What exactly are the issues that the Supreme Court will decide in its review of the Affordable Care Act?  The best summary I’ve found is here.


One of the most far-reaching innovations in the PPACA is the creation of an Independent Payment Advisory Board (IPAB), which will allow changes in Medicare reimbursement rules to be fast-tracked starting in 2015.  The purpose of the IPAB is to reduce the per capita rate of growth in Medicare spending. Continue reading ‘INDEPENDENT PAYMENT ADVISORY BOARD’


Effective immediately, the annual market basket updates are being reduced for 15 different types of Medicare services.  The statute expressly provides, as to each of the following services that, as a result of these adjustments, a provider’s or supplier’s annual percentage increase,  may be less than zero percent in a fiscal year and thus may “result in payment rates … for a fiscal year being less than such payment rates for the preceding fiscal year.”

A major element of these reductions is the insertion of a “productivity adjustment.” Continue reading ‘Provider reimbursement – reduction in market basket updates’


The Health Reform law (otherwise known as the “Patient Protection and Affordable Care Act” or “PPACA”) contains numerous provisions relevant to home health agencies (“HHAs”).

Reimbursement changes

Perhaps most important to HHAs themselves are a number of reimbursement changes.  The HHA prospective payment system (“PPS”) will be rebased starting in 2014.  HHA rates will be adjusted  by a percentage determined appropriate Continue reading ‘Changes affecting home health agencies’


Many Medicare beneficiaries who can afford to do so purchase “Medigap” insurance policies to cover many of the self-pay portions of standard Medicare.   Since 1992, federal law has required these policies to offer one of several defined packages of benefits.

Under the Affordable  Care Act (the government’s new name for the consolidated health reform statutes), there will be a number of changes to standard Medigap policies, effective for policies sold on or after June 1, 2010.  The Center for Medicare Advocacy, Inc. has published a good description of these changes, which you can access here.


The House Office of Legislative Counsel has published an integrated version of the Patient Protection and Affordable Care Act (Pub. L. 111-148, known as “PPACA”), incorporating the changes made by both Article X of the PPACA and the subsequently-enacted Health Care and Education Reconciliation Act of 2010 (“HCERA”).  You can see it here.

Thanks to Alan Goldberg for the heads-up on this helpful document.


The Senate has passed the Health Care and Education Affordability Reconciliation Act of 2010 (H.R. 4872), with two minor tweaks not affecting the healthcare portions of the bill.  Last night, the House of Representatives concurred in the revised version.

For a version of the health reform law that incorporates the Reconciliation Act’s provisions, click here.  (Warning: The site is a bit frustrating to use, as you’re pretty much limited to scrolling to find anything.)


I have updated the following posts to focus on changes for nursing homes that are contained in the newly enacted health reform statute –


While we all watch and wait to see if the Reconciliation Bill passes the Senate, I’m going to focus on what’s in the legislation that has been enacted so far — H.R. 3590 (formerly called the “Senate Bill”), which has passed both chambers of Congress.

At the risk of  verging into the political sphere,  it seems to me at this point that we are going to end up very soon with one of just two alternative pieces of legislation.  First, there’s Reform Law #1, the House version, which will consist of H.R. 3590 , as amended by H.R. 4872 (the Reconciliation Bill).  If the Senate fails to enact the Reconciliation Bill, there is still Reform Law #2 — H.R. 3590 (Cornhusker Kickback and all).

President Obama signed H.R. 3590 into law on March 23, 2010.  (That means that where I refer elsewhere on this blog to a provision becoming effective so much time after the date of enactment, March 23, 2010 is where you start counting.)

Since there’s nothing in the Reconciliation Bill that would amend H.R. 3590′s substantial provisions affecting long-term care, I’ve focused first on those, which are now law regardless of whether we end up with Reform Law #1 or Reform Law #2.


With the obvious intent to improve access to primary care for Medicaid recipients, the Health Care and Education Affordability Reconciliation Act of 2010 will increase Medicaid payment rates to at least the level of the Medicare rates for Evaluation & Management (E&M) codes in 2013 and 2014.  The new rates will be available to all physicians with a primary specialty designation of family practice, general internal medicine, or pediatrics.

For these physicians, Medicare rates will also apply to services related to immunization administration for vaccines and toxoids for which CPT codes 90465, 90466, 90467, 90468, 90471, 90472, 90473, or 90474 (as subsequently modified) apply.

The increased payment requirement would also apply to Medicaid managed care plans, “regardless of  the manner in which such payments are made, including in the form of capitation or partial capitation.”




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