000 already pay a larger share of Medicare premiums, the budget calls for higher premiums for those with higher incomes:
  5. Doughnut Hole Closing: The good news is that the dreaded doughnut hole would be closing as soon as 2015;
  6. Cuts to Healthcare Providers: Hospitals would see the amount of money provided to them because of bad debt slashed by almost two-thirds and the amount paid to teaching hospitals also decreased.

Of course, this is just a snapshot of the proposed budget, but it is vital that all of us take notice of the possible changes and the likelihood that many of these provisions will become enacted and to prepare accordingly.    

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such.  Plan to attend Attorney LaMagna's free seminar, "Talking Dollars and Sense," at the Kensington Assisted Living, White Plains, NY on May 16, 2013 from 6:00-7:30pm. RSVP by calling The Kensington at 914-220-4259.  Michael LaMagna is a Partner at LaMagna & Associates, PC, practicing Elder Law/Probate/Disability/Wills, Trusts and Estates, Health Care Regulatory, Medicare Appeals, Social Security and General Legal practice in both New York and Connecticut.    Email him at Mlamagna@nyandctlaw.com, call him at 914-437-5955 or visit Attorney LaMagna's website at www.nyandctlaw.com for more information.     

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HHS: Affordable Care Act Extended Free Preventive Care to 71M with Private Health Insurance
March 18, 2013 2:17 PM by Lisa Brzezicki
Health and Human Services (HHS) Secretary Kathleen Sebelius announced today in a press release that about 71 million Americans in private health insurance plans received coverage for at least one free preventive health care service, such as a mammogram or flu shot, in 2011 and 2012 because of the Affordable Care Act (ACA).

Additionally, an estimated 34 million Americans in traditional Medicare and Medicare Advantage plans have received at least one preventive service, such as an annual wellness visit at no out-of-pocket cost because of the healthcare law.

Taken together, this means about 105 million Americans with private health plans and Medicare beneficiaries have been helped by the ACA's prevention coverage improvements.

Preventive services, consumer protections and other reforms under the ACA are giving millions of Americans of all ages more value for their healthcare dollars and contributing to the slowest growth in healthcare costs in 50 years, according to HHS.

"Preventing illnesses before they become serious and more costly to treat helps Americans of all ages stay healthier," Secretary Sebelius said.  "No longer do Americans have to choose between paying for preventive care and groceries."

Secretary Sebelius released the preventive services report as HHS celebrates the Affordable Care Act's third anniversary this week.  The law is keeping down costs and providing more value for consumers and taxpayers through new consumer protections, holding insurance companies accountable, building a smarter health care system, and providing seniors with vital savings on their prescription drugs.

According to HHS, the ACA is giving Americans better value for their health insurance plans by:

  • Eliminating lifetime dollar caps on essential health benefits, and phasing out annual caps. About 105 million Americans no longer have to fear their benefits will disappear when they need them most because their insurer put a lifetime cap on the amount it would pay.
  • Prohibiting health insurance companies from denying coverage to children based on a pre-existing condition, such as asthma or cancer.
  • And in 2014, it will be illegal for health insurance companies to deny coverage to any American or to charge more because of a pre-existing condition. No longer will 129 million Americans with health conditions have to fear seeing their premiums increased or getting locked out of the insurance market.
  • The law will also make it illegal for a health insurer to charge women more simply because they are women. "That means," Secretary Sebelius said, "being a woman will no longer be a pre-existing condition."

The full report on expanded preventive care for Americans with private health insurance is available at http://aspe.hhs.gov/health/reports/2013/PreventiveServices/ib_prevention.cfm.

Learn more about the key features of the Affordable Care Act at www.healthcare.gov/law/timeline/full.html.

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Bill Introduced to Improve Advance Care Planning with the Help of EHRs
March 15, 2013 8:29 AM by Lisa Brzezicki

This week, Congressman Earl Blumenauer (OR-03) introduced The Personalize Your Care Act, bipartisan legislation that will provide Medicare and Medicaid coverage for voluntary consultations about advance-care planning every 5 years or in the event of a change in health status. The bill also provides grants to states to establish or expand Physician Orders for Life Sustaining Treatment (POLST) programs, and ensures that an individual’s electronic health record is able to display his or her current advance directive and/or POLST form.

