Welcome to Health Care POV | sign in | join
The Politics of Healthcare

Preventing Healthcare Fraud
July 26, 2012 12:01 PM by Lisa Brzezicki
According to the Health and Human Services (HHS), HHS Secretary Kathleen Sebelius and Attorney General Eric Holder announced the launch of a ground-breaking partnership among the federal government, State officials, several leading private health insurance organizations and other healthcare anti-fraud groups to prevent healthcare fraud. This voluntary, collaborative arrangement uniting public and private organizations is the next step in the Obama administration's efforts to combat healthcare fraud and safeguard healthcare dollars to better protect taxpayers and consumers.

The new partnership is designed to share information and best practices to improve detection and prevent payment of fraudulent healthcare billings. Its goal is to reveal and halt scams that cut across a number of public and private payers. The partnership will enable those on the front lines of industry anti-fraud efforts to share their insights more easily with investigators, prosecutors, policymakers and other stakeholders. It will help law enforcement officials more effectively identify and prevent suspicious activities, better protect patients' confidential information and use the full range of tools and authorities provided by the Affordable Care Act and other essential statutes to combat and prosecute illegal actions.

"This partnership puts criminals on notice that we will find them and stop them before they steal health care dollars," Secretary Sebelius said in a release. "Thanks to this initiative and the anti-fraud tools that were made available by the healthcare law, we are working to stamp out these crimes and abuse in our healthcare system."

One innovative objective of the partnership is to share information on specific schemes, utilized billing codes and geographical fraud hotspots so that action can be taken to prevent losses to both government and private health plans before they occur. Another potential goal of the partnership is the ability to spot and stop payments billed to different insurers for care delivered to the same patient on the same day in two different cities. A potential long-range goal of the partnership is to use sophisticated technology and analytics on industry-wide healthcare data to predict and detect healthcare fraud schemes.

The partnership builds on existing tools provided by the Affordable Care Act, resulting in:

  • Tougher sentences for people convicted of healthcare fraud. Criminals will receive 20 to 50 percent longer sentences for crimes that involve more than $1 million in losses;
  • Enhanced screenings of Medicare and Medicaid providers and suppliers to keep fraudsters out of the program.
  • Suspended payments to providers and suppliers engaged in suspected fraudulent activity.

To read the press release in its entirety and see a list of the organizations and government agencies that are among the first to join this partnership, click here.

For more information on the partnership and the Obama administration's work to combat healthcare fraud, go to: http://www.healthcare.gov/news/factsheets/2011/03/fraud03152011a.html and http://www.stopmedicarefraud.gov/

Healthcare Law Provides Rebates, Saves Consumers Over $1 Billion
June 21, 2012 3:00 PM by Lisa Brzezicki
Earlier today, Health and Human Services (HHS) Secretary Kathleen Sebelius announced that 12.8 million Americans will benefit from $1.1 billion in rebates from insurance companies this summer, because of the Affordable Care Act's 80/20 rule, also known as the Medical Loss Ratio (MLR) standard. These rebates will be an average of $151 for each family covered by a policy.

The healthcare law generally requires insurance companies to spend at least 80 percent of consumers' premium dollars on medical care and quality improvement. Insurers can spend the remaining 20 percent on administrative costs, such as salaries, sales and advertising. Beginning this year, insurers must notify customers how much of their premiums have been actually spent on medical care and quality improvement.

Insurance companies that do not meet the 80/20 standard must provide their policyholders a rebate for the difference no later than Aug. 1, 2012. 

"The 80/20 rule helps ensure consumers get fair value for their health care dollar," Secretary Sebelius said in a HHS release.

Consumers owed a rebate will see their value reflected in one of the following ways:

  • a rebate check in the mail;
  • a lump-sum reimbursement to the same account that they used to pay the premium if by credit card or debit card;
  • a reduction in their future premiums; or
  • their employer providing one of the above, or applying the rebate in a manner that benefits its employees.

According to HHS, consumers in every state will also receive a notice from their insurance company informing them of the 80/20 rule, whether their company met the standard, and, if not, how much of difference between what the insurer did or did not spend  on medical care and quality improvement will be returned to them.

