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So far Paul Natinsky has created 91 blog entries.

Risky Business For Health Plans

By PAUL NATINSKY
This summer featured continued disruption in aspects of the Affordable Care Act. This time, the vehicle was suspended risk adjustment payments to health plans. The payments have since resumed, but the methodology used to determine them has come under question.

So-called “risk adjustment” payments were established in the ACA to stabilize the health insurance market by transferring money to plans serving higher risk patients from those serving lower risk patients. The total in transfers for 2017 is $10.4 billion.

Two lawsuits, one in Massachusetts and one in New Mexico, declared the methodology used to determine payments respectively legal and then illegal. These lawsuits prompted CMS to issue a final rule […]

Risky Business For Health Plans2018-10-08T19:47:36+00:00

LETTER: Medicare For All Solves Many Problems

Editor:

Read your paper for the first time (Sept., 2018 issue), picked it up at U of M hospital.
Interesting letter to the editor by Allan Dobzyniak, MD. Apparently, he needs to research exactly what Medicare for all means. If he seriously thinks that doctors and other providers won’t be paid, he is mistaken. He also claims that socialized medicine, as he refers to it does not work and is akin to slavery. Funny, I don’t see any ofthe countries that have socialized medicine taking steps to get rid of it. Socialized medicine is a term some like to use to scare people and whether we admit it or not, we already […]

LETTER: Medicare For All Solves Many Problems2018-10-08T19:33:38+00:00

COMPLIANCE CORNER: Suggestion For Medicare Providers

Erin Diesel Roumayah, Esq.
Wachler & Associates, P.C.

In June, the Office of Medicare Hearings and Appeals (OMHA) publicly implemented an expanded Settlement Conference Facilitation program. SCF is an alternative dispute resolution process which provides appellants and the Center for Medicare and Medicaid Services an opportunity to discuss a mutually agreeable resolution for claims appealed to the Administrative Law Judge (ALJ) or Medicare Appeals Council levels of appeal. This program applies mediation principles to resolve eligible Medicare appeals in an expedient and efficient manner. Through this program, an OMHA senior attorney or program analyst trained in mediation techniques acts as a neutral facilitator between the appellant and CMS in a one-day […]

COMPLIANCE CORNER: Suggestion For Medicare Providers2018-10-08T19:26:52+00:00

LEGAL LEANINGS: Mental Health Parity

By ERICA MORRIS, GREGORY MOORE AND RUSSELL KOLSRUD
Mental Health Parity Really Does Mean Equal Benefits
By Erica Morris, Gregory Moore and Russell Kolsrud

In Danny P. v. Catholic Health Initiatives, 891 F.3d 1155 (9th Cir. 2018), the Ninth Circuit clarified the full extent of the “parity” required in the federal mental health parity law1 which has been in place since 2008.

In Danny P., the Ninth Circuit held that a particular group health plan (the Catholic Health Initiatives Medical Plan—Blue Cross Blue Shield) was prohibited from denying the same or equivalent room and board coverage in behavioral health facilities that it provided in non-behavioral health facilities, overturning the district court’s […]

LEGAL LEANINGS: Mental Health Parity2018-10-08T19:21:39+00:00

LANSING LINES

He’s Running As A Doctor But Can’t Practice . . . Does It Matter?
Matt Longjohn’s chief selling point in his Michigan 6th Congressional district run is that he’s a medical doctor. But he can’t practice medicine in Michigan because he isn’t professionally licensed in this state or in Illinois, where he formerly worked.

Longjohn, the Democrats’ nominee in the southwest Michigan district, has made a career on the administrative side of health care, most significantly as the first-ever National Health Officer for the 2,700 YMCAs in the United States when he worked in Chicago.

In campaign materials, he refers to himself as Dr. Matt Longjohn, MD, and uses the squiggly heartbeat signal […]

LANSING LINES2018-10-08T19:11:47+00:00

Drugmakers Play The Patent Game

By SARAH JANE TRIBBLE
David Herzberg was alarmed when he heard that Richard Sackler, former chairman of opioid giant Purdue Pharma, was listed as an inventor on a new patent for an opioid addiction treatment.

