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PPACA ADDS NEW RULES PHYSICIANS MUST FOLLOW


BY CRYSTAL CONDE, ASSOCIATE EDITOR Now that the Supreme Court has upheld the Patient Protection and Affordable Care Act (PPACA), physicians have many new rules and regulations to follow. As business owners and employers, physicians need to understand the new law and adapt to meet its specifications and to foster economic sustainability. PPACA contains human resources implications and provi- sions that could affect physicians’ insurance contracts with managed care plans, says Donna Kinney, director of research and analysis for TMA. “With the expansion of insurance coverage for preventive


care services and the increase in insured patients, physicians may have more market power, ensuring they can continue to practice in an economically viable environment,” she said. TMA President Michael E. Speer, MD, said in a statement that Congress and the Obama administration must find a way to reduce the new law’s overbearing bureaucracy. He said TMA “has said since day one that we need to find what’s missing, keep what works, and fix what’s broken in the new law. We absolutely must reduce the law’s red tape and bureaucracy that interfere with patient care. Today’s health care system is riddled with hundreds of regulations imposed by federal health law that do little to improve patient care, but instead divert our time and energy away from our patients.” In the meantime, physicians need to educate themselves on the new law to ensure their practices survive and thrive. In addition, physicians can direct their uninsured patients to visit www.healthcare.gov. The website contains the temporary high-risk pool application, a link to the state high-risk pool and Medicaid applications, and lists of insurers by ZIP code. To access TMA health system reform resources, visit www


.texmed.org/HSR. For answers to questions about health sys- tem reform, contact the TMA Knowledge Center by calling (800) 880-7955 or emailing knowledge@texmed.org.


HUMAN RESOURCES IMPLICATIONS Some PPACA provisions require practices to update their policy and procedure guides. TMA offers a tool to aid in effective communication with employees and patients and in implemen- tation of human resources policies and procedures. (See “TMA Policies, Procedures Guide,” page 24.)


Under the law, employers must provide a private place — not a bathroom — in the workplace where nursing employees can express breast milk, as well as reasonable break times for nursing mothers. The law doesn’t require employers to pay their employees during these nursing breaks. Employers with fewer than 50 employees who can demonstrate significant difficulty or expense in complying with the requirement can request an exemption. Last year, the federal government began requiring people


with health savings accounts and flexible spending accounts who wish to use funds from the accounts to pay for over-the- counter medicines to obtain written prescriptions from their physicians. Ms. Kinney advises physicians to develop a practice policy for addressing prescription requests for these medicines and for accommodating nursing employees.


INSURANCE CONTRACT IMPLICATIONS Physicians may witness an influx in patients who have new insurance coverage for preventive health services. PPACA requires new individual and group health plans to cover in- network preventive health services without any copayment or deductible, including immunizations, preventive care for women and children, and other preventive services rated A or B by the U.S. Preventive Services Task Force (USPSTF). This provision took effect in September 2010, but health plans update their coverage requirements as USPSTF recom- mendations change. For example, Ms. Kinney says, the task force approved recommendations for women’s preventive care just last year, meaning plans will include changes to their cov- erage requirements for those services with this year’s renewals. To access a list of preventive services with an A or B rating


that are relevant for implementing PPACA, visit www.uspre ventiveservicestaskforce.org/uspstf/uspsabrecs.htm. The preventive services coverage requirement also applies to non-grandfathered renewed health plans. The federal gov- ernment considers plans existing before March 23, 2010, (the date PPACA took effect) “grandfathered” and exempt from this provision. If a currently grandfathered plan makes material changes in benefit design or patient cost-sharing at renewal, however, it will lose its grandfathered protection. These changes will trigger a loss of grandfathered status:


September 2012 TEXAS MEDICINE 23


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