For the first time, all of this information will be publicly posted on HealthCare.gov this summer, allowing consumers to learn what value they are getting for their premium dollars in their health plan.


The Trouble With Metadata & Health Privacy
June 14, 2012 8:48 AM by Lisa Brzezicki

(Editor's note: This blog was written by ADVANCE editorial intern Rebecca Hepp.) 

Advances in technology over the past decade have raised serious concerns for patient privacy, an issue that sparked an intense panel discussion at the Second International Summit on the Future of Health Privacy, held last week in Washington, DC. Panelists debated current legislation's ability to properly protect patients in the age of smart phones, tablets and electronic records. For James Pyles, a health law attorney who has worked on privacy measures for HIPAA and the HITECH Act, legislation is lagging far behind technology, leaving patients unprotected from potential electronic violations of privacy.

"We now have electronic disclosures of patient privacy that are entirely different from disclosures of paper records," Pyles said. "You can get a paper record back; you cannot get an electronic record back. You can disclose millions of electronic records simultaneously; you cannot do that with paper records."

"The damage that can be done to someone is perpetual," Pyles added. "And the damages that can be awarded are incalculable."

Joy Pritts, chief privacy officer for the Office of the National Coordinator for Health IT (ONC), agrees with Pyles that technology is advancing much quicker than the law, although she did argue that HIPAA still has its strengths. Under HIPAA, enforcement of federal privacy regulations is in the hands of the states, who are free to extend enforcement beyond the floor set by the federal regulation.

"In some states, there are very strict standards on how [health information] can be shared," Pritts said. "In other states, they didn't see a need to do that because they thought patients were comfortable getting care and sharing that information for certain purposes without having to expressly write it down on a piece of paper."

Adding fuel to the fire, Frank Pasquale, a healthcare regulation and enforcement professor at Seton Hall University, brought up the related debate over metadata and its potential to give patients more control over their personal information. "We've got to create new modes, enable modes of granular control over the data in order to make people feel safe," Pasquale said. "Otherwise, we're never going to have the type of benefits we can get from big data analysis, from observational research."

Metadata, according to the ONC, is data that provides more detail or information about a piece of data, which has the potential to drastically improve the way health organizations communicate electronically. However, without any accepted standards for metadata tags, the National Committee on Vital and Health Statistics (NCVHS), the statutory public advisory body to the U.S. Department of Health & Human Services, recommended that the ONC refrain from including metadata standards in Stage 2 of the Meaningful Use incentive program.

Referring to the NCVHS's recommendation, Pritts told the panel last week that metadata is currently on hold for electronic health records, at least until metadata standards are better assessed and understood. With such a powerful tool at hand, precautions must be taken to ensure there are no unintended consequences that could infringe on patient privacy. 


Pharma Industry Persuaded to Embrace Healthcare Law
June 7, 2012 3:30 PM by Lisa Brzezicki
(Editor's Note: This guest blog was written by Michael LaMagna.)

In a rare glimpse into political backdoor dealing, emails were released this last week revealing exactly how the White House was able to convince the pharmaceutical industry to embrace the controversial healthcare law. The emails, which were released from the Pharmaceutical Research and Manufacturers of America show that in exchange for their support of the law, the White House pledged to abandon price controls for prescription drugs and would prohibit importing cheaper drugs from foreign countries. In return, the pharmaceutical industry pledged to back the law.

In addition, emails reveal that it was made clear that if the industry did not back the law, the administration would seek a 15% rebate on Medicare drugs and try to remove a tax deduction that would cost the industry around 100 billion dollars over the next 10 years. Moreover, the pharmaceutical industry agreed to pay higher Medicaid rebates and publically supported the law. For their support, the drug companies were given input into the very policies that would govern their industry.

The administration fired back, defending their alignment with the drug companies as a private/public partnership and considers the release of the emails a political measure. As many of you are aware, the Supreme Court will be ruling on the constitutionality of the law at some point this month. This article will have a full analysis of the ruling as it is announced. Stay Tuned!!