"This bill will help ensure that every family has the tools, even during difficult and emotional circumstances, to manage end-of-life decisions," Blumenauer said in a press release. "From a young person in a terrible car accident to someone who has had a long life well lived, we all deserve to make our own decisions about the care we want and to have the confidence that those decisions will be carried out."

According to the press release, a study published in the New England Journal of Medicine found that more than one in four elderly Americans lacked the capacity to make their own medical care decisions at the end of life. Under those circumstances, care decisions fall to family members and doctors who may not know the treatment preferences of the elderly patient. Elderly patients with advance directives, however, usually receive the care they chose. Evidence also demonstrates that advance care planning and end-of-life discussions reduce stress, anxiety, and depression in surviving relatives.

"Families need the tools and ability to work with healthcare providers to determine and express their wishes for care in the event that they no longer have the capacity to make decisions," Blumenauer said. "This legislation gives providers the necessary time, space, and funding to conduct complex discussions with patients so that can be appropriately cared for. These consultations will ensure that an individual’s values and goals for care are identified, understood and respected."

The bipartisan original cosponsors of the legislation include Representatives Richard Hanna (R-NY), Phil Roe (R-TN), Allyson Schwartz (D-PA), Ron Kind (D-WI), George Miller (D-CA), Jim McDermott (D-WA), Ami Bera (D-CA), Jan Schakowsky (D-IL), Lois Capps (D-CA) and Tom Reed (R-NY).

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HHS Approves Four More States to Run State Partnership Marketplaces
March 8, 2013 8:56 AM by Lisa Brzezicki

Health and Human Services (HHS) Secretary Kathleen Sebelius has announced in an HHS press release that more states are moving forward to implement the healthcare law and establishing Health Insurance Marketplaces. HHS conditionally approved Iowa, Michigan, New Hampshire and West Virginia to operate State Partnership Marketplaces, which will be ready for open enrollment in October 2013.

 

"HHS will continue to work collaboratively with all states to build the marketplace," Secretary Sebelius said. "Working together, we will be ready in seven months when consumers will be able to use the new marketplace to easily purchase quality, affordable health insurance plans."

 

These latest conditional approvals bring the total number of states that have been conditionally approved to partially or fully run their marketplace to 24 states and the District of Columbia. In addition, several other states have suggested their own approaches to contributing toward plan management in their marketplace in 2014. HHS says it will continue to provide all states with the flexibility, resources, and time needed to support the establishment of the new health insurance marketplace.

 

Consumers in every state will soon be able to buy insurance from qualified health plans directly through a marketplace and may be eligible for premium tax credits and cost sharing assistance to help lower their costs, according to HHS. These health plans will ensure consumers have the same kinds of valuable insurance choices as members of Congress, and cannot be denied coverage because of a pre-existing condition.

 

For more information on the new Health Insurance Marketplace, visit www.healthcare.gov/marketplace/

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Healthcare Law Glitch Will Leave Many Without Insurance
February 8, 2013 11:21 AM by Lisa Brzezicki

(Editor's Note: The guest blog was written by Michael LaMagna.)

In somewhat unexpected news, there appears to be a serious crack in the healthcare law, one which may "price out" millions of families from healthcare coverage altogether. The issue recently came to light when confusing language in the new law appears to carve out lower income families who do not qualify for Medicaid, requiring them to either pay more for their employee sponsored health insurance or go without insurance.

The problem arises because the law redefined what employers are responsible to pay for insurance. Under the law, an employer will face a penalty if the premiums are so expensive that a worker would qualify for a subsidy. Subsidies are available for unaffordable coverage, deemed as 9.5% of a worker's household income. The problem is that the benchmark used is cost of an individual policy, not a family policy. Anyone who pays for health insurance knows it is often 3-4 time more expensive for a family policy than an individual, so if you base the calculation on an individual policy, not very many people would qualify for the subsidy and the employers are not responsible to make up the difference.

The numbers certainly are staggering. There are as many as 4 million households, including 500,000 children, affected by this glitch. Using 2011 figures, a family making more than $9,700 per year would be ineligible for a subsidy, while the cost of that plan for a family is actually more than $4,000 per year, far more than most families can afford without some assistance from the employer or the government.

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such. Michael LaMagna is a partner at The Law Office of LaMagna & Associates, PC, practicing Health Care Regulatory, Elder /Probate/Disability/Trusts and Estates, Social Security and General Legal practice in both New York and Connecticut. Email him at Mlamagna@nyandctlaw.com, call him at 914-534-1048 or visit Attorney LaMagna's website at www.nyandctlaw.com for more information. You can also follow Attorney LaMagna on Twitter@michaellamagna1.

