Practice Alert! October 1 Notice Requirement under the Affordable Care Act

Employers covered by the Fair Labor Standards Act are required to provide notice to employees of the existence of the Health Insurance Marketplace (previously Exchange) by October 1. 

Any business with gross revenue of $500,000 or more is covered, so virtually all medical practices will be required to give the notice. Read the Department of Labor’s (DOL) FAQ. The DOL has two recommended forms, one for employers who provide health insurance and one for employers who do not provide health insurance. While some advisors have warned of a per day penalty for failure to report, there is no penalty. This notice is required by the labor laws even though other employer obligations to report and make payments under the Affordable Care Act have been delayed for a year.

Read the DOL guidance document. The purpose of the notice is to inform all employees  of the Health Insurance Marketplace; indicate if the employer plan’s share of the costs of benefits is less than 60% then the employee may be eligible for a premium tax credit; and that if the employee purchases a plan in the Marketplace that he/she may lose the employer’s contribution to the plan offered by it.

Practice Alert! October 1 Notice Requirement under the Affordable Care Act

Employers covered by the Fair Labor Standards Act are required to provide notice to employees of the existence of the Health Insurance Marketplace (previously Exchange) by October 1. 

Any business with gross revenue of $500,000 or more is covered, so virtually all medical practices will be required to give the notice. Read the Department of Labor’s (DOL) FAQ. The DOL has two recommended forms, one for employers who provide health insurance and one for employers who do not provide health insurance. While some advisors have warned of a per day penalty for failure to report, there is no penalty. This notice is required by the labor laws even though other employer obligations to report and make payments under the Affordable Care Act have been delayed for a year.

Read the DOL guidance document. The purpose of the notice is to inform all employees  of the Health Insurance Marketplace; indicate if the employer plan’s share of the costs of benefits is less than 60% then the employee may be eligible for a premium tax credit; and that if the employee purchases a plan in the Marketplace that he/she may lose the employer’s contribution to the plan offered by it.

Dense Breast Legislation Update

A bill which MSNJ has been working on in great detail requires insurance companies to cover certain screenings and requires physicians to provide information to  certain patients. The bill was amended this week so the lay letter that physicians must distribute to certain patients reads as follows: A facility that provides a mammography report pursuant to the federal Mammography Quality Standards Act, 42 U.S.C. s.263b, shall include the following information, at a minimum, in the mammography report sent to the patient and the patient’s health care provider:

“Your mammogram may show that you have dense breast tissue as determined by the Breast Imaging Reporting and Data System established by the American College of Radiology.  Dense breast tissue is very common and is not abnormal.  However, in some cases, dense breast tissue can make it harder to find cancer on a mammogram and may also be associated with a risk factor for breast cancer. Discuss this and other risks for breast cancer that pertain to your personal medical history with your health care provider.  A report of your results was sent to your health care provider.” You may also find more information about breast density at the website of the American College of Radiology, www.acr.org.”

In addition, three sections were added that would (1) clarify that the bill does not impose a standard of care obligation upon a patient’s health care provider (2) require the Mandated Health Benefits Advisory Commission to prepare a report regarding the implementation and administration of the bill, including analyses of social, medical and financial impact and (3) requires the Department of Health, in conjunction with the Medical Society of New Jersey, to convene a work group to review and report on strategies to improve the dialogue between patients and health care professionals regarding risk factors for breast cancer and breast imaging options.  MSNJ continues to work with legislators on this bill.

Sunshine Act Resources

The Sunshine Act, which is part of the Affordable Care Act (ACA), requires manufacturers of drugs, medical devices, and medical supplies that participate in Federal health care programs to begin reporting on financial interactions with physicians, beginning August 1st of this year. The majority of this information will be posted on a public website managed by the federal government. The key dates are as follows:

• August 1 through December 31, 2013: Manufacturers are required to begin collecting and tracking payment, transfer, and ownership information. Thereafter, they are required to report for each full calendar year.
• January 1, 2014: CMS expects to launch the physician portal that allows physicians to sign-up to receive notice when their individual consolidated report is available for review. This portal will also allow physicians to contact manufacturers/GPOs if they want to dispute the accuracy of a report.
• March 31, 2014: Manufacturers/GPOs will report the data for 2013 to CMS.
• June 2014: CMS is expected to provide physicians access to their individualized consolidated version of all manufacturers/GPO reports for the prior calendar year in June 2014. Physicians may access the consolidated reports via an online website portal maintained by CMS and will be able to seek correction or modification by contacting the manufacturer/GPO through the portal.
• September 30, 2014: CMS will release most of the data on a public website.