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 /disability/veteran's law, 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.

Hospital Visitation Rules: Hospitals Must Honor Patient Requests
May 21, 2012 12:36 PM by Lisa Brzezicki

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

When you are admitted to a hospital there are new standards that hospitals must abide by regarding your visitation rights. In the past, hospitals would generally limit visitors to immediate family members, which potentially excluded and discouraged friends and domestic partners from visiting. In addition, the hospital would also limit their discussions of surrogate decision making to immediate family members as well. However, in a little-noticed change in policy, President Obama mandated that hospitals notify patients of their right to decide who visits. This now has become a condition of participation in Medicare and Medicaid programs and part of a hospital's reaccreditation by the Joint Commission.

  • A hospital is now required to notify and explain to all patients their right to choose who may visit them regardless whether the visitor is a family member, a spouse, a domestic partner or another type of visitor. These changes also protect the rights of hospital patients to choose a representative to act on their behalf. Hospitals must give deference to a patient's wishes concerning representatives;
  • Advise patients of their right to withdraw or deny consent at any time;
  • Respect the rights of a same-sex partner as patient representative to make decisions on behalf of a partner with respect to visitation if the patient is incapacitated; and
  • Inform patient representatives of their rights to serve as the support person for an incapacitated same-sex partner.

If you find yourself in a hospital and they do not abide by your wishes regarding visitation or whom you appoint as a decision maker and you feel that your rights have been violated, you can report the violation to that hospitals quality assurance committee, your local department of health or to JCAHO directly.

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 /disability/veteran's law, 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.

HHS Finalizes Rules to Cut Provider Regulations and Save $5 Billion
May 14, 2012 10:22 AM by Lisa Brzezicki

(Editor’s note: This guest blog was written by Jill Hoffman, managing editor at Executive Insight.)


Health and Human Services (HHS) Secretary Kathleen Sebelius has announced significant steps to reduce unnecessary, obsolete or burdensome regulations on American hospitals and healthcare providers. These steps will help achieve the key goal of President Obama’s regulatory reform initiative to reduce unnecessary burdens on business and save nearly $1.1 billion across the healthcare system in the first year and more than $5 billion over 5 years.


The new rules are being issued today by the Centers for Medicare & Medicaid Services (CMS). The first rule revises the Medicare Conditions of Participation (CoPs) for hospitals and critical access hospitals (CAHs). CMS estimates that annual savings to hospitals and CAHs will be approximately $940 million per year. The second, the Medicare Regulatory Reform rule, will produce savings of $200 million in the first year by promoting efficiency. This rule eliminates duplicative, overlapping, and outdated regulatory requirements for health care providers.


Among other changes, the final rules will:

·   Increase flexibility for hospitals by allowing one governing body to oversee multiple hospitals in a single health system,

·   Let CAHs partner with other providers so they can be more efficient and ensure the safe and timely delivery of care to their patients;

·   Require that all eligible candidates, including advanced practice registered nurses and physician assistants, be reviewed by medical staff for potential appointment to the hospital medical staff and then be granted all of the privileges, rights, and responsibilities accorded to appointed medical staff members; and

·   Eliminate obsolete regulations, including outmoded infection control instructions for ambulatory surgical centers, outdated Medicaid qualification standards for physical and occupational therapists, and duplicative requirements for governing bodies of organ procurement organizations. 

