“The federal government apparently was concerned that Americans would not find anything to read this summer, and kindly dropped hundreds of pages of regulations related to healthcare, just in time for the beach.
The Centers for Medicare and Medicaid Services (CMS), one of the Big Three Departments that spend our federal tax dollars (numero uno, at 22 percent, being the Social Security Administration; number two is CMS at 21 percent; and number three, the Defense Department, at 19 percent) released a phone-book sized volume of regulations the day after Independence Day. The new regulations define how Medicaid and Children’s Health Insurance Program (CHIP) will change as a result of the Patient Protection and Affordable Care Act.
If that wasn’t enough, the following week CMS released several proposed regulations changing how Medicare will reimburse your local doctor and hospital, as well as how those providers will be measured.
Because these final and proposed regulations dropped July 4 week and the tradition beginning of summer vacations, my immediate assumption is it can only be bad news. In the end, it turned out to be bad news and good news, combined with a good old-fashioned dose of government bureaucracy. A little something for everyone, just like Christmas only six months early.
For employers, there was good news in that they will not be required to report on their respective employees health insurance status until 2015. Their respective employees, however, will be responsible for self-reporting their insurance status.
For low income Americans, the new regulations define the process for getting tax credits to offset health insurance purchased through exchanges, as well as streamlined processes for qualifying for Medicaid and CHIP.
For Americans pretending to have low incomes to get federal tax credits to subsidize their insurance purchased through the exchanges, the new regs spell out the penalties if caught: A fine of up to $25,000 if the government can’t prove you lied, and up to $250,000 if they catch you red-handed.
For Medicare beneficiaries who prefer receiving their healthcare services in the privacy of their physician’s office rather than in the impersonal setting of a hospital, there’s good news. The proposed regulations recommending cutting reimbursements where hospitals received more than physicians.
Of course, for hospitals, the new regulations mean Medicare doesn’t care that your overhead is more–you’ll be getting reimbursed at a lower rate, closer to what physicians get.
But on the plus side, hospitals next year will see an increase in Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center (ASC) Payment System Policy Changes and Payment Rates, of 9.5 percent and 3.51 percent, respectively.
The new regulations and proposed regulations contain a wealth of changes for insurers, state governments, and anyone else involved in the healthcare supply chain. Fortunately, all of us will have the summer to read and digest them.”