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HBMA: Congressional Delay Could Cost Providers Millions
December 20, 2012 10:00 AM by Lisa Brzezicki
In a recent press release, the Healthcare Billing & Management Association, a non-profit educational resource and advocacy group representing third-party medical billing companies and billing professionals, announced that it is urging Congress to avert the pending 26.5% reduction in the Medicare physician fee schedule (MPFS) Conversion Factor on Jan. 1, 2013, and impose the longest possible Medicare sustainable growth rate (SGR) fix immediately this year, in 2012.

HBMA members believe that should this cut occur as scheduled, thousands of physicians will either dramatically curtail the number of Medicare patients they will see in their practice, or in the most extreme cases, no longer accept Medicare patients.

 "Either way, millions of Medicare beneficiaries will surely see a precipitous drop in the availability of medical care they have come to expect and deserve," said HBMA President, Don Rodden, in the release.

Medical billing companies, such as those which are members of HBMA, are retained by physicians to handle the business aspects of a busy medical practice.  These medical business experts, or member companies, are intimately familiar with what it costs a physician to submit a medical claim and get paid for the services they render.  If Congress decided to retroactively "fix" the SGR problem, as they have done in the past, the costs of the retroactive adjudication would add to the already high cost of doing business, the HBMA release said.

Whether Congress decides on a long-term or short-term fix, HBMA is urging Congress to act now, prior to Jan. 1, 2013, and not to postpone action.

HBMA recognizes that new payment methodologies may be necessary to maintain the long-term viability of the Medicare Trust Fund.  However, the more steps a medical claim must go through, the higher the cost of getting a claim processed.  In many cases the cost of processing the claim could become higher than the value of the claim, according to the HMBA.

 "Medicare beneficiaries deserve to know that the quality healthcare they have come to rely upon will be there when they need it," Rodden added.

What are your thoughts on the issue?

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Medicare Settles Lawsuit: Many Will Gain Access to Services
December 13, 2012 8:32 AM by Lisa Brzezicki

(Editor's note: This guest blog was written by Michael LaMagna.)

If any readers have patients Medicare refused to pay for skilled nursing, home care or other outpatient benefits because their condition was "stable, chronic, not improving or that the necessary services were for maintenance," keep reading because there is some very good news.

In early October, CMS settled a class action lawsuit filed by the Center for Medicare Agency and Vermont Legal Aid. According to the settlement, CMS will reverse course and allow Medicare to pay for services "necessary for the performance of a safe and effective maintenance program." In addition, CMS will no longer deny claims because a Medicare beneficiary wouldn't be able to achieve complete independence or because they can no longer return to their prior functioning level.

Under the agreement, CMS will also set up an appeals process, similar to the process currently in place, in which a beneficiary can appeal a denial for a claim, all the up to an impartial Administrative Law Judge. It is expected the new policy revision will enable thousands to gain access to needed skilled care and allows those Medicare providers to continue needed services, in particular, to those with chronic conditions, including Alzheimer's, Parkinson's and multiple sclerosis.

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such. Michael LaMagna is a partner at The Law Office of Michael LaMagna, LLC, practicing Health Care Regulatory, Elder /Probate/Disability/Trusts and Estates, Social Security and General Legal practice in both New York and Connecticut. Email him at Mlamagna@nyandctlaw.com, call him at 914-534-1048 or visit Attorney LaMagna's website at www.nyandctlaw.com for more information. You can also follow Attorney LaMagna on Twitter@michaellamagna1.

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Medicare Premiums to Rise in 2013
November 21, 2012 3:07 PM by Lisa Brzezicki

(Editor's Note: This guest blog was written by Michael LaMagna.) 

The premium for Medicare Part B, which is the voluntary Medical insurance covering medically necessary doctors' services, preventive care, durable medical equipment, laboratory tests, x-rays, limited home health and ambulance services will rise by $5 in 2013. This increase will offset the Social Security cost of living increase for 2013 of 1.7%, or an average of $19 per month.

The new Part B cost for the majority of beneficiaries will be $104.90, up from the current $99.90 per month. However, those "high income" beneficiaries, whose income is more than $85,000 for an individual or $170,000 for couples will see an increase of $42 to $230.80 per month. Most beneficiaries will not realize the change because they pay directly from their Social Security check.

