Health Law Consulting Blog

The Patient-Centered Primary Care Collaborative (PCPCC) states that the “medical home” (also referred to as the “patient-centered medical home”) is best described as a model or philosophy of primary care that is patient-centered, comprehensive, team-based, coordinated, accessible, and focused on quality and safety. It is now a widely accepted model for how primary care should be organized and delivered throughout the health care system, and is a philosophy of health care delivery that encourages providers and care teams to meet patients where they are, from the simplest to the most complex conditions. It is a place where patients are treated with respect, dignity, and compassion, and enable strong and trusting relationships with providers and staff. Above all, the medical home is not a final destination, instead it is a model for achieving primary care excellence so that care is received in the right place, at the right time, and in the manner that best suits a patient's needs.

The latest reports show that the Healthcare.gov website is showing signs of improvement and operating 90 percent of the time.  The White House announced that the troubled website is now working smoothly for “the vast majority of users,” which is a drastic improvement from October when the site was operating 43 percent of the time and frequently crashed.  Officials said that the website had more than 1 million people visit it on Monday (December 2) and the first half of Tuesday (December 3).  Although some people received a message to return later at a less busy time, there are no reports of the site crashing this week.

As discussed in earlier blog posts, the Affordable Care Act (ACA) does not require employers with fewer than 50 full-time equivalent employees (Small Employers) to offer health insurance to their employees.  However, the ACA provides financial incentives for some Small Employers that decide to offer their employees health insurance.

On November 13, 2013, at 3:30 pm (EST), the Department of Health and Human Services released the much requested enrollment data for individuals obtaining health insurance plans through the state or federal health insurance Exchanges (or Marketplace).

The highly anticipated launch of the state and federal health insurance “exchange” - sometimes used interchangeably with “marketplace” - was met with dismal reviews. Several concerns were raised by consumers regarding the technical problems associated with both state and federal exchanges in addition to a much needed clarification regarding the tax penalty provisions effective January 1, 2014. Lawmakers are now scrambling to address the public’s concern regarding the exchanges and the tax penalty provisions.

Read on to learn more about the health insurance exchanges and what state and federal agencies are doing to help the general public easily access health insurance information in order to obtain health care coverage before the tax penalty deadline.

What is the Health Insurance Exchange?

Before PPACA passed, health insurance companies had a broad range of options in determining the types of policies they issue to consumers and the costs of that health care coverage. In particular, companies could limit or deny insurance coverage to consumers that had pre-existing conditions and raise health care premiums, without justification, subject to certain state law limitations.

After PPACA, insurance companies must work within clearly defined standards that greatly impact who will receive insurance coverage, the types of coverage they will receive, and the costs of such coverage. For instance, insurance companies will no longer be able to raise insurance premiums solely for profit based reasons or disproportionately benefit from such higher premiums. If premiums are raised, insurance companies will now have to justify any rate increase greater than 10% to the states in which they operate in and disclose the information to their customers.

Read on to learn more about how the PPACA is impacting insurance companies and individuals.

On October 10 through 11, 2013, I attended the National Committee for Quality Assurance (NCQA) Education program “Facilitating Patient-Centered Medical Home Recognition” held in San Diego, CA at the Hard Rock Hotel.  The program was very informative and instructive on how physician practices can prepare to become NCQA accredited as a Patient-Centered Medical Home (PCMH).   Faulk & Associates is working with several interested parties contemplating PCMH recognition.  However, the recurring theme I hear is “what are the financial benefits to becoming recognized as a PCHM physician practice?  Specialty physician practices want to know how they may be affected by PCMH recognized “primary care providers” (PCP) (i.e., will PCPs be less likely to refer patients to specialists)?

 What is a Patient-Centered Medical Home (PCMH)?

The patient-centered medical home (PCMH) is a model of care in which patients are engaged in a direct relationship with a chosen provider who coordinates a cooperative team of healthcare professionals, takes collective responsibility for the comprehensive integrated care provided to the patient, and advocates and arranges appropriate care with other qualified providers and community resources as needed.

The Patient Protection and Affordable Care Act (ACA) will provide several benefits and opportunities for small businesses to increase access to affordable health care coverage options.  The parts of the ACA that most directly affect small businesses are:  (1) the new state insurance exchanges; (2) tax credits; and (3) the employer mandate. The insurance exchanges and tax credits will take effect as planned on January 1, 2014.  The employer mandate will be put off for an additional year until 2015.

Read on to learn more about the parts of the ACA that directly affects businesses.

The employment status of several individuals across the nation may soon change once key provisions of the Patient Protection and Affordable Care Act (ACA) take effect.  In particular, some employers are shifting their employees from full-time to part-time employment status to avoid paying additional costs pertaining to the employer mandate provision of the ACA.

Read on to learn more about what is happening to employees under the new employment mandate provision of the ACA.

The Obama Administration recently delayed implementation of the Employer Shared Responsibility provision (Employer Mandate) and accompanying employer reporting requirements under the 2010 Patient Protection and Affordable Care Act (ACA), by one year. The Employer Mandate was set to go into effect on January 1, 2014, but now employers will not be subject to penalties or taxes for failing to offer full-time employees health care coverage meeting certain minimum standards until 2015.

The U.S. government has passed legislation throughout the past decade to award eligible healthcare professionals with monetary incentives for providing quality healthcare services to their patients. Key quality care reporting systems, such as the Physicians Quality Reporting System, have been implemented to monitor and award eligible professionals for providing quality care.