Under the new law, the tax will be applied to services beginning on or after January 1, 2012 and the tax will be levied upon a “carrier’s” or “third party administrator’s”1 paid claims.
The new law was signed in anticipation of action by the Centers for Medicare and Medicaid offices to disallow the current Use Tax on Medicaid contracted health plans and specialty prepaid health plan as a means to generate State revenue for purposes of obtaining federal matching funds for the Medicaid program. Thus, the new tax replaces the current six percent (6%) Use Tax levied upon Medicaid contracted health plans and specialty prepaid health plans.
A copy of the new law is available online through the Michigan Legislature website at: http://www.legislature.mi.gov/(S(d2epzp45p2r4odfaqtuhrjff))/mileg.aspx?page=getObject&objectName=2011-SB-0348
1Please see definitions set forth under the new law at: http://www.legislature.mi.gov/(S(d2epzp45p2r4odfaqtuhrjff))/mileg.aspx?page=getObject&objectName=2011-SB-0348
.]]>HHS issued a Notice of Final Determination (“NFD”) concluding that Cignet Health, located in Maryland, (“Cignet”) violated the Privacy Rule and imposed a civil money penalty (“CMP”) of $4,351,600.]]>
The workshop had two overriding goals: to help integrative care thrive in America and for the Government to be proper stewards of appropriate markets and proper non-collusive behaviors. In Mr. Berwick’s words, “to have your cake and eat it, too.” Though the goals are lofty, all of the panelists and representatives of the agencies stated their belief and commitment to meeting those goals.
The FTC seemed to indicate that they were either going to prepare guidance, based on existing statutes and case law or create a statutory safe harbor for ACOs. Overwhelmingly the panelists asked for guidance, rather than a set of clear cut proscriptive rules or a bright line safe harbor from the antitrust laws. The reasoning is that bright line rules might stifle creative approaches to creating innovative delivery systems in an ACO. In any event, the FTC indicated that it would issue either guidance or regulations yet this Fall.
As to CMS and OIG, concerning the Stark, Anti-Kickback Statute and Civil Monetary Penalties issues that ACOs pose, they, too, indicated that a waiver of the respective fraud and abuse laws as to ACOs, or a new safe harbor would also be issued yet this Fall. CMS and OIG indicated that some form of waiver, coupled with either a safe harbor or other regulations were the most likely ways they would handle the issues with ACOs.
After attending the workshop, I am convinced that America stands on the cusp of radically changing the way healthcare is delivered – through ACOs and other payment and delivery system models – that will increase the quality and safety of care, as well as, hopefully, reduce overall costs. ACOs are one way that health care providers can work collaboratively to better manage a patient’s health care experience and outcomes. It will be interesting to see how the various agencies, FTC, OIG and CMS interpret their respective laws to achieve these goals.
]]>In a case of first impression before the U.S. District Court, Eastern District of Michigan, Judge George Steeh held the “individual mandate” to purchase health insurance under the Patient Protection and Affordable Care Act (“PPACA”) is constitutionally permissible; and therefore denied the plaintiffs’ request for an injunction against the Federal government.
In Thomas More Law Center, et al. v. Barack Hussein Obama, et al., the plaintiffs argued that Congress lacked the authority to impose an individual mandate to purchase health insurance and further asserted that the tax penalty for failing to buy health insurance is unconstitutional because the money would go into the government's general fund and could be used to fund abortions.
Under the PPACA, the individual mandate requires that each “applicable individual” purchase health insurance, or be subject to a “penalty.” The definition of “applicable individual” is an individual other than religious objectors who opposes health insurance in principle, non-residents or illegal residents, and incarcerated individuals. Thus the individual mandate to purchase health insurance applies to everyone living in the United States, unless they are excepted.
According to opinion, the Commerce Clause, which regulates interstate commerce, grants Congress the constitutional authority to impose such mandate. In addressing the Congressional power to regulate interstate commerce under the Commerce Clause, Judge Steeh expressed that, “the Commerce Clause affords Congress broad power to regulate even purely local matters that have substantial economic effects.” In applying the Commerce Clause to the facts of this case, Judge Steeh concluded Congress has the right to require that each individual purchase health insurance for two reasons: “[f]irst, the economic decisions that the Act [PPACA] regulates as to how to pay for health care services have direct and substantial impact on the interstate health care market and [s]econd, the minimum coverage provision is essential to the Act’s [PPACA’s] larger regulation of the interstate business of health insurance.”
Based on a number of news sources, the plaintiffs’ fight is not over. Various media outlets are reporting that Robert Muise, attorney for plaintiff Thomas More Law Center, plans to appeal Judge Steeh’s decision to the U.S. Court of Appeals for the Sixth Circuit. If an appeal is timely filed, its possible this Michigan case will be the first health reform challenge to reach a Federal appellate court.
A copy of the opinion is available online at the United States District Court, Eastern District of Michigan website at: http://www.mied.uscourts.gov/
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