Below is what every Hospital Administrator should know about health care reform.... By: MD Profit Associates, Inc. 10/18/2012
New Regulations Hospital Administrators Should Know Section 1001 Subsection 2713 – Coverage of Preventive Health Care A group health plan and a health insurance issuer offering group or individual health insurance coverage shall, at a minimum provide coverage for and shall not impose any cost sharing requirements forevidence-based items or services that have in effect a rating of `A’ or `B’ in the current recommendations of the United States Preventive Services Task Force; immunizations that have in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention with respect to the individual involved; and with respect to infants, children, and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resource Services Administration. Section 1201 Subsection 2704 – Prohibition of Preexisting Conditions A group health plan and a health insurance issuer offering group or individual health insurance coverage may not impose any preexisting condition exclusion with respect to such plan or coverage. Section 2301- Coverage for Birthing Centers A State shall provide separate payments to providers administering prenatal labor and delivery or postpartum care in a freestanding birth center (as defined in subparagraph (B)), such as nurse midwives and other providers of services such as birth attendants recognized under State law, as determined appropriate by the Secretary. For purposes of the preceding sentence, the term `birth attendant’ means an individual who is recognized or registered by the State involved to provide health care at childbirth and who provides such care within the scope of practice under which the individual is legally authorized to perform such care under State law (or the State regulatory mechanism provided by State law), regardless of whether the individual is under the supervision of, or associated with, a physician or other health care provider. Nothing in this subparagraph shall be construed as changing State law requirements applicable to a birth attendant. Section 3008 – Incentive to Reduce Hospital Acquired Conditions In order to provide an incentive for applicable hospitals to reduce hospital acquired conditions with respect to discharges from an applicable hospital occurring during fiscal year 2015 or a subsequent fiscal
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year, the amount of payment as applicable for such discharges during the fiscal year shall be equal to 99 percent of the amount of payment that would otherwise apply to such discharges. Section 3025 – Payment Reduction for Hospital Readmissions With respect to payment for discharges from an applicable hospital occurring during a fiscal year beginning on or after October 1, 2012, in order to account for excess readmissions in the hospital, the Secretary shall reduce the payments that would otherwise be made to such hospital for such a discharge by an amount equal to the product of the base operating DRG payment amount for the discharge; and the adjustment factor for the hospital for the fiscal year. Section 3111 – Payment for Bone Density Tests For dual-energy x-ray absorptiometry services (bone density, identified in 2006 by HCPCS codes 76075 and 76077 (and any succeeding codes)) furnished during 2010 and 2011, instead of the payment amount that would otherwise be determined under this section for such years, the payment amount shall be equal to 70 percent of the product. Section 3125 – Payment Adjustment for Low-Volume Hospitals For discharges occurring in fiscal years 2011 and 2012, the Secretary shall determine an applicable percentage increase for purposes of using a continuous linear sliding scale ranging from 25 percent for low-volume hospitals with 200 or fewer discharges of individuals entitled to, or enrolled for, benefits under part A in the fiscal year to 0 percent for low-volume hospitals with greater than 1,500 discharges of such individuals in the fiscal year. Section 3133 – Disproportionate Share Hospital Payments For fiscal year 2015 and each subsequent fiscal year, instead of the amount of disproportionate share hospital payment that would otherwise be made to a hospital for the fiscal year, the Secretary shall pay to the hospital a 25 percent of such amount (which represents the empirically justified amount for such payment, as determined by the Medicare Payment Advisory Commission in its March 2007 Report to the Congress). In addition to the payment made to a hospital for fiscal year 2015 and each subsequent fiscal year, the Secretary shall pay to hospitals an additional amount equal to the product of the following factors: A factor equal to the difference between the aggregate amount of payments that would be made to hospitals if this did not apply for such fiscal year (as estimated by the Secretary); and the aggregate amount of payments that are made to hospitals for such fiscal year (as so estimated). For each of fiscal years 2015, 2016, and 2017, a factor equal to 1 minus the percent change (divided by 100) in the percent of individuals under the age of 65 who are uninsured, as determined by comparing the percent of such individuals who are uninsured in 2012, the last year before coverage expansion under the Patient Protection and Affordable Care Act. Section 3134 – Misvalued Codes Under Physician Fee Schedule For purposes of identifying potentially misvalued services pursuant to clause (i)(I), the Secretary shall examine (as the Secretary determines to be appropriate) codes (and families of codes as appropriate) for
