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The Politics of Health Care

Observations Days: Is It Inpatient or Outpatient?
March 12, 2013 8:14 AM by Michael LaMagna
I want to revisit the topic of Hospital Observation Days. This is a poorly understood concept and one that I receive many questions about.

If you have Medicare, Part A and you are admitted as an inpatient for three overnight stays, on the fourth day your Skilled Nursing Benefit would be active, and if admitted to a nursing facility, Medicare would pay for up to 100 days of rehabilitation and skilled nursing. The benefit period pays 100% of the nursing costs for days 1 to 20 and there is a co-pay of $148 per day from day 21 to 100. This part is relatively uncomplicated; however, this isn't the end of the story.

Whether you are inpatient or outpatient during your stay at the hospital is critical. Although you are staying overnight, that doesn't necessarily mean you are an inpatient, and very often you are considered under Observation, which is outpatient status and not counted toward the three night qualifying stay, thereby costing seniors thousands of dollars for rehabilitation that Medicare would have paid for if the hospital had classified the stay as inpatient. In order to be considered inpatient you must be actually admitted to the hospital with a physician order. You are considered outpatient if your receiving emergency department services, lab tests, x-rays and the physician hasn't written an order to admit.

To protect yourself, you have a right to ask hospital personnel the status of your hospital stay, and if you don't agree, you have a right to appeal any adverse decision; however the appeal time frames are very short, in some cases 48 hours, so make sure you read all the information provided and take notes when talking to hospital staff.

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 LaMagna & Associates, PC, practicing Health Care Regulatory, Elder /Probate/Disability/Wills, 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 914-437-5955 or visit Attorney LaMagna's website at www.nyandctlaw.com for more information.

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The Alzheimer's Crisis
February 19, 2013 7:40 AM by Michael LaMagna
As many of you already know, caring for someone with Alzheimer's disease is both emotionally and financially draining. Alzheimer's is an incurable disease, which in many cases erodes a person's memory and makes the most basic daily care tasks that we take for granted, such as bathing, dressing and cooking, virtually impossible. Each week families who are struggling with this vicious disease visit my office seeking advice regarding finances, government benefits, housing alternatives and support groups. It's a very long and difficult road, but one that doesn't need to be traveled alone.

Unfortunately, the disease is quickly growing and a recent report noted the expected number of Alzheimer's cases could triple from 5 million currently to nearly 14 million by 2050, costing an estimated $1.1 trillion. Besides the human toll on the families and the patients, it is an overwhelming cost to the Medicare and Medicaid systems, which pay more than 70% of all related costs. It has been shown that patients with Alzheimer's will spend three times more on healthcare than patients with other types of illnesses. Medicare patients with Alzheimer's and other dementias spend $43,847 on healthcare and long-term care services annually, compared to $13,879 spent by patients without those illnesses. However, that leaves 30% of the overwhelming costs to the individuals.

Because the disease is progressive, early detection is crucial. If you see signs of Alzheimer's, which includes memory loss that disrupts daily life, difficulty completing daily tasks and confusion with time or place, see a physician immediately. In addition, it is critical you get your legal affairs in order, such as the power of attorney and healthcare proxy, so you have the peace of mind that other people are appointed to make decisions even when someone no longer has the capacity to make them. In addition, it is critical to have your finances in order and professionals to assist in obtaining benefits to avoid the overwhelming financial and emotional toll.

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 /Estate Administration/Probate/Disability/Wills, Trusts and Estates, Social Security and General Legal practice in both New York and Connecticut. Email him at Mlamagna@nyandctlaw.com, call him at 914-437-5955 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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Healthcare Law Glitch Will Leave Many Without Insurance
February 5, 2013 5:04 PM 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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SMART Act Puts Deadlines on Settlement Money
January 29, 2013 11:56 AM by Michael LaMagna
A little known law is about to have a pretty big impact on Medicare beneficiaries who find themselves victims of negligence and wait for their settlement money. Currently when a Medicare beneficiary has a lawsuit and receives a monetary judgment or settles out of court and Medicare has paid the related medical bills, that person is required to wait until Medicare is reimbursed before receiving the proceeds of that lawsuit. Currently, it can take months or even years just for Medicare to provide you with the amount they are due reimbursement.

The new law, the Strengthening Medicare and Repaying Taxpayers (SMART) Act, sets time frames for CMS and Medicare beneficiaries to provide information in cases where a settlement is expected. Under the SMART law, a beneficiary must notify CMS within 120 days of the lawsuit settlement. CMS then has 65 days to tell the parties how much is owed. The agency can request an additional 30 days if necessary. Moreover, if beneficiaries believe the amount posted is wrong, they can provide documentation to CMS, and the agency has 11 days to respond. The law also limits to 3 years the time CMS has to pursue reimbursement.