Patent No. 9861628 is for a fast-dissolving wafer containing buprenorphine, a generic drug that has been around since the 1970s. Herzberg, a historian who focuses on the opioid epidemic and the history of prescription drugs, said he fears the patent could keep prices high and make it more difficult for poor addicts to get treatment.

“It’s hard not to have that reaction of, like … these vultures,” said Herzberg, an associate professor at the University at Buffalo.
James Doyle, […]

Drugmakers Play The Patent Game2018-10-08T19:06:00+00:00

Dems Call For Immediate PFAS Hearings; They Won’t Happen

House Democrats called on Republicans to hold hearings this week, specifically in the Natural Resources and Oversight committees, to have the Department of Environmental Quality present what it knows about PFAS contamination and how extensive the problem is in Michigan.

Eight Democrats, led by Minority Floor Leader Christine Greig (D-Farmington Hills), held a press conference Sept. 4 to demand the hearings and that lawmakers take immediate action to strengthen water quality standards for perfluoroalkyl and polyfluoroalkyl substances (PFAS), a diverse group of compounds resistant to heat, water and oil. Such chemicals have been used in hundreds of consumer products and industrial applications including carpeting, apparels, upholstery, food paper wrappings, fire-fighting foams […]

Dems Call For Immediate PFAS Hearings; They Won’t Happen2018-09-18T23:50:33+00:00

Toxic Déjà Vu – PBBs And Now PFAS

By GERALD NATZKE, JR., DO
Do you remember Polybrominated Biphenyls (PBBs) sowing fear and disease into the lives of Michigan citizens approximately 43 years ago? Those PBB’s entered the larger food chain through a single error made by a Gratiot County chemical company worker when a ton of Firemaster (a toxic fire retardant) was added to cattle feed. PBB’s were ingested by cattle throughout this area and spread throughout Michigan and the Midwest, producing one of the largest chemical poisonings in the Western world. Another much larger and more dangerous toxic chemical exposure has been discovered. This family of toxins, through ignorance, and poor oversight has been introduced to Michigan’s and […]

Toxic Déjà Vu – PBBs And Now PFAS2018-09-18T23:46:41+00:00

I’m Voting For Healthcare Interoperability In November. How About You?

By EWA MATUSZEWSKI
We know that “Fix the Damn Roads” is a critical imperative for one of Michigan’s gubernatorial candidates—and hopefully for both. But is “Fix the damn interoperability problem with electronic health records” another? The intersection of healthcare and politics is obviously not new. I would contend it’s more visible—and viscious—than ever. Still, the focus tends to be on access to care and delivery of care, and I understand that. Interoperability of EHR hardly pulls at the heartstrings or incites passionate conversation from either side of the aisle. Accordingly, it doesn’t garner much attention from the consumer media either. That is why it is important for healthcare decision makers to […]

I’m Voting For Healthcare Interoperability In November. How About You?2018-09-18T23:40:19+00:00

Updated Opioid Laws Enact More Stringent Reporting And Usage Requirements

By JESSE A. MARKOS, ESQ.
Wachler & Associates, P.C.
The Michigan Opioid Laws include a 10-bill package of legislation passed in December, 2017, to help curb Michigan’s increasing substance abuse and drug diversion problem. The majority of these provisions came into effect on June 1, 2018 and healthcare providers must become familiar with and incorporate these provisions in to their practice to ensure they are compliant with the changes.

Healthcare providers use the Michigan Automated Prescription System (MAPS) to review a history of any Schedule 2-5 controlled substances that a patient has legally obtained. Not only does MAPS list the prescriber and type of controlled substance that has been prescribed, but it also […]

Updated Opioid Laws Enact More Stringent Reporting And Usage Requirements2018-09-18T23:37:55+00:00