OCI recently posted a bulletin to insurers addressing the new state law requirements for coverage of hearing aids, cochlear implants, and related treatment of infants and children. Group and individual policies and self-insured health plans of the state or a county, city, town, village, or school district issued or renewed beginning on January 1, 2010, must comply with the law.
von Briesen Health Law Blog
February 17, 2010
January 29, 2010
CMS Approves Organizations to Accredit Advanced Imaging Services Supplies
View CMS’s full press release. The American College of Radiology, the Intersocietal Accreditation Commission, and The Joint Commission have each been designated to accredit suppliers furnishing the technical component of advanced diagnostic imaging procedures. All suppliers who furnish the technical component of advancing imaging must become accredited by January 1, 2012, as required by the Medicare Improvements for Patients and Providers Act of 2008.
January 25, 2010
Wisconsin to Receive Federal Matching Funds for Electronic Health Record Incentives Program
Read the January 21, 2010 press release here.
CMS recently announced that Wisconsin’s Medicaid program would receive approximately $1.37 million in federal matching funds for state planning activities necessary to implement the electronic health record (EHR) incentive program established by the 2009 American Recovery and Reinvestment Act (ARRA). EHR’s improve health care efficiency and quality, and make it easier for patients to access necessary information about their health.
January 12, 2010
OCI Bulletin to Insurers Regarding ARRA Premium Subsidy Benefit Extension
The Wisconsin Office of the Commissioner of Insurance (OCI) recently posted a bulletin to insurers concerning ARRA amendments extending the eligibility period and duration of the ARRA premium subsidy benefit. The amendments extended the eligibility period for an additional two months (through February 28, 2010) and extended the premium subsidy duration by an additional 6 months (from 9 to 15 months).
OCI issued the bulletin to inform insurers that, even if they are not subject to federal COBRA, OCI expects insurers to comply with the new ARRA premium subsidy provisions for group health plans with less than 20 employees who are required to comply with the Wisconsin continuation and conversion law, Wisconsin Statutes section 632.897.
Read OCI’s bulletin here. Wisconsin Statutes section 632.897 can be found here.
January 11, 2010
Minnesota CAH Settles False Claims Act Allegations for Almost One Million Dollars
The Justice Department recently announced a $846,461 settlement by a Minnesota critical access hospital and one of its physician’s to settle False Claims Act allegations. A former doctor at the critical access hospital filed a qui tam (“whistleblower”) action alleging that the physician admitted patients that did not need to be admitted, or kept other patients in acute care when doing so was not medically necessary, and ordered unnecessary testing. The whistleblower contended that he complained to the hospital about the physician’s alleged practices, but that the hospital did nothing. The government investigated the allegations, reviewing nearly 200 of the physician’s patient admissions. Several admissions were identified as not medically necessary under Medicare rules. Additionally, the investigation revealed that the physician generated more than $4 million a year in billings for the hospital, which is 10 times that of its other doctors. You may read the DOJ’s press release here.
December 28, 2009
OCI posts FAQ Bulletin Concerning Mandated Coverage for Autism Services
Wisconsin’s Office of the Commissioner of Insurance posted today a “Frequently Asked Questions” guide concerning Wisconsin Statute section 632.895(12m), requiring certain insurers to cover certain treatments for individuals with autism spectrum disorders. The bulletin answers questions concerning the applicability and scope of the mandate, including services covered, providers that may be used, and claims issues. The mandate applies to certain policies issued or renewed on or after November 1, 2009. Read the full FAQ guide by clicking here.
November 18, 2009
HHS and CMS Revise and Improve Medicare Fee-for-Service Error Rate Calculations
CMS announced today that the Department of Health and Human Services (HHS) will employ new standards in calculating improper Medicare payment rates for 2009. The tougher standards are intended to facilitate CMS’s ability to target improper payments. The new standards are part of the Obama Administration’s goal of reducing waste, fraud, and abuse in Medicare. HHS Secretary Kathleen Sebelius explained that “[t]hrough a more stringent review of Medicare claims, we have been able to establish a more complete accounting of errors, enabling CMS to take more actionable steps to further reduce the error rate and identify abusive or potentially fraudulent actions before they become problems.”
CMS’s full press release may be found here.
November 2, 2009
Enforcement Deadline for Red Flags Rule Extended Again
The Federal Trade Commission (FTC) extended again the enforcement deadline for the “Red Flags Rule” until June 1, 2010. (The previous deadline was November 1, 2009.) The Rule requires financial institutions and creditors with covered accounts to develop and implement an identity theft prevention program. Thus far, the FTC’s interpretation of who is a “creditor” with a “covered account” for purposes of the Rule has been extremely broad, generally advising that any entity that “regularly defers the payment of a debt” to consumers or in situations where there is a “reasonably foreseeable risk” of identity theft, is subject to the Rule. This broad interpretation may be the predominant cause for the continued enforcement deadline extensions, as various entities continue to seek guidance and clarification of the Rule’s intended scope.
You can read the FTC’s entire press release here.
For further detail on Red Flag Rules, see von Briesen & Roper’s Health Law Bulletin: “Red Flag Rules: Are They Applicable to You?”
October 30, 2009
Sebelius Releases Report Highlighting How Health Insurance Reform Will Reduce Costs for Small Businesses
HHS Secretary Kathleen Sebelius recently released a report summarizing how small businesses’ premiums for health insurance tend to be 18% more than large firms’ premiums, and highlighting how health insurance reform will lower premiums for small businesses. Sebelius outlined that health insurance reform will lower premiums in four important ways:
- Health insurance exchange. Health insurance reform will create a health insurance exchange. The exchange will pool together millions of Americans with small businesses and their employees. This pooling will increase competition and purchasing power in the insurance market, which will have the effect of lowering premiums. The exchange would also decrease small firms’ administrative costs, as it will be easier to compare health plan prices, benefits, and quality.
- Small business tax credit. Health insurance reform will provide a tax credit to millions of small business nationwide. The credit will save a percentage off a small business’s premium costs.
- No more “hidden tax.” Because health insurance reform will expand health care coverage to all Americans, the “hidden insurance tax” of more than $1,000 added onto family policies to cover the cost of care for those without insurance, will end.
- No more arbitrary premium hikes. Health insurance reform will prevent insurance discrimination based on health status. This reform measure includes preventing coverage denial based on a pre-existing conditions, preventing premium increases when someone falls ill, and prohibiting charging more if someone is a woman. Health insurance reform will also limit the amount insurance companies may spend on administrative costs, and will require transparency among insurance companies so small business owners can see how insurance companies are spending premium dollars.
Read the full report here.
October 21, 2009
OCI Develops Emergency Rule Implementing New Wisconsin Statute Requiring Insurance Coverage for Autism Spectrum Disorders
Governor Doyle recently announced an emergency rule developed by The Office of the Commissioner of Insurance (OCI) pursuant to recent legislation requiring insurance companies to cover treatment for autism. Effective November 1, 2009, insurance companies must provide coverage for intensive level therapy for insured children between the ages of 2 and 9 with a verified diagnosis of autism spectrum disorder, and coverage for non-intensive level therapy for individuals with a verified diagnosis of autism spectrum disorder who do not qualify for intensive level therapy.
Wisconsin Statutes Section 632.895(12m) required OCI to develop a rule defining “intensive-level services” and “nonintensive-level services,” as well as other terms regarding the level of training and education required to be considered qualified under the rule for treating such disorders. View OCI’s full proposed order and rule. The emergency rule will remain in effect for one year. OCI is working on a permanent rule to replace the emergency rule.