The previous system not only would cause delays in the settlement process, but affected whether or not a case would even go forward, as most attorney's want the information regarding the Medicare figure prior to taking a case. Moreover, if a case is expected to go to mediation and the mediator doesn't have accurate numbers, a decision cannot be reached.

In addition, the slow reporting process didn't allow for the famous ever-dwindling Medicare Trust Fund to get promptly repaid. In 2011, more than 480,000 new cases were recorded, and CMS realized more than $860 million in payments and savings related to such cases, many months or years longer than they could have. It is expected that the new law will allow for more timely reimbursement. However, with the new time frames, I could foresee a situation where Medicare foregoes its right to be paid back altogether, if they do not pursue reimbursement within 3 years.

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 www.nyandctlaw.com for more information. You can also follow Attorney LaMagna on Twitter@michaellamagna1.

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Medicare Settles Lawsuit: Many Will Gain Access to Services
December 11, 2012 11:19 AM 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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Carefully Weighing the Effect of Raising the Medicare Age Requirement
December 4, 2012 11:36 AM by Michael LaMagna
Medicare, the primary insurer for those who are over 65 or disabled, is going through some serious challenges at the moment. The Medicare trust, which is the money withheld through the Medicare payroll tax, is slated to become insolvent at some point between 2016 and 2024. This fact, coupled with the upcoming Fiscal Cliff, has politicians scrambling for ideas to save money and keep Medicare solvent. The latest idea is to increase the age of Medicare eligibility from 65 years of age to 67.

The premise is that if you increase the age by 2 years, the 3.3 million individuals who would be disqualified would be required to either: 1) pay for coverage out of pocket; 2) go without insurance and pay a fine; 3) rely on employer sponsored insurance; or 4) rely on Medicaid. The proposed result would be a total savings of $5.7 billion; however it is projected to cost the entire healthcare system $11.4 billion dollars in spending.

The spending costs include the cost of seniors paying for replacement plans, fines and costs to employers. The question remains to be seen whether raising the eligibility age would simply shift the costs from the Federal government, who pays for Medicare, to the individuals and ultimately the states (Medicaid costs).

Now, I am not suggesting that raising the age isn't a viable solution; however, I am calling on Washington to carefully consider all of the ramifications of changing the system and ensuring the states will be able to withstand the impact.

Your comments are always appreciated.

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.

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Medicare Premiums to Rise in 2013
November 19, 2012 9:59 AM 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 2, 2012 6:21 PM by Michael LaMagna

Starting 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 24, 2012 9:19 AM by Michael LaMagna
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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Physician Medicare Upcoding Costs $11 Billion Over Past 10 Years
September 17, 2012 6:10 PM by Michael LaMagna
The Center for Public Integrity recently reported that physician upcoding will cost an addition $11 billion for the past 10 years. When a Medicare beneficiary visits their physician, that service or services gets a billing code. That code is then submitted to Medicare for payment. Upcoding is the practice of billing more expensive services than were performed by the physician. Codes range as low as $20 for a few minutes of a physician's time to more than $140 for more extensive services performed.

Medical groups have quickly defended the physicians' usage of higher codes, stating that the population has grown older and sicker, thereby necessitating the higher codes and ultimately higher reimbursement. However, reports have shown very little shift in cumulative age or infirmity.

Medicare spending is a hot button issue right now as both campaigns are focused on the $500 billion paid out for services in 2011. Upcoding contributes significantly to the costs of Medicare, upwards of $43 per claim, with more than half of the upcoding charges from physician visits and the rest from nursing homes and hospitals. 

One explanation for the prevalence of upcoding is the move to electronic medical records and billing systems. The new technology makes it very easy to make the changes and document the justification for the higher codes. In addition, Medicare hasn't kept up with the technology and lacks a uniform standard for coding, leaving it up to the providers to set their own standards, which is a prescription for error.   

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.   

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New Numbers Show Affordable Care Act May Be Saving Money
September 13, 2012 1:21 PM by Michael LaMagna
The Department of Health and Human Services released a report touting that the healthcare law-ACA-saved an estimated $2.1 billion dollars on healthcare insurance premiums. The numbers are reported by the insurance companies as part of a transparency and accountability measure contained in the healthcare law (the "reporting rule"). This new reporting rule began on Sept. 1, 2011, requiring each health insurance company to publically report proposed rate increases, implemented an approval procedure if the increases were to be more than 10% and established a grant for a rate review program. So far 42 states have obtained grant money for the rate review programs.

