CMS will allow “grandmothered” health plans to stay through 2018

CMS will allow “grandmothered” health plans to stay through 2018

At the agencies

The Centers for Medicare and Medicaid Services (CMS) has announced they will allow health insurance plans that do not meet the Affordable Care Act (ACA) basic requirements to remain for an additional year. Initially the Obama Administration had permitted noncompliant plans to remain only until 2014 but the deadline was extended twice, the last extension would have ended this year. States will now have the responsibility of deciding whether to grant additional extensions for 2018 for their exchanges. 

On the Hill

Seema Verma, President Trump’s nominee for CMS Administrator has cleared the Senate Finance Committee in a 13-12 vote. The vote came a day after originally scheduled, which was delayed due to the lack of a sufficient number of Republicans present. Verma’s nomination now heads to the Senate for a full vote where she is expected to be confirmed.

In a written response following Senator Menendez’s (D-N.J.) questioning during her hearing, Verma stated that if confirmed, she will recuse herself from certain mental health policy decisions, including mental health parity enforcement. Verma said that the Office of Government Ethics had advised her to steer away from issues that intersect with her husband’s child psychiatry practice at the Indiana Health Group. She added in her response that she may not be able to meet with behavioral health providers and would skip meetings with providers seeking “health insurance coverage in the small group market for mental health services as an essential health benefit.” She further explained that “the analysis of my recusal obligation for a particular matter will be made on a case-by-case basis.” In the event of her recusal the Department of Health and Human Services (HHS) Deputy Secretary or HHS Chief of Staff would assume the responsibility.

Following the release of an outline of the president’s budget that may threaten some mental health related programs, a number of Republicans have called for protecting funding for those labor, health and education programs for next year. Several GOP members used the “member’s day” hearing to voice their support for mental health services, opioid addiction treatment and vocational education grants among other things. Representative Tim Murphy (R-Pa.) stressed his support for stronger mental health services, saying, “This investment will save lives.”

The House Judiciary Committee is set for a full committee mark-up on a bill which would tighten the statute of limitations for malpractice suits, capping certain damage awards and restrictions for attorney fees. There are also new protections for providers from prescription drug lawsuits involving Food and Drug Administration approved drugs in the current bill language. The bill sets the statute of limitations to require patients to file suit within three years of an injury and would cap noneconomic damages, like pain and suffering awards, at $250,000.  Under the legislation, attorneys would only be able to collect on a fixed percentage of the plaintiff’s total award. 

In the courts

A New Jersey doctor has been indicted for illegally selling high-dose prescriptions of oxycodone to addicts, dealers and patients. Dr. Byung Kang ran a family and general practice in Little Falls, N.J. where his wife was also employed as the receptionist. Dr. Kang faces decades in prison if convicted and may face liability for the overdose of a 26-year old man to whom Dr. Kang allegedly prescribed oxycodone.  Dr. Kang faces charges of varying degrees of strict liability for drug induced death, money laundering, conspiracy, unlawful distribution, filing of a false state tax return and failure to pay state income tax. The same day of Dr. Kang’s indictment by a state grand jury, the New Jersey Attorney General revealed that 31 doctors in New Jersey had been sanctioned in 2016 for overprescribing painkillers and other addictive narcotics, a record number for the state.

For more information on this topic, or to learn how Baker Tilly healthcare specialists can help, contact our team.

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