Weekly recap of Federal and State Developments in Health Care Reform

Week of August 24, 2009

With opposition to a government-plan option evident at many health care reform town hall meetings this summer, an alternative option based on private regional cooperatives is now getting a lot more serious attention.

If your company is a medical provider, health care insurance payor, or you need to gather insights on the coming changes in electronic health care, HIPAA, and ARRA related health care developments, Contact us to schedule a discussion with one of our industry experts

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Senate Finance Committee member Senator Mike Enzi (R-WY), part of a six-member team that continues to try to achieve a bipartisan agreement throughout the Congressional recess, said last week that he could support a co-op provision. However, the co-op idea has its detractors and is still not well defined.

Federal

With Congress in recess, there is no federal report this week.

States

CALIFORNIA: Legislation to initiate a health insurance tax to fund the state’s high-risk pool has been shelved for the year.

The tax would have required all health insurers to be assessed up to $1 per member per month across each company’s entire book of business, including self-funded clients.

Insurance companies led the opposition to this tax, which has been proposed in the past by California-domiciled health insurers and HMOs. Insurance companies argued that funding a high-risk pool should be broad-based and not single out one industry, nor should it tax employers that do not purchase insurance but instead choose to fund health benefit arrangements in-house. The concept of funding high-risk pools by tapping employer’s self-funded arrangements was proposed but ultimately withdrawn or defeated in Oregon, Maine and Colorado this year as well. It is anticipated that these states will revisit the legislation in 2010.

NEW YORK: Governor Paterson’s office is again outlining its priorities for federal health care reform for New York’s congressional delegation and is signaling its intent to maintain or strengthen the state’s role in regulating health care benefits.

The Governor’s office is emphasizing a need for any insurance exchange program to ensure a level playing field between the exchange and non-exchange insurers; the view that the federal law should be a floor and not a ceiling; and that there should be concurrent jurisdiction of the federal and state governments to regulate the insurance industry. In addition, Governor Paterson appointed James Wrynn as the new superintendent of insurance. The Senate is expected to act on this and other appointments in a one-house special session on Sept. 10.

TEXAS: In a press conference held last week, Governor Rick Perry emphasized the importance of state-developed health care reform rather than the costly, expansive, one-size-fits-all mandates being considered by the federal government.

The Governor expressed concern over the potential loss of a state’s ability to develop solutions tailored to the unique needs of its citizens. He further argued that current federal health care reform legislation would pose a serious threat to patients and providers, and would cost Texas taxpayers tens of billions of dollars over the next 10 years, without significantly improving care for Texans.

August 14, 2009 – Study urges action to get patients to follow prescriptions – It is based on seven systematic reviews of medical literature, as well as interviews with 16 health care organizations, insurers, drug makers, and technology companies. The health care institute recommends some system wide changes, such as revamping how health care providers are paid. Other recommendations include using health information technology to monitor what happens after an electronic prescription is transmitted to a pharmacy and to help patients manage multiple medication regimens.

health care process improvement, electronic health record, electronic medical record, management consulting, human and investment capital, outsourcing. Specializing in health care, financial services, education, renewable energy, retail. www.noworldborders.com

Michael F. Arrigo

Michael is Managing Partner & CEO of No World Borders, a leading healthcare management and IT consulting firm. He serves as an expert witness in Federal and State Court and was recently ruled as an expert by a 9th Circuit Federal Judge. He serves as a patent expert witness on intellectual property disputes, both as a Technical Expert and a Damages expert. His vision for the firm is to continue acquisition of skills and technology that support the intersection of clinical data and administrative health data where the eligibility for medically necessary care is determined. He leads a team that provides litigation consulting as well as advisory regarding medical coding, medical billing, medical bill review and HIPAA Privacy and Security best practices for healthcare clients, Meaningful Use of Electronic Health Records. He advises legal teams as an expert witness in HIPAA Privacy and Security, medical coding and billing and usual and customary cost of care, the Affordable Care Act and benefits enrollment, white collar crime, False Claims Act, Anti-Kickback, Stark Law, physician compensation, Insurance bad faith, payor-provider disputes, ERISA plan-third-party administrator disputes, third-party liability, and the Medicare Secondary Payer Act (MSPA) MMSEA Section 111 reporting. He uses these skills in disputes regarding the valuation of pharmaceuticals and drug costs and in the review and audit of pain management and opioid prescribers under state Standards and the Controlled Substances Act. He consults to venture capital and private equity firms on mHealth, Cloud Computing in Healthcare, and Software as a Service. He advises ERISA self-insured employers on cost of care and regulations. Arrigo was recently retained by the U.S. Department of Justice (DOJ) regarding a significant false claims act investigation. He has provided opinions on over $1 billion in health care claims and due diligence on over $8 billion in healthcare mergers and acquisitions. Education: UC Irvine - Economics and Computer Science, University of Southern California - Business, studies at Stanford Medical School - Biomedical Informatics, studies at Harvard Medical School - Bioethics. Trained in over 10 medical specialties in medical billing and coding. Trained by U.S. Patent and Trademark Office (USPTO) and PTAB Judges on patent statutes, rules and case law (as a non-attorney to better advise clients on Technical and Damages aspects of patent construction and claims). Mr. Arrigo has been interviewed quoted in the Wall Street Journal, New York Times, and National Public Radio, Fortune, KNX 1070 Radio, Kaiser Health News, NBC Television News, The Capitol Forum and other media outlets. See https://www.noworldborders.com/news/ and https://www.noworldborders.com/clients/ for more about the company.

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