As a result of the savings, consumers and in larger part, employers are expected to share in approximately $1.1 billion dollars in direct rebates from their health insurance provider. This initiative requires insurance companies to spend at least 80 percent of premiums on the consumers or provide rebates to their customers. Insurance companies that did not meet the new standards rule will provide nearly 13 million rebates this year. The average rebate is approximately $151 per household. However, it is still uncertain whether individuals or their employers will receive the rebates, how much the rebates will be and when the rebates will show up in your mailbox.

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 www.nyandctlaw.com for more information.

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The Big ACA Ruling: Penalty/ Tax -- Is Anything Solved?
July 3, 2012 7:58 AM by Michael LaMagna
The Supreme Court has ruled! Unless you have been living under a rock, you what the 9 justices decided about the constitutionality of the ACA (Accountability Care Act) case. Or do we?

Let's start from the top. Like all of you, including President Obama, I was watching the television news media when the decision came down. In fact for a brief time I was part of the media as a few newspapers asked me to send comments right after the ruling. Unlike CNN and FOX, I have read enough Supreme Court rulings to know that you never know the outcome until you read the end. And true to form the media reported that the individual mandate was struck down, which was entirely incorrect.

It was a good thing I didn't comment until I read the ruling.

So is this a really big deal? YES!

Just to clue you in. We now have a comprehensive national healthcare plan. This is something I have been hearing about since grade school -- universal healthcare is coming along with the metric system; but universal healthcare, or, according to Chief Justice Roberts, comprehensive healthcare, is nearly a reality. What the law does is take Medicaid, which is health insurance for the elderly, disabled and poor, and transform the program to meet the healthcare needs of the entire non-elderly population based on income, not on disability status or age.

Like I said, a big deal.

The Justices preserved the individual mandate (the part of the law requiring everyone to either purchase health insurance or pay a penalty) and thus by "law" transforming what the government called a penalty into a tax. This was because they court chose to not expand Congress' power to penalize us on inaction or our failures to do something, in this case buy health insurance. However, they found that it is perfectly fine to tax us on our failure to purchase health insurance, like the taxes we pay on gasoline or other goods.

Additionally, the other part of the ruling, the one that garnered much less press, but will prove to have the most impact (mark my words), stated that the Federal Government cannot force individual states to implement this law by taking away all their Medicaid money. In fact Chief Justice Roberts said this would be "a gun to the head" of the individual states. So now the individual states can opt out of the law. Although, it would be difficult to imagine New York offering universal coverage and Connecticut not. As a state-based system, there are vast differences in Medicaid coverage now between states.

So is anything solved? That's the easy question. Not a bit.

As I was told by a wonderful care manager, John Murphy, who I had the pleasure of speaking with about this issue, when Medicare came into practice in the ‘60s no one knew what to make of it and it has been transformed several times; so will this law.

The good news is that for healthcare devotees as myself and many of you, we will get to see the transformation, write about it and maybe even have hand in shaping it. Certainly 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.

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Pharma Industry Persuaded to Embrace Healthcare Law
June 7, 2012 8:04 AM 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.

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Impact of Healthcare Reform on Insurance Plans
May 31, 2012 7:02 PM by Michael LaMagna
If the Affordable Care Act (ACA) is upheld by the Supreme Court later this month, many existing health plans will be required to enhance health insurance benefits by early 2014 to comply with the new regulations. The law will require basic or essential health benefits be offered to all insured. According to the journal Health Affairs, more than half of the current health plans do not offer the basic requirements and will have to be enhanced in order to comply.

Under the new standards of the ACA, consumers will not only be entitled to additional health plan benefits, but will also pay lower out of pocket costs; however, the new expansive benefits will not come without an increase in premiums. Under ACA, there will be four types of insurance plans offered through the insurance exchanges: bronze, silver, gold and platinum. Using the bronze plan as the benchmark, Health Affairs found that most of the health insurers will have to increase the basic coverage, more specifically in the following areas:

  • Annual out of pocket costs will be capped at $6,050 for an individual or $12,100 family;
  • Maternity coverage will be required to be covered; and
  • Eliminate an insurer's ability to refuse to offer coverage for individuals with pre-existing conditions.

It is hard to tell how much premiums will increase due to the new regulations; estimates are in the 6-7% range. The increase will most likely occur because patients with pre-existing illnesses will now be able to purchase insurance, which should drive the total costs upward.

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.

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Hospital Visitation Rules: Hospitals Must Honor Patient Requests
May 21, 2012 7:16 AM 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.

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