A busy day in the federal courts – potential circuit split on the Affordable Care Act

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What Happened?  Yesterday, two federal appellate courts issued conflicting rulings regarding tax credit subsidies for individuals who purchase health insurance through “exchanges” run by the federal government. Exchanges. Under the Affordable Care Act (the “ACA”), each state may establish a health insurance exchange where individuals can purchase health insurance policies, known as a “state-run” exchange. Read More

Employers cannot dump workers into health exchanges says IRS

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According to the New York Times, the IRS ruled last month that employers may not shift health care costs by “sending their employees to a health insurance exchange with a tax-free contribution of cash to help pay the premiums”.  Under existing law, when employers provide health care coverage to employees, the cost of the insurance isRead More

Transition relief in ACA implementation, extended renewal of non-compliant health insurance plans permitted

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Last fall, the federal government announced that insurance companies could renew health insurance policies in the individual and small group markets that would have otherwise been cancelled for failing to comply with certain market reforms required by the Affordable Care Act (the “ACA”).  However, some insurance companies decided against renewing non-compliant plans, even though theyRead More

Getting Ready for the Transition from ICD-9 to ICD-10

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On January 16, 2009, the U.S. Department of Health and Human Services (“HHS”) released the final rule mandating that everyone covered by the Health Insurance Portability and Accountability Act (“HIPAA”) must transition from ICD-9 diagnosis and procedure codes to ICD-10 diagnosis and procedure codes.  The new ICD-10 code set was created to provide greater detailRead More

Get Your Certificate Before You Collaborate!

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Last summer Governor Bentley signed legislation authorizing Regional Care Organizations (“RCOs”), which, among other things, encourage collaboration among health care providers.  In a nutshell, RCOs will be entities in five regions of Alabama responsible for the care of Medicaid beneficiaries.  By 2016, RCOs will receive a capitated payment from the state and are “at-risk” ifRead More

Employer Mandate for some delayed another year by President Obama

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President Obama’s administration has issued regulations that only employers with more than 100 full time employees will be subject to fines in 2015 unless they offer coverage under Obamacare.  The requirement to offer coverage for employers with 50 to 100 employees has been delayed until 2016.  These regulations followed the decision last year to notRead More

Changes to Implementation of Pain Management Provider Registration

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The Sirote Health Care Blog reported in December that, beginning January 1, 2014, and continuing every year thereafter, all physicians who provide pain management services (as defined by the Alabama Board of Medical Examiners) must obtain a pain management registration from the Board.  The deadline for initial registration for 2014 is February 15, 2014. On JanuaryRead More

Doctor shopping is a crime in Alabama

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Last year, three bills known as the Prescription Drug Abuse and Diversion Package and aimed at decreasing the abuse of prescription drugs in Alabama were signed into law by Governor Robert Bentley.  In recent Sirote Health Care Blog posts, we discussed the pain management bill (HB 151), as well as amendments to the Prescription DrugRead More

Understanding Alabama’s Prescription Drug Monitoring Program

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The Alabama Prescription Drug Monitoring Program (“PDMP”) is a program developed to promote the public health and welfare of Alabama citizens by detecting diversion, abuse, and misuse of prescription medications classified as controlled substances under the Alabama Uniform Controlled Substances Act.  Anyone who dispenses Class II, III, IV, or V controlled substances (i.e., codeine, morphine,Read More

Structural changes in health reform poised to impact provider’s bottom line

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Health reform continues to make daily headlines at the federal and state level.  Major changes are already in place and more are on the way.  Whether you’re a fan of health reform or not, figuring out what it means for your business is a complex task, and requires balancing many different objectives.  Several components ofRead More