Proposed Rule Extends Look Back Period on RAC Audits, Supreme Court Hears Challenges to ACA

CMS Announces Extended RAC Audit “look back” Period in Proposed Rule — Earlier this month CMS, in an effort to implement section 6402(a) of the Affordable Care Act, created a proposed rule entitled ‘‘Reporting and Returning of Overpayments.’’ This policy requires any provider that has received an overpayment to report or return the overpayment to the government or a contractor within 60 days of identifying the overpayment. As part of this proposed rule, CMS proposes extending the “look back” period for RAC Auditors to review potential overpayments to 10 years from the current 3-4 years; providers are also responsible for identifying potential overpayments over the 10 year period under the proposed rule. An overpayment is defined as “any funds that a person receives or retains under title XVIII of the [Social Security] Act to which the person, after applicable reconciliation, is not entitled under such title”. Medical providers have taken issue with the proposal as the statute does not explicitly provide this authority to extend the period in which providers are responsible for accounting for overpayments. CMS is accepting public comment on the proposed rule through April 16th, 2012. MORE

Read the Full Proposed Rule here

Supreme Court Hears Challenge to Affordable Care Act — The United State Supreme Court is currently hearing oral arguments on the constitutionality of the Patient Protection Affordable Care Act (PPACA), the often controversial health care legislation passed into law in 2010.  The challenge was filed on behalf of 26 state attorney’s general and is generally focused on whether Congress has the right, under the Commerce Clause, to force Americans to purchase health insurance or pay a fine.

The Supreme Court will hear three days of oral arguments beginning March 26th.  The first day of argument will focus on whether the Court has “standing” to hear the case since the penalties involved in the challenge will not begin to go into effect until 2014.  By all accounts, the Justices seemed to suggest they intended to hear the arguments on the constitutionality, not kick the can down the road a few more years as of Monday’s testimony. 

Tuesday’s arguments are the main event, discussing the constitutionality of the “individual mandate” of the bill, which will force all Americans to purchase health insurance or choose to pay a fine.  Those who have insurance through their employer, or public health benefits would be exempt, there are also subsides depending on income levels up to $90,000 annual income for a family of four.  The argument against the individual mandate is that the government does not have right to force Americans to purchase something if they are technically not engaging in commerce, such as forcing someone to purchase broccoli because it is good for you.  The government’s attorney’s will argue that Americans need access to health care and would need to sign a waiver explicitly waiving their rights to go to a hospital to reach the standard of “not engaging in commerce” argued by the suit.  

Wednesday will hear arguments on the government’s right to force individual states to expand their Medicaid enrollment criteria.  The PPACA expands Medicaid enrollment to 133% of the Federal Poverty Level, creating an estimated 15-20 million newly eligible enrollees in 2014. The Federal government will cover the costs of the newly eligible enrollees for the first two years, but will begin to shift costs back to the states after the initial period.

The Court is likely to issue their opinion on the constitutionality of the individual provisions listed above and the constitutionality of the entire law sometime in late June, which is actually very prompt by Supreme Court standards.

OPGA Government Relations will continue to monitor the Supreme Court, check back for additional updates.

This entry was posted in Orthotics and Prosthetics, Prosthetist, re provider, Regulatory and tagged , , , , . Bookmark the permalink.

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