Friday, November 01, 2013

Friday Miscellany

Yesterday House and Senate leaders made available a discussion draft of a bill to replace the Medicare Part B sustainable rate of growth formula with a reformed "fee-for-service (FFS) payment system [that places] greater focus on value over volume, and encourage[s] participation in alternative payment models (APM), such as accountable care organizations and patient-centered medical homes [consistent with the ACA]. According to the Washington Post, the American Medical Association supports the bipartisan proposal.

AHIP announced that a bipartisan bill to delay the onerous health insurer fee has been introduced in Congress.  The FEHBlog has higher hopes for passage of the SGR replacement bill.

Earlier this week, CMS announced that the Medicare Part B premiums and deductible will not change for 2014. "The Medicare Part A deductible that beneficiaries pay when admitted to the hospital will be $1,216 in 2014, an increase of $32 from this year's $1,184 deductible."  The Part A deductible covers the first sixty days of inpatient confinement per spell of illness.  "Beneficiaries must pay $304 per day for days 61 through 90 in 2014, and $608 per day for hospital stays beyond the 90th day.  For 2013, per day payment for days 61 through 90 was $296, and $592 for beyond 90 days.  For beneficiaries in skilled nursing facilities, the daily co-insurance for days 21 through 100 in a benefit period will be $152.00 in 2014, compared to $148.00 in 2013."

The IRS announced yesterday that the $2500 cap on contributions to health care flexible spending accounts will not increase for 2014.  The IRS did create a new option yesterday that allows health care FSA plan sponsors to allow participants to roll over up to $500 in unused funds at year end (in lieu of the permitted grace period).  The roll over would not count against the $2500 cap for the next year. IRS Notice 2013-71 

A friend forwarded me a link to a Tenesseean article about hospitals thinking about footing the bill for patients' subsidized ACA exchange coverage similar to the way in which they help impoverished patients sign up for Medicaid.
Into this environment of uncertainty and change, hospitals and clinics are asking the question: “If my patients do not buy the new Obamacare health insurance, can we get it for them?” A recent Credit Suisse report has analyzed the ACA exchange rates and concluded that up to 6.5 million Americans could literally get free health insurance if they select the Bronze Plan. If it is free, can hospitals sign them up? If it is not free, can hospitals pay the premium for them? 
According to this report from the Association of Corporate Counsel, HHS Secretary Kathleen Sebelius has informed Congress that qualified health plans on the exchanges are not federal health programs subject to the federal programs anti-kickback act.  Subjecting QHPs to the AKA would have complicated the hospitals' plan. The fly in the ointment is that a patient cannot just enroll for subsidized coverage when he or she is admitted unless the admission occurs during an Open Season and even then the coverage at best begins on the first day of the following month.

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