HHS Announces First Batch of Health Care Innovation Awards
May 8, 2012 2:00 PM by Lisa Brzezicki
Health and Human Services (HHS) Secretary Kathleen Sebelius has announced the first batch of organizations for Health Care Innovation awards. Made possible by the healthcare law – the Affordable Care Act – the awards will support 26 innovative projects nationwide that will save money, deliver high quality medical care and enhance the healthcare workforce. The preliminary awardees announced today expect to reduce health spending by $254 million over the next 3 years. 
“We can’t wait to support innovative projects that will save money and make our healthcare system stronger,” said Secretary Sebelius. “It’s yet another way we are supporting local communities now in their efforts to provide better care and lower cost.”
The new projects include collaborations of leading hospitals, doctors, nurses, pharmacists, technology innovators, community-based organizations, and patients’ advocacy groups, among others, located in urban and rural areas that will begin work this year to address healthcare issues in local communities. This initiative allows applicants to come up with their best ideas to test how we can quickly and efficiently improve the quality and affordability of healthcare.
Preliminary awardees were chosen for their innovative solutions to the healthcare challenges facing their communities and for their focus on creating a well-trained healthcare workforce that is equipped to meet the need for new jobs in the 21st century health system. The Bureau of Labor Statistics projects the healthcare and social assistance sector will gain the most jobs between now and 2020.
Today’s awards total $122.6 million. The Center for Medicare and Medicaid Innovation within the Centers for Medicare & Medicaid Services at HHS administers the awards through cooperative agreements over 3 years.
For more information on the awards announced today, go to: http://innovations.cms.gov/initiatives/Innovation-Awards/Project-Profiles.html

Affordable Care Act Grants to Help Build, Expand Community Health Centers
May 1, 2012 12:00 PM by Lisa Brzezicki

According to Health and Human Services (HHS) Secretary Kathleen Sebelius, awards made possible by the new healthcare law that will help build, expand and improve community health centers nationwide.


Funding of more than $728 million will support 398 renovation and construction projects, boosting health centers’ ability to care for additional patients and creating jobs. The awards are part of a series of capital investments made available to community health centers under the Affordable Care Act, which provides $9.5 billion to expand services over 5 years and $1.5 billion to support major construction and renovation projects at community health centers.


According to a new report released today, the healthcare law has supported 190 construction and renovation projects at health centers and the creation of 67 new health center sites across the country, and will support more than 485 new health center construction and renovation projects and the creation of 245 new community health center sites over the next 2 years.


Overall, since the beginning of 2009, employment at community health centers nationwide has increased by 15 percent. And, through the Affordable Care Act and the Recovery Act, community health centers are serving nearly 3 million additional patients today and will serve an additional 1.3 million additional new patients in the next 2 years.


The announcement made today is for awards from two capital programs for community health centers. One will provide approximately $629 million to 171 existing health centers across the country for longer-term projects to expand their facilities, improve existing services and serve more patients. This program will expand access to an additional 860,000 patients. The second set of awards will provide approximately $99.3 million to 227 existing health centers to address pressing facility and equipment needs.

CMS Reports Accountable Care Organizations Off to Strong Start
April 10, 2012 2:50 PM by Sharlene George

Under the new Medicare Shared Savings Program (Shared Savings Program), 27 Accountable Care Organizations (ACOs) have entered into agreements with CMS, according to a press release issued today. The Shared Savings Program and other initiatives related to Accountable Care Organizations are made possible by the Affordable Care Act, the health care law of 2010. Participation in an ACO is purely voluntary for providers and beneficiaries and people with Medicare retain their current ability to seek treatment from any provider they wish.

The first 27 Shared Savings Program ACOs will serve an estimated 375,000 beneficiaries in 18 States. This brings the total number of organizations participating Medicare shared savings initiatives on April 1 to 65, including the 32 Pioneer Model ACOs that were announced last December, and six Physician Group Practice Transition Demonstration organizations that started in January 2011. In all, as of April 1, more than 1.1 million beneficiaries are receiving care from providers participating in Medicare shared savings initiatives.

Their models for coordinating care and improving quality vary in response to the needs of the beneficiaries in the areas they are serving. CMS is reviewing more than 150 applications from ACOs seeking to enter the program in July.

To ensure that savings are achieved through improving and providing care that is appropriate, safe, and timely, an ACO must meet strict quality standards. For 2012, CMS has established 33 quality measures relating to care coordination and patient safety, appropriate use of preventive health services, improved care for at-risk populations, and the patient and caregiver experience of care.

CMS also announced that five ACOs are participating in the Advance Payment ACO Model beginning April 1. This model will provide advance payment of expected shared savings to rural and physician-based ACOs participating in the Shared Savings Program that would benefit from additional start-up resources. These resources will help build the necessary care coordination infrastructure necessary to improve patient outcomes and reduce costs, such as new staff or information technology systems. CMS is reviewing more than 50 applications for Advance Payments that start in July.