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which there has been the fastest growth; codes (and families of codes as appropriate) that have experienced substantial changes in practice expenses; codes for new technologies or services within an appropriate period (such as 3 years) after the relative values are initially established for such codes; multiple codes that are frequently billed in conjunction with furnishing a single service; codes with low relative values, particularly those that are often billed multiple times for a single treatment; codes which have not been subject to review since the implementation of the RBRVS (the so-called `Harvard-valued codes’); and such other codes determined to be appropriate by the Secretary. Section 4104 – Elimination of Co-Pay Elimination of coinsurance (co-pay) on preventive services (ie. physical exams). Elimination of coinsurance (co-pays) in outpatient hospital settings. Section 4108 – Incentive for Prevention of Chronic Diseases Incentives for prevention of chronic diseases. A program described in this paragraph is a comprehensive, evidence-based, widely available, and easily accessible health program, proposed by the State and approved by the Secretary, that is designed and uniquely suited to address the needs of Medicaid beneficiaries and has demonstrated success in helping individuals achieve one or more of the following: ceasing use of tobacco products, controlling or reducing their weight, lowering their cholesterol, lowering their blood pressure, avoiding the onset of diabetes or, in the case of a diabetic, improving the management of that condition. Section 5202 - Nursing Student Loan Repayment The Secretary shall establish and carry out a pediatric specialty loan repayment program under which the eligible individual agrees to be employed full-time for a specified period (which shall not be less than 2 years) in providing pediatric medical subspecialty, pediatric surgical specialty, or child and adolescent mental and behavioral health care, including substance abuse prevention and treatment services. Section 5301 – Financial Assistance for Students Going Into Primary Care To provide need-based financial assistance in the form of traineeships and fellowships to medical students, interns, residents, practicing physicians, or other medical personnel, who are participants in any such program, and who plan to specialize or work in the practice of the fields of family medicine, general internal medicine, or general pediatrics training programs. Section 9007 Subsection 4959 – Taxes on Hospital Failures If a hospital organization to which section 501(r) applies fails to meet the requirement of section 501(r)(3) for any taxable year, there is imposed on the organization a tax equal to $50,000.The Secretary of the Treasury or the Secretary’s delegate shall review at least once every 3 years the community benefit activities of each hospital organization to which section 501(r) of the Internal Revenue Code of 1986 applies.
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Section 9017 – Excise Tax on Cosmetic Surgery There is hereby imposed on any cosmetic surgery and medical procedure a tax equal to 5 percent of the amount paid for such procedure (determined without regard to this section), whether paid by insurance or otherwise. MD Profit Associates, Inc. can help you prepare for the new economic realities by enabling your company to adopt intelligent short-term and long-term approaches that support your entire business into the future—while continuing to respond to near-term cost pressures. Contact us to find out how MD Profit Associates, Inc. can help your company experience improve its performance through outsourcing resources.
For more information To learn more about how MD Profit Associates, Inc. can help your organization meet the demands of health reform with MD Profit Associates Services, please contact us at
[email protected]. About MD Profit Associates, Inc. MD Profit Associates, Inc. is a global healthcare management & operational, consulting, technology services and outsourcing company, with thousands of serving clients in many countries. Combining unparalleled experience, comprehensive capabilities across all industries and business functions, and extensive research on the world’s most successful companies, MD Profit Associates, Inc. collaborates with clients to help them become high-performance businesses.
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