Too good to last: Chipping away at Massachusetts' universal health care law

Well, it was only a matter of time, right?  Just over two months after its enactment, the first formal proposal undercutting the Massachusetts universal coverage law was rolled out.  The Boston Globe reported that "[t]he state . . . proposed to exempt businesses from the $295-per-employee annual fee that is part of a healthcare overhaul if 25 percent of their workers sign up for a company’s insurance plan or the company pays one-third of the premiums for an individual’s coverage."  Advocates and commentators are lining up predictably in support/opposition. 

Pay it forward?

CMS recently issued a reminder to all fee-for-service providers and suppliers concerning the Federales’ latest approach to fiscal management.  As you no doubt recall, per the DRA "a brief hold will be placed on Medicare payments for all claims during the last 9 days of the Federal fiscal year (September 22 through September 30, 2006). . . . No interest will be accrued and no late penalties will be paid to an entity or individual by reason of this one-time hold on payments.  All claims held during this time will be paid on October 2, 2006."  So — plan accordingly.

For more information, see the full MLN Matters Article.

New OIG advisory blesses municipal ambulance service "insurance only" billing for residents

OIG Advisory Opinion 06-07, posted June 29, confirms earlier advisories and, interestingly, relies on a manual provision (Pub. 100-2 BPM Chap. 16, sec. 50.3.1) that permits municipally-owned facilities to waive copays.  The advisory is crystal clear, however, in limiting the opinion to municipal services — a private service that offers to waive copays for residents will be seen as offering illegal remuneration in order to have a municipal contract awarded.

CMS giveth, and CMS taketh away

CMS published its proposed 2007 Medicare physician fee schedule today (all 260-some pages of it).  It’s a good news/bad news sort of announcement.  The good news is that CMS recognizes that physician work RVUs are undervalued, collectively, by about $4 billion.  The bad news is that budget neutrality rules won’t let CMS actually pay physicians $4 billion more next year.  Ah, well.

Massachusetts low-cost insurance plans

Time marches on and work proceeds apace on design of benefit packages and premiums for the low-cost insurance plans mandated by the Massachusetts universal health care law.  As reported by

Gov. Mitt Romney (R) recently said premiums on the products will range from $150 to $250 per month. "But you’ll see far more affordable products offered in our marketplace," he said June 8 at the annual conference of America’s Health Insurance Plans, held in San Diego. Massachusetts’s groundbreaking legislation, enacted in April, requires all residents to have insurance by July 1, 2007.

These rates are below current average premium levels.  The challenge will be to design products that are both affordable and attractive.      

What is . . . Tax-Exempt?

If your not-for-profit institution feels as though its tax exempt status is in jeopardy, you’re not alone. The N.Y. Times reported on June 18:

The Internal Revenue Service has begun a wide-ranging investigation of nonprofit hospitals to determine whether they are flouting standards for tax-exempt status, whether they deny care to people without insurance and whether they provide significant amounts of charity care.

The agency has sent "compliance check questionnaires" to more than 550 tax-exempt hospitals, seeking detailed information about their operations and billing practices and the compensation of top hospital executives.

Lois G. Lerner, director of the exempt organizations division of the I.R.S., said the questionnaires could be used in deciding whether standards for nonprofit hospitals should be changed or clarified. The current standards, with little changed since 1969, rely on a vaguely defined concept of "community benefit."

While reviewing the questionnaires, Ms. Lerner said, the agency may decide to conduct formal audits of some hospitals, with a full-scale examination of their records.

This week, Health Affairs published online a collection of papers entitled How Nonprofits Matter addressing, among other things, the issue of whether health care providers should be accorded nonprofit status, and the question of whether tax-exempt health care providers provide better health care than their for-profit counterparts.  The short answer: the jury’s still out.