View AMA’s archived broadcast from the April 25 webinar on “Physicians Preparing for the Sunshine Act: What You Need to Know and How to Prepare.” Read the Sunshine Act Physician Brochure and view FAQ’s and other resources on AMA’s website.

 

Medicaid Agrees to Retroactive Payment to January 1

Medicaid has agreed to pay certain resubmitted claims retroactive to January 1 in response to an MSNJ request. In January 2013, the Medicaid program required that all physicians who order, refer, or attend Medicaid beneficiaries, but do not bill for their services, enroll in the program as non-billing providers. The program confirmed to MSNJ that enrolling will not cause a physician to become a participating provider, but it will allow participating providers to be paid and will bring the program into compliance with the Affordable Care Act.

MSNJ subsequently received complaints from Medicaid participating providers who are not being paid due to the ordering/referring physician’s failure to enroll as a non-billing provider. In April MSNJ requested that the Medicaid program “consider making an exception that allows for resubmission of claims for payment once the non-billing provider has enrolled.”  The program recently advised that the treating physician may resubmit denied claims after the ordering/referring physician enrolls as a non-billing provider.

In 2013, non-billing provider enrollment will be retroactive to January 1, 2013. In 2014 and going forward, non-billing provider enrollment will be retroactive to one year prior to receipt of the enrollment application. For instance, a non-billing provider who submits an enrollment application on March 15, 2014 will be retroactively enrolled back to March 15, 2013. This is to allow participating physicians enough time to resubmit claims within the timely filing limit (up to one year).

MSNJ appreciates the Medicaid program’s response to our request.

US Supreme Court Allows Class-Arbitration for Physicians: Agrees with Arguments Advanced by MSNJ and AMA

On June 10, the United States Supreme Court found that the Oxford participation agreement’s arbitration clause allowed payment disputes to be pursued by physicians as a class. Over a decade ago Oxford had compelled  Dr. John Sutter, a New Jersey pediatrician, to arbitrate his payment disputes, but challenged his right to arbitrate the disputes with other physicians similarly situated as a class. The arbitrator ruled that a class arbitration was appropriate as did each court that reviewed the matter. Undeterred, Oxford took the case all the way to the US Supreme Court. MSNJ and the AMA filed friends-of-the-court briefs supporting the physicians’ right to class arbitration.  Now, the highest court in the land has agreed.

This is an example of success by MSNJ’s legal advocacy program.

American Board of Medical Specialties under Fire for Maintenance of Certification™ Program

Criticism of the American Board of Medical Specialties’ (ABMS) Maintenance of Certification™ (MOC) program has escalated over the past year. This has manifested in a number of ways. A national specialty society and at least two states have introduced resolutions that will be heard by the AMA; one national association has filed a lawsuit.

The AMA has already developed a number of policies on maintenance of certification and maintenance of licensure issues which address the cost, disruption to practice, and possible negative impact on access to care. In response to a joint resolution introduced by Camden, Mercer, and Passaic counties, the MSNJ Board of Trustees considered a resolution during its meeting on Sunday, June 2. After extensive testimony from the proponents of the resolution, county leaders, board members, and fellows, the Board took action on the resolution. It referred part of the proposed resolution back to the Policy and Strategy Panel and  adopted the following concepts:

• Acknowledging that certification requirements within the Maintenance of Certification™ can be costly, time intensive, and result in significant disruptions to the availability of physicians for patient care;
• Requiring MSNJ to communicate to the AMA and the ABMS examples of disproportional fees, onerous time requirements and unnecessary fragmentation of commonly recognized specialties; and
• Opposing Maintenance of Certification™ in its present form, but reaffirming the need for ongoing CME to meet the AMA Physician’s Recognition Award and demonstrating the commitment to quality patient care.

The MSNJ delegation to the AMA will be guided by the discussion that took place during the Board meeting for its deliberations on the similar resolutions that will be considered at the AMA Annual Meeting in Chicago this month.

On a different tack, the American Association of Physicians & Surgeons filed a lawsuit in the New Jersey Federal District Court against the American Board of Medical Specialties alleging that its Maintenance of Certification™ program violates federal antitrust laws and that its statement about physician’s status in terms of maintenance of certification are misleading.

