Health Reform Turns 1 – Key 2011 Provisions

One year ago today President Obama signed the Patient Protection Affordable Care Act into law.  One would think that after a full year had passed that health reform would cease being front page news, right?  Alas, health reform is here to stay with advocates and opponents holding events this week marking the anniversary of the controversial laws passage.  With the House and Senate on recess this week, it seems like a good time to identify some of the key aspects of reform that are already impacting the O&P industry and, also, provisions that will have a major impact moving forward in 2011.

The Department of Health and Human Services (HHS) has been churning out reports, rules and opinions at an unprecedented rate this past year.  Regulatory changes like new Medicare supplier standards, maintenance of effort requirement waivers for Medicaid and RAC audits all came to fruition. O&P-friendly policy changes allowing dependents to remain on insurance through age 26, eliminating of annual/lifetime coverage caps and barring pre-existing condition exclusions for children have all moved forward this past year as well.

In 2010 work began on several provisions crucial to the future of the Affordable Care Act, but tangible policy proposals have yet to materialize.  2011 will bring clarity on major issues like the “essential benefits package” and “accountable care organizations”.  The essential benefits package will form the basis of all insurance plans offered in the state-based health exchanges in 2014. The inclusion of orthotics and prosthetics in the essential benefits package is crucial to the future of the O&P profession; initial recommendations on the list of services covered in the packages are due out later this year.  This spring, the administration will also issue a proposed rule for a voluntary program outlining the way hospitals, physicians and other providers must coordinate care for Medicare patients. Participants may keep part of any savings realized by their ability to offer higher-quality care and prevent medical conditions from getting worse. These “accountable care organizations” could have a large impact on the O&P profession in the years to come as hospitals could have an interest in combining services with O&P providers.

House and Senate Republicans efforts to repeal or block funding for ACA implementation will continue in 2011. At the same time, many Governors will argue that federal control over insurance is inappropriate and that the law’s expansion of Medicaid is too costly for already tight state budgets. Federal courts will also rule on more than 20 challenges to the law’s constitutionality, which the Supreme Court is likely to settle by this time next year.


ROI for Your EHR? I recently visited a medical practice that was like so many others I’ve been to before. This practice just wasn’t getting their investment back from their EHR. The practice had been live on the EHR for about five months and was functioning effectively without pulling charts for patient visits. The clinical staff was comfortable with the system and seeing a full complement of patients. More

Report Offers Global Projections for Orthopedic, Prosthetic and Orthotic Markets A new report from Global Industry Analysts (GIA) provided a review of the global prosthetics industry, market trends, product innovations, industry activity and profiles of market organizations. “Orthopedic Prosthetics: A Global Strategic Business Report,” projected that the global orthopedic prosthetics market will reach $19.4 billion by 2015. More

MEDPAC Calls for Small Pay Increase for Docs in 2012 Codifying recommendations made at a meeting last month, the Medicare Payment Advisory Commission (MedPAC) has officially recommended that physician reimbursement under the Medicare program be increased by 1% in 2012. More

Injured and Amputee Veterans Bill of Rights Reintroduced in US House On February 16, 2011, Congressman Bob Filner (D-CA), Ranking Member of the House Veterans Affairs Committee, reintroduced the bipartisan Injured and Amputee Veterans Bill of Rights in the U.S. House of Representatives. The new bill number is H.R. 805, and the bill was referred to the Veterans Affairs Committee, now chaired by Congressman Jeff Miller (R-FL). More

Obama Medicaid Cost-Cut Plan: Aid Sickest As governors have been sounding the alarm about a collective $175 billion shortfall in state Medicaid budgets in the coming fiscal year, the Obama administration is looking to reduce the gap by improving the treatment of just 2.9 million of Medicaid’s 58 million enrollees. How could the treatment of just 5 percent of beneficiaries make a dent in such a huge funding gap? More

Bipartisan DMEPOS “Competitive Bidding” Repeal Bill Introduced Legislation introduced by Congressmen Glenn “GT” Thompson (R-Centre) and Jason Altmire, (D-Allegheny) would repeal Medicare’s controversial competitive bidding program for home medical equipment. H.R. 1041 is titled the “Fairness in Medicare Bidding Act” More

Medicaid Data Mining Proposed To ramp up efforts to detect Medicaid fraud, the Department of Health and Human Services is proposing a rule that would enable states to use federal matching funds to support Medicaid claims data mining. More

Arizona Seeks to Cut 120,000 from Medicaid Rolls, Cut Benefits Under a 12-part, $500 million proposal released late Tuesday, the state would cut about 120,000 people from the Arizona Health Care Cost Containment System, the state’s Medicaid program, instead of the 280,000 Brewer originally proposed as a move to help close the state’s budget shortfall. More

Pending Medicaid Rate Regulation Raises GOP Concerns Republican lawmakers are increasingly concerned about a pending regulation that will seek to clarify what states can do with their Medicaid rates. Several medical providers have sued states, claiming that low reimbursement rates violate the Medicaid statute because beneficiaries can’t access care if there are too few providers. More

Appeals Court Ruling Puts an End to Red Flag Controversy A federal appeals court has dismissed a lawsuit centering around a rule that would require physicians to adhere to insurance fraud monitoring programs in their practices or face a steep fine. The ruling effectively puts an end to several years of controversy over the Federal Trade Commission’s so-called “red flag rule,” which deemed doctors as “creditors” because they bill for their services and collect money later. More

Obama Admin Appeals Health Reform Ruling The Obama administration has appealed the ruling by a federal judge in Florida that the individual mandate provision of the Affordable Care Act is unconstitutional and therefore the entire law is void. On Jan. 31, Judge Roger Vinson ruled that it’s unconstitutional to require people to purchase health insurance. And because that provision in the law cannot be removed from the rest of the Affordable Care Act (ACA), “the entire Act must be declared void. More

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