To learn more about the ACOs announced today, visit:


For more information on the Advanced Payment ACO Model, including the participating ACOs, visit:


HHS: New Healthcare Law Provisions Will Save Up to $4.6 Billion
April 9, 2012 4:30 PM by Lisa Brzezicki

Department of Health and Human Services (HHS) Secretary Kathleen Sebelius has announced a proposed rule that would establish a unique health plan identifier under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The proposed rule would implement several administrative simplification provisions of the Affordable Care Act.

The proposed changes would save healthcare providers and health plans up to $4.6 billion over the next 10 years, according to estimates released by the HHS today. The estimates were included in a proposed rule that cuts red tape and simplifies administrative processes for doctors, hospitals and health insurance plans.

"The new healthcare law is cutting red tape, making our healthcare system more efficient and saving money," Sebelius said. "These important simplifications will mean doctors can spend less time filling out forms and more time seeing patients."

Currently, when health plans and entities like third party administrators bill providers, they are identified using a wide range of different identifiers that do not have a standard length or format. As a result, healthcare providers run into a number of time-consuming problems, such as misrouting of transactions, rejection of transactions due to insurance identification errors, and difficulty determining patient eligibility.

The rule simplifies the administrative process for providers by proposing that health plans have a unique identifier of a standard length and format to facilitate routine use in computer systems. This will allow provider offices to automate and simplify their processes, particularly when processing bills and other transactions.

The proposed rule also delays required compliance by 1 year — from Oct. 1, 2013 to Oct. 1, 2014 — new codes used to classify diseases and health problems. The ICD-10 codes will include new procedures and diagnoses and improve the quality of information available for quality improvement and payment purposes.

Many provider groups have expressed serious concerns about their ability to meet the Oct. 1, 2013, compliance date. The proposed change in the compliance date for ICD-10 would give providers and other covered entities more time to prepare and fully test their systems to ensure a smooth and coordinated transition to these new code sets.

The proposed rule announced is the third in a series of administrative simplification rules in the new healthcare law. HHS released the first in July of 2011 and the second in January of 2012, and plans to announce more in the coming months.

More information on the proposed rule is available on fact sheets at http://www.cms.gov/apps/media/fact_sheets.asp

The proposed rule may be viewed at www.ofr.gov/inspection.aspx.

Comments are due 30 days after publication in the Federal Register.

HHS Secretary Reports on Health Care Fraud Prevention Progress
April 4, 2012 1:16 PM by Sharlene George

Secretary of Health and Human Services Kathleen Sebelius reviewed significant achievements in the fight against health care fraud during a speech at the Chicago Fraud Prevention Summit today.

In his introduction, U.S. Attorney General Eric Holder noted that during the last fiscal year alone, efforts by the Justice Department and HHS recovered nearly $4.1 billion in funds stolen or taken improperly from federal health programs across the country. Holder called this accomplishment "unprecedented."

The agencies' ability to collaborate and analyze claims and other data to identify emerging fraud patterns though a joint initiative known as HEAT - the Health Care Fraud Prevention and Enforcement Action Team - has given the nation's health care fraud prosecution and prevention efforts much needed momentum.

Three years ago, the nation was "falling behind" the scammers who made "easy money" by submitting false claims and collecting payments, often at the expense of vulnerable seniors, Sebelius said. Today, the HHS has a comprehensive database that systematically screens current and prospective providers against provider licensing and criminal records.

"I am proud to announce today that we have already removed 3,000 ineligible providers from the Medicare program identified in just the first month of these new screening procedures," Sebelius said.

She also cited new data analysis tools that allow HHS to analyze claims in real time and freeze questionable payments as another line of defense against those criminals who do find their way into the system.

Educated and informed consumers are on the frontlines of fighting fraud, Sebelius emphasized, and she praised the outreach efforts of Senior Medicare Patrol volunteers who give communities tools they need to recognize, resist, and report fraud.

