CMMS vs COVID-19

Via email from CMMS:

"[This past Friday], the Centers for Medicare & Medicaid Services (CMS) took additional actions to ensure America’s patients, healthcare facilities and clinical laboratories are prepared to respond to the 2019-Novel Coronavirus (COVID-19).

CMS has developed a second Healthcare Common Procedure Coding System (HCPCS) code that can be used by laboratories to bill for certain COVID-19 diagnostic tests to help increase testing and track new cases. In addition, CMS released new fact sheets that explain Medicare, Medicaid, Children’s Health Insurance Program, and Individual and Small Group Market Private Insurance coverage for services to help patients prepare as well."

This seems especially crucial given the increased risk favors faced by those on Medicare (seasoned citizens).

The agency also released 3 helpful publications:

■ Medicare Fact Sheet Highlights

■ Medicaid and Children’s Health Insurance Program (CHIP) Fact Sheet Highlights

■ Individual and Small Group Market Insurance Coverage

#Kudos!

[The entire press release is also available here]

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Chilling, but #TruthWillOut

We generally don't do partisan politics here at IB, but this particular example of (inadvertent?) truth-telling is important:

Biden tells crowd he wants to increase premiums and make sure that healthcare is 'not quality, but only affordable'... pic.twitter.com/fNhtcW7kxx

— Sean Hannity (@seanhannity) March 6, 2020

"[W]e’ll make sure it’s not quality, but only affordable”

And that, in a nutshell, is the whole premise of a "Public Option" (or any "universal care" scheme, really).

But what, exactly, is the problem with a Public Option?

"The "Public Option" is a euphemism for Single Payer, the obvious end-game for the ObamaTax from the get-go. And how do we know this?"The [Obama] administration still intends to control medical costs by ... a single payer mechanism"

And there you have it: full circle.

#Medicaid4All

[Hat Tip: Mr Jones]

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One step forward?

On the one hand:

"As the Board of Directors for America’s Health Insurance Plans, we are fully committed to help America’s powerful health care system meet the challenges posed by the Coronavirus strain COVID-19 ... We are taking decisive action to help prevent the spread of this disease, to ensure that people have coverage for and access to needed testing, and to help patients who are infected receive the care and treatment they need."

They go on to say that this includes coverage for diagnostic testing, as well as easing up on network issues (ie no "surprise billing"), and sharing information among different health care stakeholders (such as hospitals and physicians). It's pretty comprehensive.

But (and you knew there'd be a 'but' here, right?):

First, this is a promise from a trade group, not a specific contract waiver from any given carrier. In fact, I received an email the other day from Anthem saying that their "clinical team is actively monitoring external queries and reports from the Centers for Disease Control and Prevention to help us determine what, if any, action is necessary on our part."

And, of course, given AHIP's history, skepticism is absolutely warranted here.

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Life or Death: A Healthy Bet?

If nothing else, one has to admire the creativity of this idea:

"Life Settlement Players Root for Health Account Bill"

So let's unpack this, shall we?

First, what, pray tell, are "Life Settlement Players?"

Long time readers know that this refers to the viatical market:

"Since life insurance is property, it can generally be sold. In this case, the client saved the annual premium and picked up an easy $5,000."

That is, one can sell one's life insurance policy to another person for a quick buck or three (depending on one's health and life expectancy). This is generally perfectly legal (there are, of course, other considerations, biut that's another post). And, thanks to a little known piece of HIPAA, there are some great tax advantages, as well:

"A viatical settlement made to an individual considered terminally ill (under HIPAA, one who has a life expectancy of 24 months or less) is entirely tax free."

We'll circle back to that "terminally ill" qualifier in a moment.

Okay, Henry, but what's that got to do with the price of tea in China, or some pending health insurance-related legislation?

Well, let's see what H.R. 5958's all about, shall we?

A clue may be found in the name: "Senior Health Planning Account Act."

Basically, it "could help people use the proceeds from the sale of life insurance policies to pay health care expenses."

So what's the big deal?

Well, let's circle back to HIPAA, viaticals, and taxes:

Remember, one can only receive viatication funds tax-free if one is either terminally ill or using the the proceeds to fund one's (uninsured) long term are needs. But if you're not in one of those categories, there are some taxes to be paid. What this bill does is to obliterate that distinction for tax purposes:

"Under the provisions of H.R. 5958, a consumer who sold an in-force policy and put the money in a senior health planning account could spend the money on “qualified health care expenses” without paying federal income taxes on the proceeds from the life insurance policy sale."

Sweet!

Of course, we then have to define "qualified health care expenses," but that should be relatively easy under existing regs (specifically, Section 213d, also used for HSAs/HRAs/FSAs).

So one can see why this would be an attractive marketing tool for folks in the viatical settlement industry: it basically opens up a (potentially vast) new market.

Of course, still has to pass...

[Hat Tip: FoIB Allison Bell]

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The Magic 50th

As in 50th employee:

"[I]f you employ more than 49 people, you've either got to offer (and help pay for) a group plan or pay a penalty tax"

One can see the problem here for potential employee #50: what are the odds he (or, of course she) will actually be offered a job? Because that new employee is going to raise the employer's cost of doing business substantially, what with having to either install a group plan or face a stiff penalty. The Boss is going to have some major soul-searching on this hire.

But at least there's a light at the end of the tunnel, yes? The rule/tax/penalty sunsets eventually, right?

Ummm, not so much:

"The Internal Revenue Service (IRS), in a recently released memorandum from the Office of Chief Counsel.... has taken the position that the Employer Shared Responsibility Payment (ESRP) imposed by section 4980H of the Internal Revenue Code is not limited by any statute of limitations, and that it could assess these payments for years — potentially indefinitely — after a failure to comply." [emphasis in original]

Oy.

Breathe a sigh of relief if you're #49.

Or maybe not:

 

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Oy Canada - Another day, another looney

So to speak:

Still waiting for emergency surgery on broken ankle. Hospital ER overloaded and no private options for surgery in SK, the birthplace of Canadian Medicare. https://t.co/HVW5rrFmT8

— Heather Chapman (@PatientFactor) March 1, 2020

#Medicaid4All

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Sausage making and the ACA: A How-To Guide

When applying for an ObamaPlan on the 404Care.gov website, one is required to provide certain information, including date(s) of birth, Social Security number(s), and the like. This is then matched against other government databases for confirmation.

But what if you (or the person helping you) enters incorrect information?

Well, this may be of help (via email from CMMS):

"The information consumers provide when applying for Marketplace coverage is used to determine whether they are eligible for coverage and, possibly, financial assistance. In some cases, the information on a consumer’s application may be different from the Marketplace’s trusted data sources, including the Social Security Administration, the Department of Homeland Security, and the Internal Revenue Service ... The Marketplace may require a consumer to provide documentation to resolve this inconsistency or DMI [Data Matching Issue]"

And how, precisely can this be done?

So glad you asked:



Your tax-dollars at work!

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