Implementation of the National Health Care Law. forum: Implementation requirements for Sept. 2010
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|I wish I had the answer to the obvious question, "What does this all mean?? but all I can do is suggest that you try to talk to someone in the medical field that may know just what all this means. I will continue to publish the requirements as they come due and, hopefully, someone who knows more about what they actually mean will explain it to us.
September 1, 2010
Medicaid: Deadline for the Secretary to take steps to allow States to implement by October 1,
2010 the National Correct Coding Initiative, which will promote correct coding and control
improper coding leading to inappropriate payment. (Sec. 6507)
September 19, 2010 (180 days after the date of enactment)
• Government Programs: Deadline for the Secretary to develop information technology
standards and protocols to facilitate enrollment of individuals in Federal and State health and
human services programs. (Sec. 1561)
• Medicare, Medicaid and SCHIP: Deadline for the Secretary, in consultation with the Office
of the Inspector General, to determine screening procedures for enrolling providers and
suppliers in Medicare, Medicaid and SCHIP. The level of screening will be determined
according to the risk of fraud, waste and abuse for a category of providers or suppliers.
Screening procedures must include a licensure check, and may include (at the Secretary’s
discretion) a criminal background check, fingerprinting, unscheduled and unannounced site
visits, database checks, and other screening as deemed appropriate. To pay for the new
screening measures, the Secretary is required to impose a fee of $500 for institutional
providers. The new screening procedures will apply to those providers and suppliers
revalidating their enrollment beginning September 19, 2010; to new providers and suppliers
beginning March 23, 2011; and to current providers and suppliers March 23, 2012. (Sec.
• Public Health: Deadline for the Secretary to issue regulations establishing an administrative
process for resolving claims by covered entities (i.e. children’s hospital and disproportionate
share hospitals) that they have been overcharged for drugs purchased under the 340B
program and for claims by drug manufacturers against covered entities they claim have
violated the program. (Sec. 7102)
September 23, 2010 (6 months after the date of enactment)
Insurance: Start date for new requirements on insurance companies (Note: requirements
apply for plan years beginning on or after 6 months after enactment; for most plans, this date is
likely January 1, 2011).
• All insurance companies may not:
o impose lifetime limits on essential health benefits (Sec. 10101 and H.R. 4872 Sec.
o rescind coverage except in instances in which an individual commits fraud (Sec. 1001
and H.R. 4872 Sec. 2301)
• All insurance companies must allow “children” to remain on their parent’s health plan
until age 26, if the “child” is not eligible to enroll in an employer-sponsored health plan).
(Sec. 101 and H.R.4872 Sec. 2301).
• Group health plans and new individual plans may not:
o exclude payment for treating a pre-existing condition for any child under 19. (H.R.
4872 Sec. 2301)
o impose unrestricted annual limits on “essential health benefits” as defined by the law
and the Secretary. (Sec. 1001 and H.R.4872 Sec. 2301)
• All insurance companies that are not grandfathered (i.e., all new plans) must:
o cover – without cost-sharing requirements – preventive services as graded “A” or “B”
by the U.S. Preventive Services Task Force, certain immunizations; preventive
services for infants, children, adolescents and women as provided in guidelines
developed by HHS’s Health Resources and Services Administration. (Sec. 1001); and
o implement an internal and external appeals process for coverage determinations and
claims. (Sec. 1001)
|Thanks for the detailed info.|
|I doubt if most medical professionals could explain what it all means, either.|
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