"No one group, agency, or business owns all of the resources or expertise we need to keep criminals out of the healthcare system," Sebelius said. "Because we all have a stake in preventing health care fraud, we're all doing our part."

Millions of Americans Ensured Health Coverage Thanks to Affordable Care Act
March 16, 2012 2:33 PM by Lisa Brzezicki

Health and Human Services (HHS) Secretary Kathleen Sebelius today announced final policies that will ensure that millions of uninsured Americans will have a simple, seamless path to affordable health insurance coverage.


"The Medicaid improvements in the Affordable Care Act will help simplify the system and ensure all Americans have the affordable high-quality coverage they need," Secretary Sebelius said.


The Affordable Care Act makes Medicaid available to individuals between ages 19 and 64 with incomes up to 133 percent of the federal poverty level – currently $14,856 for an individual and $30,656 for a family of four. These changes will become effective in 2014 when Affordable Insurance Exchanges begin operation. The federal government will pay 100 percent of the cost of the Medicaid expansion for the first 3 years and at least 90 percent after that.


"Today, too many uninsured Americans turn to the emergency room for care and can’t pay their bills," said Marilyn Tavenner, acting administrator of the Center for Medicare & Medicaid Services (CMS). "Insuring more Americans will decrease the hidden tax states and consumers with insurance pay to cover the cost of caring for the uninsured."


The policies announced today were first proposed in August 2011. After the proposed rule was issued, HHS participated in listening sessions across the country to hear comments and suggestions from a diverse array of stakeholders. In addition, CMS held a national eligibility conference attended by states and other stakeholders and conducted numerous conference calls and webinars to solicit public input. In response, the final rule provides additional protections for consumers, as well as additional flexibilities and options for states.


The final rule announced today also makes it easier for eligible individuals and families to enroll in Medicaid and the Children’s Health Insurance Program (CHIP) by cutting back on red tape and coordinating enrollment with the new Affordable Insurance Exchanges. Families will be able to enroll in the appropriate coverage program through a single, streamlined, online application and states will have the benefit of reduced administrative costs.


The rule builds on successful state efforts to modernize the eligibility, enrollment, and renewal processes in Medicaid and CHIP. This final rule and the recently issued Affordable Insurance Exchange final rule are building a seamless system of coverage so that in 2014, Medicaid, CHIP and the Affordable Insurance Exchanges will work together to efficiently meet consumers’ healthcare needs, improve quality and lower costs.


To learn more about this final rule, visit: http://www.medicaid.gov/AffordableCareAct/Provisions/Eligibility.html

New Oregon Healthcare Law May Be a New Promising Model
March 8, 2012 1:58 PM by Lisa Brzezicki

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

In what may prove to be a model for the Medicaid system and healthcare in general, Oregon Governor John Kitzhaber signed a new Health Care Initiative aimed at significantly decreasing Medicaid expenditures.

The new law, known as Bill 1580, provides legislative approval to start creating local coordinated care organizations. The network of providers will deliver more comprehensive mental, physical and dental care for the state's 600,000 Medicaid clients.

The new health plan utilizes an Accountable Care Organization approach, by using the coordination of care amongst many providers, including physicians, nurses, mental, dental and health providers, to ensure better communication and outcomes. In addition, those providers who save Medicaid money will be financially compensated for keeping their patients healthy, especially those with chronic illnesses, which costs millions of dollars to the Medicaid system each year.

Unlike the federal healthcare law, the Oregon law does not have mandates for the uninsured or for private insurers, but it does create oversights for the program. The new law is expected to save Oregon Medicaid $155 million in the next year, and by 2017, as much as $4.6 billion. If successful, this bill may very well be the future healthcare model.

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 /disability/veteran's law, 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.

CMS Partnership Marks Anniversary of the Signing of CHIPRA
February 29, 2012 1:34 PM by Lisa Brzezicki

The Centers for Medicaid & Medicaid Services (CMS) announced yesterday it will partner with Text4Baby, a free national health texting service, to promote enrollment in both Medicaid and the Children’s Health Insurance Program (CHIP) and provide pregnant women and new mothers free text messages on important healthcare issues.


