Health Care Reform Updates at the Federal and State Level

Federal

Health insurance firms organized  meetings with the Federal government to discuss the pending HHS program to waive the annual limit requirements under PPACA for certain qualifying plans. Without such a waiver, limited benefit plans will be discontinued beginning on September 23, 2010.

States

CALIFORNIA: The California Department of Insurance (CDI) announced an e-mail notification system that will alert consumers when new individual health insurance rate filings are submitted.

NEW JERSEY: Following enactment of Governor Chris Christie’s budget, the Democrat-controlled legislature passed supplemental bills to restore $24 million in funding for state’s uninsured health coverage program known as FamilyCare, and $7.4 million in aid for women’s health and family planning programs. The FamilyCare restoration, if signed into law, would have allowed adults with income between 134 to 200 percent of the federal poverty level to remain in the program. Despite bipartisan support in the Senate, Governor Christie vetoed the legislation, saying that the state has reset spending to a level that taxpayers can afford. Legislative leadership has indicated they may try to override the governor’s veto. Overriding the governor’s veto would require a two-thirds majority in both houses.

NEW MEXICO: The Public Regulation Commission (PRC) has appointed John G. Franchini as the new Superintendent of Insurance, a position that has been vacant since the May 4 resignation of his predecessor, Morris Chavez.  Franchini was selected from among five finalists and will assume his new duties in mid-August.

OHIO:  The Strickland Administration advised state agencies to begin planning for the next two years at both current levels and with a 10 percent cut in funding. The Budget Planning and Management Commission has held hearings for Ohio’s budget adoption. The current budget ends June 30, 2011 and is billions in the red. Testimony before the Commission focused on increasing efficiencies by combining certain administrative functions of local and state governments and utilizing performance audits to determine if tax dollars are being spent efficiently. The Center for Community Solutions suggested to legislators that principal stakeholders in Medicaid (such as managed care companies and hospitals) be given budget targets and be asked to come up with ways to slow the growth of Medicaid. Conversely, the Health Policy Institute of Ohio guided legislators to the possibility of Ohio “rebalancing” its long-term care spending to shift utilization from long-term care facilities to home and community-based services.

While PPACA-related budget priorities will take place after the next biennial budget is adopted, it was previously determined that the federal expansion of Medicaid eligibility as part of health care reform will cost the state $190 million in 2014 —rising to $332 million by 2019. Absent any federal law changes, annual costs will rise substantially in 2020 and beyond, as the federal government’s match for new enrollees will drop to 90 percent of the total cost.

The total state cost of Medicaid expansion from 2014 to 2019 is projected to be $1.45 billion.

OKLAHOMA: Oklahoma was the only state to request an open enrollment period for the PPACA provision requiring coverage of children under 19 for individual insurance.  HHS decided open enrollment periods will be permitted at the discretion of insurance companies.  The Oklahoma Supreme Court scheduled oral arguments on August 4 in a lawsuit filed by Commissioner Kim Holland, on behalf of Department of Insurance (DOI), challenging the constitutionality of a new 1 percent claims-paid fee passed by the legislature in late May.  The bill is scheduled to take effect August 27, unless there is court intervention. The DOI announced last week that a final contract for a new temporary high-risk pool has been signed and sent back to HHS.  The DOI is in the process of drafting the application that will be used with the pool.  Oklahoma was awarded $60 million for use over 40 months.  Candidates are being interviewed to be the High Risk Pool Manager.  Open enrollment will begin August 1 with an effective date of September 1.

Tags:

Michael F. Arrigo

Michael is Managing Partner & CEO of No World Borders, a leading healthcare management and IT consulting firm. He serves as an expert witness in Federal and State Court and was recently ruled as an expert by a 9th Circuit Federal Judge. He serves as a patent expert witness on intellectual property disputes, both as a Technical Expert and a Damages expert. His vision for the firm is to continue acquisition of skills and technology that support the intersection of clinical data and administrative health data where the eligibility for medically necessary care is determined. He leads a team that provides litigation consulting as well as advisory regarding medical coding, medical billing, medical bill review and HIPAA Privacy and Security best practices for healthcare clients, Meaningful Use of Electronic Health Records. He advises legal teams as an expert witness in HIPAA Privacy and Security, medical coding and billing and usual and customary cost of care, the Affordable Care Act and benefits enrollment, white collar crime, False Claims Act, Anti-Kickback, Stark Law, physician compensation, Insurance bad faith, payor-provider disputes, ERISA plan-third-party administrator disputes, third-party liability, and the Medicare Secondary Payer Act (MSPA) MMSEA Section 111 reporting. He uses these skills in disputes regarding the valuation of pharmaceuticals and drug costs and in the review and audit of pain management and opioid prescribers under state Standards and the Controlled Substances Act. He consults to venture capital and private equity firms on mHealth, Cloud Computing in Healthcare, and Software as a Service. He advises ERISA self-insured employers on cost of care and regulations. Arrigo was recently retained by the U.S. Department of Justice (DOJ) regarding a significant false claims act investigation. He has provided opinions on over $1 billion in health care claims and due diligence on over $8 billion in healthcare mergers and acquisitions. Education: UC Irvine - Economics and Computer Science, University of Southern California - Business, studies at Stanford Medical School - Biomedical Informatics, studies at Harvard Medical School - Bioethics. Trained in over 10 medical specialties in medical billing and coding. Trained by U.S. Patent and Trademark Office (USPTO) and PTAB Judges on patent statutes, rules and case law (as a non-attorney to better advise clients on Technical and Damages aspects of patent construction and claims). Mr. Arrigo has been interviewed quoted in the Wall Street Journal, New York Times, and National Public Radio, Fortune, KNX 1070 Radio, Kaiser Health News, NBC Television News, The Capitol Forum and other media outlets. See https://www.noworldborders.com/news/ and https://www.noworldborders.com/clients/ for more about the company.