In addition, Medicare's hospitalization deductible will increase by $28, to $1,184. The deductible is the amount a person must pay before health insurance kicks in. It is recommended that seniors have supplemental coverage to offset their Medicare hospital deductible.

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such. Michael LaMagna is a partner at The Law Office of Michael LaMagna, LLC, practicing health care regulatory, elder /probate/disability/trusts and estates, social security and general legal practice in both New York and Connecticut. Email him at Mlamagna@nyandctlaw.com, call him at 914-534-1048 or visit www.nyandctlaw.com for more information.

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Two More Provisions of ACA Now in Effect
October 31, 2012 11:41 AM by Lisa Brzezicki

(Editor's Note: This guest blog was written by Michael LaMagna.) 

As of Oct.1, 2012, two very important provisions of the Affordable Care Act (ACA) went into effect, which will significantly impact hospitals and other healthcare facilities. The two provisions are: 1) penalizing hospitals for readmitting patients within 30 days of discharge and 2) utilizing hospital value-based purchasing, which ties hospital payments to achieving clinical thresholds.

It is anticipated that more than 2,200 hospitals will be fined at least $125,000 this year as a result of readmissions. As expected, the hospitals are outraged for being fined for conditions that may be out of their control, which includes the readmission of chronically ill people. The variables that will be measured in the first year include: heart attacks, heart failure and pneumonia. The penalty is capped at 1% of the hospital's Medicare payments, rising to 3% in the next few years and adding variables, which includes: joint replacements, stenting, heart bypass and stroke.  

Hospitals have been looking to after-hospital care, including: rehab centers, hospices, home health agencies and nursing homes to decrease the incidences of readmissions. The major emphasis has been on effective discharge planning and wellness programs.

Regarding the Hospital Value-Based Purchasing Program, Medicare will look at a set of standard clinical quality measures and on surveys of patients' experience, to determine reimbursement.  Medicare has been sharing data with the hospitals to assist with diminishing their impact and the public can view the information on Hospital Compare, located at http://www.medicare.gov/ starting later this month.     

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such.  Michael LaMagna is a partner at Timins & LaMagna, LLP, practicing Health Care Regulatory, Elder /Probate/Disability/Trusts and Estates, Social Security and General Legal practice in both New York and Connecticut. Michael was just appointed to the ACO Task Force of the American Health Lawyers Association.  Email him at Mlamagna@nyandctlaw.com, call him at 914-819-0663 or visit Attorney LaMagna's website at www.nyandctlaw.com for more information.    

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Projected Costs of Health Care Law Changing
September 26, 2012 3:30 PM by Lisa Brzezicki

(Editor's Note: This blog was written by Michael LaMagna, a partner at Timins & LaMagna, LLP)

The Congressional Business Office (CBO) reports that in 2016, which is when the 2010 health care law becomes fully in effect, 2% of Americans, or roughly 6 million individuals, will be subject to the health care penalty tax. This is significantly higher than the estimated 4 million, in large part due to higher than anticipated unemployment, lower wages and salaries as well as changes to the law since its passage in 2010.

The new penalty is the infamous individual mandate upheld by the Supreme Court as a tax, which requires that you either obtain health insurance or pay a penalty, amounting to $695 or 2.5% of your annual household income. The tax is expected to bring in more than $7 billion in 2016 and $8 billion thereafter.

In addition, the CBO projected that the total amount of individuals who will remain uninsured with be 30 million, up from the projected 21 million. The reason why it is projected that 6 million will be subject to the tax is because the other 24 million include: undocumented aliens, Indian tribe members and those with lower incomes.

The CBO has projected that the total cost for the new law will be upward of $2.6 trillion dollars in the next 10 years, which is significantly higher than the first estimates of $900 billion and covers fewer individuals than first thought.

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such. Michael LaMagna is a partner at Timins & LaMagna, LLP, practicing Health Care Regulatory, Elder /Probate/Disability/Trusts and Estates, Social Security and General Legal practice in both New York and Connecticut. Michael was just appointed to the ACO Task Force of the American Health Lawyers Association. Email him at Mlamagna@nyandctlaw.com, call him at 914-819-0663 or visit Attorney LaMagna's website at www.nyandctlaw.com for more information.

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