Obamacare Countdown to 2018—Inch by Inch, Rule by Rule

Terri Bernacchi, PharmD, MBA  Health Advisory Professionals 

It’s impossible to predict what the new Congress will do to amend or repeal all or portions of the health care law that we call Obamacare.  Just beholding the tremendous number of provisions of the Patient Protection and Affordable Care Act (PPACA) continues to astonish!  Though the details of the regulations required by each of the elements will unfold only gradually, the timeline has been laid out in an easy-to-use interactive calendar by Employee Benefit News.  (See the link here: http://ebn.benefitnews.com/health-care-reform/timeline.html?mstr_chnnl=ebn_health_care_reform)

Many of us are now several inches deep on specific components (for me, it’s the operational aspects of the Coverage Gap) but only an inch deep on others (for me, it’s almost everything else).  Thus, this 50,000 foot view of the timelines for each provision will continue to be a useful tool. 

Over the course of time, authors contributing to this blog will comment on some of the provisions, as they roll into effect or as they are clarified. 

One of the most insane provisions set to go into effect in 2011  is the one that disallows the use of FSAs, HSAs, or Archer MSAs for covering the cost of an over-the-counter medicine or drug (except insulin) unless a prescription is obtained. This new provision requires that the person must spend ADDITIONAL funds by getting to a physician in order to get the prescription, incurring additional cost for the person but also burdening the provider and payer parts of the system. 

The logic for this new provision? It appears to be tax revenues for the Government to cover the cost burden of Obamacare.

It’s difficult to track down any other logical reason that such a grand idea would be part of PPACA or why this would be in the best interest of any of the players in health care:  new burdens on the doctor, a reduction in the value of the HSA or FSA for the employee, incurring new medical expenses for the health plan or employer by creating MORE reasons to see a doctor.  This stupid provision actually penalizes routine self-care-----patients must again go see a doctor for a prescription for a cough/cold product. 

This seems to simply be a means to reduce the eligible use of pre-tax dollars for health care purposes so that the IRS will have greater access to taxes from that individual. Our IRS lays out its new stipulations in a very matter-of-fact way, but does not offer any other explanation.  Read more about the IRS ruling at the URL:  http://www.irs.gov/pub/irs-drop/n-10-59.pdf.   They would love to hear your comments.

Terri currently works for a large health sciences firm serving payers, pharmaceutical and device manufacturers and other stakeholders in health care as a Senior Principal in Managed Markets.  The thoughts put forth on these postings are not necessarily reflective of the views of her employer nor other Health Thought Leader colleagues.   Terri has had a varied career in health related settings including:  9 years in a clinical hospital pharmacy setting, 3 years as a pharmaceutical sales rep serving government, wholesaler, managed markets and traditional physician sales, 3 years working for the executive team of an integrated health system working with physician practices, 4 years as the director of pharmacy for a large BCBS plan, 12 years experience as founder and primary servant of a health technology company which was sold to her current employer three years ago.   She has both a BS and a PharmD in Pharmacy and an MBA.

New Anti-Fraud Provisions in PPACA Require Executive Criminal Checks - Government

Terri Bernacchi, PharmD, MBA, Health Advisory Professionals  

As the elements of the Patient Protection and Affordable Care Act (PPACA), as amended by the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act, or the ACA) have begun to be formulated as regulatory rules that providers and other health care players must conform to, it is clear that some of the anti-fraud provisions are more onerous in terms of requirements and penalties than previous laws.  

Under the proposed rules, for example, newly enrolling home health agencies and suppliers of durable medical equipment (which are considered at “high risk” for fraud) will be subject to fingerprinting and background checking.  The provision would apply to apply to the owners, authorized or delegated officials, and managing employees, who theoretically would be more likely to get a financial gain from the act of fraud.

The law itself (under Section 6401(a)) grants the Secretary new and wide discretion to impose temporary moratoria on the enrollment of new Medicare, Medicaid, or CHIP providers and suppliers specifically to prevent or combat fraud, waste, or abuse.  

An October 6, 2010 white paper has been written and is available in the public domain by the National Health Care Anti-Fraud Association.  This URL link should take the reader to that paper:  http://www.nhcaa.org/eweb/docs/nhcaa/PDFs/Member%20Services/WhitePaper_Oct10.pdf

While the problem of health care fraud is a long-standing one for the private and government sector alike, the requirements posited under these regulations will add administrative cost and burden for health care providers.  The money required to build and maintain the government infrastructure for the fraud background screening and program integrity activities will be covered, in part, by the imposition of new $500 fees on the providers and suppliers. (Gee, I wonder if they’ll pass that cost along to patients and other payers?)  Theoretically, however, the costs will be more than offset by savings due to less fraud.  

CMS continues to take comments on its Proposed Rules for screening providers, asking providers and suppliers to submit comments, accepted until 5:00 p.m. on November 16, 2010. 

Terri currently works for a large health sciences firm serving payers, pharmaceutical and device manufacturers and other stakeholders in health care as a Senior Principal in Managed Markets.  The thoughts put forth on these postings are not necessarily reflective of the views of her employer nor other Health Thought Leader colleagues.  Terri has had a varied career in health related settings including:  9 years in a clinical hospital pharmacy setting, 3 years as a pharmaceutical sales rep serving government, wholesaler, managed markets and traditional physician sales, 3 years working for the executive team of an integrated health system working with physician practices, 4 years as the director of pharmacy for a large BCBS plan, 12 years experience as founder and primary servant of a health technology company which was sold to her current employer three years ago.   She has both a BS and a PharmD in Pharmacy and an MBA.