Advocates Respond to New IRC § 501(r) Requirements for Tax Exempt Hospitals

In a July 22, 2010 letter to Douglas Shulman, Commissioner of Internal Revenue, various organizations supporting tax exempt hospitals, including the American Hospital Association, offered comments regarding the application of certain requirements imposed by new Internal Revenue Code (the “Code”)  § 501(r), as enacted by § 9007(a) of the Patient Protection and Affordable Care Act of 2010 (“PPACA”).  New Code § 501(r) requires that tax exempt hospital organizations meet certain new requirements for each hospital facility operated and use Schedule H of IRS Form 990 to provide the information to meet the requirements. Read more

Interim Final Regulations Implement Preventive Services Requirements Under the PPACA

On July 14, 2010, the Administration issued interim final regulations implementing the rules for group health plans and health insurance coverage for groups and individuals regarding preventive health services under the Patient Protection and Affordable Care Act.  They become effective sixty days after publication in the Federal Register and are applicable to plan years beginning on or after September 23, 2010.

These Regulations require that a group health plan or health insurance issuer provide benefits  and prohibit the imposition of cost-sharing requirements with respect to:

• Evidence-based items or services that have in effect a rating of A or B in the current recommendations of the U.S. Preventive Services Task Force (the “Task Force”) such as breast and colon cancer screenings, screening for vitamin deficiencies during pregnancy, screenings for diabetes, high cholesterol and high blood pressure.  Additionally, tobacco cessation counseling will be covered under these Rules.
• Routine immunizations as recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention including childhood vaccines and periodic adult tetanus shots.
• Recommended preventive care for children such as regular pediatrician visits, vision and hearing screening, developmental assessments, immunizations, and obesity screenings.
• Recommended preventive care for women to be determined by the Task Force on August 2, 2011.

The complete list of recommendations and guidelines that are required to be covered can be found at http://www.HealthCare.gov/center/regulations/prevention.html.  The requirements to cover recommended preventive services without any cost-sharing requirements do not apply to grandfathered health plans.

Medicare’s Three Day Admission Requirement: What’s a Hospital to Do?

While vacationing at the Jersey Shore recently, I came across an article in the July 4, 2010 edition of The Philadelphia Inquirer.  The article by Michael Vitez describes the plight of a family whose 86 year old matriarch was taken to the emergency room after she passed out, fell and broke her arm.  She suffered from mild dementia.  Although the patient needed only a brief hospital stay, she required rehabilitation services in a nursing home as a result of her injury.

Under Medicare rules dating back to 1966, Medicare does not pay for rehabilitation in a nursing home unless a patient first is an inpatient at a hospital for three days.  Anything less than the three day stay and the patient (usually the patient’s family) must pay for the rehabilitation services.  Faced with the prospect of footing the entire bill for costly rehabilitation, a patient’s family is likely to pressure the hospital and its physicians to keep a patient for the full three days, even though the prolonged stay may be unnecessary. Read more

Feds Issue Interim Final Rules Under PPACA for Preexisting Conditions, Lifetime and Annual Limits, Rescissions and Patient Protections

On June 28, 2010, the Departments of Treasury, Labor and Health and Human Services issued interim final rules under the Patient Protection and Affordable Care Act for group health plans and health insurance issuers.  The interim final rules pertain to preexisting condition exclusions, lifetime and annual limits, rescissions and certain patient protections under the PPACA. They become effective August 27, 2010.

Preexisting Condition Exclusions: The current rules in effect regarding preexisting condition exclusions apply only to group health plans and group health insurance and permitted limited exclusions under certain circumstances.  The new rules prohibit any preexisting condition exclusion from being imposed by group health plans or group health insurance coverage and extend this protection to individual health insurance coverage.  This prohibition takes effect in plan or policy years on or after January 1, 2014 but for enrollees under 19 years of age, it takes effect on and after September 23, 2010. Read more