President Obama signs the Protecting Access to Medicare Act of 2014

President Obama signs the Protecting Access to Medicare Act of 2014

President Obama signed HR 4302 (Public Law 113-93) into law “Protecting Access to Medicare Act of 2014”. 

Most employer-sponsored plans would see that headline and ask, “what does this mean to my and my plan?”  Here are the two key highlights that most of you will be interested in.

  • President Obama signs into law ICD-10 delay, SGR patch.  This week, President Barack Obama signed into law the Protecting Access to Medicare Act of 2014 (HR 4302). Amongst other things, this law delays ICD-10 implementation until Oct. 1, 2015.  ICD-10 consists of over 140,000 diagnosis codes, and each code consists of three to seven digits, which means that the new codes will require more time and effort to assign.  Many laboratories – which heavily rely on physicians to furnish the diagnosis codes necessary to bill for the testing they perform – are struggling with ICD-10 implementation issues and undoubtedly will welcome the reprieve.  Note:  Remember, ICD-9 was first rolled out in the 1970s and was used primarily in the hospital inpatient setting for indexing purposes.  It was not used for billing purposes until much later.  However, as early as 1990 the National Committee on Vital and Health Statistics (NCVHS) has been reporting to HHS (the Department of Health and Human Services) that there were problems with ICD-9-CM’s ability to keep pace with medical science.  Consider surgical procedures from the 1970s that have their own ICD-9 code now are labeled with a sub-code of “other” because they were done laparoscopically or with a laser.  Simply put, ICD-10 has been on the horizon for 5 years and is designed to enhance efficiency, accuracy and more.  HHS’ 2004 cost/benefit analysis concluded that the costs were outweighed by the benefits that would be derived, and they estimated saved dollars in the following categories:
      • More accurate payment for new procedures
      • Fewer rejected claims
      • Fewer fraudulent claims
      • Better understanding of new procedures
      • Improved disease management
  • Sec. 213. Elimination of limitation on deductibles for employer-sponsored health plans.  One piece of PPACA that was originally scheduled for the first plan year on/after 1/1/2014 was that deductibles could be no higher than $2,000 for self-only coverage and $4,000 for other coverages.  Initially that requirement didn’t apply to Grandfathered plans.  Changes, over the years made it so that it did not apply to self-funded plans.  When large employers (that were fully insured) complained, they made that provision not apply to large-employer plans too (generally 100-lives plus).  With this latest amendment, this provision no longer applies to small groups either.  Since the requirement has been stricken as if it was included in the original PPACA bill/law, it basically takes effect for plans on 1/1/2014.  While this may not offer much relief to plans that have already set their 2014 deductible limits, it will offer other employers options.   This also means that 2015’s proposed “maximum deductibles” (of $2,050/single and $4,100/family) are now moot too.

Links:  Read the full bill here.