The announcement is part of activities marking the anniversaries of both the signing of the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) and the launch of Text4Baby, whose partners include Healthy Mothers, Healthy Babies Coalition, Voxiva, which provides the mobile health platforms, and a host of wireless carriers.


“As a mother, I know how important health coverage and health information is for pregnant women and new moms,” said HHS Secretary Kathleen Sebelius in a release. “Through CHIPRA, the healthcare law and this partnership, we are helping more and more women across the country have the insurance and information they need to have healthy babies and keep them healthy as they grow up.”


Organizations across the country are using the CHIPRA and Text4Baby anniversaries to highlight how access to both health coverage and health information is critical for families.


Activities are already taking place in locations in California, Florida, Illinois, Michigan, New Jersey, Oklahoma and others.  For example, applicants using an online application to apply for Medicaid and CHIP in San Diego will now be able to enroll with Text4Baby directly; the Florida Department of Health will place contact information for both Text4Baby and Florida Healthy Kids (the State’s children’s health insurance program) on the envelopes used to send birth certificates to families with newborns; and Oklahoma hospitals are being encouraged to connect new mothers to Text4Baby when they enroll newborns in Medicaid right after birth.


“The partnership will help encourage eligible mothers and children to enroll in Medicaid and CHIP,” said Marilyn Tavenner, CMS acting administrator. “Text4Baby users will be alerted to the availability of health insurance options, and we are encouraging our partners and other organizations working to help get children enrolled in health coverage to make sure new moms know how to sign up with Text4Baby for all kinds of health tips and reminders.”


“Text-messaging is a part of the culture in terms of how we communicate,” added U.S. Surgeon General, Regina Benjamin. “Using text-messaging to help conduct outreach to families about health coverage for their children is just one more way that the appropriate use of technology is enhancing how we make sure pregnant women and children get the health care they need.”


In 2011, Medicaid and CHIP covered 43.5 million children. Under CHIPRA, CMS has awarded a total of $90 million in grants to states, Tribes, nonprofit groups, schools, healthcare providers and others to conduct activities to ensure eligible children are enrolled in health coverage and remain enrolled for as long as they qualify.


More than 184,000 current Text4Baby users are receiving a new message alerting them to the availability of free and low-cost health coverage through Medicaid and CHIP.  The message will provide a connection to the InsureKidsNow phone number and website for information about how to sign up. Additional messages will be periodically texted to provide Text4Baby users information about the importance of prenatal visits for women and the value of health coverage for keeping children healthy and getting the care they need when they’re sick.   


New Legislation Effecting Healthcare
February 23, 2012 8:46 AM by Lisa Brzezicki
(Editor's note: This guest blog was written by Michael LaMagna.)

This week Congress and the Senate passed legislation that will have an immediate effect on healthcare payments to most providers, including: hospitals, physicians, rehabilitation specialists and laboratories. The new legislation, which is called the Middle Class Tax Relief and Job Creation Act of 2012, extends the payroll tax cut and unemployment benefits, as well as makes the following adjustments to the healthcare system:

  • Freezes the current reimbursement rate that Medicare pays physicians, preventing the proposed 27.4% cut in payments, which was to begin on March 1, 2012. The cuts are now postponed to Dec. 31, 2012;
  • Extends the outpatient therapy cap exception process, whereby Medicare beneficiaries can exceed the caps on obtaining therapy as long as the physician certifies that the therapy is medically necessary; and
  • Stops a planned reduction in hospital payments for evaluation and management services in outpatient departments.

To assist paying for the cuts in reimbursement, the bill reduces the amount of money hospitals and nursing facilities are reimbursed for bad debt. Under current law, Medicare reimburses hospitals and nursing facilities for 70% of what they are unable or unwilling to collect and 100% of the nursing facility bad debt resulting from the treatment of the dual eligibles (those with Medicare and Medicaid).

This provision would reduce the reimbursement to 65% within a 3 year period, saving approximately $7 billion to the Medicare system; however, it would cause unknown harm to the providers, who have razor thin margins already.

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 /disability/veteran's law, 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


About this Blog

Keep Me Updated