Gun Violence Reduction Initiatives

The Governor, through Executive Order Number 130 has created of a Mental Health and Community Safety Working Group to serve as an inter-agency, multidisciplinary

working group focused on decreasing violence, promoting safer and healthier communities, and highlighting the importance of de-stigmatizing mental illness, while encouraging early intervention.  The Governor had created the New Jersey SAFE Task Force on Gun Protection, Addiction, Mental Health and Families, and Education Safety (“NJ SAFE Task Force”) in January to conduct a comprehensive, balanced, and well-informed review of the root causes of mass violence.  In its April 10, 2013 report, the NJ SAFE Task Force recommended the creation of a standing interagency working group to consider the many long-term issues raised by their study.  The Working Group will consist of the following cabinet members: the Commissioners of the Department of Children and Families, the Department of Corrections, the Department of Education, the Department of Health, the Department of Human Services; the Attorney General; and the following non-cabinet members: the Executive Director of the Juvenile Justice Commission and the Chairman of the State Parole Board. Among other things, the working group will 1) develop strategies with respect to prevention and intervention, including, but not limited to, educating youth, parents, and teachers about the warning signs of violence and the negative consequences felt by teens and young people who are ostracized, isolated, and experience despair; 2) develop a public information campaign utilizing all forms of media, communications, and technology to better inform New Jersey residents about the broad range of programs and services available in the community as well as encourage individuals to seek help and no longer suffer under the shadow of the stigma of mental health illness; and 3) focus on strategies to facilitate workforce expansion in, among other professions, licensed clinical social workers, nursing, and psychiatry, while also encouraging such professionals in those and similar disciplines to work in the public or community health systems.

License Renewal-MSNJ Asks that Physicians Complete the Workforce Survey

Last week, the NJ Board of Medical Examiners mailed and posted notices for license renewal. The notices were delayed at least in part because of pending legislation which would have required physicians to complete the accompanying  physician workforce survey. Governor Christie vetoed the legislation. Participation in the workforce survey is voluntary. MSNJ is urging our members and all physicians in the state to participate in the voluntary workforce survey which is included in the license renewal. The information will assist the state in its evaluation of physician demographics and access to care.

Applications are due on or before July 15, 2013. Please see the MSNJ FAQ and BME Guide for more information.

Ruth Schulze, M.D. Installed as 221st President of the Medical Society of New Jersey

Lawrenceville, NJ – Ruth Schulze, M.D. was installed as the 221^st president of the Medical Society of New Jersey (MSNJ) at its annual meeting held in May. She is the fourth woman to hold the title of MSNJ president since the organization was established in 1766.  She joined the MSNJ Board of Trustees in 2004 and has served six years as secretary followed by vice-president and president-elect positions.  She is a past officer and president of the Bergen County Medical Society.

Dr. Schulze practices at Women’s Total Health of Woodcliff Lake with Dr. Gail Sobel. Her gynecology practice focuses on adolescent, perimenopausal and senior women’s health and surgical needs. In addition, Dr. Schulze serves as the director of the Obstetrics and Gynecology department for Valley Hospital in Ridgewood. She was the first female president of the medical staff at Valley Hospital from 2010-2012.

During her inaugural speech, Dr. Schulze presented a number of initiatives for her term, focusing on expanding membership to include physicians from all types of practice and employment settings, as well as representation from all subspecialty organizations. Dr. Schulze is particularly interested in partnering with physicians in training along with community groups and business organizations to encourage healthcare forums or town hall type discussions to focus needed healthcare changes on quality medicine and patient safety.

“Ralph Waldo Emerson said it best, ‘Nothing worthwhile in life is accomplished without passion,’” said Schulze. “I am passionate about medicine and I am passionate about the Medical Society of New Jersey. With all of us working together, I firmly believe we are ready to create a new revitalized MSNJ speaking as the united voice of medicine.”

Dr. Schulze, a Phi Beta Kappa scholar, graduated from Union College in Schenectady, NY summa cum laude with a BS in Biology. She earned her medical school degree at SUNY Stony Brook and completed her residency at Baystate Medical Center in Springfield, MA. She has been married for 30 years to her college sweetheart and they are the proud parents of three daughters.

“Ruth’s passion and commitment to organized medicine and her vision for her term as president of MSNJ will result in new initiatives and an energized and diverse membership base,” said Larry Downs, CEO of MSNJ. “We welcome her as president and look forward to putting into action MSNJ’s aggressive agenda to improve healthcare in New Jersey.”