President Obama's PPACA to Receive Supreme Court Ruling

The long awaited review of the Patient Protection and Affordable Care Act (PPACA) by the Supreme Court is in sight. On Monday, it was announced that the Supreme Court would rule on the bill during the 2011-2012 term. The Individual Mandate, requiring citizens to purchase healthcare or face a fine, is the controversial core of the legislation’s legal battle:

The president, a Democrat, has championed the individual mandate as a major accomplishment of his presidency and as a way to try to slow soaring health care costs while expanding coverage to the more than 30 million Americans without it.

The 11th Circuit Court of Appeals, based in Atlanta, ruled 2-1 last month in favor of 26 states and others that challenged the mandate for exceeding the power of Congress.

The current administration is convinced of the Individual Mandate’s constitutionality. According to Reuters, the administration had the option of asking the Court of Appeals to reconsider their position prior to the Supreme Court level, but the risk would have pushed back any Supreme Court ruling to the 2013 term.

The PPACA is potentially the most significant accomplishment of the Obama Administration, leading many political analysts to believe that the Supreme Court’s ruling will be among the deciding factors in the upcoming 2012 election. If the administration is as confident as they claim, it should come as no surprise that they wanted to push the ruling out before the major business of election campaigns begins.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

News From The 2011 CMS Fall Conference

The CMS Fall Conference this year can be defined with one word: improvements. The conference was designed with a series of breakout sessions, each intended to give CMS experts the ability to hear questions, concerns, and criticisms from those of us in the industry. It wasn’t a one-way conversation, however, as the experts in attendance provided plenty of information and commentary.

As I have already said, CMS made a great effort to stress their initiatives for improving Medicare and Medicaid programs. These efforts will include:

• Valuable products
• Clear benefits
• Accurate communications
• Accurate benefits
• No tricks at educational events
• Regulation-consistent marketing
• Secret shopping
• A stricter policy on misleading print ads and marketing

On a more positive note, CMS experts were enthusiastic about Part C and Part D programs. They were quick to stress that existing programs were not bad, but that they could do more. These initiatives are all intended to lead to better care, healthier communities, and conformity to ACA law.

The other major point of discussion was the CMS star rating system. A perfect five-star rating can bring many advantages to a plan, including year-round marketing to beneficiaries turning 65. A beneficiary may join or switch to a five-star plan from an MA, MAPD, or PDP plan, barring a few limitations:

• Beneficiaries can only join a plan in their area.
• They can only enroll in a 2012 plan with a five star rating.
• A beneficiary can only use this process one time per year.
• If one moves from a plan with drug coverage to a five-star plan that does not have drug coverage, they lose that coverage and cannot return to their previous plan.

CMS warned plans that deliberately structuring themselves to maximize ratings would not be an effective tactic, and that if plans stay focused on overall quality of care, and appropriate care, their star rating will be good.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

The 2011 CMS Fall Conference

It's that time of year again! Halloween decorations are already for sale in malls and grocery stores, the kids are back in school, and the words on everyone's lips are 'Prescription Drug Marketing Compliance."

That last bit may be a bit of an exaggeration, but nevertheless, it is time for the CMS 2011 Medicare Advantage and Prescription Drug Plan Fall Enrollment, Marketing and Compliance Conference. As usual, I, Pamela Argeris, will be attending on behalf of Merrill Corporation. This year's conference promises to be interesting, with plenty of topics that need stronger clarification, combined with the fact that a Presidential election year will soon be upon us:

• New Annual Enrollment Period and other related Enrollment Period’s
• Medicare Advantage Disenrollment Period/ 5 Star (SEP) Special Enrollment Period
• Marketing and Enrollment
• Part D IRMAA/ Reinstatement for Good Cause
• End of Year Transition and Systems Activity
• Quality Improvement Strategy for the Medicare Advantage Program
• Changes in the Enrollment Chapters (regulations)

The conference  begins on September 20th, and will also be broadcast live on the web, for registered attendees that cannot make it to the conference. There are also planned break-out sessions covering HPMS Training, Retroactive Processing Contractor, and MARx Reports. These sessions will give CMS experts the opportunity to listen to concerns and questions about these systems.

The goal of the Fall conference is to ensure that all sponsors and marketers working within the health and pharmaceutical fields remain up-to-date on the most recent changes to prescription drug marketing compliance.

The CMS Fall Conference is always a great source of information, and Merrill Corporation looks forward to the opportunity to better perfect our health industry services.
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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

Are Our Hospitals Prepared for Disaster?

It isn't something that many like to bring up, but with the tenth anniversary of 9/11 this weekend, some critics worry that our health facilities haven’t done enough to secure themselves through those ten years. The threat that these critics bring up is an act of bio-terrorism. If there were an outbreak of anthrax, or any other highly contagious disease, as a result of a terrorist attack, would our hospitals be prepared to handle it?

A report issued Sept. 1 by Trust for America's Health and the Robert Wood Johnson Foundation shows that significant public health improvements were made following the 2001 events.

Such improvements include developing clear emergency response plans, bolstering laboratory staffing and bio-testing capabilities, and implementing more effective disease surveillance systems in state health departments.

But during the past 10 years, the report says these efforts have been losing effectiveness, due largely to public health budget cuts. The cuts are leaving many departments across the country with too few staff members to adequately implement the measures.

This American Medical News article stresses that public health employees would be the first to recognize the signs of a large-scale bioterrorist attack, and recent budget cuts have drastically reduced their numbers. Further, critics point out that our health defenses have become too complacent, and that we will not be capable of defending a terrorist attack until after the attack has occurred.

A similar NJ.com column does mention that, after 9/11, many emergency procedures were put in place, with the intention of preparing hospitals for any disaster. However, low staffing and funding mean that very few hospitals would actually be able to follow through with their plans, should anything occur.

For the sake of future safety, it is clear that something needs to change, but many experts are left questioning what that change could actually be.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

Irene Leaves A Paper Trail

During natural disasters, the preservation of human life takes precedence over anything else. When it comes to health facilities, that can often mean the relocation or evacuation of patients and staff. In the case of the recent Hurricane Irene, it also meant that many facilities were suddenly faced with the massive logistical and compliance problems of moving hundreds of patients out of hospitals and nursing homes.

Now that the threat has passed, many hospitals are left with a paperwork nightmare that could take days to sort through.

Many questions have arisen. What is the Medicare and Medicaid reimbursement policy with respect to the transfer of patients between institutions? If a federal disaster area is declared, do the feds pick up the tab? How will private insurers pay for the costs incurred?

Crain’s New York Business asked CEO of the New York State Health Facilities Association, Richard Herrick, for his opinion. “The question is, who pays for what? Who bills for the services and costs incurred?” It is certainly a perplexing problem.

For many of the states affected, nothing on this scale has ever occurred, and contingency plans to handle the crisis were not in place. It is unreasonable to expect every facility to prepare for every possible disaster, but until federal agencies are willing to provide answers, many health facilities will be left to work things out on their own.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.